References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Celiac Disease http://www.nlm.nih.gov/medlineplus/ency/article/000233.htm

5. Alessio Fasano. Systemic Autoimmune Disorders in Celiac Disease: Autoimmune Diseases Associated with Celiac Disease. http://www.medscape.com/viewarticle/547107_4

6. C. O’leary, C.H. Walsh, P. Wieneke, P. O’regan, B. Buckley, D.J. O’halloran, J.B. Ferriss, E.M.M. Quigley, P. Annis, F. Shanahan and C.C. Cronin. Coeliac disease and autoimmune Addison’s disease: a clinical pitfall. Q J Med 2002; 95: 79-82.

7. Elfström et al. Risk of primary adrenal insufficiency in patients with celiac disease. J Clin Endocrinol Metab .2007

8. Corrado Betterle, Francesca Lazzarotto, Aglaura Cinzia Spadaccino, Daniela Basso¹, Mario Plebani¹, Beniamino Pedini, Silvia Chiarelli² and Mariapaola Albergoni³ Celiac disease in North Italian patients with autoimmune Addison’s disease. European Journal of Endocrinology, Vol 154, Issue 2, 275-279

9. Logan RF, Ferguson A, Finlayson ND, Weir DG. Primary biliary cirrhosis and coeliac disease: an association? Lancet. 1978 Feb 4;1(8058):230-3.

10. Primary biliary cirrhosis and coeliac disease. Lancet. 1978 Apr 1;1(8066):713–714.11.

11. Shanahan F, O’Regan PF, Crowe JP. Primary Biliary Cirrhosis associated with Coeliac Disease. Ir Med J. 1983 Jun;76(6):282–282.

12. Schrijver G, Van Berge Henegouwen GP, Bronkhorst FB. Gluten-sensitive coeliac disease and primary biliary cirrhosis syndrome. Neth J Med. 1984;27(6):218–221

13. P. Ginn and R. D. Workman. Primary biliary cirrhosis and adult celiac disease. West J Med. 1992 May; 156(5): 547–549.

14. Mirza, E. Bonilla and P. E. Phillips. Celiac disease in a patient with systemic lupus erythematosus: a case report and review of literature. Journal Clinical Rheumatology Issue Volume 26, Number 5 / May, 2007

15. Mondher Zitouni, Wafa Daoud, Maryam Kallel and Sondés Makni. Systemic lupus erythematosus with celiac disease: a report of five cases. Joint Bone Spine Volume 71, Issue 4, July 2004, Pages 344-346.

16. Freeman HJ. Adult celiac disease followed by onset of systemic lupus erythematosus. J Clin Gastroenterol. 2008 Mar;42(3):252-5.

17. Deepak Gupta and Naureen Mirza^. Systemic lupus erythematosus, celiac disease and antiphospholipid antibody syndrome: a rare association. Journal Rheumatology International Issue Volume 28, Number 11 / September, 2008

18. Abenavoli L, Proietti I, Leggio L, Ferrulli A, Vonghia L, Capizzi R, Rotoli M, Amerio PL, Gasbarrini g, Addolorato G. Cutaneous Manifestations In Celiac disease. World Journal Of Gastroenterology. 2006 February 14;12(6):843-852

19. EDOARDO ROSATO, DANIELA De NITTO, CARMELINA ROSSI, VALERIO LIBANORI, GIUSEPPE DONATO, MARCO Di TOLA, SIMONETTA PISARRI, FELICE SALSANO and ANTONIO PICARELLI. High Incidence of Celiac Disease in Patients with Systemic Sclerosis. The Journal of Rheumatology. http://www.jrheum.org/content/36/5/965.abstract

20. Melvin B. Heyman, MD. Lactose Intolerance in Infants, Children, and Adolescents. PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1279-1286.

21. ELIAKIM Rami ⁽¹⁾ ; SHERER David M. ⁽²⁾ ; Celiac disease : Fertility and pregnancy.  ⁽¹⁾ Division of Gastroenterology, Rambam Medical Center, Technion School of Medicine, Haifa, ISRAEL. ⁽²⁾ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center, University of Columbia College of Physicians and Surgeons, New York, N.Y., ETATS-UNIS. http://cat.inist.fr/?aModele=afficheN&cpsidt=859066

22. A.Gasbarrini, E.Torre, C.Trivellini, S.De Carolis, A.Caruso, G.Gasbarrini. Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. The Lancet, Volume 356, Issue 9227, Pages 399-400.

23. Rami Eliakim^a, David M. Sherer^b Celiac Disease: Fertility and Pregnancy. Gynecol Obstet Invest 2001;51:3-7.

20. Porpora, Maria Grazia MD; Picarelli, Antonio MD; Porta, Romana Prosperi MD; Di Tola, Marco BSc; D’Elia, Claudia MD; Cosmi, Ermelando Vinicio MD, PhD.  Celiac Disease as a Cause of Chronic Pelvic Pain, Dysmenorrhea, and Deep Dyspareunia. Obstetrics & Gynecology: May 2002 – Volume 99 – Issue 5, Part 2 – p 937-939.

21. P Collin, S Vilska, P K Heinonen, O Hällström, P Pikkarainen. Infertility and coeliac disease. Gut 1996;39:382-384; doi:10.1136/gut.39.3.382.

22. K Rostami, EAP Steegers, WY Wong, DD … – Coeliac disease and reproductive disorders: a neglected association. European Journal of Obstetrics and Gynecology, 2001 – Elsevier. Science Ireland Ltd. All rights reserved.

23. Bradley, Ryan J. * and; Rosen, Mitchell P. MD + Subfertility and Gastrointestinal Disease: ‘Unexplained’ Is Often Undiagnosed. Obstetrical & Gynecological Survey. 59(2):108-117, February 2004.

24. Gian Mario Tiboni^1,3, Maria Grazia de Vita¹, Raffaella Faricelli², Franca Giampietro¹ and Marco Liberati¹ Serological testing for celiac disease in women undergoing assisted reproduction techniques. Human reproduction Vol 21, No. 2 pp376-379,2206. http://humrep.oxfordjournals.org/cgi/reprint/21/2/376.pdf

25. Adams Scott. Miscarriage: Italian Researchers Link celiac Disease To Spontaneous Abortion And Fetal Growth Retardation. www.celiac.com http://tinyurl.com/yaxxj6s

26. Dickey W. Epilepsy, Cerebral Calcifications, and Coeliac Disease. Lancet 1994;344:1585-6

27. Gobbi G, Bouquet F, Greco L, et al. Coeliac Disease, Epilepsy, and Cerebral Calcifications. The Italian Working Group On Coeliac Disease and Epilepsy. Lancet 340:439, 1992.

28. Hadjivassiliou M, Davies-Jones GA, Saunders DS, Grunwald (2 dots)RA. Dietary treatment of Gluten Ataxia. J Neuro Neurosurg Psychiatry. 2003 Sep;74(9):1221-4.

29. Hadjivassiliou M, Grünwald R, Sharrack B, Sanders D, Lobo A, Williamson C, Woodroofe N, Wood N, Davies-Jones A. Gluten Ataxia in Perspective: Epidemiology, Genetic susceptibility, And Clinical Characteristics. Brain 2003 Mar;126(pt 3): 685-91.

30. Hadjivassilou M, Grünwald RA, Lawden M, Davies-Jones GA, Powell T, Smith CM. Headache and CNS White Matter Abnormalties Associated with Gluten Sensitivity. Neurology 2001 Feb 13;56(3):385-8.

31.Cooke WT, Thomas-Smith W. Neurological Disorders Associated with Adult Coeliac Disease. Brain 1966;89:683-722.

32. Hadjivassilou M and Grünwald RA, Davies-Jones GAB. Gluten Sensitivity As a Neurological Illness. Journal of Neurology, Neurosurgery, and Psychiatry 2002;72:560-563

33. Jorge O, Jorge A, Camus G. Celiac disease associated with antiphospholipid syndrome. Rev Esp Enferm Dig. 2008 Feb;100(2):102-3.

34. Hall WH. Proximal muscle atrophy in adult celiac disease. Am J Dig Dis. 1968 Aug;13(8):697–704.

35. Hafström, et el. 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. Rheumatology 2001;40:1175-9

36. Lubrano et el. The Arthritis of Celiac Disease: Prevalence And Pattern In 200 Adult Patients. British Journal of Rheumatology. 1996;35:1314-8.

37. Bourne JT, Kumar P, Huskisson EC, Mageed R, Unsworth DJ, Wojtulewski JA. Arthritis And Celiac disease. Ann Rheum Dis 1985, September;44(9):592-598.

38. Adams Jefferson. Studies Show High Instance of Rheumatoid Arthritis And Osteoporosis In Patients With Celiac Disease. www.celiac.com

39. Collin P, Korpela M, Hallstrom O, et el. Rheumatic Complaints As A Presenting Symptom In Patients With Celiac Disease. Scan J Rheumatol 1992;21:20-3.

40. Patients With Osteoporosis Should Be Screened For Celiac Disease, Study Suggests. ScienceDaily (Mar. 16, 2005) — St. Louis, Feb. 28, 2005. http://www.sciencedaily.com/releases/2005/03/050308131921.htm

41. Stazi AV, Trecca A, Trinti B. Osteoporosis in celiac disease and in endocrine and reproductive disorders. World J Gastroenterol. 2008 Jan 28;14(4):498-505.

42. Szodoray P, Barta Z, Lakos, Szakall S, Zeher M. Coeliac Disease In Sjogren’s Syndrome-A Study of 111 Hungarian Patients. Rheumatol Int 2004 Sep;24(5):278-82. Epub 2003 Sep 17.

43. Matz Jenilee. The Link Between Type 1 Diabetes and Celiac Disease. http:www.myoptumhealth.com

44. Hilde Kloster Smerud, Bengt Fellström, Roger Hällgren, Sonia Osagie, Per Venge and Gudjón Kristjánsson Gluten sensitivity in patients with IgA nephropathy. Nephrology Dialysis Transplantation 2009 24(8):2476-2481; doi:10.1093/ndt/gfp133.

45. Pekka Collin, M.D., Jaana Syrjänen, M.D. , Jukka Partanen, Ph.D  , Amos Pasternack, M.D.  , Katri Kaukinen, M.D.  , Jukka Mustonen, M.D. Celiac disease and HLA DQ in patients with IgA nephropathy. The American Journal of Gastroenterology Volume 97 Issue 10, Pages 2572 – 2576

46. Sandyk R., MD, Brennan M.J.W., MB, BCh, PhD. Isolated Ocular Myopathy And Celiac Disease In Childhood. Neurology 1983;33:792. American Academy Of Neurology.

47. Wong M, et el. Proximal Myopathy And Bone Pain As The Presenting Features Of Coeliac Disease. Ann Rheum Dis, 2002, 61(1):p87-8.

48. Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005 Feb;31(2):260-5.

49. Possible Relationship Between Myopathies And Celiac Disease. ScienceDaily (Feb. 24, 2007)

50. Albert Selva-O’Callaghan, MD, PhD ^{1 *}, Francesc Casellas, MD, PhD ², Ines de Torres, MD, PhD ³, Eduard Palou, MD, PhD ⁴, Josep M. Grau-Junyent, MD, PhD ⁵, Miquel Vilardell-Tarrés, MD, PhD ¹ Celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathy. Muscle & Nerve, Volume 35 Issue 1, Pages 49 – 54.Published Online: 11 Sep 2006

51. Erkan Kozanoglu¹, Sibel Basaran¹ and M. Kamil Goncu^1. Proximal myopathy as an unusual presenting feature of celiac disease. Journal Clinical Rheumatology. Issue Volume 24, Number 1 / February, 2005. Pages 76-78

52. Vivek Jain¹, Rajeshwar Reddy Angitii¹, Surjit Singh¹, Babu Ram Thapa² and Lata Kumar^{1  Proximal Muscle Weakness—An Unusual Presentation of Celiac Disease. Department of Pediatrics, Postgraduate Institute of Medical Education and Research PGIMER), Chandigarh, India}

53. Alawneh K, Ashley C, Carlson JA. Neutrophilic myositis as a manifestation of celiac disease: a case report. Journal of Tropical Pediatrics 2002 48(6):380-381; doi:10.1093/tropej/48.6.380. © 2002 by Oxford University Press http://www.ncbi.nlm.nih.gov/pubmed/18180977

54. Hardoff D, Sharf B, Berger A. Myopathy as a presentation of coeliac disease. Dev Med Child Neurol. 1980 Dec;22(6):781-3.

55. Goel NK, McBane RD, Kamath PS. Cardiomyopathy associated with celiac disease. Mayo Clin Proc. 2005 May;80(5):674-6. http://www.ncbi.nlm.nih.gov/pubmed/15887437

56. Nidhi Narula^a, Pawan Rawal^b, Rohit Manoj Kumar^a and Babu Ram Thapa^b  Association of Celiac Disease with Cardiomyopathy and Pulmonary Hemosiderosis. Oxford Journals. Journal of Tropical Pediatrics Advance Access published online on November 6, 2009. Journal of Tropical Pediatrics, doi:10.1093/tropej/fmp088. http://tropej.oxfordjournals.org/cgi/content/abstract/fmp088v1

57. Mario Curione, Maria Barbato, Pietro Cugini, Silvia Amato, Silvia Da Ros, Simonetta Di Bona.  Association of cardiomyopathy and celiac disease: an almost diffuse but still less know entity. Arch Med Sci 2008; 4, 2: 103–107. http://www.termedia.pl/magazine.php?magazine_id=19&article_id=10658&magazine_subpage=ABSTRACT

58. Lodha, Ankur MD; Haran, Mehandi MD; Hollander, Gerald MD; Frankel, Robert MD; Shani, Jacob MD. Celiac Disease Associated with Dilated Cardiomyopathy. Southern Medical Journal: October 2009 – Volume 102 – Issue 10 – pp 1052-1054.

59. Tarcisio Not^a, Elena Faleschini^a, Alberto Tommasini^a, Alessandra Repetto^b, Michele Pasotti^b, Valentina Baldas^a, Andrea Spano^a, Daniele Sblattero^c, Roberto Marzari^c, Carlo Campana^b, Antonello Gavazzi^d, Luigi Tavazzi^b, Federico Biagi^e, Gino Roberto Corazza^e, Alessandro Ventura^a and Eloisa Arbustini^f,* Celiac disease in patients with sporadic and inherited cardiomyopathies and in their relatives. European Heart Journal 2003 24(15):1455-1461; doi:10.1016/S0195-668X(03)00310-5. http://eurheartj.oxfordjournals.org/cgi/content/abstract/24/15/1455

60. M. Curione^, , M. Barbato^b, F. Viola2^b, P. Francia^a, L. De Biase^c and S. Cucchiara^b  Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance. Digestive and Liver Disease Volume 34, Issue 12, December 2002, Pages 866-869. http://tinyurl.com/y9hhwjt

61. Jorge O, Jorge A, Camus G. Celiac disease associated with antiphospholipid syndrome. Rev Esp Enferm Dig. 2008 Feb;100(2):102-3.

62. R Shamir, Y Shoenfeld, M Blank, R Eliakim, N Lahat, E Sobel, E Shinar, A Lerner. The prevalence of coeliac disease antibodies in patients with the antiphospholipid syndrome. Division of Paediatric Gastroenterology and Nutrition, Meyer Children’s Hospital of Haifa, Haifa, Israel, shamirr@netvision.net.il. Department of Paediatrics, Carmel Medical Center, Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

63. P.Rush, R.Inman, M.Bernstein, P.Carlen, L.Resch. Isolated vasculitis of the central nervous system in a patient with celiac disease. The American Journal of Medicine, Volume 81, Issue 6, Pages 1092-1094

64. S Meyers, S Dikman, H Spiera, N Schultz, H D Janowitz. Cutaneous vasculitis complicating coeliac disease. Gut 1981;22:61-64; doi:10.1136/gut.22.1.61

65. V. Alegre, R. Winkelmann, J. Diez-Martin, P. Banks. Adult celiac disease, small and medium vessel cutaneous necrotizing vasculitis, and T cell lymphoma† Journal of the American Academy of Dermatology, Volume 19, Issue 5, Pages 973-978.

67. Ola Olén?¹,^2†, Scott M. Montgomery?³,⁴⁵, Göran Elinder?¹,², Anders Ekbom?³,⁶ and Jonas F. Ludvigsson?³,⁷ Increased risk of immune thrombocytopenic purpura among inpatients with coeliac disease. Scandinavian Journal of Gastroenterology 2008, Vol. 43, No. 4, Pages 416-422.

68. L. STENHAMMAR ¹ C. G. LJUNGGREN ¹  Thrombocytopenic Purpura and Coeliac Disease. Acta Pædiatrica Volume 77 Issue 5, Pages 764 – 766

69. Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.

70. Rensch M.J. et el. The Prevalence Of Celiac Disease Autoantibodies In Patients With Systemic Lupus Erythematosus. American Journal Of Gastroenterology 96 (2001):1113-5. In this study, the researchers found antigliadin antibodies in some individuals with Lupus. The IgA antiendomysial antibodies and scopes were negative, so the researchers thought the antigliadin results were false negatives. IgA antiendomysial antibodies correspond with the level of intestinal damage so this test would likely be negative considering that the scope results were negative (also could have a IgA deficiency). Many with CD do not have bowel involvement, so I think the positive antigliadin antibodies in this study could indicate that these people are gluten sensitive (similar to gluten ataxia).

71. Hadjivassilou et el. Gluten Sensitivity Masquerading As Systemic  Lupus Erythematosus. Annals Of Rheumatic Diseases 63 (2004): 1501-3.

72. Peter Elfström^*, Scott M. Montgomery, Olle Kämpe, Anders Ekbom, and Jonas F. Ludvigsson. Risk of primary adrenal insufficiency in patients with celiac disease. Journal of Clinical Endocrinology & Metabolism doi:10.1210/jc.2007-0960.

The presence of cardiopulmonary symptoms as discussed in this post, indicates that you should talk to your MD about tests for gluten sensitivities/CD and tests to rule out other possible causes of your symptoms. Testing for CD/gluten sensitivities is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,62,63,67), and many other health complications that will be discussed in the posts about CD/gluten sensitivity symptoms. It is my hope that if you have cardiopulmonary symptoms you can print out this post complete with medical references to take with you to the MD when you request testing. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that some of your symptoms could be due to a food allergy/sensitivity or other disease process. Allergy testing, and/or an elimination diet may help you to identify offending foods. Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. A consultation with a Registered Dietitian can provide guidance to ensure all nutritional needs are met. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.

