Who Should trial a gluten free casein free diet?
By Blake Graham, B.Sc
Clinical Nutritionist
Nutritional Healing
 
Aggression
Alcoholism
ALS
Anxiety
Autism/ADHD
Bulimia Nervosa
Chronic Fatigue
Fibromyalgia
Dementia under 70
Depression
Dermatitis 
   herpetiformis
Diabetes mellitus
  (I & II)
Diverticulitis
Down Syndrome
Epilepsy
Gait disturbances
Headaches
Infertility
Inflammatory bowel
    syndrome
Intestinal lymphoma
Irritable bowel
    syndrome
Maldigestion/
    malabsorption Osteoporosis
Panic attacks
Pernicious anaemia
Psoriasis
Rheumatoid arthritis
Schizophrenia
Sjogren’s syndrome
Stomach ulcers
Systemic lupus
Thyroid problems


...there are people with various risk factors or diseases that are at greater risk of developing gluten sensitivity who should undoubtedly be tested. These include: 

  • Microscopic colitis
  • Relatives of gluten-sensitive individuals
  • Gluten-sensitive individuals 1 year after treatment
  • Chronic diarrhea of unknown origin
  • Irritable bowel syndrome
  • Inflammatory bowel disease
  • Gastroesophageal reflux disease
  • Hepatitis C
  • Autoimmune liver disease
  • Other causes of chronic liver disease
  • Dermatitis herpetiformis
  • Diabetes mellitus,
         type 1
  • Rheumatoid arthritis
  • Sjogren's syndrome
  • Lupus
  • Scleroderma
  • Autoimmune thyroid  
        disease
  • Dermatomyositis
  • Psoriasis
  • Any autoimmune
        syndrome
  • Chronic Fatigue
  • Fibromyalgia
  • Asthma
  • AIDS
  • Osteoporosis
  • Iron deficiency
  • Short stature in
        children
  • Down's syndrome
  • Mothers of kids with
        neural tube defects
  • Female infertility
  • Peripheral neuropathy
  • Cerebellar ataxia
  • Seizure disorders
  • Psychiatric disorders
  • Depression
  • Alcoholism
  • Autism
  • ADHD/ADD 
  • With a Celiac Disease prevalence of 1 in 100-150, a case might be made for screening everyone...although that is not common practice. A few researchers believe that some degree of gluten sensitivity may be present in up to 30% or more of the population, with symptoms varying widely. Are you at increased risk?  

    Reseachers are collecting information on Celiac Disease as it relates to other autoimmune disease. Some believe an underlying gluten sensitivity may be a catalyst for setting the autoimmune ball rolling, and research on this is ongoing.

    Interestingly, a sensitivity to cow's milk protein may have some significance in the development of Type 1 Diabetes. Gluten and casein are top offenders, but other foods (soy, corn, yeast) may pose similar risks, and it may vary from person to person.

    Sometimes, once gluten sensitivity has been identified and treated with a gluten free diet, patients may find symptomatic improvement or remission of some other autoimmune disease symptoms. There are anecdotal reports of this happening, although scattered.

    Unfortunately, in many cases, it is too late for intervention in a disease processes well underway. Early detection of the gluten risk factor or gluten sensitivity and intervention with a preventative approach may reduce the risk of developing related health problems.



    Pub Med


    CONCLUSION - The prevalence of celiac disease among first degree relatives (2.6%) was 5 times higher than that in the general population. Although the recommendations for screening asymptomatic high risk groups, such as first degree relatives, are not unanimous the early diagnosis is crucial in preventing complications, including nutritional deficiency and cancer.
    Celiac disease in first degree relatives of celiac children.

    PMID:23011243  Sept 2012

    A significant increase of autoantibodies, in both phases, was observed in the relatives when compared to the non-relatives (P = 0.0064), specifically to anti-thyroid microssome and anti-parietal cell. In both phases, the female/male proportion of autoantibodies was of 4:1 to 3:1 (P<0.041). The frequency of autoantibodies amongst 1st and 2nd degree relatives was 11.8% and 9.68% in phase I and 4% and 6.67% in phase II.
    Autoantibodies in relatives of celiac disease patients: a follow-up of 6-10 years.

    PMID:23011242  Sept 2012

    Results: A significant increase in IgA-EmA/IgA-tTG was detected in relatives of patients with CD when compared to controls (p ≤ 0.001). The positivity of antibodies was higher in females (2.4:1 in phase II; p = 0.039), and its high frequency amongst siblings (∼18.81%) highlights the risk of CD in these individuals. The distribution of antibodies by age suggested that CD can occur at any age in relatives, calling attention to the newly tested relatives >60 years of age (p = 0.0657).
    Serological and Clinical Follow-Up of Relatives of Celiac Disease Patients from Southern Brazil.

