Neurological/Pshyciatric Manifestations of Celiac/Gluten Sensitivity

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What do Depression, Mood Disorders, ADHD, Gluten Ataxia, Autism, Neurological Issues, Migraine Headaches, Epilepsy, Seizures, White Matter on Brain and Schizophrenia; have in common? According to NIH (National Institute of Health), all of the above are also symptoms of Celiac Disease and Gluten Sensitivity which can affect adults and children!

I get asked about this so often by customers, at least once or twice a week, that I thought I would write about this in depth. Some are having multiple neurological complications from their Celiac or Gluten Sensitivity or their child is exhibiting ADHD Symptoms and stomach aches but has not been tested for Celiac Disease. (I am Celiac and also have Ataxia (Neurological symptoms; loss of balance & coordination, fumbled speech and I exhibit signs of ADHD-can’t concentrate when exposed to gluten). The shocking thing is that many in the medical community are not investigating the gluten connection by testing for Celiac Disease first! Often a child or adult are just put on ADHD medications or anti depressants and just sent on their way. Often the medicines are just addressing some of the symptoms; not the actual cause! The result is ongoing pain and suffering because the true condition is NEVER addressed. The good news is that NIH (National Institute of Health) has put solid information out there for our physicians and us to see!

First we need to understand the difference between Celiac Disease and Gluten Sensitivity. Then we will learn that psychological and neurological issues can be preset in either condition. NIH has some great information about this and will clear up any question that you or your medical provider have about the validity of these symptoms. Finally, I give you a link to these neurological and psychological symptoms; which are sometimes the only symptoms that an adult or child actually presents with. (Yes, many don’t even have any gastrointestinal symptoms or stomach aches!)

First, read this, all of it. Second, if any of this applies to you or you child, get yourself or your child tested for Celiac Disease (while still eating gluten) by a gastroenterologist who is well versed in Celiac Disease.

Celiac Disease (CD) affects about 1% of the population (about 1 in 130) and gluten sensitivity affects about 6% of the population. Even with all of the knowledge that we have now, it is believed that as many as 85% of cases of CD go undiagnosed. CD is dependent on an autoimmune reaction to gluten (the protein found in wheat, rye and barley) and is usually characterized by intestinal symptoms. Those with gluten sensitivity (GS) don’t have intestinal damage (villous atrophy) or antibodies for CD but can test positive for antibodies to gliadin. Those with CD and GS can present with many neurological and psychiatric symptoms. However, gluten sensitivity remains under-treated and under-recognized as a contributing factor to psychiatric and neurological manifestations.

In CD, the classic symptoms typically include abdominal bloating, steatorrhea (excretion of abnormal quantities of fat due to malabsorption) and weight loss. Some just present with a rash that looks like eczema, but is really the skin manifestation of Celiac Disease known as Dermatitis Herpeterormis (DH). However, there are too many symptoms to list here; so a link will follow. Diagnosis is confirmed by testing for a number of different antibodies including anti-endomysial antibodies (EMA), anti-tissue transglutaminase antibodies (tTG), and anti-gliadin antibodies (AGA).  We understand what causes the intestinal damage and the genetics related to CD.  Those genes are HLA-DQ2 or HLA-DQ8 and their other versions.

There are more than 300 signs and symptoms of CD. Click Here for List. This list is great because it describes symptoms as they affect different body systems and there is also a list of how children may present with Celiac Disease (that list is at the bottom of the link). Not everyone presents with the same symptoms..some just have bloating and constipation and stomach aches. Some just are fatigued, irritable and are moody or present with Autism or ADHD like symptoms. The intestinal biopsy used to be the gold standard.  Now there are 5 criteria for a Celiac diagnosis. Those with GS often have the same symptoms as those with CD.

Five Criteria for Diagnosing Celiac Disease and someone only has to have 4 of the 5!

  1. The presence of signs and symptoms compatible with celiac disease.
  2. Positive serology screening (high serum levels of anti-TTG and/or EMA).
  3. Presence of the predisposing genes HLA-DQ2 and/or –DQ8.
  4. Histological evidence of auto-insult of jejunal mucosa typical of celiac disease.
  5. Resolution of the symptoms and normalization of serology test following the implementation of a gluten-free diet.

