Celiac diease, gluten and the brain-gut connection supported by finding of intestinal and brain antibody deposits.

Antibodies for tissue transglutaminase found in intestine of blood test negative celiac disease are also found in intestine and brain in people with brain disease due to gluten. Gluten ataxia is a brain disorder characterized by balance disturbance not explained by any other cause but due to ingestion of gluten. The disorder responds to a gluten free diet if irreversible brain damage has not already occurred. Calcifications can be seen in the brain on magnetic resonance imaging (MRI).

Deposits of gluten related antibodies have been found in brain tissue obtained on biopsy and autopsy specimens. Mario Hadjivassiliou, M.D. from Sheffield England recommends gluten ataxia be added to a list of gluten related diseases that includes peripheral neuropathy and the skin disorder dermatitis herpetiformis. He has called for a new paradigm to be accepted where celiac disease is not considered primarily as an intestinal disease.

Dr. Hadjivassiliou and colleagues recently published a report of nine patients with gluten ataxia compared with seven patients with ataxia due to other causes. They found tissue transglutaminase IgA deposition on jejunum intestinal tissue on all nine patients with gluten ataxia but none of the control patients. Brain tissue from an autopsy of one patient with gluten ataxia was also found to have IgA tTG deposits in the cerebellum, pons and medulla of the brain but not in a control brain.

Previous studies have found negative blood celiac blood tests in patients with gluten ataxia suggesting that they may not have celiac though they had gluten related disease. In light of a new report that blood test negative celiac disease can have intestinal tTG and advanced intestinal damage it is curious to wonder if the gluten ataxia patients with blood tests negative are seronegative celiac disease. It is increasingly appearing that there is a very broad spectrum of gluten related disease and there are non-celiac gluten related symptoms that include the brain, skin, musculoskeletal system as well as the gut.

Many patients I have seen with gluten sensitivity describe symptoms of balance difficulty, concentration problems or “brain fog”, headaches, and neuropathy and a few report symptoms such as “bug crawling” sensations and strange muscle twitches. These symptoms commonly improve with gluten-free diet and return with intentional or accidental gluten exposure. In some intestinal symptoms or skin rashes occur, often at the same time as the onset of the brain symptoms but some don't have any gut symptoms. The concept of gluten as a cause of brain symptoms is still not one widely known or accepted by many doctors, especially in the United States. However in Europe, especially England, Germany and Scandinavian countries, as well as Australia and New Zealand the gluten brain-gut connection is more accepted.

The concept that casein, the major milk protein, causes brain symptoms that imrove on a dairy-free diet, casein-free diet, is also not commonly accepted by doctors in the U.S. though many lay public organizations and support groups have found casein-free diet to be associated with improvement of brain function as well as helping autism.

What is needed is more openness of U.S. doctors to role of diet and foods in such symptoms and diseases and much more scientific research. I ask you to join me on the journey of the food, bacteria, gut-brain-joint-skin connection to disease and health. You may help spread the word through e-mailing this post to others by clicking on the letter icon below. You may subscribe to the Food Doc blog by clicking on subscribe to this post atom on the right side of this post so that you will be automatically alerted to my new posts.

Autoantibody targeting of brain and intestinal transglutaminase in gluten ataxia. Hadjivassiliou M. et. al. Neurology 2006; 66:373-377.

Endomysial antibody-negative coeliac disease: clinical characteristics and intestinal autoantibody deposits. Gut 2006; 55:1746-1753.


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Ostoporosis risk increased by celiac and heartburn medications: Is there a collision of increase risk?

Osteoporosis is increased by long-term use of acid blocker medications called proton pump inhibitors for chronic heartburn, a symptom commonly missed as a sign of celiac disease. So, not only doctors frequently unaware that osteoporosis is a common complication of undiagnosed and untreated celiac disease but are also likely aggravated the problem in many of these people by prescribing acid blocking medications for heartburn symptoms that are due to gluten.

Osteoporosis risk goes up with age. The prevalence is less than 15% at age 50 but increases to almost 30% at age 60, 50% at age 70 and 70% at age 80. I have however, noted increasing number of below 60 year old women and more men diagnosed with osteoporosis, almost none of whom have been screened for celiac disease or inflammatory bowel disease.