I recommend waiting until CD/gluten sensitivity testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

Diagnosed Celiacs and people with food allergies/sensitivities, please comment about your symptoms  and experiences at the end of each post. This will help other readers to see how the sometimes illusive symptoms of CD or food sensitivities can affect each of us.  We are all unique!

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. F.M. Stevens, C.E. Connolly, J.P. Murray, C.F. McCarthy. Lung Cavities in Patients with Coeliac Disease.  Digestion 1990;46:72-80

5. Williams AJ, Asquith P, Stableforth DE. Susceptibility to tuberculosis in patients with coeliac disease. Tubercle. 1988 Dec;69(4):267-74.

6. J F Ludvigsson^1,2, J Wahlstrom³, J Grunewald³, A Ekbom^2,4, S M Montgomery^2,5   Coeliac disease and risk of tuberculosis: a population based cohort study. Published Online First: 17 October 2006. doi:10.1136/thx.2006.059451
Thorax 2007;62:23-28

7. Goel NK, McBane RD, Kamath PS. Cardiomyopathy associated with celiac disease. Mayo Clin Proc. 2005 May;80(5):674-6. http://www.ncbi.nlm.nih.gov/pubmed/15887437 

8. Nidhi Narula^a, Pawan Rawal^b, Rohit Manoj Kumar^a and Babu Ram Thapa^b  Association of Celiac Disease with Cardiomyopathy and Pulmonary Hemosiderosis. Oxford Journals. Journal of Tropical Pediatrics Advance Access published online on November 6, 2009. Journal of Tropical Pediatrics, doi:10.1093/tropej/fmp088. http://tropej.oxfordjournals.org/cgi/content/abstract/fmp088v1 

9. Mario Curione, Maria Barbato, Pietro Cugini, Silvia Amato, Silvia Da Ros, Simonetta Di Bona.  Association of cardiomyopathy and celiac disease: an almost diffuse but still less know entity. Arch Med Sci 2008; 4, 2: 103–107. http://www.termedia.pl/magazine.php?magazine_id=19&article_id=10658&magazine_subpage=ABSTRACT

10. Lodha, Ankur MD; Haran, Mehandi MD; Hollander, Gerald MD; Frankel, Robert MD; Shani, Jacob MD. Celiac Disease Associated with Dilated Cardiomyopathy. Southern Medical Journal: October 2009 – Volume 102 – Issue 10 – pp 1052-1054.

11. Tarcisio Not^a, Elena Faleschini^a, Alberto Tommasini^a, Alessandra Repetto^b, Michele Pasotti^b, Valentina Baldas^a, Andrea Spano^a, Daniele Sblattero^c, Roberto Marzari^c, Carlo Campana^b, Antonello Gavazzi^d, Luigi Tavazzi^b, Federico Biagi^e, Gino Roberto Corazza^e, Alessandro Ventura^a and Eloisa Arbustini^f,* Celiac disease in patients with sporadic and inherited cardiomyopathies and in their relatives. European Heart Journal 2003 24(15):1455-1461; doi:10.1016/S0195-668X(03)00310-5. http://eurheartj.oxfordjournals.org/cgi/content/abstract/24/15/1455

12. M. Curione^, , M. Barbato^b, F. Viola2^b, P. Francia^a, L. De Biase^c and S. Cucchiara^b  Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance. Digestive and Liver Disease Volume 34, Issue 12, December 2002, Pages 866-869. http://tinyurl.com/y9hhwjt

13. Ricardo Schmit T De Bem^{1, 4} , Shirley Ramos Da Ro Sa Utiyama², Renato Mitsunori Nisihara², Jerônimo Antônio fortunato³, josuÉ Augusto Tondo³, Eliane Ribeiro Carmes¹, Raquel Almada E. Souza¹, Julio CÉsar Pisani¹ and Heda Maria Barska Dos Santos Amarante¹ Celiac Disease Prevalence in Brazilian Dilated Cardiomyopathy Patients. Journal Digestive Diseases and Sciences Issue Volume 51, Number 5 / May, 2006  http://www.springerlink.com/content/t13467701v3648nu/

14. Ravi Mahadeva,^a Christopher Flower,^b John Shneerson^a  Bronchiectasis in association with coeliac disease. Thorax 1998;53:527-529; doi:10.1136/thx.53.6.527

15. Tugcin B. Polat^a,, Nafiye Urganci^b, Yalim Yalcin^a, Cenap Zeybek^a, Celal Akdeniz^a, Abdullah Erdem^a, Elnur Imanov^a and Ahmet Celebi^a  Cardiac functions in children with coeliac disease during follow-up: Insights from tissue Doppler imaging. Digestive and Liver Disease Volume 40, Issue 3, March 2008, Pages 182-187. http://tinyurl.com/ydzutq7

16. WEI, L. *; SPIERS, E. +; REYNOLDS, N. ++; WALSH, S. [S]; FAHEY, T. [P]; MACDONALD, T. M. *   The association between coeliac disease and cardiovascular disease. Alimentary Pharmacology & Therapeutics. 27(6):514-519, March 15, 2008. http://tinyurl.com/yeyw2aw

17. Siry M, Burges C, Stiens R, Schneider H, Steiff J. [First diagnosis of celiac disease in a 67-year old female patient]. Dtsch Med Wochenschr. 2000 Aug 4;125(31-32):932-6.

18. Loren A. Laine, MD; Kenneth M. Holt, MD. Recurrent Pericarditis and Celiac Disease. JAMA. 1984;252(22):3168.

19. R. Faizallah^{1, 2}   , F. C. Costello^{1, 2}, Frank I. Lee^{1, 2} and Robin Walker^{1, 2}  Adult celiac disease and recurrent pericarditis. Journal Digestive Diseases and Sciences Volume 27, Number 8 / August, 1982

20. Dawes PT, Atherton ST. Coeliac disease presenting as recurrent pericarditis. Lancet. 1981 May 9;1(8228):1021-2.

21. D. Pratil^{b, ,} , M. T. Bardella^c, M. Peracchi^c, L. Porretti^a, M. Cardillo^a, C. Pagliari^c, C. Tarantino^c, E. Della Torre^a, M. Scalamogna^b, P. A. Sianchi^c, G. Sirchia^a, D. Conte and North Italy Transplant Programme Working Group (NITp)^c  High frequency of anti-endomysial reactivity in candidates to heart transplant. Digestive and Liver Disease
Volume 34, Issue 1, January 2002, Pages 39-43. http://tinyurl.com/ye75v9p 

22. Andrea Frustaci, MD; Lucio Cuoco, MD; Cristina Chimenti, MD; Maurizio Pieroni, MD; Giuseppina Fioravanti, CTER; Nicola Gentiloni, MD; Attilio Maseri, MD; Giovanni Gasbarrini, MD. Celiac Disease Associated With Autoimmune Myocarditis. (Circulation. 2002;105:2611.)

23. Malena Cohen-Cymberknoh¹, Michael Wilschanski² Concomitant cystic fibrosis and coeliac disease: reminder of an important clinical lesson.  BMJ Case Reports 2009 [doi:10.1136/bcr.07.2008.0578].

24. Davidson DC, Shannon RS.  Letter: Cystic fibrosis and coeliac disease. Arch Dis Child. 1974 Jun;49(6):501.

25. Franklin JL, Asquith P, Rosenberg IH. The occurrence of cystic fibrosis and celiac sprue within a single sibship. Am J Dig Dis. 1974 Feb;19(2):149-55.

26. Hide DW, Burman D. An infant with both cystic fibrosis and coeliac disease. Arch Dis Child. 1969 Aug;44(236):533-5.

27. Goodchild MC, Nelson R, Anderson CM. Cystic fibrosis and coeliac disease: coexistence in two children. Arch Dis Child 1973 Sep;48(9):684-91.

28. Katz AJ, Falchuk ZM, Schwachman H. The coexistence of cystic fibrosis and celiac disease.  Pediatrics. 1976 May;57(5):715-21.

29. Santer R, Harms HK.  [Cystic fibrosis and celiac disease. Report of two cases]. Monatsschr Kinderheilkd. 1990 Sep;138(9):623-6.

30. Chiaravalloti G, Baracchini A, Rossomando V, Ughi C, Ceccarelli M. [Celiac disease and cystic fibrosis: casual association?]. Minerva Pediatr. 1995 Jan-Feb;47(1-2):23-6.

31. Venuta A, Bertolani P, Casarini R, Ferrari F, Guaraldi N, Garetti E. [Coexistence of cystic fibrosis and celiac disease. Description of a clinical case and review of the literature]. Pediatr Med Chir. 1999 Sep-Oct;21(5 Suppl):223-6.

32. G. Fluge, H. Olesen, M. Gilljam, P. Meyer, T. Pressler, O. Storrösten, F. Karpati, L. Hjelte. Co-morbidity of cystic fibrosis and celiac disease in Scandinavian cystic fibrosis patients. Journal of Cystic Fibrosis, Volume 8, Issue 3, Pages 198-202.

33. Conn DL, McDuffie FC, Holley KE, Schroeter AL. Immunologic mechanisms in systemic vasculitis. Mayo Clin Proc. 1976 Aug;51(8):511-8.

34. Vázquez Gomis RM, Izquierdo Fos I, Zapata A, Parra G, Chicano Marin FJ. [Dilated myocardiopathy as a form of presentation of coeliac disease in childhood.]. An Pediatr (Barc). 2009 Oct 9.

35. Prati D, Bardella MT, Peracchi M, Porretti L, Scalamogna M, Conte D. Antiendomysial antibodies in patients with end-stage heart failure. Am J Gastroenterol. 2002 Jan;97(1):218-9.

36. Nisheeth K. Goel, MD; Robert D. McBane, MD; and Patrick S. Kamath, MD. Cardiomyopathy Associated With Celiac Disease. Mayo Clinic Proc. 2005;80(5):674-676.

37. Ph. Camus, T.V. Colby. The Lung In Inflammatory Bowel Disease. Eur Respir J 2000; 15:5-10.

38. O.C. Ioachimescu, S. Sieber, A. Kotch. Idiopathic Pulmonary Haemosiderosis Revisited. Eur Respir J 2004;24;162-169.

39. Mario Curione, maria Barbato, Pietro Cugini, Silvia Amato, Silvia Da Ros, Simonetta Di Bona. Association of Cardiomyopathy And Celiac Disease: An Almost Diffuse But Still Less Known Entity. Arch Med Sci 2008; 4, 2:103-107.

40. Ackerman Z, Eliashiv S, Reches A, Zimmerman J. Neurological manifestations in celiac disease and vitamin E deficiency. J Clin Gastroenterol. 1989 Oct;11(5):603–605

41. Henri-Bhargava Alexandre, Melmed Calvin, Glikstein Rafael, and Schipper Hyman M. NEUROLOGIC IMPAIRMENT DUE TO VITAMIN E AND COPPER DEFICIENCIES IN CELIAC DISEASE. Neurology, Vol. 71, Issue 11, 860-861, September 9, 2008

42. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.

43. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

44. Vincent Cottin^a,, Gael Clérici^b, Nicole Fabien^c, Hugues Rousset^d and Jean-François Cordier^a  Celiac disease revealed by diffuse alveolar hemorrhage and heart block. Respiratory Medicine Extra Volume 2, Issue 3, 2006, Pages 89-91.

45. Maddalena Peracchi MD¹, Cristina Trovato MD¹, Massimo Longhi MD², Maurizio Gasparin DSc², Dario Conte MD¹, Cristina Tarantino BSc¹, Daniele Prati MD³ and Maria Teresa Bardella MD¹  Tissue transglutaminase antibodies in patients with end-stage heart failure. The American Journal of Gastroenterology (2002) 97, 2850–2854; doi:10.1111/j.1572-0241.2002.07033.x.

46. Alessandro Luciani^*,, Valeria Rachela Villella, Angela Vasaturo, Ida Giardino, Valeria Raia^¶, Massimo Pettoello-Mantovani^*, Maria D’Apolito^*, Stefano Guido^,, Teresinha Leal^||, Sonia Quaratino^# and Luigi Maiuri^2,*,** SUMOylation of Tissue Transglutaminase as Link between Oxidative Stress and Inflammation^1. Published online July 22, 2009
The Journal of Immunology, 2009, 183, 2775 –2784. 

47. Wong M, et el. Proximal Myopathy And Bone Pain As The Presenting Features Of Coeliac Disease. Ann Rheum Dis, 2002, 61(1):p87-8.

48. Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005 Feb;31(2):260-5.

49. Albert Selva-O’Callaghan, MD, PhD ^{1 *}, Francesc Casellas, MD, PhD ², Ines de Torres, MD, PhD ³, Eduard Palou, MD, PhD ⁴, Josep M. Grau-Junyent, MD, PhD ⁵, Miquel Vilardell-Tarrés, MD, PhD ¹ Celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathy. Muscle & Nerve, Volume 35 Issue 1, Pages 49 – 54. Published

50. Hadjivassiliou M, Maki M, Saunders DS, Williamson CA, Grunewald RA, Woodroof NM, Korponay-Szabo IR. Autoantibody Targeting of Brain and Intestinal Transglutaminase in Gluten Ataxia. Neurology 2006 Feb.14;66(3):373-7.

51.  T Matsuzaka, H Tanaka, M Fukuda, M Aoki, Y Tsuji, and H Kondoh. Relationship between vitamin K dependent coagulation factors and anticoagulants (protein C and protein S) in neonatal vitamin K deficiency. Arch Dis Child. 1993 March; 68(3 Spec No): 297–302.

52. Jorge O, Jorge A, Camus G. Celiac disease associated with antiphospholipid syndrome. Rev Esp Enferm Dig. 2008 Feb;100(2):102-3.

53. Armando D’Angelo, Silvana Viganò D’Angelo. Protein S deficiency. Haematologica, Vol 93, Issue 4, 498-501 doi:10.3324/haematol.12691

54. E Myrsky,^* K Kaukinen,^† M Syrjänen,^* I R Korponay-Szabó,^‡ M Mäki,^* and K Lindfors^{*  Coeliac disease-specific autoantibodies targeted against transglutaminase 2 disturb angiogenesis.} Clin Exp Immunol. 2008 April; 152(1): 111–119.

55. Deepak Gupta¹ and Naureen Mirza¹ Systemic lupus erythematosus, celiac disease and antiphospholipid antibody syndrome: a rare association. Journal Rheumatology International, Volume 28, Number 11 / September, 2008.

56. R Shamir, Y Shoenfeld, M Blank, R Eliakim, N Lahat, E Sobel, E Shinar, A Lerner. The prevalence of coeliac disease antibodies in patients with the antiphospholipid syndrome. Division of Paediatric Gastroenterology and Nutrition, Meyer Children’s Hospital of Haifa, Haifa, Israel, shamirr@netvision.net.il. Department of Paediatrics, Carmel Medical Center, Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

57. P.Rush, R.Inman, M.Bernstein, P.Carlen, L.Resch. Isolated vasculitis of the central nervous system in a patient with celiac disease. The American Journal of Medicine, Volume 81, Issue 6, Pages 1092-1094

58. S Meyers, S Dikman, H Spiera, N Schultz, H D Janowitz. Cutaneous vasculitis complicating coeliac disease. Gut 1981;22:61-64; doi:10.1136/gut.22.1.61

59. V. Alegre, R. Winkelmann, J. Diez-Martin, P. Banks. Adult celiac disease, small and medium vessel cutaneous necrotizing vasculitis, and T cell lymphoma† Journal of the American Academy of Dermatology, Volume 19, Issue 5, Pages 973-978.

60. Siiri E. Iismaa, Bryony M. Mearns, Laszlo Lorand and Robert M. Graham. Transglutaminases and Disease: Lessons From Genetically Engineered Mouse Models and Inherited Disorders. Physiol. Rev. 89: 991-1023, 2009.

61. Luigi Maiuri^2,*,, Alessandro Luciani^,, Ida Giardino, Valeria Raia^¶, Valeria R. Villella^||, Maria D’Apolito, Massimo Pettoello-Mantovani, Stefano Guido^||, Carolina Ciacci, Mariano Cimmino^#, Olivier N. Cexus^**, Marco Londei^,* and Sonia Quaratino^2,**,   Tissue Transglutaminase Activation Modulates Inflammation in Cystic Fibrosis via PPAR Down-Regulation¹ The Journal of Immunology, 2008, 180, 7697 –7705.

61. Vincent Cottin^{a, ,} , Gael Clérici^b, Nicole Fabien^c, Hugues Rousset^d and Jean-François Cordier^a  Celiac disease revealed by diffuse alveolar hemorrhage and heart block. Respiratory Medicine Extra Volume 2, Issue 3, 2006, Pages 89-91.

62.  Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007.

63 James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002.

64. Jefferson dams. Celiac G+ Antibody Assay for the Detection of Auto-antibodies in Celiac Disease. http://www.celiac.com/articles/21919/1/Celiac-G-Antibody-Assay-for-the-Detection-of-Auto-antibodies-in-Celiac-Disease/Page1.html

65. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.

66. Hadjivassilou M and Grünwald RA, Davies-Jones GAB. Gluten Sensitivity As a Neurological Illness. Journal of Neurology, Neurosurgery, and Psychiatry 2002;72:560-563

67. School of Medicine News: University of Maryland School of Medicine Scientists Pinpoint Critical Molecule to Celiac, Possibly Other Autoimmune Disorders. Tuesday, September 29, 2009. http://somvweb.som.umaryland.edu/absolutenm/templates/?a=915 

68. Diet and Human Immune Function by David A. Hughes, L. Gail Darlington, and Adrianne Bendich. Humana Press; 1 edition (Dec 4 2003)

69. S. Rashtak, M. Ettore, H. Homburger, J. Murray. Comparative Usefulness of Deamidated Gliadin Antibodies in the Diagnosis of Celiac Disease. Clinical Gastroenterology and Hepatology, Volume 6, Issue 4, Pages 426-432

The presence of psychological and cognitive symptoms as discussed in this post, indicates that you should talk to your MD about tests for gluten sensitivities/CD and tests to rule out other possible causes of your symptoms. Testing for CD/gluten sensitivities is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,5,6,91), and many other health complications that will be discussed in the posts about CD/gluten sensitivity symptoms. It is my hope that if you have psychological or cognitive symptoms, you can print out this post complete with medical references to take with you to the MD when you request testing. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that some of your symptoms could be due to a food allergy/sensitivity or other disease process. For example, Dr. Stephen Wangen (http://tinyurl.com/yjsrqle) describes how a boy with TIC disorder benefited  a gluten-free, dairy-free diet (92). Allergy testing, and/or an elimination diet may help you to identify offending foods. Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. A consultation with a Registered Dietitian can provide guidance to ensure all nutritional needs are met. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.