Click Here for More     Click Here for 4 of 5 Rule

People with GS would not fit into less than 4 of the 5 categories. GS is a diagnosis of exclusion; this diagnosis is given once CD and wheat, rye or barley allergies are ruled out. This means all of the above testing was done while the patient is still consuming gluten and did not meet 4 of the 5 criteria for CD. Then the patient is put on a Gluten-Free diet.  If symptoms resolve; you are given a diagnosis of gluten sensitivity!  (There is some evidence that GS is just an early form of CD.)

Neurological/Psychiatric complications of CD have been known to the medical community for over 40 years. Meanwhile, GS sensitive patients also have many neurological and psychiatric complications. However, based on the lack of intestinal involvement, the neurological and psychiatric complications may be the prime presentation in patients suffering from GS! Therefore gluten sensitivity may easily go unrecognized and untreated.

Studies have shown that about 22% of  patients with CD develop neurological or psychiatric dysfunction and as many as 57% of people with neurological dysfunction of unknown origin test positive for anti-gliadin antibodies. Neurological and psychiatric complications observed with gluten-mediated immune responses include a variety of disorders.

From 1953 to 2011 a PubMed literature search located 162 original articles associating psychiatric and neurologic complications to celiac disease or gluten sensitivity!  36 articles for seizure disorders, 20 for ataxia and cerebellar degeneration, 26 for neuropathy, 20 for schizophrenia, 14 for depression, 12 for migraine. There were up to 10 articles each for anxiety disorders, attention deficit and hyperactivity disorder (ADHD), autism, multiple sclerosis, myasthenia gravis, myopathy, and white matter lesions.

However, the  vast majority of research to date has not looked at CD and GS independently, so the true prevalence of the neurological/psychiatric complications with each is hard to pin down. It does call attention to the fact that GS and CD are different gluten-mediated immune responses that may be the cause of patients presenting with a host of psychiatric and neurological complications.

For more information on the symptoms listed at the top of the article (NIH) please use this link. It goes into detail about each neurological and psychological manifestation, just click on link and scroll down, good stuff in here..! Click Here for NIH Info

 

 

10 Healthy Gut Supplements; What They Do for You!

Concept image of a lost and confused signpost against a blue cloudy sky.

In the latest issue of Simply Gluten Free Magazine, Dr.Alexander Shikhman shares some great information about the top 10 healthy gut supplements.  If you are like me, you are probably familiar with some of these but don’t really understand what they actually do for your digestive health. This will definitely be an eye opener for you; it definitely was for me. So, I decided to paraphrase it for all of you.

