Friday, April 20, 2012

Dementia is Skyrocketing - Does Gluten Intolerance Play a Role?




According to the World Health Organization, cases of dementia are set to soar in the coming decades. While over 35 million people suffer with dementia in 2010, the estimate is that numbers will double by 2030. The United Nations health agency said this week that in 2050 it expects dementia cases to triple to well over 100 million people. If you’ve ever lived with a relative with dementia or even had a close friend who had a family member suffering, you know the toll that it takes on the patient as well as their family. I know that in our practice here at HealthNOW, I frequently meet patients who have dementia in their family, and for them, preventing it in themselves is a major goal. The question we will address here is: Does gluten intolerance play a role in dementia?


Alzheimer’s is considered to be a major cause of dementia. Alzheimer’s is an autoimmune disease, which means that the body’s own immune system is responsible for attacking the patient’s brain and creating the symptoms of dementia. Celiac disease is not only an autoimmune disease in itself, but it is known to cause other autoimmune diseases as a result of the damage creating in the small intestine – called a leaky gut. Research shows that the longer a person has undiagnosed celiac disease, the more likely they are to develop an autoimmune disease, making early diagnosis extremely important.1

Here at HealthNOW we find both patients with celiac disease and gluten sensitivity at risk for autoimmune disease. We also often see a nice resolution or improvement of those autoimmune symptoms when gluten is removed from the diet.


Our ability to diagnose celiac disease is quite poor in the U.S. We only diagnose 3 to 5% of those suffering. Recent research shows us that celiac incidence factually increases with the age of the patient. So while 1% of the population having celiac disease makes it the most common life-long disorder in the US and Europe, that number quadruples to 4% with age. Therefore there are likely many millions of adults in this country living with undiagnosed celiac disease (not to mention gluten sensitivity) who are unknowingly suffering from brain damage as a result.


Does gluten affect the brain? There is ample research to show that the body’s immune system reacts to gluten and that can result in a host of brain related issues including: brain atrophy, lesions in the brain (called white matter lesions), decreased blood flow to the brain (call hypoperfusion) and inflamed blood vessels in the brain (called vasculitis). It is understandable how such damage could create symptoms of dementia.


British clinician, Dr. Maios Hadjivassiliou, a world renown authority on gluten, reported in The Lancet that gluten sensitivity can be at times exclusively a neurological disease.2 In other words, people suffering from gluten intolerance can have absolutely no digestive symptoms but will have issues with brain dysfunction.


How many of those with undiagnosed gluten intolerance develop dementia? We don’t know exactly. One study found two patients with Alzheimer’s disease who were later diagnosed with celiac disease. Once a gluten-free diet was begun, their cognitive symptoms (mental clarity) improved.3


Unfortunately, this damage to the brain is not relegated to the adult population. Researchers in Israel found neurological problems in 51% of children with gluten sensitivity. They also state there is a link between gluten sensitivity and attention deficit/hyperactivity disorder (ADHD).
I’m often asked how something you eat can affect your brain. Even with patients who notice a marked improvement in their own mood, memory and depression once embarking on a gluten-free diet, they often cannot believe that it is really gluten creating these effects and have a hard time explaining how it happens to others.


The best way to understand a rather complex issue involving the body’s immune system, gluten and inflammatory chemicals, is to look at a simple analogy.


Imagine the rooms of your house to be parts of your body. The kitchen is your digestive tract, the attic is your brain, the living room is your liver, etc. Let’s say you ate gluten and your body reacted poorly to it because you were gluten intolerant. When gluten arrives in your digestive tract, the irritation it creates is analogous to having a fire start. Continuing with our analogy, the ingested gluten has created a fire in your kitchen.
But do fires ‘stay put’ or do they tend to spread?


Now let’s imagine that the kitchen fire is so severe that the sheer force of it sends sparks and flames to other areas of the house. Before you know it, your living room, attic, bathroom, and bedrooms are all in flames. Remember that each of these rooms represents a different part of your body.


Much in the way a fire can spread throughout a house, so too can gluten affect other parts of your body through the rapid spread of chemicals. These chemicals are call cytokines (site-o-kines) and they can create serious damage wherever they go, but most especially the brain responds negatively to them. In fact, elevated levels of cytokines are found in patients with Alzheimer’s, Parkinson’s, autism and multiple sclerosis. Cytokines truly are inflammatory, so likening them to flames isn’t far off.


