Tag Archive for: celiac disease

Posts

Autoimmune thyroid disease and celiac disease often share symptoms.

Common Links Between Thyroid Disease & Celiac Disease

/in /by

If you’ve been diagnosed with either celiac disease or thyroid disease but continue to experience symptoms like fatigue, digestive issues, or unexplained pain, a co-existing autoimmune disorder at play. If you’ve been feeling “unwell,” especially for a prolonged period of time, it is important that all your body systems are carefully examined to determine if deficiencies are preventing you from getting better.

At The Kaplan Center, we prioritize your overall health, not just the symptoms. We provide a comprehensive and holistic approach to testing and treatment to ensure an expedited and accurate diagnosis, addressing all factors contributing to your condition. If you’ve struggled with chronic issues and haven’t found relief despite seeing multiple doctors, contact us today. Speak with one of our nurses to explore how we can help you on your path to better health.

Signs and symptoms of celiac disease

Celiac disease is an autoimmune disorder in which your body attacks and damages the lining of your small intestine when you consume gluten. Even the smallest amount can trigger an inflammatory response that targets and damages the villi, fingerlike projections whose job it is to absorb nutrients from the digested foods you eat. When villi become damaged, your body is no longer able to absorb nutrients it needs to stay healthy and malnutrition and other serious health conditions become a serious risk. Long-term consequences of celiac can include infertility and pregnancy complications, developing other autoimmune disorders, and cancer. Common symptoms of celiac disease include diarrhea, weight loss, nausea, bloating, and abdominal pain.

Because celiac disease can lead to other serious health conditions early diagnosis is key. But, because celiac shares symptoms with many other conditions, it may be years before it is detected.

Signs and symptoms of thyroid disease

If you’re diagnosed with autoimmune thyroid disease, your immune system attacks and damages the tissues of your thyroid gland, causing it to produce either too much or too little thyroid hormone. Because of the major role your thyroid gland plays in regulating your body’s mechanics, like how quickly you burn calories, your heart rate, and other vital functions, any breakdown of the thyroid gland can cause a cascade of symptoms to appear. The signs and symptoms associated with thyroid disease vary depending upon whether your thyroid is under-producing or over-producing thyroid hormone.

Hypothyroidism: Too little thyroid hormone, or hypothyroidism is the most common type of thyroid disease. It’s most often caused by the autoimmune condition Hashimoto’s thyroiditis, but it can also be caused by other factors, such as iodine deficiency. If you have hypothyroidism, your symptoms may include fatigue, a general sense of feeling cold, and dry skin and hair. You may also have elevated cholesterol levels, experience weight gain due to a decrease in metabolism, have difficulty with mental concentration (“brain fog”), or have irregular menstrual periods. People with an underactive thyroid often experience many other problems associated with weight gain including insulin resistance and diabetes, high blood pressure, and heart disease.

Hyperthyroidism: Symptoms of hyperthyroidism, too much thyroid hormone, include weight loss, enlarged thyroid (goiter), nervousness, high blood pressure, gastrointestinal problems, and a rapid heartbeat. Hyperthyroidism is most often caused by the autoimmune condition, Graves’ disease, accounting for between 60-80% of cases.

Both types of thyroid disorders may cause you to experience sleep disorders, severe fatigue, and changes in bowel habits, ranging from constipation to diarrhea. Pregnant women, whose hormone levels change dramatically to accommodate the growing fetus, may experience a variety of problems due to untreated thyroid conditions.

Co-occurrence of thyroid disease and celiac disease

Generally speaking, if you have an autoimmune condition, you are predisposed to developing other autoimmune conditions. Studies have shown that people with celiac disease are more likely to develop ATD than the general public, and the reverse is also true. This research suggests that considering and possibly testing for thyroid disorders in patients with CD – and vice versa – should become routine.

Too often medical providers become focused on one symptom or one disease process to the exclusion of other important medical evidence. In fact, the New England Journal of Medicine published a study suggesting that the #1 mistake most doctors make is narrowing the differential diagnosis – or list of possible conditions – too quickly, which limits what we’re able to see, never mind accurately diagnose and treat. It’s critical to cast a wide net in the process of diagnosing a patient, and this takes time.