    PMID: 21042020   Oct 2010

    RESULTS: We recruited 111 index cases that had 579 FMs, of whom 344 (59%) were investigated. The average screening rate among families was 65%. A positive tTGA test was found in 47 (14%), 33 with a positive EMA test. CD was diagnosed in 39 (21 males), with an estimated prevalence of 11% (lambda(R) = 16.1). All affected FMs carried the at-risk genotypes. Twenty-one (54%) had "silent" disease, most with severe intestinal villous atrophy. Carrying HLA-DQ2 (odds ratio, 16.1; 95% confidence interval, 2.1-123) and being a sibling (odds ratio, 2.5; 95% confidence interval, 1.1-5.8) are high-risk factors for CD.
    Predictors of Family Risk for Celiac Disease: A Population-Based Study.
    PMID: 18585974   June 2008

    The cumulative risk of subsequent autoimmune disease was lower in patients compliant to a gluten-free diet versus noncompliant patients (at 10 years, 6% +/- 2% vs 15.6% +/- 5.9%, respectively; P = .02). The incidence of autoimmune diseases was 5.4 per 1000 patient-years during adherence to a gluten-free diet versus 11.3 per 1000 patient-years during nonadherence to the diet (P = .002). Results were similar in both the pediatric and the adult populations. CONCLUSIONS: Celiac patients most at risk for autoimmune disease are those diagnosed early in life and having a family history of autoimmunity. The gluten-free diet has a protective effect.
    Incidence of Autoimmune Diseases in Celiac Disease: Protective Effect of the Gluten-Free Diet.
    PMID: 18255352  Feb 2008

    There is, however, growing evidence that the loss of the intestinal barrier function typical of celiac disease could be responsible of the onset of other autoimmune disease. This concept implies that the autoimmune response can be theoretically stopped and perhaps reversed if the interplay between autoimmune predisposing genes and trigger(s) is prevented or eliminated by a prompt diagnosis and treatment.
    Systemic autoimmune disorders in celiac disease
    PMID: 17053448  Nov 2006  Full text on Medscape

    When the finely tuned trafficking of macromolecules is dysregulated in genetically susceptible individuals, both intestinal and extraintestinal autoimmune disorders can occur. This new paradigm subverts traditional theories underlying the development of autoimmunity, which are based on molecular mimicry and/or the bystander effect, and suggests that the autoimmune process can be arrested if the interplay between genes and environmental triggers is prevented by re-establishing intestinal barrier function.
    Mechanisms of disease: the role of intestinal barrier function in the pathogenesis of gastrointestinal autoimmune diseases.
    PMID: 16265432  Sept 2005

    Relatives of CD patients had an increased prevalence of AD compared to control groups, and relatives of CD patients with ADs, have a risk as high as 25% of being silent celiacs: they should thus be screened for CD. Relatives of CD patients had an increased prevalence of AD compared to control groups, and relatives of CD patients with ADs, have a risk as high as 25% of being silent celiacs: they should thus be screened for CD.
    Prevalence of autoimmune disorders in relatives of patients with celiac disease.
    PMID: 12141796 July 2002

    Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis.
    PMID: 15738367   Feb 2005

    Recent reports that stress the importance of screening high-risk groups (i.e. siblings of index cases and first degree relatives, patients with Type I diabetes, patients with Downs syndrome, patients with IgA deficiency) will be highlighted.
    Emerging Concepts in Celiac Disease 
    PMID: 15367850   Oct 2004

    The prevalence of celiac disease among relatives of celiac disease patients
    PMID: 15506303   2004

    144 (57.14%) and 108 (42.86%) patients showed classical and subclinical/silent celiac disease, respectively. The most frequent extraintestinal marker of subclinical celiac disease were iron-deficiency anemia (27.77%), alopecia and dermatitis herpetiformis (11.36%), osteoporosis (6.81%) and recurrent aphtous stomatitis (5.68%), while first-degree relatives (30%), Basedow's disease (25%) and insulin-dependent diabetes (20%) were the most frequent in silent celiac disease.
    Prevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation. 
    PMID: 11379333   Mar 2001

    Celiac disease in patients with an affected member, type 1 diabetes, iron-deficiency, or osteoporosis? 
    PMID: 15825127 April 2005

    Increased prevalence of celiac disease and need for routine screening among patients with osteoporosis.
    PMID: 15738367   Feb 2005

    144 (57.14%) and 108 (42.86%) patients showed classical and subclinical/silent celiac disease, respectively. The most frequent extraintestinal marker of subclinical celiac disease were iron-deficiency anemia (27.77%), alopecia and dermatitis herpetiformis (11.36%), osteoporosis (6.81%) and recurrent aphtous stomatitis (5.68%), while first-degree relatives (30%), Basedow's disease (25%) and insulin-dependent diabetes (20%) were the most frequent in silent celiac disease.
    Prevalence and clinical presentation of subclinical/silent celiac disease in adults: an analysis on a 12-year observation. 
    PMID: 11379333   Mar 2001

    Two patients observed the gluten-free diet regimen very strictly, and, after a 28-month follow-up period, showed an improvement in echocardiographic parameters as well as in cardiological features and quality of life, as evaluated by the Minnesota Living with Heart Failure questionnaire and the Gastrointestinal Symptom Rating Scale questionnaire. The third patient did not observe the gluten-free diet and presented a worsening in the echocardiographic parameters and cardiological symptoms which required supplementary drug therapy.
    Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance.
    PMID:12045166 Dec 2002

    The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.
    Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.