  1. Probiotics: live microorganisms that will improve our microbial balance and suppress pathogenic microorganisms in our intestines (sometimes referred to as our microbiom).  We can get them directly from live fermented foods like sauerkraut, pickled vegetables, buttermilk, GF soy sauce, kimchi and yogurts or we can get them though supplements. If we go the supplement route, we need to understand how they are measured..which is by CFU’s or colony forming units. For gut maintenance use 20-25 million CFU’s daily. During antibiotic treatment we should increase that dose to 100 billion CFU’s daily. If you have Candida (chronic yeast infection), colitis or leaky gut; you should take 100-500 billion CFU’s daily. (I buy True Nature Probiotic at Costco and it is in a blue box and is gluten-free, dairy-free and soy-free)
  2. Prebiotics: non-digestible food ingredients (carbohydrate based) and they stimulate the growth of beneficial bacteria in our intestinal tract. They are not live microorganisms; actually they are heat resistant fiber like substances! Basically, they increase production of short-chain fatty acids by stimulated bacteria that will feed normal gut microbiota; they provide energy supply to the cells that form the intestinal lining. They are found naturally in foods like leeks, onions garlic, asparagus, artichokes and gluten-free brewer’s yeast. They also facilitate absorption of calcium, magnesium and vitamin D and stimulate mucosal immune responses, reduce inflammation, prevent colon cancer and normalize our bowel movements! (Who knew? Yup, I gotta get some of these.) But wait, there is more…they should include mannan-oligisaccharides (MOS) and galacto-olifosaccharides (GOS). Daily dose varies between 1,000 to 5,000 milligrams.
  3. Digestive Enzymes: proteins that break down large food molecules into smaller fragments in order to aide in their absorption by our bodies.  They are found naturally in our saliva, stomach and pancreatic juices and in secretions in the small and large intestines.  However, how well we produce these proteins is really age dependent. As we age, our production of these enzymes gets sluggish so as we age we  will require external digestive enzymes in the form of micronutrients which are available from animal or plant based sources. Most people don’t know this part: If you eat a high protein diet, you should use an enzyme with a high protease concentration. For high fat diets; you should consume one with a high lipase concentration. The amount should be proportional to the meal that you are consuming.
  4. Betaine HCL: naturally occurring and found in lots of foods such as beets and spinach. Betaine HCL acts as a gastric juice acidifier (it lowers our gastric pH). It activates gastric protein that degrades enzymes and will stimulate the entire digestive process. Production of this acid declines as we age and makes it difficult to digest protein rich foods. It is recommended for those on high protein diets and is take before meals in amount of 400 to 600 milligrams per meal. (cannot be taken together with anti-inflammatory drugs)
  5. Magnesium: controls gastric acid production, gastric emptying, intestinal motility and bile secretion along with our digestive enzyme production. Deficiency symptoms might include constipation, bloating, indigestion and muscle cramps.  It is found in unrefined grains, seeds, cocoa, nuts, almonds and green leafy veggies. We only absorb about 2/3 of what we consume! Dosage would be 250 to 500mg per day.
  6. Bioflavanoids: stimulate bile production, improve circulation in intestines, optimize mucosal immune response, inhibit histamine, suppress yeast overgrowth, enhance toxin elimination as well as prevent inflammation. They are usually citrus or quercetin with dosage of 500 mg to 2 grams.
  7. Turmeric: comes from curcumin and it stimulates the gall bladder to make bile and breakdown large fat globs and improves digestion. It also reduces inflammation in our digestive tracts and is often used to treat colitis. Daily dose can range from 1 to 5 grams. (I don’t have a gall bladder, not sure if this would help me)
  8. Glutamine: acts like a fuel and is an important source of nitrogen for the lining of our small intestine and is key in maintaining our mucosal cell integrity and the function of our gut barrier. It stabilizes intestinal permeability  and is used for prevention of leaky gut syndrome. Dosage is 500 mg to 10 g, depending on current gut health.
  9. Butyrate: (Butyric Acid) is a short chain fatty acid whose salts are know as butyrates which are produced by fermentation of dietary fibers in the GI tract. They control intestinal and colon permeability and aid in controlling inflammation. This deficiency is often associated with leaky gut syndrome. Daily requirements vary based on health of the diet and health of the digestive system. Dosages can range from several hundred to several thousand milligrams. (magnesium and calcium salts are more slowly absorbed than the sodium and potassium forms. Sodium and potassium are taken during the day when the gut cycle is much more active…calcium and magnesium salts are taken at night.
  10. Triphala: acts like a digestive cleanser that promotes contractions that will move the food through the digestive tract and will aid in bowel functions.  It will also improve circulation and liver function, normalizes stress response and improve adrenal function as well as reduce our cholesterol. It also has anti-microbial, anti-inflammatory and cancer preventing characteristics. Consumption is 500-1000 mg before each meal and 1000-2000 mg before bed.  

As always, contact your physician before starting any supplement; I know I will be talking to my physician about this. For more information about Dr. Alexander Shikhman (Board Certified in Internal Medicine and Rheumatology) and founder of The Institute for Specialized Medicine and Gluten-Free Remedies. All of his supplements are certified GF to 5ppm by the Celiac Support Association (CSA).

Click Here for IFSMed                             Click Here for Gluten Free Remedies

 

Cheeri-Oh-Nos, Not GF Says Canadian Celiac Association!

cheerios-GFL

In the summer and fall of 2015, I spent a lot of time blogging about the sloppy processing and testing of General Mills “Gluten Free” (GF) Cheerios. Not only are they not using certified GF Oats, they are using sub-par testing methods to make their”GF” claim! Hence the nickname that I gave them; “Cheeri-Oh-Nos”! The Canadian Celiac Association has just advised those with Celiac Disease or Gluten Sensitivity not to eat them.

What happened and why have I been perpetually banging my head against the proverbial brick wall for over a year? How can this be so?  You just won’t believe it, so here is the re-cap and update.

Basically, the problem is that General Mills (GM) is using contaminated oats and “shaking” them in order to get off the offending wheat, rye and barley. Then they are using a testing method known as “means testing” to get their final ppm. A product must test below 20ppm to be called Gluten Free. So, if they make a batch of cheerios, they will  take out several samples…if one sample is 21pm, one is 80ppm and one is 5ppm..they would combine those to get the actual parts per million. Then they would keep adding in batches at lower ppm to get their 20ppm score. That is dangerous because in the end, you can mix them together over and over but there is still a high likelihood that some or many boxes will test higher than 20ppm.  The big problem is that they were not testing the final batch or boxes.