I recommend waiting until CD/gluten sensitivity testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

Diagnosed Celiacs and people with food allergies/sensitivities, please comment about your symptoms  and experiences at the end of each post. This will help other readers to see how the sometimes illusive symptoms of CD or food sensitivities can affect each of us.  We are all unique!

Links to more Information

1. Dr. Scot Lewey. Celiac Disease and gluten linked to brain disease by deposits in intestine and brain. http://tinyurl.com/yje7nv5

2. Dr. David Perlmutter, MD, FACN, ABIHM. Gluten sensitivity (Celiac Disease), ADHD, and other neurological problems in children. http://tinyurl.com/c2pzoo

3. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD Symptoms In persons With celiac Disease.  http://jad.sagepub.com/cgi/content/abstract/10/2/200

4. Nathanel Zelnik MD, Avi Pacht MD, Raid Obeid MD, Aaron Lerner MD. Range of Neurological Disorders In Patients With Celiac Disease.  http://tinyurl.com/yjwaqrp

5. Elaine Gottschall. Recognizing Celiac behavior and catching it early by using SCD™ – would it prevent Autism? http://www.breakingtheviciouscycle.info/autism/dr_hass_exerpt.htm

6. Dr. Vikki Peterson. D.C., C.C.N. Gluten Sensitivity And Depression. http://tinyurl.com/bl7ox3

7. Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G. Grown-up Coeliac Children: The Effects Of Only A Few Years On A Gluten-Free Diet In Childhood. http://www.ncbi.nlm.nih.gov/pubmed/15709993

8. The gluten connection: the association between schizophrenia and celiac disease.    http://www3.interscience.wiley.com/journal/118626206/abstract 

9. Findings in this study suggest that immune reactions in the intestine may affect individuals cognitively.  A J Wakefield FRCS et el. Enterocolitis in children with developmental disorders. http://www.nature.com/ajg/journal/v95/n9/abs/ajg2000579a.html

10. Ron Hoggan. Memory/Learning: Eating to Learn: How Grains Impact on Our Ability to Focus, Comprehend, Remember, Predict, and Survive. http://tinyurl.com/4nr67d

11. Prof. Rodney Ford M.B., B.S., M.D., F.R.A.C.P. Gluten Causes Brain Disease! http://tinyurl.com/naqvg9

12. Wendy Cohan, RN. Gluten, Celiac Disease and the Brain. http://tinyurl.com/d4z4c6

13. Ron Hoggan. ADD, Attention Deficit Hyperactivity Disorder – ADHD and Celiac Disease. http://tinyurl.com/ll9tpw

14. PA Pynnonen et el. Untreated Celiac Disease And Development Of Mental Disorders In Children And Adolescents.   http://psy.psychiatryonline.org/cgi/reprint/43/4/331.pdf 

15. Cholesterol is often low in undiagnosed Celiacs. Could the behaviour in this study be due to undiagnosed CD? Total serum cholesterol level, violent criminal offences, suicidal behaviour, mortality and the appearance of conduct disorder in Finnish male criminal offenders with antisocial personality disorder.  http://www.ncbi.nlm.nih.gov/pubmed/12056583

16. Cholesterol is often low in undiagnosed Celiacs. Could the behaviour in this study be due to undiagnosed CD?  Association of Serum Cholesterol and History of School Suspension among School-age Children and Adolescents in the United States. http://aje.oxfordjournals.org/cgi/content/abstract/161/7/691

17. Low Cholesterol and Mental Disorders in Children and Adolescents With Celiac Disease. http://psy.psychiatryonline.org/cgi/content/full/50/3/300

18. Part 1: Video (case study) about the neurological presentation of Celiac Disease in a baby. http://www.youtube.com/watch?v=Am6AUFVpKUk&NR=1

19. Part 2: Video (case study) about the neurological presentation of Celiac Disease in the same child as he became a toddler and preschooler. http://www.youtube.com/watch?v=TL_O-uInv3U&feature=related

Links for Autism

If you think your child may have CD/gluten sensitivities or other food sensitivities, consult your doctor for testing. A consultation with an Allergist for allergy testing may help to identify other allergies. A consultation with a Registered Dietician may help to ensure nutrient requirements are being met.

1. Substitutive and dietetic approaches in childhood autistic disorder: interests and limits”. http://www.ncbi.nlm.nih.gov/pubmed/19068339

2. Enterocolitis in children with developmental disorders.  http://www.nature.com/ajg/journal/v95/n9/abs/ajg2000579a.html

3. Wendy Cohan, RN. Gluten, Celiac Disease and the Brain. http://tinyurl.com/d4z4c6

4. Autistic disorder and gastrointestinal disease.  http://www.ncbi.nlm.nih.gov/pubmed/12352252?dopt=Abstract

5. Panenteric IBD-Like Disease in a Patient with Regressive Autism Shown for the First Time by the Wireless Capsule Enteroscopy: Another Piece in the Jigsaw of this Gut-Brain Syndrome? http://www3.interscience.wiley.com/journal/118681866/abstract

6. Focal-Enhanced Gastritis in Regressive Autism with Features Distinct from Crohn’s and Helicobacter Pylori Gastritis. http://www3.interscience.wiley.com/journal/118744704/abstract

7. The intestinal lesion of autistic spectrum disorder. http://www.ncbi.nlm.nih.gov/pubmed/16003130?dopt=Abstract

8. Differences between the gut microflora of children with autistic spectrum disorders and that of healthy children. http://www.ncbi.nlm.nih.gov/pubmed/16157555?dopt=Abstract

9. Oxidative stress in autism. http://tinyurl.com/yfwf6mh 

10. A Randomised, Controlled Study of Dietary Intervention in Autistic Syndromes. http://www.ncbi.nlm.nih.gov/pubmed/12168688 

11. Can the pathophysiology of autism be explained by the nature of the discovered urine peptides? http://www.ncbi.nlm.nih.gov/pubmed/12608733

12. Immune response to dietary proteins, gliadin and cerebellar peptides in children with autism. http://www.ncbi.nlm.nih.gov/pubmed/15526989

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

5. Excellent Book: Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007. http://tinyurl.com/nwsc79

6. Excellent Book: James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002. http://tinyurl.com/knswhn 

7. Medicinenet.com. How Are Malabsorption And Malnutrition Evaluated In Celiac Disease. http://www.medicinenet.com/celiac_disease/page7.htm#tocp

8. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

9. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.

10. Ron Hoggan. Memory/Learning: Eating to Learn: How Grains Impact on Our Ability to Focus, Comprehend, Remember, Predict, and Survive. http://www.celiac.com/articles/711/1/MemoryLearning-Eating-to-Learn-How-Grains-Impact-on-Our-Ability-to-Focus-Comprehend-Remember-Predict-and-Survive-by-Ron-Hoggan/Page1.html

11. Prof. Rodney Ford M.B., B.S., M.D., F.R.A.C.P. Gluten Causes Brain Disease! http://www.celiac.com/articles/1085/1/Gluten-Causes-Brain-Disease-By-Prof-Rodney-Ford-MB-BS-MD-FRACP/Page1.html

12. Wendy Cohan, RN. Gluten, Celiac Disease and the Brain. http://www.celiac.com/articles/21635/1/Gluten-Celiac-Disease-and-the-Brain/Page1.html

13. Ron Hoggan. ADD, Attention Deficit Hyperactivity Disorder – ADHD and Celiac Disease. http://www.celiac.com/articles/110/1/ADD-Attention-Deficit-Hyperactivity-Disorder—ADHD-and-Celiac-Disease/Page1.html

14. Ludvigsson JF, Reutfors J, Osby U, Ekbom A, Montgomery SM. Coeliac disease and risk of mood disorders–a general population-based cohort study. J Affect Disord. 2007 Apr;99(1-3):117-26. Epub 2006 Oct 6.

15. Pynnönen PA, Isometsä ET, Aronen ET, Verkasalo MA, Savilahti E, Aalberg VA. Mental disorders in adolescents with celiac disease. Psychosomatics. 2004 Jul-Aug;45(4):325-35.

16. Päivi A Pynnönen,¹ Erkki T Isometsä,² Matti A Verkasalo,¹ Seppo A Kähkönen,³ Ilkka Sipilä,¹ Erkki Savilahti,¹ and Veikko A Aalberg¹ Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. BMC Psychiatry. 2005; 5: 14.

17. William Eaton, professor,¹ Preben Bo Mortensen, professor,² Esben Agerbo, assistant professor,² Majella Byrne, assistant professor,² Ole Mors, associate professor,³ and Henrik Ewald, professor³ Coeliac disease and schizophrenia: population based case control study with linkage of Danish national registers. BMJ. 2004 February 21; 328(7437): 438–439.

18. Bryan D Kraft¹ and Eric C Westman^{2 Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature.} Nutr Metab (Lond). 2009; 6: 10.

19. O. Dhodanand Kowlessar,^† Lorraine J. Haeffner,^‡ and Gordon D. Benson^§ Abnormal Tryptophan Metabolism in Patients with Adult Celiac Disease, with Evidence for Deficiency of Vitamin B₆^*. J Clin Invest. 1964 May; 43(5): 894–903.

20. M I Torres,^* M A López-Casado,^† P Lorite,^* and A Ríos^‡ Tryptophan metabolism and indoleamine 2,3-dioxygenase expression in coeliac disease. Clin Exp Immunol. 2007 June; 148(3): 419–424.

21. Ciacci C, Iovino P, Amoruso D, Siniscalchi M, Tortora R, Di Gilio A, Fusco M, Mazzacca G. Grown-up coeliac children: the effects of only a few years on a gluten-free diet in childhood. Aliment Pharmacol Ther. 2005 Feb 15;21(4):421-9.

22. Signs and symptoms of Depression http://www.nimh.nih.gov/health/publications/depression/complete-index.shtml#pub3

23. Dr. Scot Lewey. Celiac Disease and gluten linked to brain disease by deposits in intestine and brain. Ezine Articles. http://tinyurl.com/yje7nv5

24. Dr. David Perlmutter, MD, FACN, ABIHM. Gluten sensitivity (Celiac Disease), ADHD, and other neurological problems in children. http://tinyurl.com/c2pzoo

25. Niederhofer H, Pittschieler K. A preliminary investigation of ADHD Symptoms In persons With celiac Disease. Journal of Attention disorders, 2006 Nov;10(2):200-4. http://jad.sagepub.com/cgi/content/abstract/10/2/200

26. G Addolorato, DD Giuda, GD Rossi, V Valenza, et el. Regional cerebral hypoperfusion in patients with celiac disease. The American Journal of Medicine, Volume 116, Issue 5, Pages 312-317

27. Nathanel Zelnik MD, Avi Pacht MD, Raid Obeid MD, Aaron Lerner MD. Range of Neurological Disorders In Patients With Celiac Disease. Pediatrics Vol. 113 No. 6 June 2004, pp.1672-1676. http://tinyurl.com/yjwaqrp

28. Ciacci C, Iavarone A, Mazzacca G, De Rosa A: Depressive symptoms in adult coeliac disease. Scand J Gastroenterology 1998; 33:247–250

29. Hallert C, Martensson J, Allgen LG: Brain availability of monoamine precursors in adult coeliac disease. Scand J Gastroenterol 1982; 17:87–89

30. Hallert C, Derefeldt T: Psychic disturbances in adult coeliac disease, I: clinical observations. Scand J Gastroenterol 1982; 17:17–19

31. Hallert C, Åström J, Walan A: Reversal of psychopatology in adult coeliac disease with the aid of pyroxidine (vitamin B6). Scand J Gastroenterol 1983; 18:229–304

32. Addolorato G, Stefanini GF, Capristo E, Caputo F, Gasbarrini A, Gasbarrini G: Anxiety and depression in adult untreated celiac subjects and in patients affected by inflammatory bowel disease: a personality "trait" or a reactive illness? Hepatogastroenterology 1996; 43:1513–1517.

33. Elaine Gottschall. Recognizing Celiac behavior and catching it early by using SCD™ – would it prevent Autism? http://www.breakingtheviciouscycle.info/autism/dr_hass_exerpt.htm

34. Dr. Vikki Peterson. D.C., C.C.N. Gluten Sensitivity And Depression. http://tinyurl.com/bl7ox3   www.celiac.com

35. Hjiej H, Doyen C, Couprie C, Kaye K, Contejean Y. Substitutive and dietetic approaches in childhood autistic disorder: interests and limits. Encephale. 2008 Oct;34(5):496-503. Epub 2008 Mar 4.

36. Päivi A. Pynnönen, M.D., Erkki T. Isometsä, M.D., Ph.D., Matti A. Verkasalo, M.D., Erkki Savilahti, M.D., Ph.D., and Veikko A. Aalberg, M.D., Ph.D. Untreated Celiac Disease and Development of Mental Disorders in Children and Adolescents. Psychosomatics 43:331-334, August 2002.

37. A J Wakefield FRCS^1,2, A Anthony PhD, MBBS, MSc², S H Murch PhD, FRCP, FRCPCH³, M Thomson MBChB, MRCP, FRCPCH³, S M Montgomery PhD², S Davies MRCPath², J J O’Leary MD, DPhil, MRCPath⁴, M Berelowitz FRCPsych⁵ and J A Walker-Smith MD, FRCP, FRACP, FRCPCH³  Enterocolitis in children with developmental disorders. The American Journal of Gastroenterology (2000) 95, 2285|[ndash]|2295; doi:10.1111/j.1572-0241.2000.03248.x http://www.nature.com/ajg/journal/v95/n9/abs/ajg2000579a.html

38. Luca Mascitelli, M.D., Medical Service Comando Brigata Alpina "Julia" Udine, Italy, Francesca Pezzetta, M.D., Cardiology Service Ospedale di Tolmezzo Tolmezzo, Italy, and Mark R. Goldstein, M.D., Fountain Medical Court Bonita Springs, FL United States. Low Cholesterol and Mental Disorders in Children and Adolescents With Celiac Disease. Psychosomatics 50:300-301, May-June 2009

39. William W. Eaton, Ph.D., Majella Byrne, Ph.D., Henrik Ewald, Dr.Med.Sc., Ole Mors, Ph.D., Chuan-Yu Chen, Ph.D., Esben Agerbo, M.S., and Preben Bo Mortensen, M.D., Dr.Med.Sc. Association of Schizophrenia and Autoimmune Diseases: Linkage of Danish National Registers. Am J Psychiatry 163:521-528, March 2006. http://ajp.psychiatryonline.org/cgi/content/abstract/163/3/521

40. Ron Hoggan. Memory/Learning: Eating to Learn: How Grains Impact on Our Ability to Focus, Comprehend, Remember, Predict, and Survive. http://www.celiac.com/articles/711/1/MemoryLearning-Eating-to-Learn-How-Grains-Impact-on-Our-Ability-to-Focus-Comprehend-Remember-Predict-and-Survive-by-Ron-Hoggan/Page1.html www.celiac.com 

41. O. Dhodanand Kowlessar,^† Lorraine J. Haeffner,^‡ and Gordon D. Benson^§  Abnormal Tryptophan Metabolism in Patients with Adult Celiac Disease, with Evidence for Deficiency of Vitamin B₆^*  J Clin Invest. 1964 May; 43(5): 894–903.

42. PA Pynnonen, ET Isometsa, MA Verkasalo, E Savilahti, VA Aalberg. Untreated Celiac Disease And Development Of Mental Disorders In Children And Adolescents.  Psychosomatics 43:331-334, August 2002. http://psy.psychiatryonline.org/cgi/reprint/43/4/331.pdf

43. Hallert C, Derefeldt T. Psychic disturbances in adult coeliac disease. I. Clinical observations. Scand J Gastroenterol. 1982 Jan;17(1):17-9. http://www.ncbi.nlm.nih.gov/pubmed/7134833

44. Hallert C, Aström J. Psychic disturbances in adult coeliac disease. II. Psychological findings. Scand J Gastroenterol. 1982 Jan;17(1):21-4. http://www.ncbi.nlm.nih.gov/pubmed/7134834

45. Hallert C, Aström J, Sedvall G. Psychic disturbances in adult coeliac disease. III. Reduced central monoamine metabolism and signs of depression. Scand J Gastroenterol. 1982 Jan;17(1):25-8.

46. C. CIACCI, A. IAVARONE, G. MAZZACCA, A. DE ROSA. Depressive Symptoms in Adult Coeliac Disease. Scandinavian Journal of Gastroenterology 1998, Vol. 33, No. 3, Pages 247-250

47. Hallert C, Sedvall G. Improvement in central monoamine metabolism in adult coeliac patients starting a gluten-free diet. Psychol Med. 1983 May;13(2):267-71.

48. A Hernanz and I Polanco. Plasma precursor amino acids of central nervous system monoamines in children with coeliac disease. Gut. 1991 December; 32(12): 1478–1481. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1379246/

49. Smith KA, Fairburn CG, Cowen PJ. Relapse of depression after rapid depletion of tryptophan. Lancet. 1997 Mar 29;349(9056):915-9.

50. LAHAT, SHAPIRO, KARBAN, GERSTEIN, KINARTY & LERNER. Cytokine Profile in Coeliac Disease. Scandinavian Journal Of Immunology, Volume49 Issue 4, Pages 441-447.

51. Olga J.G. Schiepers, Marieke C. Wichers^, and Michael Maes. Cytokines and major depression. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Volume 29, Issue 2, February 2005, Pages 201-217.