A 2006 study out of Mayo Clinic found a strong correlation between celiac disease and mental decline. Published in Archives of Neurology the authors stated that despite finding mental impairment associated with celiac disease, no doctor had made that association with these patients. They urged that doctors reevaluate the role that gluten can play in a treatable dementia and look for it in their patients.4


In the study of 13 patients, aged 45 – 79, with progressive mental decline over two years and biopsy-proven celiac disease that was not under control based on digestive symptoms, 3 patients improved or stabilized after initiating a gluten-free diet. Realize this is over 23% of the patients showing stabilization or improvement – no small percentage.
In support of gluten causing their symptoms, 10 had ataxia (unstable gait) that is an extremely common condition as a result of gluten intolerance. Four patients had nutrient deficiencies (vitamin E and B12), but supplementing the diet did nothing to improve their symptoms. [Note: with the age of these patients and undiagnosed celiac disease, the likelihood that they were unable to absorb the nutrition due to the damage of their intestines, is high.]


Here’s the truth of the matter: Dementia is on the rise dramatically. Much of the cause of dementia is Alzheimer’s. Alzheimer’s and decreased mental ability has a strong relationship to gluten intolerance. Diagnosing gluten intolerance and changing your diet can positively affect the brain.


So the takeaway message is: Get tested for gluten intolerance and, most especially if dementia or any autoimmune disease runs in your family, get tested soon!


I hope this was helpful. Please share this information with your friends and family. I am committed to increasing awareness of gluten intolerance and improving the health of all Americans (actually let’s include the whole planet!). Sharing this information will help accomplish that goal.


Our destination clinic treats patients from across the country and internationally. You don’t need to live locally to get help. If you would like any assistance improving your health, I’d like to invite you to receive a free health analysis. 

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! C
all 408-733-0400.

I look forward to hearing from you.

To your good health,
Dr Vikki Petersen, DC, CCN, CFMP

IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

Author of the eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




Affiliations

References
1. Gastroenterology 1999 Volume 117, Issue 2 , Pages 297-303, August 1999 “Duration of exposure to gluten and risk for autoimmune disorders in patients with celiac disease”
2. Hadjivassiliou M, Grunewald RA, Chattopadhyay AK, Davies-Jones GA, Gibson A, Jarrat JA, et el. Clinical, Radiological, Neurophysiological, And Neuropathological Characteristics Of Gluten Ataxia. Lancet 1998;352:1582-5.
3. Lurie Y, Landau DA, Pfeffer J, Oren R. Celiac disease diagnosed in the elderly. J Clin Gastroenterol. 2008 Jan;42(1):59-61. http://www.ncbi.nlm.nih.gov/pubmed/18097291
4. William T. Hu, MD, PhD; Joseph A. Murray, MD; Melanie C. Greenaway, PhD; Joseph E. Parisi, MD; Keith A. Josephs, MST, MD. Cognitive Impairment and Celiac Disease Arch Neurol. 2006;63:1440-1446.
. Dickey W. Epilepsy, Cerebral Calcifications, and Coeliac Disease. Lancet 1994;344:1585-6
. Hadjivassilou M and Grünwald R. The Neurology of Gluten Sensitivity: Science vs. Conviction. Practical Neurology 2004 4, 124-126.
4. Collin P, Pirttilä T, Nurmikko T, Somer H, Erilä T, Keyriläinen O. Celiac disease, brain atrophy, and dementia. Neurology. 1991 Mar;41(3):372–375.
5. Ghezzi A, Filippi M, Falini A, Zaffaroni M. Cerebral involvement in celiac disease: a serial MRI study in a patient with brainstem and cerebellar symptoms. Neurology. 1997 Nov;49(5):1447–1450.
6. Matthias Kieslich, MD, Germán Errázuriz, MD, Hans Georg Posselt, MD, Walter Moeller-Hartmann, MD, Friedhelm Zanella, MD, and Hansjosef Boehles, MD. Brain White-Matter Lesions in Celiac Disease: A Prospective Study of 75 Diet-Treated Patients. PEDIATRICS Vol. 108 No. 2 August 2001, p. e21.
7. Addolorato G et al (2004) Regional cerebral hypoperfusion in patients with celiac disease Am J Med 116 (312-317)
8. B. Emanuel, A. Lieberman. Electroencephalogram changes in celiac disease. The Journal of Pediatrics, Volume 62, Issue 3, Pages 435-437.
9. Lea ME, Harbord M, Sage MR. Bilateral Occipital Calcification Associated With Celiac Disease, Folate Deficiency, And Epilepsy. AJNR 16:1498-1500, Aug 1995.
10. B. Emanuel, A. Lieberman. Electroencephalogram changes in celiac disease. The Journal of Pediatrics, Volume 62, Issue 3, Pages 435-437
11. Regional cerebral hypoperfusion in patients with celiac disease. The American Journal of Medicine, Volume 116, Issue 5, Pages 312-317
12. R. L. Chin, MD, H. W. Sander, MD, T. H. Brannagan, MD, P. H.R. Green, MD, A. P. Hays, MD, A. Alaedini, PhD and N. Latov, MD PhD. Celiac Neuropathy. Neurology 2003;60:1581-1585.
13. Wilkinson ID, Hadjivassiliou M, Dickson JM, Wallis L, Grünwald RA, Coley SC, Widjaja E, Griffiths PD. Cerebellar Abnormalities On Proton MR Spectroscopy in Gluten Ataxia. J Neurol Neurosurg Psychiatry. 2005 Jul;76(7):1011-3.
14. Kepes JJ, Chou SM, Price LW., Jr Progressive multifocal leukoencephalopathy with 10-year survival in a patient with nontropical sprue. Report of a case with unusual light and electron microscopic features. Neurology. 1975 Nov;25(11):1006–1012. 