At least one study has documented that less than half of doctors are aware that osteoporosis is a manifestation of celiac disease. Heartburn is a common symptom also not commonly recognized by doctors as a manifestation of celiac disease. Gluten ingestion can impair gastric emptying resulting in more gastro-esophageal reflux. Initiation of gluten-free diet has been shown to diminish reflux symptoms and result in healing of esophagitis.

Several patients I have evaluated for reflux symptoms, particularly when these symptoms were poorly controlled or the patient was considering surgery rather than take daily medications, were found to have celiac disease or non-celiac gluten sensitivity. In my experience, reflux symptoms frequently dramatically improve on a gluten free diet.

This effect I have observed not only in celiac disease patients but also in those not meeting strict diagnostic criteria for CD. Prior to starting a gluten-free diet I took a daily proton pump inhibitor myself. After a GFD, I occasionally experience heartburn when I drink too much coffee or combine coffee, alcohol and chocolate in the same meal. In my opinion, everyone with significant heartburn or a diagnosis of reflux disease should be screened for gluten sensitivity and/or consider a trial of GFD.

Celiac increases the risk of osteoporosis. How much celiac disease increases osteoporosis is debated. Studies have shown from small increases (1.5-1.8 times) to much larger (3-5 times) increases osteoporosis in CD. Such increased risk has prompted for calls for screening all people with celiac disease for osteoporosis and all people with osteoporosis for celiac disease.

With this new study raising the concern about long-term use of acid blocking medications, especially the so-called proton pump inhibitors like nexium and prilosec, causing an increase risk of osteoporosis and the frequently unrecognized association of heartburn with undiagnosed celiac disease that also increases the risk.

You are now forewarned about blindly accepting a doctor’s offer to just write you a prescription for such medication without looking further into the possible causes of your heartburn as well as the risks of simply treating your symptom with a medication. This is especially important since the medication may actually worsen a known complication of an underlying undiagnosed problem that can be simply treated by diet decreasing your risk of osteoporosis. Subscribe to this blog to receive automatic updates of new posts offering information and insights from the Food Doc so that you are kept up to date
with the knowledge you need to be your own advocate for food related illness and digestive conditions.


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Gluten-free flours:Gluten-free substitutes for wheat include tapioca

Today I used Tapioca flour to coat an oven bag for our turkey. Tapioca is a gluten-free starch derived from dried cassava tuber or root. The cassava plant is a woody tropical shrub cultivated primarily in Brazil, Thailand, Nigeria, Zaire, and Indonesia. It is also known as yucca or manioc.

Tapioca flour is an excellent substitute for gluten containing wheat flour in cooking when a light texture is needed, for example in pancakes and waffles. Tapioca flour can be used to thicken foods such as puddings (tapioca pudding), sauces or gravies. In baking it can provide a bit more stickiness lacking in gluten-free baking.

The cassava tuber contains about 30% starch but very little protein. The tuber can be prepared like a potato but similarly should not be eaten raw. Toxic cyanogenic glucosides in raw cassava tubers are rendered non-toxic with cooking.

The origin of the word tapioca comes from the Tupi-Guarani language of Brazil, the largest producer of Cassava. From tipi, meaning residue, and ok, meaning to squeeze out, we get tapioca. This is traditionally the roots are grated then squeezed or pressed to remove the sap. The residue is then further dried. Dried roots can be milled into flour that is gluten-free.


Bob’s Red Mill pure tapioca flour or all-purpose gluten free baking flour made from tapioca, garbanzo, potato, sorghum and fava flour, both work well for cooking. Bob’s Red Mill stone grinds gluten-free flours in a dedicated facility that is free from wheat and other gluten containing grains. The production line is separate from other lines and they batch test regularly using an ELISA gluten testing process that detects any gluten down to 20 parts per million. They report they are also dairy and casein free.




For one of two smaller turkeys we roasted, I applied high heat safflower oil to coat the surface prior to inserting in an oven bag coated with 1 tablespoon of tapioca flour. To the other, for those in the family who are not casein sensitive, melted organic salted butter was used to baste the surface before cooking in a separate oven.

Though maintaining a gluten-free diet can be a challenge that is necessary for those with celiac disease, it can be done and should be considered for many others who are gluten sensitive. Alternative flours exist for baking and the benefits of gluten-free lifestyle can be life changing for many individuals. For more information be sure to subscribe to this blog to receive regular updates from the Food Doc, the food allergy and food intolerance expert doctor. You may find some of Bob's Red Mill gluten-free products at the Food Doc amazon affililiate store or by visiting their website www.bobsredmill.com directly.





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