52. Maes M, Smith R. Immune Activation And Major Depression: A hypothesis. Perspectives In Depression 1999;7:6-8.

53. Ziad Kronfol, M.D., and Daniel G. Remick, M.D. Cytokines and the Brain: Implications for Clinical Psychiatry. Am J Psychiatry 157:683-694, May 2000

54. Maes M, Kubera M, Leunis JC. The gut-brain barrier in major depression: intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression. Neuro Endocrinol Lett. 2008 Feb;29(1):117-24. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=DetailsSearch&Term=18283240[uid]

55. Repo-Tiihonen E, Halonen P, Tiihonen J, Virkkunen M. Total serum cholesterol level, violent criminal offences, suicidal behavior, mortality and the appearance of conduct disorder in Finnish male criminal offenders with antisocial personality disorder. Eur Arch Psychiatry Clin Neurosci. 2002 Feb;252(1):8-11.

56. Jian Zhang¹, Matthew F. Muldoon², Robert E. McKeown³ and Steven P. Cuffe⁴  Association of Serum Cholesterol and History of School Suspension among School-age Children and Adolescents in the United States. American Journal of Epidemiology 2005 161(7):691-699.

57. Ludovico Abenavoli, MD, Lorenzo Leggio, MD, Daniela Di Giuda, MD, Giovanni Gasbarrini, MD, Giovanni Addolorato, MD. Neurologic Disorders in Patients With Celiac Disease: Are They Mediated by Brain Perfusion Changes? PEDIATRICS Vol. 114 No. 6 December 2004, pp. 1734.

58. 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.

59. Dickey W. Epilepsy, Cerebral Calcifications, and Coeliac Disease. Lancet 1994;344:1585-6

60. Gobbi G, Bouquet F, Greco L, et al. Coeliac Disease, Epilepsy, and Cerebral Calcifications. The Italian Working Group On Coeliac Disease and Epilepsy. Lancet 340:439, 1992.

61. Hadjivassilou M and Grünwald R. The Neurology of Gluten Sensitivity: Science vs. Conviction. Practical Neurology 2004 4, 124-126.

62. Hugo A. Arroyo, MD,  Susana De Rosa, MD, Victor Ruggieri, MD, María T. G. de Dávila, MD, Natalio Fejerman, MD. Epilepsy, Occipital Calcifications, and Oligosymptomatic Celiac Disease in Childhood. Journal of Child Neurology, Vol. 17, No. 11, 800-806 (2002).

63. 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.

64. 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.

65. 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.

66. Adams Scott. Brain White-Matter Lesions are Common in Celiac Disease. www.celiac.com  http://www.celiac.com/articles/112/1/Brain-White-Matter-Lesions-are-Common-in-Celiac-Disease/Page1.html

67. 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.

68. Adams Scott. Untreated Celiacs at Increased Risk of Cerebral Hypoperfusion. www.celiac.com  http://www.celiac.com/articles/775/1/Untreated-Celiacs-at-Increased-Risk-of-Cerebral-Hypoperfusion/Page1.html

69. B. Emanuel, A. Lieberman. Electroencephalogram changes in celiac disease. The Journal of Pediatrics, Volume 62, Issue 3, Pages 435-437.

70. Lea ME, Harbord M, Sage MR. Bilateral Occipital Calcification Associated With Celiac Disease, Folate Deficiency, And Epilepsy. AJNR 16:1498-1500, Aug 1995.

71. Tunc T, Okuyucu E, Ucleri S, Sonmez T, Coskun O, Selvi E, Inan LE. Subclinical celiac disease with cerebellar ataxia. Acta Neurol Belg., 2004 Jun;104(2):84-6.

72. I D Wilkinson¹, M Hadjivassiliou², J M Dickson¹, L Wallis¹, R A Grünewald², S C Coley¹, E Widjaja¹, P D Griffiths¹  Cerebellar abnormalities on proton MR spectroscopy in gluten ataxia. Journal of Neurology Neurosurgery and Psychiatry 2005;76:1011-1013.

73. Helge Topka. Chapter 2: Normal functions of the cerebellum. Klockgether Thomas. Handbook of Ataxia disorders. Informa Healthcare; 1 edition (Aug 18 2000)

74. Paul V, Henkerr J, Todt H, Eysold R. Z.Klin.Med., 1985; 40: 707-709.

75. Adams Scott. EEG Research Findings in Children with Celiac Disease According to Dietary Variations – Germany. www.celiac.com

76. B. Emanuel, A. Lieberman. Electroencephalogram changes in celiac disease. The Journal of Pediatrics, Volume 62, Issue 3, Pages 435-437

77. Regional cerebral hypoperfusion in patients with celiac disease. The American Journal of Medicine, Volume 116, Issue 5, Pages 312-317

78. 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.

79. Wilkinson ID, Hadjivassiliou M, Dickson JM, Wallis L, Grunwald RA (2dots), 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.

80. Vojdani Aristo, PhD., MT. 1*; O’Bryan Thomas, D.C., C.C.N., D.A.C.B.N. 2*. The Immunology Of Gut Sensitivity Beyond The Intestinal Tract. 1*Immunosciences Lab., Inc., 8693 Wilshire Blvd., Ste. 200. Beverly Hills, CA 90211. 2* 28379 Davis Parkway, #801, Warrenville, IL 60555.

81. E Myrsky,^* K Kaukinen,^† M Syrjänen,^* I R Korponay-Szabó,^‡ M Mäki,^* and K Lindfors^{*  Coeliac disease-specific autoantibodies targeted against transglutaminase 2 disturb angiogenesis.} Clin Exp Immunol. 2008 April; 152(1): 111–119.

82. Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol. 2008 Sep;64(3):332-43.

83. Bansal AK, Lindemann MJ, Ramsperger V, Kumar V. Celiac G+ antibody assay for the detection of autoantibodies in celiac disease. Ann N Y Acad Sci. 2009 Sep;1173:36-40. http://www.ncbi.nlm.nih.gov/pubmed/19758129 

84. Marios Hadjivassiliou^{1, 4} David S. Sanders², Nicola Woodroofe³, Claire Williamson³ and Richard A. Grünewald¹Gluten Ataxia. Springer new York, volume 7,number 3/September 2008.

85. Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol 2008 Sep;64(3):332-43.

86. Jefferson dams. Celiac G+ Antibody Assay for the Detection of Auto-antibodies in Celiac Disease. http://www.celiac.com/articles/21919/1/Celiac-G-Antibody-Assay-for-the-Detection-of-Auto-antibodies-in-Celiac-Disease/Page1.html

87. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.

88. Hadjivassilou M and Grünwald RA, Davies-Jones GAB. Gluten Sensitivity As a Neurological Illness. Journal of Neurology, Neurosurgery, and Psychiatry 2002;72:560-563

89. Hadjivassilou M, Grünwald RA, Davies-Jones GAB. Causes of Cerebellar Degeneration: Gluten Ataxia in Perspective. J Neurol Sci 2001;187(suppl1):S520.

90. Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grünewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry. 1997 Dec;63(6):770–775.

91. School of Medicine News: University of Maryland School of Medicine Scientists Pinpoint Critical Molecule to Celiac, Possibly Other Autoimmune Disorders. Tuesday, September 29, 2009. http://somvweb.som.umaryland.edu/absolutenm/templates/?a=915 

92. Dr. Stephen Wangen  “The Gluten Doctor” http://tinyurl.com/yjsrqle 

93. L. Corvaglia, M.D. ^{a *} , R. Catamo, M.D. ^b , G. Pepe, M.D. ^b , R. Lazzari, M.D. ^a , E. Corvaglia, M.D. ^b Depression in adult untreated celiac subjects: diagnosis by the pediatrician. The American Journal of Gastroenterology Volume 94 Issue 3, Pages 839 – 843.

94. A. DE SANTIS , G. ADDOLORATO , A. ROMITO , S. CAPUTO , A. GIORDANO , G. GAMBASSI , C. TARANTO , R. MANNA & G. GASBARRINI. Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten-free diet. Journal of Internal Medicine Volume 242 Issue 5, Pages 421 – 423.

95. A. E. Kalaydjian ¹ , W. Eaton ¹ , N. Cascella ² , A. Fasano ³ The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatrica Scandinavica Volume 113 Issue 2, Pages 82 – 90    http://www3.interscience.wiley.com/journal/118626206/abstract

96. Dohan FC, Grasberger JC, Lowell FM, Johnston HT Jr, Arbegast AW. Relapsed schizophrenics: more rapid improvement on a milk- and cereal-free diet.Br J Psychiatry. 1969 May;115(522):595-6.

97. PLudvigsson JF, Osby U, Ekbom A, Montgomery SM. sychiatric illness, gluten, and celiac disease.1: Biol Psychiatry. 1982 Sep;17(9):959-61.Link

98. Individuals with Celiac Disease may be at increased risk of non-affective psychosis.  1: Scand J Gastroenterol. 2007 Feb;42(2):179-85.Coeliac disease and risk of schizophrenia and other psychosis: a general population cohort study.

99. GRAFF H, HANDFORD A.Celiac syndrome in the case histories of five schizophreics.   Psychiatr Q. 1961 Apr;35:306-13.

The presence of neurological symptoms as discussed in this post, indicates that you should talk to your MD about tests for gluten sensitivities/CD and tests to rule out other possible causes of your symptoms. Testing for CD/gluten sensitivities is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,5,6,109), and many other health complications that will be discussed in the posts about CD/gluten sensitivity symptoms. It is my hope that if you have neuromuscular symptoms you can print out this post complete with medical references to take with you to the MD when you request testing. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that some of your symptoms could be due to a food allergy/sensitivity or other disease process. For example, Dr. Stephen Wangen (http://tinyurl.com/yjsrqle) describes how a boy with TIC disorder benefited  a gluten-free, dairy-free diet (95). Allergy testing, and/or an elimination diet may help you to identify offending foods. Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. A consultation with a Registered Dietician can provide guidance to ensure all nutritional needs are met. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.

I recommend waiting until CD/gluten sensitivity testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

Diagnosed Celiacs and people with food allergies/sensitivities, please comment about your symptoms  and experiences at the end of each post. This will help other readers to see how the sometimes illusive symptoms of CD or food sensitivities can affect each of us.  We are all unique!

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

5. Excellent Book: Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007. http://tinyurl.com/nwsc79

6. Excellent Book: James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002. http://tinyurl.com/knswhn

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10. 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.

11. Henri-Bhargava Alexandre, Melmed Calvin, Glikstein Rafael, and Schipper Hyman M. NEUROLOGIC IMPAIRMENT DUE TO VITAMIN E AND COPPER DEFICIENCIES IN CELIAC DISEASE. Neurology, Vol. 71, Issue 11, 860-861, September 9, 2008

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22. Wilkinson ID, Hadjivassiliou M, Dickson JM, Wallis L, Grunwald 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.

23. Hadjivassiliou M, Davies-Jones GA, Saunders DS, Grunwald (2 dots)RA. Dietary treatment of Gluten Ataxia. J Neuro Neurosurg Psychiatry. 2003 Sep;74(9):1221-4.

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69. Chinnery PF, Reading PJ, Milne D, Gardner-Medwin D, Turnbull DM. CSF antigliadin antibodies and the Ramsay Hunt syndrome. Neurology. 1997 Oct;49(4):1131–1133.

70. Kristoferitsch W, Pointner H. Progressive cerebellar syndrome in adult coeliac disease. J Neurol. 1987 Feb;234(2):116–118.

71. Hadjivassiliou M, Chattopadhyay AK, Davies-Jones GA, Gibson A, Grünewald RA, Lobo AJ. Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry. 1997 Dec;63(6):770–775.

72. Muller AF, Donnelly MT, Smith CM, Grundman MJ, Holmes GK, Toghill PJ. Neurological complications of celiac disease: a rare but continuing problem. Am J Gastroenterol. 1996 Jul;91(7):1430–1435.

73. Adams Scott. Brain White-Matter Lesions are Common in Celiac Disease. www.celiac.com  http://www.celiac.com/articles/112/1/Brain-White-Matter-Lesions-are-Common-in-Celiac-Disease/Page1.html

74. 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.

75. Adams Scott. Untreated Celiacs at Increased Risk of Cerebral Hypoperfusion. www.celiac.com  http://www.celiac.com/articles/775/1/Untreated-Celiacs-at-Increased-Risk-of-Cerebral-Hypoperfusion/Page1.html

76. B. Emanuel, A. Lieberman. Electroencephalogram changes in celiac disease. The Journal of Pediatrics, Volume 62, Issue 3, Pages 435-437.

77. Gefel Dov; Doncheva Maria; Ben-Valid Eli; el Wahab-Daraushe Abed; Lugassy Gilles; Sela Ben-Ami. Recurrent stroke in a young patient with celiac disease and hyperhomocysteinemia. The Israel Medical Association journal : IMAJ 2002;4(3):222-3.

78. Audia, S (S); Duchêne, C (C); Samson, M (M); Muller, G (G); Bielefeld, P (P); Ricolfi, F (F); Giroud, M (M); Besancenot, J-F (JF). Stroke in young adults with celiac disease. Case Reports; English Abstract; Journal Article. La Revue de médecine interne / fondée … par la Société nationale francaise de médecine interne (Rev Med Interne), published in France.

79. Fiona C. Goodwin, MB, ChB*, R.Mark Beattie, BSc, MB, BS*, John Millar, BM, BS†, Fenella J. Kirkham, BA, MB, BChir* Celiac disease and childhood stroke. Pediatric Neurology Volume 31, Issue 2, Pages 139-142 (August 2004).

80. El Moutawakil B, Chourkani N, Sibai M, Moutaouakil F, Rafai M, Bourezgui M, Slassi I. Celiac disease and ischemic stroke. Rev Neurol (Paris). 2009 Jan 12. [Epub ahead of print] Links

81. Dubey Saroj¹, Agarwal Naresh¹ and A.S. Puri¹  Atypical celiac disease with IgA deficiency presenting as Plummer–Vinson syndrome: a case report. Journal Esophagus Volume 3, Number 1 / April, 2006 Pages 23-25.

82. W Dickey MD¹ and B McConnell MD²  Celiac disease presenting as the Paterson-Brown Kelly (Plummer-Vinson) syndrome. American Journal of Gastroenterology (1999) 94, 527–529; doi:10.1111/j.1572-0241.1999.889_r.x

83. Adams Jefferson. Tg6 Antibody Plays a Key Role in Celiac Disease-Related Neurological Disorders. www.celiac.com  http://www.celiac.com/articles/21637/1/Tg6-Antibody-Plays-a-Key-Role-in-Celiac-Disease-Related-Neurological-Disorders/Page1.html

84. Adams Jefferson. Children with Migraines May Face Higher Risk for Celiac Disease. www.celiac.com  http://www.celiac.com/articles/21656/1/Children-with-Migraines-May-Face-Higher-Risk-for-Celiac-Disease/Page1.html

85. Adams Scott. Multiple Sclerosis and Celiac Disease. www.celiac.com http://www.celiac.com/categories/Celiac-Disease-Research:-Associated-Diseases-and-Disorders/Multiple-Sclerosis-and-Celiac-Disease/  He provides additional links.

86. Adams Scott. Migraine Headaches: Gluten Triggers Severe Headaches in Sensitive Individuals. www.celiac.com  http://www.celiac.com/articles/121/1/Migraine-Headaches-Gluten-Triggers-Severe-Headaches-in-Sensitive-Individuals/Page1.html

87. Adams Scott. Migraine Headaches Linked to Celiac Disease. www.celiac.com http://www.celiac.com/articles/667/1/Migraine-Headaches-Linked-to-Celiac-Disease/Page1.html

88. Adams Scott. Nerve Disease And Celiac Disease. www.celiac.com http://www.celiac.com/articles/101/1/Nerve-Disease-and-Celiac-Disease/Page1.html

89. Adams Scott. Celiac Neuropathy Should be Considered when Neuropathy has Unknown Origin. www.celiac.com http://www.celiac.com/articles/625/1/Celiac-Neuropathy-Should-be-Considered-when-Neuropathy-has-Unknown-Origin/Page1.html

90. Adams Scott. Up to 16% of Patients with Small Fiber Neuropathy May Have Celiac Disease. www.celiac.com  http://www.celiac.com/articles/681/1/Up-to-16-of-Patients-with-Small-Fiber-Neuropathy-May-Have-Celiac-Disease/Page1.html

91. Cohen Wendy. Gluten, Celiac Disease and the Brain. http://www.celiac.com/articles/21635/1/Gluten-Celiac-Disease-and-the-Brain/Page1.html www.celiac.com

92. Cohen Wendy. Is there a link between Parkinson’s Disease and Gluten Intolerance/Celiac Disease?   http://www.celiac.com/blogs/128/Is-there-a-link-between-Parkinsons-Disease-and-Gluten-IntoleranceCeliac-Disease.html  www.celiac.com

93. Nathanel Zelnik MD, Avi Pacht MD, Raid Obeid MD, Aaron Lerner MD. Range of Neurological Disorders In Patients With Celiac Disease. Pediatrics Vol. 113 No. 6 June 2004, pp.1672-1676.

94. Adams Scott. Epilepsy And Celiac Disease. www.celiac.com http://www.celiac.com/articles/116/1/Epilepsy-and-Celiac-Disease/Page1.html

95. Dr. Stephen Wangen  “The Gluten Doctor” http://tinyurl.com/yjsrqle

96. Armando D’Angelo, Silvana Viganò D’Angelo. Protein S deficiency. Haematologica, Vol 93, Issue 4, 498-501 doi:10.3324/haematol.12691
97. Author? Sensitivity To Gluten May Result In Neurological Disfunction: Independent of Symptoms. Science Daily. http://www.sciencedaily.com/releases/2002/04/020424073708.htm www.sciencedaily.com

98. Wheat allergy and ataxia. Ataxia Center, University of Minnesota. http://www.ataxiacenter.umn.edu/aboutataxia/sporadic/wheat/home.html

99. Lea ME, Harbord M, Sage MR. Bilateral Occipital Calcification Associated With Celiac Disease, Folate Deficiency, And Epilepsy. AJNR 16:1498-1500, Aug 1995.

100. Tunc T, Okuyucu E, Ucleri S, Sonmez T, Coskun O, Selvi E, Inan LE. Subclinical celiac disease with cerebellar ataxia. Acta Neurol Belg., 2004 Jun;104(2):84-6.

101. Author? Gluten  in The Diet May Be The Cause of Recurring Headaches. www.sciencedaily.com http://www.sciencedaily.com/releases/2001/02/010213072604.htm

102. Hernández MA, Colina G, Ortigosa L. Epilepsy, cerebral calcifications and clinical or subclinical coeliac disease. Course and follow up with gluten-free diet. Seizure. 1998 Feb;7(1):49-54.

