Gout And Celiac Disease: What Is The Connection?

Gout and Celiac Disease; Is There A Connection?

There has always been a considerably amount of speculation about whether or not Celiac and Gout share a common thread. There are several well-known symptoms and/or shared health problems of both of them. Among them are indications of Autoimmune Disorders, Rheumatoid Arthritis, and Bone and Joint Pain, which lead to a reasonable assumption that Gout does fit into the realm of Celiac Disease.

What is Celiac Disease?

Celiac Disease damages the small intestine and interrupts the absorption of nutrients from food. People who have Celiac have an intolerance to gluten; a protein found in wheat, rye, and barley. Gluten is usually found in foods but many other common products like medicines, vitamins, and lip balms can also contain gluten.

In extreme cases, the presence of gluten on a molecular level is enough to cause severe reactions for those with advanced sensitivities.

When someone with Celiac Disease eats certain foods or uses different products containing gluten, their immune system will damage or destroy the "villi" - the microscopic, finger-like lining of the small intestine. The villi function to allow nutrients from food to be absorbed through the walls of the small intestine into the bloodstream. Without the villi functioning properly, signs of malnutrition may start to appear.

Celiac is not only an abnormal immune reaction to gluten, but also a condition where nutrients are not absorbed adequately and studies have shown proof that it is genetic in nature.

There have been reports of Gout Sufferers who also have Celiac Disease that have found relief from both of the diseases with prolonged and intensive use of highly concentrated Antioxidants.

The symptoms of Celiac can also vary with such factors as; a person's age and/or the degree of damage that has been done to the small intestine. Some people have the symptoms and condition for 10 years or more before they are diagnosed. If left undiagnosed and untreated, the greater the risk of sustaining long-term complications.

How does Gout fit in?

Rheumatoid arthritis is typically labeled as an autoimmune disease. No condition is completely and exclusively manifested from internal sources and it is logical that there is always some form of external influences. Fairly often, Arthritis is associated with inflammatory bowel disease. Food allergies, poor gastrointestinal tract function, and immune attacks on connective tissues, are closely associated. In the case of all arthritic instances, close attention should be paid to dietary intake and monitored carefully.

Arthritis that appears to stem from an allergic reaction is not usually recognized as a food allergy, even when pain and swelling starts to develop in one of more of the joints. It doesn't matter if the food is something that is commonly eaten by an individual, or something completely new; joint inflammation can occur due to an accumulation of causes or from a combination metabolic substances. Such is the case with Gout.

Presently, Celiac Disease and "Gluten Intolerance" are often used interchangeably although this is a misconception. To diagnose Celiac, blood tests are drawn to measure for high levels of anti-tissue transglutaminase antibodies or anti-endomysium antibodies.

However this is not to discount that more reports are now showing low-level irritation and gluten sensitivities in the small intestine in more people. Due to the number of gout sufferers that are also showing signs of Celiac Disease, as well as the growing number of people expressing inflammatory bowel-like symptoms, there is evidence that low-grade gluten intolerance is affecting a much broader range of the population than previously thought.

The speculation still remains that either Celiac Disease or Gluten Intolerance is the culprit or at least an accomplice to the condition of Gout.By Bert Middleton

Leaky Gut and Autoimmune Diseases - What is the Link?

Has the link to the leaky gut and autoimmune disease become more clear? I believe it has and researchers from Canada have helped by a nice review on intestinal permeability in the British journal Gut.

Dr. J. B. Medding and his colleagues in Edmonton, Alberta Canada (Arrieta, Gut, 2006) describe how the intestine serves as a barrier when normal but becomes a source of the genesis of autoimmune diseases when it becomes abnormally permeable. That is, when your gut becomes leaky ("the leaky gut syndrome") several autoimmune diseases are known to occur.

Intestinal permeability (how leaky the gut has become) can be evaluated in a manner specific to various sites in the gut. That is, the different areas of the gut, from stomach to large intestine, can be evaluated by specific tests for leakiness and related to damage and disease in those areas. Areas of leaky gut can be observed prior to the onset of disease and appear to be involved in the development of disease, especially autoimmune diseases like Celiac disease, diabetes, Crohn's disease, as well as skin diseases like atopic dermatitis, rheumatologic conditions, and even irritable bowel syndrome.

The authors propose a new paradigm consisting of "three main features...

(1) A genetically susceptible immune system (the mucosal immune system), that allows the host to react abnormally to an environmental antigen.

(2) An environmental product that triggers the disease process.

(3) The ability for the environmental agent to interact with the mucosal immune system. Since the purpose of the epithelial barrier is to keep these two factors separate, and we measure this function of the barrier by permeability, the corollary of this is that an increase in permeability is a requirement for disease expression."