This practice resulted in many Celiacs getting sick and complaints to the FDA. Eventually GM had to recall 1.8 million boxes of GF Cheerios.  How can this be? Well, it is simple folks, the FDA does not mandate testing or a particular method for testing..they suggest that each company regulate themselves.  Yup, GM is NOT looking out for those with Celiac Disease or allergies to wheat, rye and barley!

A regular (celiac) customer came in last month and told me that his blood levels were elevated and he was having stomach problems and could not figure out why because everything he is eating is GF. He told me he would be going in for new endoscopy and biopsy in the next few weeks. I asked him, to tell me what he was eating for breakfast and he said “GF Cheerios”.   I asked when his issues started…he said around that time. He was shocked when I filled him in on the happenings. I directed him to my blog articles from last year and suggested he also do a google search and read what Gluten Free Watchdog has been saying and also suggested he remove the “GF” Cheerios and see how he does.

If you are a Celiac, Gluten Sensitive, or have an allergy to wheat, rye or barley; you are playing a game of Russian Roulette if you are eating GM’s GF Cereals.

Many of us have been outraged that the Celiac Associations in the US have not been more vocal about this. Last month the Canadian Celiac Association recommended that those with Celiac Disease or Gluten Sensitivity not eat them.  Gluten Free Living Magazine just wrote an article about this. Click Here to Read Article

bang head here

 

 

Voices For Autism:

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As many of you know, I have two nephews with Autism and many children with Autism also follow a Gluten Free diet due to Celiac Disease or Gluten Sensitivity. I try to keep you all informed about what is new in the areas of Autism research, etc. I had the pleasure of interviewing Stacey Stirmer about the non-profit;  Voices For Autism based here in Howard County, MD.

Road Trip USA: Loudon County, VA the Broussard Family

Road Trip USA

Another great Road Trip story from the Broussard Family from Loudon County, VA!

I met Maureen many years ago at a DC Celiac support group meeting, at which she served our group wonderful samples of her many gluten free specialties. I was thrilled when she opened her One Dish Cuisine cafe years later. Although it is about an hour and a half from where we live in Loudoun County, Virginia (out near Dulles Airport), we try to stop in for a meal any time we are heading up or down 95 to visit friends and family — or when we’re in the area or passing through en route to a hockey tournament for our sons!
The dilemma is always what to order, because everything is so tempting. I’m not even Celiac (it’s my son that was diagnosed 11 years ago), but I choose to eat gluten free most of the time. Going to One Dish is amazing, because the food is so good you don’t even realize it’s gluten free. My favorite thing, without question, is Maureen’s pizza. It comes in two large rectangular sizes and has a relatively thin (although not too crispy) crust…just what I like. I typically order the Margherita pizza with tomatoes and fresh basil. I can eat dairy, but even if you can’t, you can order any of Maureen’s pizzas with dairy free cheese. The pizza is the best (gluten free or not) I’ve had here in the States. In fact, it rivaled some of the gluten free Neapolitan style pizzas we enjoyed on a trip to Italy this past summer.
Another favorite at One Dish Cuisine is their Reuben sandwich. You can imagine how excited I was to learn recently that Maureen is offering a Reuben pizza! Now that my two favorite One Dish items have been “combined,” I can’t wait to try this! My husband and sons have also enjoyed various pizzas, chicken tenders and fries, chicken parmesan, and roast beef sandwiches. All deli meats and cheeses are gluten free and cut on special slicers, depending on your dietary restrictions. There’s one for meat, one for cheese, and one for dairy free cheese. It is nice for my son to be able to get fresh sliced deli meat on a slicer that’s never been cross contaminated with bread or meats that might have been marinated in a sauce containing gluten.
If we’re heading home from One Dish Cuisine — or staying somewhere with a refrigerator and freezer — we fill up a cooler with purchases “to go” (deli meats, cupcakes, donuts, muffins, bread, and ready-to-cook meals from the One Dish freezer like barbecue chicken pizza and mac-n-cheese). I’ve even purchased small containers of frozen pancakes and frozen cupcakes that are perfect to send with my son when he attends a birthday sleepover at a friend’s house.
Karen Broussard (founder of the Gluten Free Travel Site) Click Here for GF Travel Site

Road Trip: The Vignale Family

Road Trip USA