103. Díaz RM, González-Rabelino G, Delfino A. Epilepsy, cerebral calcifications and coeliac disease. The importance of an early diagnosis. Rev Neurol. 2005 Apr 1-15;40(7):417-20.

104. Bilic E, Bilic E, Sepec BI, Vranjes D, Zagar M, Butorac V, Cerimagic D. Stiff-person syndrome in a female patient with type 1 diabetes, dermatitis herpetiformis, celiac disease, microcytic anemia and copper deficiency Just a coincidence or an additional shared pathophysiological mechanism? Clin Neurol Neurosurg. 2009 May 25.

105. I D Wilkinson¹, M Hadjivassiliou², J M Dickson¹, L Wallis¹, R A Grünewald², S C Coley¹, E Widjaja¹, P D Griffiths¹  Cerebellar abnormalities on proton MR spectroscopy in gluten ataxia. Journal of Neurology Neurosurgery and Psychiatry 2005;76:1011-1013.

106. Hadjivassiliou M, Grünewald R. Reply to : Gluten Ataxia “In Perspective”.Brain Vol 126, No. 9, E5, September 2003.

107. Helge Topka. Chapter 2: Normal functions of the cerebellum. Klockgether Thomas. Handbook of Ataxia disorders. Informa Healthcare; 1 edition (Aug 18 2000)

108. Jay H. Stein, Merle A. Sande, Nathan J. Zvaifler, and John H. Klippel. Internal Medicine  A Mosby Title; 5 edition (Feb 1 1998)

109. School of Medicine News: University of Maryland School of Medicine Scientists Pinpoint Critical Molecule to Celiac, Possibly Other Autoimmune Disorders. Tuesday, September 29, 2009. http://somvweb.som.umaryland.edu/absolutenm/templates/?a=915 

110. Giuseppe Gobbi, Gianna Bertani and the Italian Working Group (IWG) Chapter 10: on Celiac Disease and Epilepsy. Gobbi G Epilepsy & Other Neurological Disorders in Coeliac Disease John Libbey & Co; 1 edition (1997).

111. Paul V, Henkerr J, Todt H, Eysold R. Z.Klin.Med., 1985; 40: 707-709.

112. Adams Scott. EEG Research Findings in Children with Celiac Disease According to Dietary Variations – Germany. www.celiac.com

113. B. Emanuel, A. Lieberman. Electroencephalogram changes in celiac disease. The Journal of Pediatrics, Volume 62, Issue 3, Pages 435-437

114. Regional cerebral hypoperfusion in patients with celiac disease. The American Journal of Medicine, Volume 116, Issue 5, Pages 312-317

115. 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.

116. Wilkinson ID, Hadjivassiliou M, Dickson JM, Wallis L, Grunwald RA (2dots), 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.

117. Cervio E, Volta U, Verri M, Boschi F, Pastoris O, Granito A, Barbara G, Parisi C, Felicani C, Tonini M, DeGiorgio R. Sera Of Patients With Celiac Disease And Neurologic Disorders Evoke A Mitrochondrial-Depend. Gastroenterology (2007) 133: 195-206.

118. Vojdani Aristo, PhD., MT. 1*; O’Bryan Thomas, D.C., C.C.N., D.A.C.B.N. 2*. The Immunology Of Gut Sensitivity Beyond The Intestinal Tract. 1*Immunosciences Lab., Inc., 8693 Wilshire Blvd., Ste. 200. Beverly Hills, CA 90211. 2* 28379 Davis Parkway, #801, Warrenville, IL 60555.

119. Marios Hadjivassiliou^{1, 4} David S. Sanders², Nicola Woodroofe³, Claire Williamson³ and Richard A. Grünewald¹Gluten Ataxia. Springer new York, volume 7,number 3/September 2008.

120. Katrin Bürk, MD ^{1 2 *}, Marie-Louise Farecki ¹, Georg Lamprecht, MD ³, Guenter Roth, PhD ⁴, Patrice Decker, PhD ², Michael Weller, MD ⁵, Hans-Georg Rammensee, PhD ², Wolfang Oertel, MD ^{1  Neurological symptoms in patients with biopsy proven celiac disease} Movement Disorders http://www3.interscience.wiley.com/journal/122656874/abstract?CRETRY=1&SRETRY=0 

121. Cervio E, Volta U, Verri M, et el. Sera of Patients With Celiac Disease And neurological Disorders Evoke A Mitochondrial-dependent apoptosis in vitro. Gastroenterology, 2007;133:195-206.

122. A.Alaedini. Ganglioside reactive antibodies in the neuropathy associated with celiac disease. Journal of Neuroimmunology, Volume 127, Issue 1, Page 145.

123. Volta U, De Giorgio R, Granito A, Stanghellini V, Barbara G, Avoni P, Liguori R, Petrolini N, Fiorini E, Montagna P, Corinaldesi R, Bianchi FB. Anti-ganglioside antibodies in coeliac disease with neurological disorders. Dig Liver Dis. 2006 Mar;38(3):183-7. Epub 2006 Feb 7.

124. Mayo Clinic http://www.mayoclinic.com/health/ataxia/DS00910/DSECTION=symptoms

125. E Myrsky,^* K Kaukinen,^† M Syrjänen,^* I R Korponay-Szabó,^‡ M Mäki,^* and K Lindfors^{*  Coeliac disease-specific autoantibodies targeted against transglutaminase 2 disturb angiogenesis.} Clin Exp Immunol. 2008 April; 152(1): 111–119.

126. Snell Richards S. Clinical Neuroanatomy. Lippincott Williams & Wilkins; 7 edition (Jan 1 2009)

127. http://www.neuropathy.org/

128. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/epileptic-syndrome/#cesec4

129. http://www.healthlinkbc.ca/kbase/topic/major/hw116874/symptoms.htm

130. Fujimoto S, Yokochi K, Togari H, Nishimura Y, Inukai K, Futamura M, Sobajima H, Suzuki S, Wada Y. Neonatal cerebral infarction: symptoms, CT findings and prognosis. Brain Dev. 1992 Jan;14(1):48-52.

131. http://www.mayoclinic.com/health/stroke/DS00150/DSECTION=symptoms

132. http://www.mayoclinic.com/health/dementia/DS01131/DSECTION=symptoms

133. Zsolt Barta, Gabriella Mekkel, Margit Zeher, and K. O. Bushara. Antigliadin antibodies in Huntington’s disease. Neurology, Vol. 63, Issue 4, -a August 24, 2004.

134. Deepak Gupta¹ and Naureen Mirza¹ Systemic lupus erythematosus, celiac disease and antiphospholipid antibody syndrome: a rare association. Journal Rheumatology International, Volume 28, Number 11 / September, 2008.

135. R Shamir, Y Shoenfeld, M Blank, R Eliakim, N Lahat, E Sobel, E Shinar, A Lerner.The prevalence of coeliac disease antibodies in patients with the antiphospholipid syndrome. Division of Paediatric Gastroenterology and Nutrition, Meyer Children’s Hospital of Haifa, Haifa, Israel, shamirr@netvision.net.il. Department of Paediatrics, Carmel Medical Center, Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

136. Pengiran Tengah CD, Lock RJ, Unsworth DJ, Wills AJ. Multiple sclerosis and occult gluten sensitivity. Neurology. 2004 Jun 22;62(12):2326-7. http://www.ncbi.nlm.nih.gov/pubmed/15210909?dopt=Abstract

137. Reichelt KL, Jensen D. IgA antibodies against gliadin and gluten in multiple sclerosis. Acta Neurol Scand. 2004 Oct;110(4):239-41. http://www.ncbi.nlm.nih.gov/pubmed/15355487?dopt=Abstract

138. Shor DB, Barzilai O, Ram M, Izhaky D, Porat-Katz BS, Chapman J, Blank M, Anaya JM, Shoenfeld Y. Gluten sensitivity in multiple sclerosis: experimental myth or clinical truth? Ann N Y Acad Sci. 2009 Sep;1173:343-9. http://www.ncbi.nlm.nih.gov/pubmed/19758171

139. Leong EM, Semple SJ, Angley M, Siebert W, Petkov J, McKinnon RA.  Complementary and alternative medicines and dietary interventions in multiple sclerosis: what is being used in South Australia and why? Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, University of South Australia, North Terrace, Adelaide, SA 5000, Australia. Complement Ther Med. 2009 Aug;17(4):216-23. Epub 2009 Apr 21. http://www.ncbi.nlm.nih.gov/pubmed/19632549

140. Ferrò MT, Franciotta D, Riccardi T, D’Adda E, Mainardi E, Montanelli A. A case of multiple sclerosis with atypical onset associated with autoimmune hepatitis and silent coeliac disease. Neurol Sci. 2008 Feb;29(1):29-31. Epub 2008 Apr 1. http://www.ncbi.nlm.nih.gov/pubmed/18379737?dopt=AbstractPlus

141. Hernández-Lahoz C, Rodríguez S, Tuñón A, Saiz A, Santamarta E, Rodrigo L. Neurologia. Sustained clinical remission in a patient with remittent-recurrent multiple sclerosis and celiac disease gluten-free diet for 6 years. Neurologia. 2009 Apr;24(3):213-5.

142. Ghezzi A, Zaffaroni M. Neurological manifestations of gastrointestinal disorders, with particular reference to the differential diagnosis of multiple sclerosis. Neurol Sci. 2001 Nov;22 Suppl 2:S117-22.

143. Shor DB, Barzilai O, Ram M, Izhaky D, Porat-Katz BS, Chapman J, Blank M, Anaya JM, Shoenfeld Y. Gluten sensitivity in multiple sclerosis: experimental myth or clinical truth? Center for Autoimmune Diseases, Department of Medicine B, Sheba Medical Center, Ramat-Gan, Israel. Ann N Y Acad Sci. 2009 Sep;1173:343-9.author reply 933-4.

144. http://wildhorse.insinc.com/directms03oct2007/ Video by Potential Therapeutic Characteristics of Pre-agricultural Diets in the Prevention and Treatment of Multiple Sclerosis . This presentation is narrated by Dr Loren Cordain of the Colorado State University, USA.

145. Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol 2008 Sep;64(3):332-43.

146. Jefferson dams. Celiac G+ Antibody Assay for the Detection of Auto-antibodies in Celiac Disease. http://www.celiac.com/articles/21919/1/Celiac-G-Antibody-Assay-for-the-Detection-of-Auto-antibodies-in-Celiac-Disease/Page1.html

147. Bansal AK, Lindemann MJ, Ramsperger V, Kumar V. Celiac G+ antibody assay for the detection of autoantibodies in celiac disease. Ann N Y Acad Sci. 2009 Sep;1173:36-40. http://www.ncbi.nlm.nih.gov/pubmed/19758129 

148. Turner MR, Chohan G, Quaghebeur G, Greenhall RC, Hadjivassiliou M, Talbot K.  A case of celiac disease mimicking amyotrophic lateral sclerosis. Nat Clin Pract Neurol. 2007 Oct;3(10):581-4.

149. Michiaki Koga, Nobuhiro Yuki, Koichi Hirata. Antiganglioside antibody in patients with Guillain-Barré syndrome who show bulbar palsy as an initial symptom. J Neurol Neurosurg Psychiatry 1999;66:513-516 ( April ).

150. William F. Brown, Charles F. Bolton, and Michael J. Aminoff. Neuromuscular Function and Disease: Basic, Clinical, and Electrodiagnostic Aspects, 2-Volume Set. A Saunders Title; 1 edition (April 16 2002)

151. Maurizio GabrielliM.D. ^a , Filippo CremoniniM.D. ^a , Giuseppe FioreM.D. ^{b, c} , Giovanni AddoloratoM.D ^{b, c} , Cristiano PadalinoM.D ^{b, c} , Marcello CandelliM.D ^{b, c} , Maria Elena De LeoM.D ^{b, c} , Luca SantarelliM.D ^{b, c} , Mario GiacovazzoM.D ^{b, c} , Antonio GasbarriniM.D ^{b, c} , Paolo PolaM.D ^{b, c} , Antonio GasbarriniM.D. Association Between Migraine and Celiac Disease: Results From a Preliminary Case-Control and Therapeutic Study. The American Journal of Gastroenterology  Volume 98 Issue 3,  2004,  Pages 625 – 629.

152. Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase. Ann Neurol. 2008 Sep;64(3):332-43.

153. Volta U, De Giorgio R, Petrolini N, Stangbellini V, Barbara G, Granito A, De Ponti F, Corinaldesi R, Bianchi FB. Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders. Scand J Gastroenterol. 2002 Nov;37(11):1276-81.

154. Klockgether T. Handbook of Ataxia Disorders Informa Healthcare; 1 edition (Aug 18 2000)

155. P.Rush, R.Inman, M.Bernstein, P.Carlen, L.Resch. Isolated vasculitis of the central nervous system in a patient with celiac disease. The American Journal of Medicine, Volume 81, Issue 6, Pages 1092-1094

156. S Meyers, S Dikman, H Spiera, N Schultz, H D Janowitz. Cutaneous vasculitis complicating coeliac disease. Gut 1981;22:61-64; doi:10.1136/gut.22.1.61

157. V. Alegre, R. Winkelmann, J. Diez-Martin, P. Banks. Adult celiac disease, small and medium vessel cutaneous necrotizing vasculitis, and T cell lymphoma† Journal of the American Academy of Dermatology, Volume 19, Issue 5, Pages 973-978

158. Gene V. Ball and S. Louis Bridges Jr. Vasculitis. Oxford University Press; Second Edition edition (Jan 15 2008)

159. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.
160. Prause, Christian; Ritter, Maria; Probst, Christian; Daehnrich, Cornelia; Schlumberger, Wolfgang; Komorowski, Lars; Lieske, Ruediger; Richter, Thomas; Hauer, Almuthe C; Stern, Martin; Uhlig, Holm H; Laass, Martin W; Zimmer, Klaus-Peter; Mothes, Thomas. Antibodies Against Deamidated Gliadin as New and Accurate Biomarkers of Childhood Coeliac Disease. Journal Of Pediatric Gastroenterology And Nutrition. July 2009-Volume 49-Issue 1-p 52-58.
161. S. Rashtak, M. Ettore, H. Homburger, J. Murray. Comparative Usefulness of Deamidated Gliadin Antibodies in the Diagnosis of Celiac Disease. Clinical Gastroenterology and Hepatology, Volume 6, Issue 4, Pages 426-432.

CD can be present in preteen/adolescents that are growing normally so normal growth rate (height) should not be a factor that excludes the possibility of CD in those with delayed puberty (51). Many individuals with undiagnosed CD will have no bowel symptoms (3,7,48,50). Weight loss may or may not occur, and is dependent on the amount of the intestine that is damaged (3,50). Therefore, the symptoms in this post could occur in the absence of stunted growth, weight loss, or bowel symptoms.

The presence of urological symptoms as discussed in this post, indicates that you should talk to your MD about tests for CD, allergy tests, and tests to rule out other possible causes of your symptoms. Testing for CD is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,5,6,9,47,48), and many other health complications that will be discussed in the posts about CD symptoms. It is my hope that if you have urological symptoms you can print out this post complete with medical references to take with you to the MD when you request a CD test. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

I recommend waiting until CD testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

Links To More Information

1. Wendy Cohen RN

Gluten Sensitivity and Bladder Disease. http://tinyurl.com/4zx94e

Interstitial Cystitis and Gluten Intolerance. http://tinyurl.com/ydw7krc

Bladder Symptoms & Gluten Sensitivity. http://tinyurl.com/crtcjm

The Chronic Prostatitis And Celiac Disease Connection. http://tinyurl.com/ybdzsgp

2. Ron Hoggan (One author from book, “Dangerous Grains”)

Kidney Problems  http://www.gluten-free.org/hoggan/kidneyceliac.txt

Kidney Stones http://www.gluten-free.org/hoggan/kidney.txt

Nephrotic Syndrome http://www.gluten-free.org/hoggan/nephrotic.txt

3. Adams Scott. Kidney Disease And Celiac Disease. www.celiac.com http://tinyurl.com/yamwe7q

4. Adams Jefferson. Celiac Patients Face Higher Risk of Developing Chronic Renal Disease.  www.celiac.com http://tinyurl.com/az6tol

5. Relationship between intestinal permeability and antibodies against food antigens in IgA nephropathy. http://tinyurl.com/yducynx

6. The pathogenetic potential of environmental antigens in IgA nephropathy. http://tinyurl.com/ydaw6yh

7. Dietary antigens and primary immunoglobulin A nephropathy. http://tinyurl.com/yc5ehq5

8. Glomerular deposition of food antigens in IgA nephropathy. http://tinyurl.com/ydowje9

9. Mediterranean diet and primary IgA nephropathy. http://tinyurl.com/yemq8pg

10. Histamine and mucosal mast cells in interstitial cystitis. http://www.ncbi.nlm.nih.gov/pubmed/2750582 

11. Interstitial Cystitis: Correlation with Nerve Fibres, Mast Cells and Histamine. http://tinyurl.com/yjsnpe2

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

5. Excellent Book: Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007. http://tinyurl.com/nwsc79

6. Excellent Book: James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002. http://tinyurl.com/knswhn

7. M Hadjivassiliou,^a A K Chattopadhyay,^b G A B Davies-Jones,^a A Gibson,^a R A Grünewald,^a A J Lobo^c Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63:770-775 ( December )

8. Gislason Stephen, MD. Core Diet For Kids. Persona Audiovisual Productions, 1989. He started www.nutramed.com (I’m not sure if he still owns it).

9. Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.

10. Ostojska J, Okni?ska-Hoffmann E, Gutkowska J, Radzikowski A. Chronic urinary tract infection and celiac disease in children. Pediatr Pol. 1979 Nov;54(11):1263-71.

11. C. Ciacci, G. Spagnuolo, R. Tortora, C. Bucci, D. Franzese, F. Zingone, M. Cirillo. Urinary Stone Disease in Adults With Celiac Disease: Prevalence, Incidence and Urinary Determinants. The Journal of Urology, Volume 180, Issue 3, Pages 974-979

12. Gama R, Schweitzer FA. Renal calculus: a unique presentation of coeliac disease. BJU Int. 1999 Sep;84(4):528-9.

13. Codaccioni JL, Pierron H, Perrimond H, Boyer J, Unal D. Unusual development during a 1-year period of multiple complications (steatorrhea, nephropathy, statural retardation, cerebral accidents) in a 15-year-old child diabetic since the age of 4. abete. 1968 Apr-Jun;16(2):146-52.