What does this mean in lay terms and in relationship to the concept of the leaky gut syndrome? The gut or intestine is supposed to be a barrier to foreign proteins like foods and bacteria. If your immune system is genetically predisposed to react adversely to a certain food proteins and/or bacteria in your gut (or nerves, skin or joints) you may react with activation of damaging chemicals intended to protect you from foreign invaders that instead damage your gut making it more leaky and more vulnerable as well as your nerves, skin, and joints.

Leaky gut begets leaky gut. What results is more damage to your gut. Food and bacterial proteins can act together to damage the gut and allow toxic protein complexes to get through the gut that is normally supposed to be resistant to such a breach. Once in your blood stream, foreign proteins may initiate abnormal reactions that cause irritation to your brain, nerves, skin and/or joints.

What many of you and I experience then are symptoms such as abdominal pain and bloating, gas, diarrhea, headaches, nerve pain, skin rashes and joint aches. The diagnoses that result are Celiac disease, Crohn's disease and irritable bowel syndrome, multiple sclerosis, migraines, attention deficit, autism, depression, eczema, acne, rheumatoid arthritis, fibromyalgia, diabetes, chronic fatigue etc. etc.

What really concerns some of us with personal and professional experience with this and who are passionately interested in this area is that there is an explosion of autoimmune diseases occurring right under our nose yet most doctors and lay public are missing the connection. Many people are being diagnosed with multiple conditions without anyone making the connection of the overload of our gut with certain foods that may be causing much of these illnesses. All of the problem foods have specific food proteins or lectins that are difficult to digest and potentially toxic to the gut. In particular if the food has been genetically engineered or modified their lectins may be more toxic to humans. Stay tuned for more on this exciting area, as I continue writing on the relationship of food, gut and disease. As your food doctor, the food doc, I hope to help you find the information you need to eat right to feel right even if your doctors are not making the connection.By Dr. Scot Lewey

Diagnosing Celiac Disease and Gluten Sensitivity

Celiac disease, also known as gluten sensitive enteropathy is very common but frequently missed. It is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed. Classic Celiac disease is diagnosed by abnormal blood tests and an abnormal
appearing intestine on biopsy and symptoms that resolve with a gluten free diet.

Several blood tests exist for Celiac disease. They have varying degrees of accuracy. Some are more sensitive, meaning they will be positive in milder forms of the disease but are not specific, meaning a positive test may not indicate Celiac disease. Others are felt to be very specific, meaning that when they are positive, it is almost certain you have the disease.

The most specific tests are tests for Celiac disease endomysial antibodies (EMA) and
tissue transglutaminase antibody (tTG) tests. These two tests are IgA based tests and can be negative if you are deficient in the immunoglobin IgA, which occurs in 10-20% of people with Celiac. When either EMA or tTG are positive Celiac disease is very likely and usually the intestine biopsy is positive. Recent studies indicate that the tTG may only be positive in 40% of true Celiacs when mild degrees of intestine damage are present on biopsy. Seronegative Celiac, meaning the blood tests are negative but the biopsy is positive, may occur in up to 20% of Celiacs.

Antibodies for gliadin (AGA), the toxic fraction of gluten are considered very sensitive but not specific for Celiac disease. Newer assays for AGA antibodies for gluten that has undergone a chemical change
called deamidation appear to be more specific for Celiac disease (Gliadin II,
Inova) than the older gliadin tests. They also may be as or more accurate than EMA and tTG
antibody tests but are not yet widely available.

The most distressing problem for people with lesser forms of gluten intolerance who have blood tests and/or biopsies that are normal or borderline yet respond to a gluten free diet is either not being taken seriously or knowing for sure if they are sensitive to gluten. For these individuals stool
antibody testing for antigliadin and tTG have been helpful. Such stool testing has been performed in research labs and published in a few studies but are only recently available through the commercial lab, Enterolab. Founded by a former Baylor research gastroenterologist, Dr Ken Fine, the tests are available to people online without a doctors order but are not generally covered by insurance. Dr. Fine, who patented the test, has yet to publish the results of his findings in a peer reviewed journal so his tests are not widely accepted. However, his unpublished data and the clinical experience of some of us who have used his test have
indicated the tests are very sensitive for signs of gluten sensitivity. He reports that they are 100% sensitive for Celiac disease and highly sensitive
for gluten sensitivity of lesser degrees. In the presence of symptoms, that reverse on a gluten-free diet,
abnormal stool antibody levels can be found in most people before blood tests or biopsies become
abnormal.