Our functional medicine approach involves looking at all areas of your health to uncover imbalances or deficiencies that may be contributing to disease. When deficiencies are identified we’ll spend time talking with you about your diagnosis and working with you to create an integrative treatment plan that addresses not only your immediate symptoms but also any possible underlying or co-existing conditions that may be causing or aggravating them.

Does a gluten-free diet help thyroid antibodies?

When you have celiac disease and you remove gluten from your diet, your autoimmune antibodies return to normal, as expected. Medical research also suggests, however, that when people with celiac and thyroid disease adopt a gluten-free diet, not only do their celiac-related antibody levels improve, but often their thyroid antibody levels also decrease. This suggests that a gluten-free diet improves thyroid function, and it may mean that people with celiac who are gluten-free require less thyroid medication.

Additional therapies that focus on improving your digestive health and lowering inflammation, include

When a thyroid disorder is confirmed, hormone replacement may also be discussed as part of your treatment.

Original publication: August/2010; updated January/2017 & April/2024

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

References

https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease

https://my.clevelandclinic.org/health/diseases/15244-graves-disease

Ashok T, Patni N, Fatima M, Lamis A, Siddiqui SW. Celiac Disease and Autoimmune Thyroid Disease: The Two Peas in a Pod. Cureus. 2022 Jun 23;14(6):e26243. doi: 10.7759/cureus.26243. PMID: 35911325; PMCID: PMC9312543.

Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Bucur). 2010 Apr;5(2):132-4. PMID: 21977137; PMCID: PMC3150011.

Ventura A, Ronsoni MF, Shiozawa MB, Dantas-Corrêa EB, Canalli MH, Schiavon Lde L, Narciso-Schiavon JL. Prevalence and clinical features of celiac disease in patients with autoimmune thyroiditis: cross-sectional study. Sao Paulo Med J. 2014 Dec;132(6):364-71. doi: 10.1590/1516-3180-2014-1326725. Epub 2014 Sep 2. PMID: 25351758; PMCID: PMC10496779.

Dore MP, Fanciulli G, Rouatbi M, Mereu S, Pes GM. Autoimmune Thyroid Disorders Are More Prevalent in Patients with Celiac Disease: A Retrospective Case-Control Study. J Clin Med. 2022 Oct 12;11(20):6027. doi: 10.3390/jcm11206027. PMID: 36294348; PMCID: PMC9605329.

Sun, X., Lu, L., Yang, R., Li, Y., Shan, L., & Wang, Y. (2016). Increased Incidence of Thyroid Disease in Patients with Celiac Disease: A Systematic Review and Meta-Analysis. PLOS ONE, 11(12), e0168708. https://doi.org/10.1371/journal.pone.0168708

Pobłocki J, Pańka T, Szczuko M, Telesiński A, Syrenicz A. Whether a Gluten-Free Diet Should Be Recommended in Chronic Autoimmune Thyroiditis or Not?-A 12-Month Follow-Up. J Clin Med. 2021 Jul 22;10(15):3240. doi: 10.3390/jcm10153240. PMID: 34362024; PMCID: PMC8347530.

depression_pain

Is Depression Ever Just Depression?

/in , , /by

A modified model for understanding depression and anxiety ought to involve a whole person, integrative approach.

Public acts of violence seem to fill the news media streams these days and are typically followed by outcries for greater access to mental health care for those that need it most. And although almost all individuals with serious mental illness are not dangerous, many of the perpetrators of these heinous crimes later turn out to have a documented history of depression or mental illness, which often went untreated.

So, what can we do to stop the anguish? What is it that we are missing?

The Cost of Failure

Unfortunately, the number of Americans affected by serious depression and anxiety disorders is enormous, as are the costs to society due to failure to treat and/or treatment failure. Tens of millions of Americans suffer from depression, including chronic, low-grade depression (dysthymia) and anxiety. 21 million of those Americans have been diagnosed with major depressive disorder (MDD), the leading cause of disability for people ages 15 to 44.

The cost of failing to effectively treat these conditions is not just the individual’s inability to complete college, hold a job or cultivate positive relationships; it also includes the toll taken on an entire family and community when a despairing person takes their own life. And in other cases, the costs of acts of public violence – in terms of suffering, municipal expenses, personal medical and legal expenses, and lost human potential – are immeasurable.

Michael, a 17-year-old high school student, came to see me with a long history of hospitalizations after attempting to take his own life. Despite undergoing intensive psychiatric treatment, he remained depressed and suicidal. Like 40 percent of those who suffer from major depressive disorder, Michael was not responding to treatment.