14. Woodrow G, Innes A, Boyd SM, Burden RP. A Case Of IgA Nephropathy With Coeliac Disease Responding To A Gluten-free Diet. Nephrol Dial Transplant (1993) 8: 1382-1383.

15. Kenar D. Jhaveri¹, Vivette D. D’Agati², Robert Pursell³ and David Serur^1,4  Coeliac sprue-associated membranoproliferative glomerulonephritis (MPGN). NDT Advance Access published online on July 22, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp353

16. R Coppo, A Amore and D Roccatello. Dietary antigens and primary immunoglobulin A nephropathy. Journal of the American Society of Nephrology, Vol 2, S173-S180, Copyright © 1992 by American Society of Nephrology

17. Gaboardi F, Perletti L, Cambié M, Mihatsch MJ. Dermatitis herpetiformis and nephrotic syndrome. Clin Nephrol. 1983 Jul;20(1):49-51.

18. Scholey J, Freeman HJ. Celiac sprue-associated immune complex glomerulonephritis. J Clin Gastroenterol. 1986 Apr;8(2):181-3.

19. Mai Ots^a, Oivi Uibo^b, Kaja Metsküla^c, Raivo Uibo^c, Vello Salupere^a  IgA-Antigliadin Antibodies in Patients with IgA Nephropathy: The Secondary Phenomenon? Am J Nephrol 1999;19:453-458 (DOI: 10.1159/000013497)

20. Jérôme Laurent^a, Anne Branellec^a, Jean-Marie Heslan^a, Guy Rostoker^a, Charles Bruneau^a, Chantal André^b, Liliane Intrator^b, Gilbert Lagrue^a  An Increase in Circulating IgA Antibodies to Gliadin in IgA Mesangial Glomerulonephritis. Am J Nephrol 1987;7:178-183 (DOI: 10.1159/000167460)

21. S Meyers, S Dikman, H Spiera, N Schultz, and H D Janowitz. Cutaneous vasculitis complicating coeliac disease. Gut. 1981 January; 22(1): 61–64.

22. DeCoteau WE, Gerrard JW, Cunningham TA. Glomerulitis in dermatitis herpetiformis. Lancet. 1973 Sep 22;2(7830):679–680.

23. Moorthy AV, Zimmerman SW, Maxim PE. Dermatitis herpetiformis and celiac disease: association with glomerulonephritis, hypocomplementia, and circulating immune complexes. JAMA. 1978 May 12;239(19):2019–2020.

24. Hilde Kloster Smerud^1,2, Bengt Fellström¹, Roger Hällgren³, Sonia Osagie^1,6, Per Venge⁴ and Gudjón Kristjánsson^5,7 Gluten sensitivity in patients with IgA nephropathy. Nephrology Dialysis Transplantation 2009 24(8):2476-2481; doi:10.1093/ndt/gfp133.

25. Pekka Collin, M.D. ^a,b , Jaana Syrjänen, M.D. ^a,b , Jukka Partanen, Ph.D ^a,b , Amos Pasternack, M.D. ^a,b , Katri Kaukinen, M.D. ^a,b , Jukka Mustonen, M.D. ^a,b Celiac disease and HLA DQ in patients with IgA nephropathy. The American Journal of Gastroenterology  Volume 97 Issue 10, Pages 2572 – 2576 Published Online: 11 Aug 2004.

26. Peeker R, Atanasiu L, Logadottir Y. Intercurrent autoimmune conditions in classic and non-ulcer interstitial cystitis. Scand J Urol Nephrol. 2003;37(1):60-3.

27. E. Stadlmaier¹ , A. Spary², M. Tillich³ and E. Pilger² Midaortic syndrome and celiac disease: a case of local vasculitis. Journal Clinical Rheumatology Publisher Springer London Volume 24, Number 3 / June, 2005

27. S Meyers, S Dikman, H Spiera, N Schultz, and H D Janowitz. Cutaneous vasculitis complicating coeliac disease. Gut. 1981 January; 22(1): 61–64.

28. Cohan Wendy. Gluten Sensitivity And Bladder Disease. www.celiac.com  http://tinyurl.com/4zx94e

29. Cohan Wendy. The Chronic Prostatitis And Celiac Disease Connection. www.celiac.com  http://tinyurl.com/ybdzsgp

30. Adams Scott. Kidney Disease And Celiac Disease. www.celiac.com http://tinyurl.com/yamwe7q

31. Adams Jefferson. Celiac Patients Face Higher Risk of Developing Chronic Renal Disease. www.celiac.com http://tinyurl.com/az6tol

32. Cohan Wendy. Bladder Symptoms & Gluten Sensitivity. www.wellbladder.com http://tinyurl.com/crtcjm

33. A Fornasieri, R A Sinico, P Maldifassi, P Bernasconi, M Vegni, G D’Amico. IgA-antigliadin antibodies in IgA mesangial nephropathy (Berger’s disease). Br Med J (Clin Res Ed)  1987;295:78-80 (11 July), doi:10.1136/bmj.295.6590.78

34. Laurent J, Branellec A, Heslan JM, Rostoker G, Bruneau C, André C, Intrator L, Lagrue G. An increase in circulating IgA antibodies to gliadin in IgA mesangial glomerulonephritis. Am J Nephrol. 1987;7(3):178-83.

35. Nagy J, Scott H, Brandtzaeg P. Antibodies to dietary antigens in IgA nephropathy. Clin Nephrol. 1988 Jun;29(6):275-9.

36. Kovács T, Mette H, Per B, Kun L, Schmelczer M, Barta J, Jean-Claude D, Nagy J. Relationship between intestinal permeability and antibodies against food antigens in IgA nephropathy.Orv Hetil. 1996 Jan 14;137(2):65-9.

37. Kovács T, Kun L, Schmelczer M, Wagner L, Davin JC, Nagy J. Do intestinal hyperpermeability and the related food antigens play a role in the progression of IgA nephropathy? I. Study of intestinal permeability. Am J Nephrol. 1996;16(6):500-5.

38. Davin JC, Forget P, Mahieu PR. Increased intestinal permeability to (51 Cr) EDTA is correlated with IgA immune complex-plasma levels in children with IgA-associated nephropathies. Acta Paediatr Scand. 1988 Jan;77(1):118-24.

39. Coppo R. The pathogenetic potential of environmental antigens in IgA nephropathy. Am J Kidney Dis. 1988 Nov;12(5):420-4.

40. Coppo R, Amore A, Roccatello D. Dietary antigens and primary immunoglobulin A nephropathy. J Am Soc Nephrol. 1992 Apr;2(10 Suppl):S173-80.

41. Russell MW, Mestecky J, Julian BA, Galla JH. IgA-associated renal diseases: antibodies to environmental antigens in sera and deposition of immunoglobulins and antigens in glomeruli. J Clin Immunol. 1986 Jan;6(1):74-86.

42. Sato M, Kojima H, Takayama K, Koshikawa S. Clin Exp Immunol. Glomerular deposition of food antigens in IgA nephropathy. 1988 Aug;73(2):295-9.

43. Coppo R, Basolo B, Rollino C, Roccatello D, Martina G, Amore A, Bongiorno G, Piccoli G. Mediterranean diet and primary IgA nephropathy. Clin Nephrol. 1986 Aug;26(2):72-82.

44. Govind K Makharia, Chalamalasetty Sreenivasa Baba, Rajesh Khadgawat, *Suman Lal,** MS Tevatia, #Kaushal Madan, Siddhartha Dattagupta#. Celiac Disease: Variations Of Presentations In Adults. Original Article. Departments of Gastroenterology and Human Nutrition; Endocrinology, **Obstetrics and Gynecology and #Pathology, All india Institute of Medical Sciences, New delhi 110 029. http://medind.nic.in/ica/t07/i4/icat07i4p162.pdf 

45. Cohan Wendy. Interstitial Cystitis And Gluten Intolerance. www.celiac.com  http://tinyurl.com/ydw7krc

46. J. S. Cameron. The Nephrotic Syndrome. Informa HealthCare; 1 edition (Dec 29 1987)

47. Nelson David A. Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than You Think. American Family Physician, December 15th, 2002.

48. Kagnoff MF. AGA Institute Medical Position Statement on the Diagnosis and Management of CD. Gastroenterology, Official Journal of the American Gastroenterological Association (AGA). December 2006.

49. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does Cryptic Gluten Sensitivity Play A Part In Neurological Illness? Lancet. 1996 Feb. 10;347(8998):369-71.

50. M Hadjivassiliou,^a A K Chattopadhyay,^b G A B Davies-Jones,^a A Gibson,^a R A Grünewald,^a A J Lobo^c Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63:770-775 ( December )

51. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.

52. Abenavoli L, Proietti I, Leggio L, Ferrulli A, Vonghia L, Capizzi R, Rotoli M, Amerio PL, Gasbarrini g, Addolorato G. Cutaneous Manifestations In Celiac disease. World Journal Of Gastroenterology. 2006 February 14;12(6):843-852.

53. Devlin Shane MD, Andrews Christopher MD, beck Paul MD, Celiac Disease. CME Update May 2004.

54. Ron Hoggan (from book “Dangerous Grains”) Articles (responses to questions)

Kidney Problems  http://www.gluten-free.org/hoggan/kidneyceliac.txt

Kidney Stones http://www.gluten-free.org/hoggan/kidney.txt

Nephrotic Syndrome http://www.gluten-free.org/hoggan/nephrotic.txt

55. Enerbäck L, Fall M, Aldenborg F. Histamine and mucosal mast cells in interstitial cystitis. Agents Actions. 1989 Apr;27(1-2):113-6.

56. T. LUNDEBERG^1,2, H. LIEDBERG¹, L. NORDLING¹, E. THEODORSSON¹, A. OWZARSKI¹ P. EKMAN¹ Interstitial Cystitis: Correlation with Nerve Fibres, Mast Cells and Histamine. British Journal of Urology Volume 71 Issue 4, Pages 427 – 429, 1998 British Journal of Urology. Published Online: 26 Nov 2008

57. Chernoff Ronni. Geriatric Nutrition: The Health Professionals Handbook. Jones And Bartlett Publishers Inc. 3rd edition, 2006.

58. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

59. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.

60. Henri-Bhargava Alexandre, Melmed Calvin, Glikstein Rafael, and Schipper Hyman M. NEUROLOGIC IMPAIRMENT DUE TO VITAMIN E AND COPPER DEFICIENCIES IN CELIAC DISEASE. Neurology, Vol. 71, Issue 11, 860-861, September 9, 2008

61. Mayo Clinic Staff. Peripheral Neuropathy. www.mayoclinic.com

62. Dunlop William M., M.D.; James G. Watson , III, M.D., F.A.C.P.; and Hume David M. , M.D., F.A.C.S.  Anemia and Neutropenia Caused by Copper Deficiency. Annals of Internal medicine. 1 April 1974 | Volume 80 Issue 4 | Pages 470-476

63. S. Rashtak, M. Ettore, H. Homburger, J. Murray. Comparative Usefulness of Deamidated Gliadin Antibodies in the Diagnosis of Celiac Disease. Clinical Gastroenterology and Hepatology, Volume 6, Issue 4, Pages 426-432.

CD can be present in preteen/adolescents that are growing normally so normal growth rate (height) should not be a factor that excludes the possibility of CD in those with delayed puberty (55). Many individuals with undiagnosed CD will have no bowel symptoms (3,50,52,56). Weight loss may or may not occur, and is dependent on the amount of the intestine that is damaged (3,56). Therefore, the symptoms in this post could occur in the absence of stunted growth, weight loss, or bowel symptoms.

The presence of reproductive symptoms as discussed in this post, indicates that you should talk to your MD about tests for CD and tests to rule out other possible causes of your symptoms. Testing for CD is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,5,6,50,81), and many other health complications that will be discussed in the posts about CD symptoms. It is my hope that if you have reproductive symptoms you can print out this post complete with medical references to take with you to the MD when you request a CD test. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

There are factors that can cause a false negative CD test. The blood tests for CD (IgA endomysial antibodies and IgA tissue transglutaminase) tend to correspond with the severity of intestinal damage. Therefore, if the autoimmune damage is in another area (ex. skin form of CD called dermatitis herpetiformis) and no or very little intestinal damage is present, a negative result could occur. If the above tests are negative, a bloodtest for  antigliadin antibodies may be helpful to identify if increased intestinal permeability has allowed gluten (gliadin) to leak in through the tight junctions between the intestinal epithelial cells. This leakage could potentially lead to a gluten sensitivity and with continued exposure, potentially CD. A positive antigliadin result suggests that a gluten sensitivity may exist and the individual may benefit from a gluten-free diet. Antibodies against deamidated gluten should be also be added to the screening (65). Additional tests are available as well such as fecal tests and genetic tests. Other causes of false negative CD tests could include IgA deficiency (IgG tissue transglutaminase antibody test may be helpful), low gluten consumption, or the intestinal biopsy may have missed the diseased mucosa since it can be patchy in nature (multiple biopsies can be helpful to avoid this) (1,5,6,51-54,54,57,58).

It is also possible that some of your symptoms could be due to a food allergy/sensitivity or other disease process. A consultation with an allergist and/or naturopathic doctor may be helpful. There are a variety of tests that are useful for identifying allergies and sensitivities. Some individuals use the core or elimination diet to do this. A Registered Dietitian can help to ensure all nutrient requirements are fulfilled. Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well (41,57-61).

I recommend waiting until CD testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

5. Excellent Book: Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007. http://tinyurl.com/nwsc79

6. Excellent Book: James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002. http://tinyurl.com/knswhn

7. ELIAKIM Rami ⁽¹⁾ ; SHERER David M. ⁽²⁾ ; Celiac disease : Fertility and pregnancy.  ⁽¹⁾ Division of Gastroenterology, Rambam Medical Center, Technion School of Medicine, Haifa, ISRAEL. ⁽²⁾ Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Luke’s-Roosevelt Hospital Center, University of Columbia College of Physicians and Surgeons, New York, N.Y., ETATS-UNIS. http://cat.inist.fr/?aModele=afficheN&cpsidt=859066

8. Rudolph Colin D., Rudolph Abraham M., Hostetter Margaret K., and Lister George E. Rudolph’s Pediatrics,  McGraw-Hill Professional; 21 edition, 2002.

9. Green-Hernandez Carol, Singleton Joanne K., and Aronzon Daniel Z . Primary Care Pediatrics Lippincott Williams & Wilkins; 1 edition (Jan 1 2001)

10. Hudson Tori. Women’s Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health and Wellness McGraw-Hill; 2 edition (Sep 20 2007)

11. Ayhan Abaci, MD; Ihsan Esen, MD; Tolga Unuvar, MD; Nur Arslan, MD; Ece Bober, MD. Two Cases Presenting With Pubertal Delay and Diagnosed as Celiac Disease. Clinical pediatrics. http://cpj.sagepub.com/cgi/content/abstract/47/6/607

12. Gianni Bona, Daniela Marinello, Giuseppina Oderda. Mechanisms of Abnormal Puberty in Coeliac Disease. Horm Res 2002;57:63-65.

13. Coeliac disease and birth defects in offspring. (Letters to the editor) Gut 2001;49:738; doi:10.1136/gut.49.5.738

14. Aubrey J. Katz M.B., B.Ch., F.C.P.¹, Z. Myron Falchuk M.D.¹, and Harry Shwachman M.D.¹The Coexistence of Cystic Fibrosis and Celiac Disease. PEDIATRICS Vol. 57 No. 5 May 1976, pp. 715-721.

15. Malena Cohen-Cymberknoh¹, Michael Wilschanski² Concomitant cystic fibrosis and coeliac disease: reminder of an important clinical lesson. BMJ Case Reports 2009 [doi:10.1136/bcr.07.2008.0578].  Copyright © 2009 by the BMJ Publishing Group Ltd.

16. Venuta A, Bertolani P, Casarini R, Ferrari F, Guaraldi N, Garetti E. Coexistence of cystic fibrosis and celiac disease. Description of a clinical case and review of the literature. Pediatr Med Chir. 1999 Sep-Oct;21(5 Suppl):223-6.

17. Sharma KA, Kumar A, Kumar N, Aggarwal S, Prasad S. Celiac disease in intrauterine growth restriction. Int J Gynaecol Obstet. 2007 Jul;98(1):57-9.

18. A.Gasbarrini, E.Torre, C.Trivellini, S.De Carolis, A.Caruso, G.Gasbarrini. Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. The Lancet, Volume 356, Issue 9227, Pages 399-400.

19. Rami Eliakim^a, David M. Sherer^b Celiac Disease: Fertility and Pregnancy. Gynecol Obstet Invest 2001;51:3-7.

20. Porpora, Maria Grazia MD; Picarelli, Antonio MD; Porta, Romana Prosperi MD; Di Tola, Marco BSc; D’Elia, Claudia MD; Cosmi, Ermelando Vinicio MD, PhD.  Celiac Disease as a Cause of Chronic Pelvic Pain, Dysmenorrhea, and Deep Dyspareunia. Obstetrics & Gynecology: May 2002 – Volume 99 – Issue 5, Part 2 – p 937-939.

21. Rujner J. Age at menarche in girls with celiac disease. Ginekol Pol. 1999 May;70(5):359-62.

22. Pradhan M, Manisha, Singh R, Dhingra S. Celiac disease as a rare cause of primary amenorrhea: a case report. J Reprod Med. 2007 May;52(5):453-5.

23. P Collin, S Vilska, P K Heinonen, O Hällström, P Pikkarainen. Infertility and coeliac disease. Gut 1996;39:382-384; doi:10.1136/gut.39.3.382.

24. K Rostami, EAP Steegers, WY Wong, DD … – Coeliac disease and reproductive disorders: a neglected association. European Journal of Obstetrics and Gynecology, 2001 – Elsevier. Science Ireland Ltd. All rights reserved.

25. Bradley, Ryan J. * and; Rosen, Mitchell P. MD + Subfertility and Gastrointestinal Disease: ‘Unexplained’ Is Often Undiagnosed. Obstetrical & Gynecological Survey. 59(2):108-117, February 2004.