    PMID: 11910339 April 2002

    The present case supports the association between CD and psoriasis and the concept that psoriasis in CD patients can be improved by GFD
    Rapid Regression of Psoriasis in a Coeliac Patient after Gluten-Free Diet. A Case Report and Review of the Literature.
    PMID: 12949434  2003

    Patients with PsoA have an increased prevalence of raised serum IgA AGA and of coeliac disease. Patients with raised IgA AGA seem to have more pronounced inflammation than those with a low IgA AGA concentration.
    Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet.  Full text 
    PMID: 10651693  Jan 2002

    Thirty of the 33 patients with AGA completed the GFD period, after which they showed a highly significant decrease in mean PASI. This included a significant decrease in the 16 AGA-positive patients with normal routine histology in duodenal biopsy specimens
    Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet.
    PMID: 10651693  Jan 2000

    A case of IgA nephropathy with coeliac disease responding to a gluten-free diet.
    PMID: 8159309

    The possible presence of celiac disease should be investigated in patients with severe liver disease. Dietary treatment may prevent progression to hepatic failure, even in cases in which liver transplantation is considered.
    Celiac disease in patients with severe liver disease: gluten-free diet may reverse hepatic failure.
    PMID: 11910339

    Elevated transaminases were the most frequently reported abnormality. A gluten-free diet produced resolution of elevated transaminases in 115 of 130 patients. ...Mildly abnormal liver biochemistry is frequent in untreated coeliac disease and may provide a key to the diagnosis. Routine investigations for undiagnosed liver disease should include tissue transglutaminase testing. Left untreated, coeliac-induced hepatitis may rarely progress to end-stage liver disease. Primary biliary cirrhosis is clearly linked to coeliac disease.
    Systematic review: the liver in coeliac disease.
    PMID: 15740533 Mar 2005

    A shared set of predisposing HLA-DQ genes account for the epidemiological overlap of celiac sprue and microscopic colitis.Although further studies will be necessary to determine if this enteropathy is induced by dietary gluten, we speculate that the small intestinal but not colonic histopathology in patients with microscopic colitis is caused by immunological gluten sensitivity.
    High prevalence of celiac sprue-like HLA-DQ genes and enteropathy in patients with the microscopic colitis syndrome. 
    PMID: 10950045

    Symptomatic remission was induced with a gluten/lactose-free diet, oral prednisone, and sulfasalazine and has been maintained with gluten restriction alone. We propose that, in this instance, collagenous enterocolitis represented a diffuse manifestation of gluten sensitivity.
    Collagenous enterocolitis: a manifestation of gluten-sensitive enteropathy
    PMID: 1500661

    Lymphocytic gastritis (LG) is defined by the recognition of >25 intraepithelial lymphocytes (IEL) per 100 surface epithelial cells. Approximately 50% of children with celiac disease (CD) present LG, which mainly involves the gastric antrum and disappears after a gluten-free diet.
    Lymphocytic gastritis in pediatric celiac disease - immunohistochemical study of the intraepithelial lymphocytic component.
    PMID: 14704635

    Gluten sensitivity masquerading as systemic lupus erythematosus 

    A vegan diet free of gluten improves the signs and symptoms of rheumatoid arthritis: the effects on arthritis correlate with a reduction in antibodies to food antigens.
    PMID: 11600749   
    FULL TEXT

    As the treatment of CD-associated arthritis is based on dietary therapy, physicians should be alert to the possibility of occult CD in any child with arthritis of unclear origin.
    Recurrent monoarthritis in an 11-year-old boy with occult coeliac disease. Successful and stable remission after gluten-free diet.
    PMID: 10464568

    We have demonstrated a high frequency of gastric autoimmunity and gluten-associated immune reactivity in patients with sarcoidosis, occurring in almost 40% of the cases, the former being the most frequent gastrointestinal immune manifestation.
    Evidence of gastrointestinal immune reactivity in patients with sarcoidosis.
    PMID: 10363754

    These findings suggest that in patients with sarcoidosis, there is an altered gastrointestinal mucosal immune response, accompanied in about 40% of patients by specific sensitisation to wheat protein.
    Altered gastrointestinal immune response in sarcoidosis.
    PMID: 3265402

    In this series of patients with Addison's disease, a higher co-morbidity with coeliac disease was observed than in any previously studied endocrine condition. We recommend that coeliac serology (anti-endomysial and tissue transglutaminase antibody) testing be incorporated routinely into the autoimmune screen for other conditions in patients with Addison's disease.
    Coeliac disease and autoimmune Addison's disease: a clinical pitfall. Full text
    PMID: 11861954