Study: Celiac Disease and Autism

The Focus Might Surprise You

A bunch of studies related to autism, gluten, and/or celiac disease seem to be in the works, but so far it appears that not many have made it very far into the public eye.

Now the July 6 online edition of Pediatrics includes an international study that links autism with celiac disease, but perhaps not in a way that many people might have anticipated.

The study found, in part, that the children of mothers with celiac disease were more than three times more at risk for autism, reports HealthDay reporter Steven Reinberg,

So what does this mean in terms of treating autism with a gluten-free diet? The basic GFNYC stance remains the same: Before putting a child on a gluten-free diet, simply have the child tested for celiac disease by an informed pediatrician who understands that, depending on the age of the child, the serum test criteria for child diagnosis may be slightly different than those for adult diagnosis. (For infants and anyone else with neurological disorders, the anti-tissue antibodies may not be as important as the anti-gliadin antibodies.) Should the results be positive and the child go on a gluten-free diet, much improvement might result—and compliance with the diet can be monitored with using the original blood tests as a baseline.

To complement this testing, mothers (and fathers) might want to have themselves tested too.

The estimated prevalance of celiac disease in the general population is about 1:133—and possibly increasing, although most people remain undiagnosed. (Autism is slightly rarer in the United States, at about 1:150.) Among children with celiac-related developmental problems including failure to thrive, short stature, and dental enamel and tooth growth issues, it might be safe to say that they may be even more likely candidatest to be tested for celiac disease.

Certainly first- and second-degree relatives of people with celiac disease are much more likely to have the condition themselves. (The odds are about 1:22 and 1:39, respectively.)

More data can be expected over the coming months. But for now, if you're ready to put a child on a gluten-free diet, seize the opportunity to test for celiac disease first. Once a patient is gluten-free, testing for celiac disease and monitoring for dietary compliance becomes more difficult.

And, if your child has been diagnosed with autism, consider getting tested for celiac disease yourself. It could help to clarify some significant family health issues.

"Celiac Disease and Gluten Sensitivity"

Source (1:23:11)


The William K. Warren Medical Research Center for Celiac Disease (WMRCCD) in San Diego recently held another educational meeting. Thanks to YouTube and UCTV you can virtually attend the meeting, which featured Dr. Martin Kagnoff, Dr. Kimberly Newton, and Dr. Susan Algert, a registered dietician. Like last year's installment, the video is long but informative—and highly recommended!

Kagnoff's talk, "Celiac Disease and Gluten Intolerance: How to Tell the Difference" surveys many basics, including a discussion of differences between oats and wheat, barley, and rye. I was surprised by his estimate that about 15%-20% of all cases of celiac disease have been diagnosed—I've heard the that diagnoses were much lower than that—but not surprised by his remark that "there is a huge amount of individuals walking the face of the United States who have celiac disease and don't know it." In his discussion of the frequency of celiac disease he says that mild cases are more common than severe cases, and notes that Japan is unusual in being nearly free of the condition due to genetic factors. He also devotes much time to issues related to testing, including the advisability of family screening and the problems posed by people who go gluten-free before they've been tested. He acknowledge the phenomenon of gluten intolerance or sensitivity but noted that very few studies have been done on the subject so far.

Newton's talk, "Growing Without Gluten: Update on Pediatric Celiac Disease," offers an overview of special issues regarding child patients. She lists possible non-gastronomical manifestations as enamel defects, mouth sores, short stature, delayed puberty, low bone density, arthritis, headaches, ADHD, depression, epilepsy, dermatitis herpetiformus, anemia, and inflammation of the liver. Something she mentions that I've heard elsewhere is that the tTg test (very popular with Kagnoff) may not be as reliable as anti-gliadin tests when used on children under two years of age.

Algert's "Tips on Eating Gluten-Free" includes advice to include many non-processed foods that can often be found along the perimeter of the store, as they are naturally gluten-free.

The Q&A session includes an interesting comment on advice for pregnant women who want to protect infants from celiac disease. In Newton's answer, she acknowledges the study that recommended introduction of gluten during months 4-6 of breastfeeding, but also noted forthcoming studies suggesting that waiting more than 12 months might be more advisable. Also during the Q&A period, Kagnoff discusses trials of treatments for refractory sprue and notes that dozens of peptide sequences can trigger the damage associated with celiac disease.