26. Carmen Lívia da Silva Martins^I; Lenora Gandolfi^II; Pedro Luiz Tauil^III; Marilúcia de Almeida Rocha Picanço^III; Maria Ophelia Galvão de Araujo^IV; Riccardo Pratesi^{V  Celiac disease and female infertility: a frequently neglected association.} Rev. Bras. Ginecol. Obstet. vol.28 no.10 Rio de Janeiro Oct. 2006

27. K. Sharma, A. Kumar, N. Kumar, S. Aggarwal, S. Prasad. Celiac disease in intrauterine growth restriction. International Journal of Gynecology & Obstetrics, Volume 98, Issue 1, Pages 57-59.

28. Gian Mario Tiboni^1,3, Maria Grazia de Vita¹, Raffaella Faricelli², Franca Giampietro¹ and Marco Liberati¹ Serological testing for celiac disease in women undergoing assisted reproduction techniques. Human reproduction Vol 21, No. 2 pp376-379,2206. http://humrep.oxfordjournals.org/cgi/reprint/21/2/376.pdf 

29. Kotze, L M S PHD. Gynecologic and Obstetric Findings Related to Nutritional Status and Adherence to a Gluten-Free Diet in Brazilian Patients with Celiac Disease. Journal of Clinical Gastroenterology: August 2004 – Volume 38 – Issue 7 – pp 567-574.

30. G.F. Meloni^1,4, S. Dessole², N. Vargiu², P.A. Tomasi³ and S. Musumeci¹ The prevalence of coeliac disease in infertility. Human Reproduction, Vol. 14, No. 11, 2759-2761, November 1999.

31. Adams Scott. Miscarriage: Italian Researchers Link celiac Disease To Spontaneous Abortion And Fetal Growth Retardation. www.celiac.com http://tinyurl.com/yaxxj6s

32. Adams Scott. Fertility And Pregnancy In Women With Celiac Disease By Michelle Melin-Rogovin. www.celiac.com  http://tinyurl.com/yac24el

33. Adams Scott. Undiagnosed Celiac disease Increases Risk of Adverse Fetal Outcome. www.celiac.com http://tinyurl.com/y9cxjqt

34. SE Ferguson, GN Smith, MC Walker Maternal plasma homocysteine levels in women with preterm premature rupture of membranes. Medical Hypotheses, Volume 56, Issue 1, Pages 85-90.

35. James L. Mills^*,2, John M. Scott, Peadar N. Kirke, Joseph M. McPartlins, Mary R. Conley^*, Donald G. Weir, Anne M. Molloy and Young Jack Lee^* Homocysteine and Neural Tube Defects. The Journal of Nutrition.^* Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892 Department of Biochemistry, Trinity College, Dublin, Ireland Health Research Board of Ireland, Dublin, Ireland Department of Clinical Medicine, Trinity College, Dublin, Ireland

36. Nelson David A. Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than You Think. American Family Physician, December 15th, 2002.

37. Ciacca C, Cirillo M, Auriemma G, Di Dato G, Sabbatini F, Mazzaca G. Celiac Disease And Pregnancy Outcome. Am J Gastroenterol 91(4): 718-722, 1996.

38. Norgard B, Fonager K, Sorensen HT, Olsen J. Birth Outcomes Of Women With Celiac Disease: A Nationwide Historical Cohort Study. Am J Gastroenterol 94:2435-2440, 1999.

39. Ludvigsson JF, Montgomery SM, Ekbom A. Celiac Disease And Risk Of Adverse Fetal Outcome: A Population Based Cohort Study. Gastroenterology 129:454-463, 2005.

40. Adams Scott. Impotency and Celiac Disease. www.celiac.com  http://tinyurl.com/yeawdrv

41. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

42. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.

43. S. E. Ferguson^a, G. N. Smith^b and M. C. Walker^a Maternal plasma homocysteine levels in women with preterm premature rupture of membranes. Medical Hypotheses Volume 56, Issue 1, January 2001, Pages 85-90.

44. Edward J. Massaro and John M. Rogers. Folate And Human Development. Humana Press; 1 edition (Mar 10 2002)

45. Robert A. DiSilvestro. Handbook Of Minerals As Nutritional Supplements. CRC Press LLC, 2005.

46. Shils, Maurice E Shils, Moshe Shike, and A. Catharine Ross. Modern Nutrition In Health And Disease. Lippincott Williams & Wilkins; 10 edition (Aug 1 2005)

47. Namanjeet Ahluwalia^* and Hélène Grandje. Nutrition, an Under-Recognized Factor in Bacterial Vaginosis. American Society for Nutrition J. Nutr. 137:1997-1998, September 2007.

48. Corenthian J Booker, MD, Coauthor(s): Serdar H Ural, MD. Prenatal Nutrition. http://emedicine.medscape.com/article/259059-overview

49. Devlin Shane MD, Andrews Christopher MD, beck Paul MD, Celiac Disease. CME Update May 2004.

50. Kagnoff MF. AGA Institute Medical Position Statement on the Diagnosis and Management of CD. Gastroenterology, Official Journal of the American Gastroenterological Association (AGA). December 2006.

51. Ford RP. The Gluten Syndrome: A Neurological Disease. Med Hypothesis. 2009 Sept;73(3):438-40. Epub 2009 Apr 29.

52. Hadjivassiliou M, Gibson A, Davies-Jones GA, Lobo AJ, Stephenson TJ, Milford-Ward A. Does Cryptic Gluten Sensitivity Play A Part In Neurological Illness? Lancet. 1996 Feb. 10;347(8998):369-71.

53. Ron Hoggan. Celiac Disease—Gluten Sensitivity: What’s the Difference? www.celiac.com  http://tinyurl.com/ybt76oz

54. Ron Hoggan. Medical Superstitions of the Twenty-First Century. www.celiac.com  http://tinyurl.com/bwvo9p

55. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.

56. M Hadjivassiliou,^a A K Chattopadhyay,^b G A B Davies-Jones,^a A Gibson,^a R A Grünewald,^a A J Lobo^c Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63:770-775 ( December )

57. Gislason Stephen. Core Diet For Kids. Persona Audiovisual Productions, 1989.

58. Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.

59. Susan M. Lark. Menstrual Cramps. Celestial Arts; REV edition (Sep 1 2004). http://tinyurl.com/yde8gpj

60. Jonathan Brostoff and Stephen J. Challacombe. Food Allergy And Intolerance. A Saunders Ltd. Title; 2 edition (Aug 5 2002).

61. Perkin. Food Allergies And Adverse Reactions. Aspen Publishers, Inc.; 1 edition (Sep 21 1990)

62. Wong M, et el. Proximal Myopathy And Bone Pain As The Presenting Features Of Coeliac Disease. Ann Rheum Dis, 2002, 61(1):p87-8.

63. Carroccio A, Iacono G, Montalto G, Cavataio F, Marco C Di, Balsamo V, Notarbartolo A. Exocrine Pancreatic Function in Children With Coeliac Disease Before and After a Gluten-free Diet. Gut. Vol 32(7): 796-799, Jul 1991.

64. M Hadjivassiliou,a A K Chattopadhyay,b G A B Davies-Jones,a A Gibson,a R A Grünewald,a A J Loboc Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63:770-775 ( December )

CD can be present in children that are growing normally so normal growth rate should not be a factor that excludes the possibility of CD (11). Many individuals with undiagnosed CD will have no bowel symptoms (25,26,52,60). Weight loss may or may not occur, and is dependent on the amount of the intestine that is damaged (25,60). Therefore, the symptoms in this post could occur in the absence of stunted growth, weight loss, or bowel symptoms.

The presence of musculoskeletal symptoms as discussed in this post, indicates that you should talk to your MD about tests for CD and tests to rule out other possible causes of your symptoms. Testing for CD is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,2,77,78), and many other health complications that will be discussed in the posts about CD symptoms. It is my hope that if you have musculoskeletal symptoms you can print out this post complete with medical references to take with you to the MD when you request a CD test. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that some of your symptoms could be due to a food allergy/sensitivity or other disease process.  Allergy testing, and/or an elimination diet may help you to identify the offending food (5,6,31,36,48,49,53,54,57,58,76). Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.

I recommend waiting until CD testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

Diagnosed Celiacs and people with food allergies/sensitivities, please comment about your symptoms  and experiences at the end of each post. This will help other readers to see how the sometimes illusive symptoms of CD or food sensitivities can affect each of us.  We are all unique!

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

5. Excellent Book: Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007. http://tinyurl.com/nwsc79

6. Excellent Book: James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002. http://tinyurl.com/knswhn

7. Rickets http://www.nlm.nih.gov/medlineplus/ency/article/000344.htm

8. Osteomalacia http://www.nlm.nih.gov/medlineplus/ency/article/000376.htm

9. Osteoporosis http://www.nlm.nih.gov/medlineplus/ency/article/000360.htm

10. Cimaz R, , Bazzi P, Prelle A. Myopathy associated with rickets and celiac disease. Acta Paediatr 2000 Apr;89(4):496-7.

11. Lejarraga H, et el. Normal Growth Velocity Before Diagnosis Of Celiac Disease. J Pediatr Gastrenterol Nutr 2000;30:552-556.

12. Mehmet D. Demirag^a, Berna Goker^a, Seminur Haznedaroglu^a, Mehmet A. Ozturk^a, Tarkan Karakan^b, Reha Kuruoglu^c. Osteomalacic Myopathy Associated with Coexisting Coeliac Disease and Primary Biliary Cirrhosis. Med Princ Pract 2008;17:425-428

13. Costantine Albany, MD, Zhanna Servetnyk, MD, PhD. Disabling Osteomalacia And Myopathy As The Only Presenting Features Of Celiac Disease: A Case Report. Department of Medicine, St. Luke’s Roosevelt Hospital Centre, Columbia University College of Physicians And Surgeons.

14. Harzy T, et el. An Unusual Case of Osteomalacia As The Presenting Feature Of Coeliac Disease. Rheumatol Int, 2005. 26(1):p.90-91.

15. Basu RA,et el. Coeliac Disease Can Still present With Osteomalacia! Rheumatology (Oxford), 2000. 39(3):p335-336.

16. Hurtado-Valenzuela JG, Sotelo-Cruz N, López-Cervantes G, de la Barca AM. Tetany caused by chronic diarrhea in a child with celiac disease: A case report. Cases J. 2008 Sep 23;1(1):176.

17. Meyer D, Stavropoulos S, Diamond B, Shane E, Green PHR. Osteoporosis In A North American Adult Population With Celiac Disease. Am J Gastroenterol 2001, 96:112-119.

18. Vazquez H, Mazure R, Gonzalez D, Flores D, Pedreira S, Niveloni S, Smecuol E, Maurino E, Bai JC. Risk Of Fractures In Celiac Disease Patients: A Cross-Sectional, Case Control Study. Am J Gastroenterol 2000;95(1):183-189.

19. Ferretti J, Mazure R, Tanoue P, Marino A, Cointry G, Vazquez H, Niveloni S, Pedreira S, Maurino E, Zanchetta J, Bai JC. Analysis Of The Structure And Strength Of Bones In Celiac Disease Patients. Am J Gastroenterol 2003;98(2):382-90.

20. Kemppainen T. Osteoporosis in adult patients with celiac disease. Bone, Volume 24, Issue 3, Pages 249-255.

21. Endonurse. Screening Patients with Osteoporosis for Celiac Disease Appears Worthwhile. 03/01/2005. http://www.endonurse.com/hotnews/53h1162048334.html Reference in article: February 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

22. Patients With Osteoporosis Should Be Screened For Celiac Disease, Study Suggests. ScienceDaily (Mar. 16, 2005) — St. Louis, Feb. 28, 2005. http://www.sciencedaily.com/releases/2005/03/050308131921.htm

23. Stazi AV, Trecca A, Trinti B. Osteoporosis in celiac disease and in endocrine and reproductive disorders. World J Gastroenterol. 2008 Jan 28;14(4):498-505.

24. David A Nelson, JR., MD., MS., University of Arkanas for Medical Sciences, Little Rock, Arkansas. Gluten-Sensitive Enteropathy (Celiac Disease): More Common Than You Think. American Family Physician, December 15, 2002.

25. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

26. Kagnoff MF. AGA Institute Medical Position Statement on the Diagnosis and Management of CD. Gastroenterology, Official Journal of the American Gastroenterological Association (AGA). November 2006.

27. Unsure of Author, The American Journal of Managed Care.2003;9:825-831.

28. Hafström, et el. 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. Rheumatology 2001;40:1175-9

29. Lubrano et el. The Arthritis of Celiac Disease: Prevalence And Pattern In 200 Adult Patients. British Journal of Rheumatology. 1996;35:1314-8.

30. Bourne JT, Kumar P, Huskisson EC, Mageed R, Unsworth DJ, Wojtulewski JA. Arthritis And Celiac disease. Ann Rheum Dis 1985, September;44(9):592-598.

31. Adams Jefferson. Studies Show High Instance of Rheumatoid Arthritis And Osteoporosis In Patients With Celiac Disease. www.celiac.com

32. Collin P, Korpela M, Hallstrom O, et el. Rheumatic Complaints As A Presenting Symptom In Patients With Celiac Disease. Scan J Rheumatol 1992;21:20-3.

33. Usai P. Adult Celiac disease is Frequently Associated With Sarcoilitis. Dig Dis Sci 1995;40:1906-8.

34. Bagnato GF, Quattrocchi E, Gulli S et el. Unusual Polyarthritis As A Unique Clinical Manifestation Of Celiac Disease. Rheumatol Int 2000;20:29-30.

35. Borg AA, Dawes PT, Swan CH, Hathersall TE. Persistant Monoarthritis And Occult Celiac Disease. Postgrad Med j 1994;70:51-53.

36. Adams Scott. Arthritis And Celiac Disease. www.celiac.com

37. U. Lindqvist^1,, Å. Rudsander^1,2, Å. Boström², B. Nilsson³ and G. Michaëlsson^2. IgA antibodies to gliadin and coeliac disease in psoriatic arthritis. Rheumatology 2002; 41: 31-37.

38. Sandyk R., MD, Brennan M.J.W., MB, BCh, PhD. Isolated Ocular Myopathy And Celiac Disease In Childhood. Neurology 1983;33:792. American Academy Of Neurology.

39. Wong M, et el. Proximal Myopathy And Bone Pain As The Presenting Features Of Coeliac Disease. Ann Rheum Dis, 2002, 61(1):p87-8.

40. Kleopa KA, Kyriacou K, Zamba-Papanicolaou E, Kyriakides T. Reversible inflammatory and vacuolar myopathy with vitamin E deficiency in celiac disease. Muscle Nerve. 2005 Feb;31(2):260-5.

41. Possible Relationship Between Myopathies And Celiac Disease. ScienceDaily (Feb. 24, 2007)

42. Albert Selva-O’Callaghan, MD, PhD ^{1 *}, Francesc Casellas, MD, PhD ², Ines de Torres, MD, PhD ³, Eduard Palou, MD, PhD ⁴, Josep M. Grau-Junyent, MD, PhD ⁵, Miquel Vilardell-Tarrés, MD, PhD ¹ Celiac disease and antibodies associated with celiac disease in patients with inflammatory myopathy. Muscle & Nerve, Volume 35 Issue 1, Pages 49 – 54.Published Online: 11 Sep 2006

43. Erkan Kozanoglu¹, Sibel Basaran¹ and M. Kamil Goncu^1. Proximal myopathy as an unusual presenting feature of celiac disease. Journal Clinical Rheumatology. Issue Volume 24, Number 1 / February, 2005. Pages 76-78

44. Vivek Jain¹, Rajeshwar Reddy Angitii¹, Surjit Singh¹, Babu Ram Thapa² and Lata Kumar^{1  Proximal Muscle Weakness—An Unusual Presentation of Celiac Disease. Department of Pediatrics, Postgraduate Institute of Medical Education and Research PGIMER), Chandigarh, India}

45. Alawneh K, Ashley C, Carlson JA. Neutrophilic myositis as a manifestation of celiac disease: a case report. Journal of Tropical Pediatrics 2002 48(6):380-381; doi:10.1093/tropej/48.6.380. © 2002 by Oxford University Press http://www.ncbi.nlm.nih.gov/pubmed/18180977 

46. Hardoff D, Sharf B, Berger A. Myopathy as a presentation of coeliac disease. Dev Med Child Neurol. 1980 Dec;22(6):781-3.

47. Canadian Celiac Association Health Survey (2007)  http://tinyurl.com/n3fbj7  Also in Digestive Diseases And Sciences April 2007:52(4):1087-1095.

48. Roubenoff R, Coleman Laura A. Nutrition And Rheumatic Disease. Humana Press, 2008.

49. Selva-O’Callaghan A, et el. Celiac disease And Antibodies Associated With Celiac Disease In Patients With Inflammatory Myopathy. Muscle Nerve, 2006;volume 35, issue 1,page 49-54.

50. WebMd Arthritis Basics http://www.webmd.com/osteoarthritis/guide/arthritis-basics

51. Slot D, Locht H. Arthritis As Presenting Symptom In Silent Adult Celiac Disease. Scandinavian Journal Of Rheumatology. 2000;29:260-3

52. Stenson W, et el. Increased Prevalence Of Celiac Disease And Need For Routine Screening Among Patients With Osteoporosis. Archives Of Internal Medicine February 28, 2005;165(4).

53. Panush RS. Possible role of food sensitivity in arthritis. Ann Allergy. 1988 Dec;61(6 Pt 2):31-5.

54. To?rol RE, Nalbant S, Solmazgül E, Ozyurt M, Kaplan M, Kiralp MZ, Dinçer U, Sahan B. The significance of coeliac disease antibodies in patients with ankylosing spondylitis: a case-controlled study. J Int Med Res. 2009 Jan-Feb;37(1):220-6.

55. Hernandez L, Green PH. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep. 2006 Oct;8(5):383-9.Links

56. www.arthritis.org/

57. Carinini C, Brostroff J. Gut And Joint Disease. Annals Of Allergy. 1985;55:624-625.

58. Gislason Stephen. Core Diet For Kids. Persona Audiovisual Productions, 1989.

59. Williams SF, Mincey BA, Calamia KT. Inclusion body myositis associated with celiac sprue and idiopathic thrombocytopenic purpura. South Med J. 2003 Jul;96(7):721-3.