Small intestine biopsies during upper gastrointestinal endoscopy
are considered the "gold standard" for the diagnosis of Celiac disease.
However, recent studies have demonstrated that some people with gluten sensitivity, especially relatives of Celiacs
with little or no symptoms, have changes from gluten injury to the intestine that can not be seen with normal microscope examination. They can only be seen with special stains not routinely done or with a research electron microscope. The special stains are known as immunohistochemistry stains. They stain specialized white
blood cells called lymphocytes in the intestinal lining tips or villi. When these lymphocytes are increased it is known as intraepithelial lymphocytosis or increased IELs and it is the earliest sign
of gluten induced injury or irritation. Electron microscopy also reveals very early ultrastructural changes in some individuals when blood tests and standard biopsy examination are normal. When people who have these changes are
offered the option of a gluten-free diet they usually responded favorably. In contrast, those who continue to eat gluten often later developed classic Celiac disease.

What these studies suggest is that a "normal small intestine biopsy" may exclude
Celiac disease as defined by strict criteria but it is not a gold standard for detecting gluten sensitivity. This fact is appreciated by many individuals who have respond to a gluten-free diet they start
based on their symptoms, family history, suggestive blood test or stool antibody
test(s).

Another source of confusion is in the genetics of Celiac and gluten sensitivity.
Testing for specific blood type patterns on white blood cells known as HLA
DQ2 and DQ8 is increasingly being employed to determine if a person carries either of the two gene
pattern present in 95-98% of Celiacs and predisposing them to the development of Celiac disease. Some use the absence of these two patterns
as a way of excluding the possibility of Celiac disease and the need for testing or
gluten-free diet. However, there are rare reports of documented Celiac disease in people who are DQ2 and
DQ8 negative. Moreover, recent studies indicate other DQ
patterns may be associated with gluten sensitivity though unlikely to
predispose to classic Celiac disease.

Testing for all the DQ patterns is advocated by Dr. Fine, based on his
experience with stool antibody test results. He reports that other DQ types are
associated with elevated levels of gliadin and tTG in the stool and symptoms that respond to a gluten-free diet.
According to his unpublished data, all the DQ types except DQ4 are associated with
a risk of intolerance to gluten. Therefore, testing for all the DQ types allows a person to
determine if they carry one of the two high risk gene types for Celiac disease or
any of the other "minor DQ" genes Fine has found associated with gluten sensitivity.

Enterolab's stool testing for gliadin antibodies and tissue
transglutaminase antibodies, though not widely accepted, have gained favor in the lay
public's opinion as an option for determining sensitivity to gluten either despite negative blood tests and/or biopsies or in place of the more invasive tests. Most doctors still recommend the accepted blood tests and small
bowel biopsy for confirmation of Celiac. Though the reports in the lay community
are overwhelmingly positive they have not been subjected to peer review in
the medical community pending Dr. Fine publishing his data or other researchers reproducing his results.

However, doctors open to
the broader problem of gluten
sensitivity are reporting these tests helpful in many patients suspected of gluten
intolerance. Especially when someone has symptoms consistent with gluten sensitivity but has negative or inconclusive blood tests and/or biopsies these tests may be very helpful though some are not certain
how to interpret the tests. The national Celiac organizations are uncertain about how to
comment on their application without published research though a recent article
in the British Medical Journal did show stool tests highly specific for Celiac. Dr.
Fine has publicly commented that his unpublished data demonstrates those with
abnormal stool tests indicating gluten sensitivity
overwhelmingly respond favorably to a gluten free diet with improvement of
symptoms and general quality of life.

Another problem is that there are not universally agreed upon definitions for gluten sensitivity or intolerance. This becomes especially difficult for those who do not meet strict criteria for Celiac disease yet may have abnormal tests and/or symptoms that respond to a gluten-free diet. Those individuals become confused when they try to find information but do not have a formal diagnosis of Celiac disease. Consensus in the medical community on definitions and more research in this area is greatly needed.

The few doctors who appreciate the spectrum of gluten
intolerance or sensitivity are outnumbered by the medical majority that continue to
insist on strict criteria for diagnosis for Celiac disease before recommending a
gluten-free diet. Doctors either unfamiliar with the limitations of the tests as documented by Celiac research or who insist on the
strict criteria for Celiac being the only indication for recommending a gluten free
diet unfortunately may confuse or frustrate gluten sensitive individuals. Some of these people then seek answers on the internet or from alternative practitioners. Many have their diagnosis missed, challenged, dismissed, or are misinformed. As a result they fail to benefit from the health

By Dr. Scot Lewey