MYSTERY DIAGNOSIS

Okay, I admit that this episode of Mystery Diagnosis is probably not much of a mystery here—especially if you recall the Murphy family. Still, there are some fascinating twists and turns in this tale, which offers lessons about developmental problems as well as family testing. Plus, there's an appearance from Dr. Peter Green and a reference to the Westchester Celiac Sprue Support Group (WCSSG).

PART ONE (6:05)




PART TWO (8:00)

AND NOW FOR SOME WORDS FROM DR. JOSEPH MURRAY...

Dr. Joseph Murray, one of the nation's prominent authority on celiac disease, appears in this Mayo Clinic overview of celiac disease.

Dr. Murray makes two points that deserve special attention. First, he says that small amounts of gluten can result in physical damage even when a patient doesn't notice any symptoms. Second, he says that, because of the hereditary component of celiac disease, close relatives of people diagnosed with the condition should also be screened. I mention the first point because many people may rely too much on symptom detection as a way of guessing whether they've consumed gluten; I mention the second point because it can be difficult to persuade first- and second-degree relatives to participate in conventional testing for celiac disease. Perhaps the voice of authority in this video can help to make the case.

The Mayo Clinic's web materials on celiac disease can be found here.



Source (2:23)

STUDY: FOSAMAX INCREASES RISK OF ATRIAL FIBRILLATION

People who have lived with untreated celiac disease are at an above-average risk for osteoporosis. So it is a good idea to have one's bone density tested subsequent to a positive diagnosis for celiac disease.

If the patient turns out to have osteoporosis, it is likely that therapies will be considered. The very good news is that patients seem to have a very good track record rebuilding at least some bone density through a well-rounded gluten-free diet, supplementation, and exercise. However, physicians may also suggest medicinal therapy involving bisphosphonates such as Fosamax and Reclast.

Before beginning a regimen of such drugs, it is a good idea to thoroughly discuss the risks and benefits with an informed specialist. With Fosamax, there has been some concern over stress fractures and slow healing after continuing use of the drug for more than five years; with a drug such as Reclast, it seems that patients should be vetted for possible osteonecrosis of the jaw. And just this January, the FDA issued a warning about severe bone, joint, and/or muscle pain due to such bisphosphonates.

Furthermore, recent studies now suggest that women on Fosamax and Reclast may also risk atrial fibrillation.

There still may be good rationales for treating osteoporosis with these medications; it just seems to be a good idea to weigh the pluses and minuses while keeping in mind that, for people newly diagnosed with celiac disease as well as osteoporosis, simply adopting a gluten-free diet and getting appropriate nutrition can yield very good results.

As a layperson, I also find that general screening for osteoporosis looks better and better to me. In many cases, the condition seems to be more improvable the sooner it is detected, so I don't see the harm in getting baseline diagnoses early (even in one's twenties) and perhaps every ten years after that to heighten the chance of nipping the condition in the bud and perhaps reversing it before it becomes more serious. The same goes for celiac disease, especially among people who display risk factors such as chronic fatigue, gastrointestinal problems, and/or having a first or second degree relative who has been conventionally diagnosed. In both cases, early detection can lead to early, relatively simple treatment that leads to greater success with fewer medications.

FAMILY SCREENING AND FUNDRAISING EVENT

Please note that the screening information is VERY time sensitive!

First- and second-degree relatives of people with celiac disease are at an above-average risk of having the condition themselves. The longer an undiagnosed person goes untreated, the more that person may be exposed to related health problems, some of them very serious.

So it's good that the Celiac Disease Center at Columbia University is offering family screening at Rye High School on Sunday, October 14, 2007 from 9 am to 5 pm. Registration is $25 per person and the following testing criteria must be met:

You must be on a regular gluten-containing diet for at least 60 days prior to testing.

You must be 6+ years old.

You must be a first- or second-degree relative of someone with celiac disease.

You must pre-register online before Monday, October 1, 2007 at www.celiacdiseasecenter.org. (FYI, I don't think the pre-registration is up-and-running at the time of this post.)

The family screening is just one of several activities taking place at Rye High that day. The other big event is the Colin Leslie Walk for Celiac Disease, which will raise money for the Celiac Disease Center. Pre-registration is $15 for each child 17 and under and $20 for each adult. You will receive a free t-shirt for registering for the walk by Monday, October 1, 2007.

And that's not all! There will also be exhibits, entertainment, cooking demonstrations, a gluten-free vendor fair, and gluten-free lunch available for purchase.