60. M Hadjivassiliou,^a A K Chattopadhyay,^b G A B Davies-Jones,^a A Gibson,^a R A Grünewald,^a A J Lobo^c Neuromuscular disorder as a presenting feature of coeliac disease. J Neurol Neurosurg Psychiatry 1997;63:770-775 ( December )

61. April Chang-Miller, M.D. Can a gluten-free diet help reduce signs and symptoms of polymyositis? http://www.mayoclinic.com/health/polymyositis/AN00572

62. Evron E, Abarbanel JM, Branski D, Sthoeger ZM. Polymyositis, arthritis, and proteinuria in a patient with adult celiac disease. J Rheumatol. 1996 Apr;23(4):782-3.

63. Meini A, Morandi L, Mora M, Bernasconi P, Monafo V, Pillan MN, Ugazio AG, Plebani A. An unusual association: celiac disease and Becker muscular dystrophy. Am J Gastroenterol. 1996 Jul;91(7):1459-60.

64. Stenhammar L, Klintberg B, Tevebring J, Henriksson KG. Muscular dystrophy misdiagnosed as hepatic disease in a child with coeliac disease. Acta Paediatr. 1995 Jun;84(6):707-8.

65. Dubowitz Victor. The Floppy Infant. Cambridge University Press. 2 Edition, 1993.

66. Buderus S, Wagner N, Lentze MJ. Concurrence of celiac disease and juvenile dermatomyositis: result of a specific immunogenetic susceptibility? J Pediatr Gastroenterol Nutr 1997; 25: 101-103

67. Falcini F, Porfirio B, Lionetti P. Juvenile dermatomyositis and celiac disease. J Rheumatol 1999; 26: 1419-1420

68. Marie I, Lecomte F, Hachulla E, Antonietti M, Francois A, Levesque H, Courtois H. An uncommon association: celiac disease and dermatomyositis in adults. Clin Exp Rheumatol 2001; 19: 201-203

69. Iannone F, Lapadula G. Dermatomyositis and celiac disease association: a further case. Clin Exp Rheumatol 2001; 19: 757-758

70. Philippe Humbert¹, Fabien Pelletier¹, Brigitte Dreno², Eve Puzenat¹, François Aubin¹.  Gluten intolerance and skin diseases. European Journal Of Dermatology. Volume 16, Numéro 1, 4-11, January-February 2006.

71. Chernoff Ronni. Geriatric Nutrition: The Health Professionals Handbook. Jones And Bartlett Publishers Inc. 3rd edition, 2006.

72. Kamhi Ellen, Zampierson Eugene R. Arthritis: Reverse Underlying  Causes Of Arthritis With Clinically Proven Alternative Therapies. Celestial Arts. 2nd Edition, 2006.

73. Gibney MJ, Marinos E, Olle L, Dowsett J. Clinical Nutrition. Blackwell Publishing 2005.

74. Gibney MJ, Vorster HH, Kok FJ. Introduction to Human Nutrition. Blackwell Publishing 2002.

75. Carolyn S. Chen, MD,¹ Ethan U. Cumbler, MD,² and Andrzej T. Triebling, MD, PhD³ Coagulopathy Due to Celiac Disease Presenting as Intramuscular Hemorrhage. J Gen Intern Med. 2007 November; 22(11): 1608–1612.

76. Orbach H, Amitai N, Barzilai O, Boaz M, Ram M, Zandman-Goddard G, Shoenfeld Y. Autoantibody screen in inflammatory myopathies high prevalence of antibodies to gliadin. Ann N Y Acad Sci. 2009 Sep;1173:174-9.

77. Kagnoff MF. AGA Institute Medical Position Statement on the Diagnosis and Management of CD. Gastroenterology, Official Journal of the American Gastroenterological Association (AGA). December 2006.

78. Alessio Fasano, M.D. Physiological, Pathological, and Therapeutic Implications of Zonulin-Mediated Intestinal Barrier Modulation. American Journal of Pathology, 2008;173:1243-1252.

79. Smith Roger, Wordsworth Paul. Clinical And Biochemical Disorders of the Skeleton. Oxford University Press, 2005.

80. Joyce B.J. van Meurs, Ph.D., Rosalie A.M. Dhonukshe-Rutten, M.Sc., Saskia M.F. Pluijm, Ph.D., Marjolein van der Klift, M.D., Ph.D., Robert de Jonge, Ph.D., Jan Lindemans, Ph.D., Lisette C.P.G.M. de Groot, Ph.D., Albert Hofman, M.D., Ph.D., Jacqueline C.M. Witteman, Ph.D., Johannes P.T.M. van Leeuwen, Ph.D., Monique M.B. Breteler, M.D., Ph.D., Paul Lips, M.D., Ph.D., Huibert A.P. Pols, M.D., Ph.D., and André G. Uitterlinden, Ph.D. Homocysteine Levels and the Risk of Osteoporotic Fracture. New England Journal Of Medicine. Volume 350:2033-2041, Number 20  May 13, 2004

This is the fourth in a series of posts discussing the variety of symptoms that can be caused by undiagnosed Celiac Disease (CD). In this post, skin rashes, hair, and nail symptoms will be discussed. In many with undiagnosed CD, the intestinal villi, responsible for absorbing nutrients, becomes damaged, creating a flattened mucosal surface (villous flattening) that is less able to absorb nutrients. Autoimmune reactions to ingested gluten cross-react with intestinal villi and create this damage. Various nutrient deficiencies can occur and this, along with inflammation and other autoimmune factors, can lead to various skin rashes, hair, and nail symptoms (1,2,3,4). 

Skin Rashes And Other Skin Symptoms

Dermatitis  Herpetiformis (Duhring’s Disease)

Dermatitis Herpetiformis (DH) occurs when autoimmune reactions lead to a skin rash. Unfortunately, this form of CD is often misdiagnosed as other various skin disorders and conditions (1). An individual with DH may be misdiagnosed with  psoriasis, poison ivy, pustular psoriasis, shingles, scabies, acne, acne rosea, hives, unexplained dermatitis herpes, recurrent mites, mosquito bites, flea bites, eczema and many other possible diagnosis that will be listed below (1,5,6). Symptoms include a blistering (papulovesicular eruptions) or scabbed rash that is very itchy. As well, the rash can have pimple type lesions or look similar to psoriasis with raised red patches of skin. In children, the rash may only present as purpura on the palms of their hands (in isolation or in addition to other symptoms). Usually the rash occurs bilaterally on the body and is commonly found on the buttocks, back, elbows, forearms, back of knees, scalp and on the face. Clinically, the rash can present anywhere on the body (1,5,6,7).

In the book “Dangerous Grains” it mentioned that there are dermatologists who continue to prescribe medication for Dermatitis Herpetiformis without prescribing a strict gluten-free diet. Unfortunately, these patients may continue to have a high risk of associated cancers, other autoimmune damage or malabsorption issues (even without bowel symptoms) with this approach (6). One Recreational Therapist that I worked with was diagnosed with DH and put on dapsone without being told about a gluten-free diet. The dermatologist did ask her if she had any bowel symptoms. She said no. Further tests were not completed and a gluten-free diet was not mentioned. Unfortunately, she suffered with side effects from the medication for 2 years with this approach. Following a discussion with me on a lunch break, she saw her MD, a gastroenterologist, and her dermatologist. She started a gluten-free diet and was able to discontinue the dapsone following a discussion with her doctor. Now, she is the picture of health, living rash and drug free. Dr. Peter Green, in his book, “Celiac disease” said, “If you have a positive diagnosis of dermatitis herpetiformis, you have celiac disease. And you must adhere to a gluten-free diet no matter how “normal” your intestine may appear.” (1)

Dr. Green also identified that the normal blood tests (endomysial antibodies and antitissue transglutaminase) for celiac disease might be negative in DH since they tend to correspond with the severity of intestinal damage in CD, not the severity of skin damage. Therefore, absence of intestinal damage could lead to negative CD blood tests. Dr. Green also identified that the unaffected skin beside (within millimeters) the lesion should be biopsied, not the lesion itself. Apparently, the inflammation in the lesion itself may make it difficult to see (in immunological staining) the initial immune factors responsible for DH. A skin biopsy that is positive for DH indicates that a strict gluten-free diet should be started, even with a negative intestinal biopsy (1). If the skin biopsy and intestinal biopsy are negative, but the rash appears to occur after gluten consumption (can be up to many days), then the biopsies should be repeated and and gluten sensitivities should be investigated. Rashes can result from food allergies or a gluten sensitivity in the absence of CD or DH (1,5,6,77,85).

Pictures of DH may be seen at http://tinyurl.com/qsge4v, http://tinyurl.com/l3s2fa, http://tinyurl.com/n3x4ls, or http://tinyurl.com/n9fo8x.

List Of Other Skin Rashes/Conditions Associated With Celiac Disease And Gluten Intolerance

• Cutaneous vasculitis (7,8-11)

• Hereditary Angioneurotic Edema (7,12-15)

• Urticaria (7,15-20,85)

• Linear IgA bullous dermatosis (7,21-25)

• Erythema nodosum (7,26-28)

• Necrolytic migratory erythema (7,29-32,85)

• Erythema elevatum diutinum (7,33-35)

• Psoriasis (7,36-44,78,85)

• Vitiligo (7,45-48,78)

• Behçet’s disease (7,49)

• Dermatomyositis (7,50-54,85)

• Porphyria  (7,55-57)

• Ichthyosiform dermatoses (7,58)

• Pellagra (7,59)

• Generalized acquired cutis laxa (7,60,61,85)

• Atypical mole syndrome and cogenital giant naevus (7,62-66)

• Prurigo nodularis (hyde’s prurigo) (71,85)

• Pityriasis rubra pilaris (72,85)

• Erythroderma (85)

• Acne (73)

• Acquired hypertrichosis lanuginosa (67)

• Ichthyosis (74,85)

• Transverse Leukonychia (85)

• Follicular Hyperkeratosis (78)

• Scleroderma (80)

• Sarcoidosis (28,78)

• Oral Lichen Planus (68-70)

• Bullous pemphigoid (85)

• Angular Cheilitis, glossitis, ulcerative stomatitis, and aphthous ulcers (78,79,85)

• Pale skin (from anemia) (78,79)

• Dry and/or cracked skin from dehydration and malabsorption of nutrients (80,81)

• Delayed wound healing (malabsorption of nutrients) (81,82)

• Edema (swollen skin) (78,79)

• Any itchy skin rashes (78)

• Melanoma (75)

• Dermatitis or acrodermatitis (78,79)

• IgA Linear dermatosis (85)

• Lupus erythematosus (85)

• Lichen sclerosous (85)

• Cutaneous amyloidosis (85)

• Annular erythema (85)

• Partial lipodystrophy (85)

• Atopic dermatitis (85)

• Palmoplantar pustulosis (85)

• seborrheic dermatitis-from riboflavin deficiency (81,82)

• Facial butterfly Rash-from niacin deficiency (81,82)

• Increased skin pigmentation (79)

• Spontaneous ecchymoses (78)

• Bruised skin (79)

• Purpura (79)

• Petechia (78)

• Bleeding under the skin (78)

I experienced generalized dry skin and cracked peeling skin on the heels of my feet. My lips would crack at the corners and I had canker sores in my mouth. Occasionally, intensely itchy red raised areas would occur on various parts of my body and I would get little pimples on my scalp. A butterfly rash would develop over my nose about once a week for awhile, then it would disappear for a month or two (lupus tests were negative). I was always pale, and I did tend to bruise easily. My mother, also with CD, bruised easily, was pale, had dry skin (especially on her feet), and would develop an unusual blotchy rash around her neck area. My daughter, at age 4 (also with CD), had red itchy patches that would last a few hours, then disappear. My mother and daughter did not have bowel symptoms. My bowel symptoms started after the birth of my first child.

My middle child tested negative for CD. She had eczema of moderate severity, hyperactivity, lack of focus, occasional diarrhea, and abdominal discomfort. All medical tests ordered by the paediatric allergist were negative. An elimination diet revealed that she was sensitive to corn and corn derivatives (which are in most grocery store products). All symptoms resolved when I removed corn from her diet. All symptoms return with accidental ingestion of corn.

Nutrient deficiencies partially or fully contributing to the above skin symptoms may include vitamin A, B complex, C, K, essential fatty and amino acids, iron, zinc, biotin,copper, and manganese (78,79,81,82).

Hair Symptoms

Alopecia Areata (Patches of hair loss) has been associated with CD . In CD, it may be the result of an immunological attack and/or nutrient deficiencies (1,7,79,81,82,83,84,85). Alopecia can be the only presenting symptom in CD (7).

An individual with CD may have dry, thin, brittle, slow growing hair due to nutrient deficiencies. Hair might change color due to malabsorption issues with pantothenic acid or manganese deficiencies (81,82).

My mother and I had hair that grew slowly, was fine, and brittle.

Nail Symptoms

Individuals with CD, may have nails that are dry, brittle, thin, malformed, and that break easily. This can be due to nutrient deficiencies or associated conditions. Nails may grow slowly and can also also have white bands, longitudinal striations, horizontal or vertical ridges, color changes, white spots, splinter hemorrhages, a deformed nail shape that is curved up or down (ex. spoon shaped with anemia), hang nails, or be clubbed. Muehrcke’s lines may indicate albumin levels are low. Beau’s lines can result from nutrient deficiencies disrupting nail growth, onycholysis can be associated with psoriasis or sarcoidosis, and the nails might be pitted (associated with psoriasis and alopecia). Telangiectasia may develop with underlying lupus, dermatomyositis, or scleroderma (86,87). Pictures and further description of these nail disorders can be found at http://tinyurl.com/lom4nt.

Nutrients Deficiencies that can contribute to nail abnormalities can include, vitamin A, B complex, C, K, protein, calcium, iron, and zinc (86).

I had nail symptoms including dry, brittle, nails that broke easily. Hang nails were continuously present and my nails frequently had white spots. My mother had horizontal ridges on her dry, brittle nails.

Do You Have Any Of The Above Symptoms?

Many individuals with undiagnosed CD will have no bowel symptoms (1,2,3,5,6,85). Weight loss may or may not occur, and is dependent on the amount of the intestine that is damaged (78). Therefore, the symptoms in this post could occur in the absence of weight loss or bowel symptoms.

The presence of skin, hair, or nail symptoms as discussed in this post, indicates that you should talk to your MD about tests for CD and tests to rule out other possible causes of your symptoms. Testing for CD is important because undiagnosed CD increases the risk of developing other autoimmune diseases, lymphomas (skin, brain, lymph nodes, intestine), cancers (thyroid, esophageal, mouth, tongue, pharynx, tonsil, and small intestine), allergies, complications from malabsorption issues, possible decreased immune response to other illnesses (1,78,79,88,89), and many other health complications that will be discussed in the posts about CD symptoms. It is my hope that if you have any of these symptoms you can print out this post complete with medical references to take with you to the MD when you request a CD test. Highlight or underline the sections that apply to your symptoms. I’ll be posting a simplified summary and checklist in the 12th post.

It is possible to have a gluten sensitivity even if you test negative for CD. It is also possible that your symptoms could be due to a food allergy/sensitivity or other disease process.  Allergy testing, and an elimination diet may help you to identify the offending food (5,6,77,85). Other tests can help rule out other diseases. I encourage everyone to have their symptoms thoroughly investigated by their MD and specialists before implementing a therapeutic diet. Keep your MD informed about any dietary changes you are making and also the results. Of course, I would love to hear your story as well.

I recommend waiting until CD testing is complete before initiating a gluten-free diet because it may create a false negative. Discuss this with your MD or specialist. USE CAUTION WITH SUPPLEMENTS. Toxicities can occur with over supplementation and this can lead to permanent damage. Consult your MD, Registered Dietitian, or other medical specialists involved in your care to determine which nutrients should be supplemented and to identify appropriate dosages for you. Review your symptoms and everything in this post with a Medical Doctor and your specialists before you make any changes. Your MD knows your medical history and the treatments that are appropriate for you.

Diagnosed Celiacs and people with food allergies/sensitivities, please comment about your symptoms  and experiences at the end of each post. This will help other readers to see how the sometimes illusive symptoms of CD or food sensitivities can affect each of us.  We are all unique!

References

1. Excellent Book: Green PHR, Jones, R. Celiac Disease A Hidden Epidemic. Collins, Harper Collins Publishers, 2006 http://tinyurl.com/ljeqjc

2. Pruessner Harold T, MD. Detecting Celiac Disease In Your Patients. American Family Physician. March 1st, 1998.

3. Feldman Mark, MD, Friedman Lawrence S, MD, Sleisenger, Marvin H, MD, Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management 7th Edition, Volume11, 2002,Saunders

4. Barrett KE. Gastrointestinal Physiology. Lange Medical Books/McGraw-Hill 2006.

5. Excellent Book: Lieberman Shari PhD,CNC, FACN, with Linda Segall. The Gluten Connection. How Gluten Sensitivity May Be Sabotaging Your Health. Rodale Inc., 2007. http://tinyurl.com/nwsc79

6. Excellent Book: James Braly, MD., Ron Hoggan, MA. Dangerous Grains. Penguin Group, Inc., 2002. http://tinyurl.com/knswhn

7. Abenavoli L, Proietti I, Leggio L, Ferrulli A, Vonghia L, Capizzi R, Rotoli M, Amerio PL, Gasbarrini g, Addolorato G. Cutaneous Manifestations In Celiac disease. World Journal Of Gastroenterology. 2006 February 14;12(6):843-852.

8. Jones FA. The skin: a mirror of the gut. Geriatrics 1973; 28: 75-81

9. Holdstock DJ, Oleesky S. Vasculitis in coeliac diseases. Br Med J 1970; 4: 369

10. Meyers S, Dikman S, Spiera H, Schultz N, Janowitz HD. Cutaneous vasculitis complicating coeliac disease. Gut 1981; 22: 61-64

11. Similä S, Kokkonen J, Kallioinen M. Cutaneous Vasculitis As A Manifestation Of Celiac Disease. Acta Paediatrica Volume 71 Issue 6, Pages 1051-1054.

12. Brickman CM, Tsokos GC, Chused TM, Balow JE, Lawley TJ, Santaella M, Hammer CH, Linton GF, Frank MM. Immunoregulatory disorders associated with hereditary angioedema. II. Serologic and cellular abnormalities. J Allergy Clin Immunol 1986; 77: 758-767

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