When contemplating a situation like Michael’s, the question “What am I missing?” is never far from my mind. Statistics show that only about one-third of patients with MDD respond to antidepressant medication, with about the same number responding to psychotherapy alone. If we combine the two approaches the numbers improve slightly, but the fact remains that most people with MDD respond only partially to medical interventions, with almost half remaining entirely unresponsive.

A Central Nervous System in Turmoil

There is a mountain of scientific research demonstrating that neuropsychiatric conditions such as depression, anxiety disorders, and possibly bipolar disease are, in a very high percentage of cases, the result of inflammation occurring in the brain.

There is a great deal of research linking generalized inflammation to heart disease, chronic pain, and obesity. Inflammation in the body takes many forms: When we have an allergic response to pollen or food, our bodies’ inflammatory response includes the release of histamine, which makes our eyes itch and noses run; we see the inflammation associated with a skin wound when the white cells of our immune system respond to a bacterial infection. Inflammation in our brains, however, is unique in that it is mediated by tiny cells called microglia.

Microglia are the innate immune system of the central nervous system (CNS). Their job is to respond to trauma and damage to the brain. In response to brain injury, the microglia release a virtual symphony of chemical mediators that orchestrate the destruction of bacterial invaders, the elimination of damaged neuronal tissue, and the initiation of the repair process.

After responding to an assault on the brain, microglia typically return to a resting state. But ongoing and cumulative assaults to the brain will cause the microglia to remain chronically up-regulated, causing them to continuously spew out inflammatory, tissue-destroying chemicals. Examples of ongoing assaults include fever, physical assault, and emotional trauma. It can also be infections like Lyme disease or COVID-19.

Since the beginning of the COVID-19 pandemic, researchers have been studying how the SARS-CoV-2 virus affects the CNS as well as other body systems. What they are finding out is that it too heightens the activity of microglia leading to the release of inflammatory cytokines and a sequence of damaging events that can affect the brain and have other long-term effects on health.

Brain inflammation can produce a wide range of symptoms including depression, anxiety, chronic pain, difficulty focusing and concentrating, fatigue, and sleep disturbances.

Further compounding the issue is the fact that a solid understanding of the role of microglia in brain health is sadly lacking among most medical professionals, with the result that they continue to treat what are in fact “symptoms” as separate and unique “diseases.”

Looking Beyond the Symptoms

A better framework, where physicians look beyond the symptoms, involves giving priority to the discovery of the root causes of an individual’s depression or anxiety. This primarily requires an understanding of what caused the microglia to up-regulate.

Research has shown that anything that can damage neuronal tissue can be a trigger. So, an exploration of a patient’s depression may include asking them about possible traumatic head injuries, psychological traumas (acute events and chronic stress), infections (as mentioned above, tick-borne diseases, other bacteria, and viruses like Covid-19), and even biotoxins that may have entered the body from exposure to toxic molds, celiac disease, and hypoxia (usually related to sleep apnea). The list of triggers is long, and as such, the process of identifying the possible underlying causes of the disease requires putting together a thorough medical health timeline for each patient. By using this approach, treatment options expand due to the greater understanding of the origin of the illness, thereby increasing prospects for recovery.

As for Michael, my 17-year-old patient who was depressed and suicidal, it turned out that he has celiac disease. But how could a food allergy be related to his depression? Celiac disease is far more than an allergy to gluten – it is a very serious autoimmune disorder that’s triggered when even the smallest amount of gluten is ingested. As we know, with autoimmune disorders the immune system mistakenly attacks the body’s normal cells. In the case of celiac disease, when gluten is consumed the immune system goes into attack mode and causes damage to the healthy villi of the gut lining. Villi are responsible for absorbing nutrients and keeping food particles and toxins from entering the bloodstream. When the gut lining is compromised and toxins enter the bloodstream, widespread inflammation can occur, and this inflammatory response can affect more than the digestive system – it can cause inflammation in the brain. Research shows that people with celiac disease are at greater risk of neurological damage and mental health issues in addition to other serious chronic health conditions.

Michael, now gluten-free, is no longer depressed and he has re-engaged in life. He continued with antidepressant medications for a period of time, but slowly weaned himself from them under medical supervision (it takes time for the brain to heal after the assault is removed). His life has been changed, for the better, forever.