Tuesday, April 17, 2012

Celiac Disease Diagnosed without a Biopsy

There has been much discussion about the validity of the intestinal biopsy as a necessary measure when diagnosing celiac disease. A recent report regarding nomenclature stated that one could still assume celiac disease with a positive blood test and a negative biopsy if the patient clearly improved on a gluten-free diet and worsened when gluten was reintroduced.

A recent study out of Italy tried to find a correlation between blood and biopsy testing such that some people could be spared the unnecessary cost and invasive biopsy procedure. They analyzed a large group of close to one thousand patients and found out that the more positive the blood test was (they used the classic tTG test) the more it correlated with a positive intestinal biopsy.

How positive? They concluded that if the result of the tTG test was 5-fold higher than the upper limits of normal, it correlated 100% with a positive biopsy. In other words if the normal limit went from 0 – 10 and a person’s result was 50, they could receive a clear-cut diagnosis of celiac disease, without the need of a biopsy to ‘confirm’ it. Of the group of 945 patients they analyzed, this resulted in a full 1/3 of them falling into this category. Over 300 patients would be spared the need of a biopsy, according to this study.

This portends significant ramifications. Not only for the healthcare costs involved, but avoiding an invasive test with potential side effects, is always a good thing. These researchers felt strongly that this particular group of people who fell within high tTG scores, be excused from an unneeded biopsy. They summarized their findings, which conflict with traditional diagnosis, with the following statement “diagnostic criteria of celiac disease in adults need revision.”

Do understand that we are only talking about classic celiac disease with its textbook small intestine damage. This would not be valid for the types of celiac disease that don’t create such damage nor for gluten sensitivity. The reason is that the tTG test measures intestinal damage. Non-classic celiac disease and gluten sensitivity don’t typically show such damage, at least not to a significant extent.

The takeaway is this: if someone is being tested for celiac disease and receives a positive test result back and it is very high – 5x the normal limit – they now have data to support that a follow-up biopsy is unnecessary and they can show their doctor this study.

Change comes slowly to most professions and the medical profession is no different. So don’t be surprised if your medical doctor or gastroenterologist has not heard this data. But I find that patients are much better educated and savvy about their health. I know that some doctors really dislike that but personally I love it. Your body IS after all, yours. If you educate yourself about it you have every right to share that knowledge with your doctor. If they resent it, you should likely find a new one.

I hope this was helpful. Please share it with anyone considering an intestinal biopsy, who falls within the above criteria. If your health is not at the level you desire and you want to receive a free health analysis, please give me a call.

Visit us at www.RootCauseMedicalClinic.com. If you have questions or need any help, I’m here for you! C
all 408-733-0400.

I look forward to hearing from you.

To your good health,
Dr Vikki Petersen, DC, CCN, CFMP

IFM Certified Practitioner

Founder of Root Cause Medical Clinic
Co-author of “The Gluten Effect”

Author of the eBook: “Gluten Intolerance – What You Don’t Know May Be Killing You!”




Reference:
Zanini B, et al.” High tissue-transglutaminase antibody level predicts small intestinal villous atrophy in adult patients at high risk of celiac disease”. Digestive & Liver Disease. 2012 Apr; 44(4):280-5. Epub 2011 Nov 25.