It is my hope that, with a modified model for understanding depression and anxiety, involving a “whole” person, integrative approach, more patients will be correctly diagnosed and treated, as Michael was. In his case, and I suspect in many more, we’re learning that all too often, depression is not just depression.

This article originally appeared in US News and World Reports, May 12, 2015. It was reviewed and updated in May 2023.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2

Additional references

InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? [Updated 2020 Jun 18]. 

Mohammadkhanizadeh A, Nikbakht F. Investigating the potential mechanisms of depression induced-by COVID-19 infection in patients. J Clin Neurosci. 2021 Sep;91:283-287. doi: 10.1016/j.jocn.2021.07.023. Epub 2021 Jul 20. PMID: 34373041; PMCID: PMC8289699.

gluten free options

When Going Gluten-free Makes Sense

/in /by

Gluten is a general name for the family of proteins found in the grains wheat, barley, and rye. Glutenin and gliadin, the 2 main proteins in gluten, are responsible for giving dough its characteristic elasticity and glue-like structure before the baking process and its wonderful texture and rise when baked.

Most people can eat gluten without any problem. However, for some, even the smallest amount of gluten can trigger a wide array of inflammatory reactions in the body when consumed, with symptoms sometimes lasting for months. Sensitivity to gluten presents across a spectrum, sometimes being the primary factor that is making a patient ill, but more often it exacerbates an existing pain condition.

Gluten is directly correlated with 3 major gastrointestinal disorders: Celiac disease (CD), non-celiac gluten sensitivity (NCGS), and wheat allergy.

Celiac disease

Celiac disease is an autoimmune disorder that is triggered by eating foods that contain gluten. Even miniscule amounts can trigger a reaction. Celiac disease is characterized by the damage and atrophy of the villi of the intestinal cell lining. The villi are finger-like extensions that extend from the wall of the small intestine into the lumen. The primary role of these villi is to absorb nutrients from the foods we consume. This damage leads to an increase in the space between cells, allowing food particles to enter the bloodstream (also referred to as intestinal permeability or “leaky gut”), and triggers an inflammatory immune response.  CD can directly cause atopic problems, nutritional deficiencies, and anemias. Research also confirms that individuals with CD have a higher risk of developing other autoimmune disorders, such as Type 1 Diabetes, Sjogren’s Syndrome, Rheumatoid Arthritis, and Hashimoto’s thyroiditis.

Celiac disease is also genetically linked, thus, anyone with a relative who has CD is at higher risk to develop it themselves. You can be tested for celiac disease just as you can be tested for food allergies and food sensitivities.

If you have been diagnosed with Celiac disease, going gluten-free is a must. Usually, after following a gluten-free diet (GFD) for just one month the health of patients with celiac disease improves dramatically.

Non-celiac gluten sensitivity

People with non-celiac gluten sensitivity share many of the symptoms common to celiac disease but do not test positive for CD. Once gluten is eliminated from one’s diet, patients with NCGS will quickly see an improvement in several symptoms.

Wheat allergy

Wheat allergy is an allergic reaction to any number of the proteins found in wheat, not necessarily gluten. A person diagnosed with a wheat allergy must avoid eating any form of wheat to avoid triggering an immune reaction but can tolerate eating gluten found barley and rye.

Symptoms of celiac disease & non-celiac gluten sensitivity

The most common symptoms of celiac disease and gluten sensitivity are listed below. Individuals with these conditions can experience a combination of any number of symptoms and some people with CD report having no symptoms at all.

Gastrointestinal:

  • Chronic diarrhea and/ or constipation
  • Chronic indigestion
  • Dehydration
  • Irritable Bowel Syndrome
  • Flatulence
  • Sores or ulcers inside the mouth
  • Poor appetite and lactose intolerance
  • Recurring abdominal bloating, cramping, distention or pain and vomiting

Extra-intestinal:

  • Anxiety and Depression
  • Extremely itchy skin rash called dermatitis herpetiformis (DH)
  • Fatigue
  • Fluid retention
  • Hair loss
  • Joint pain, muscle weakness or cramping
  • Migraine headaches
  • Peripheral Neuropathy (tingling and numbness in hands and feet)
  • Vitamin deficiencies, especially Vitamin D
  • Weight loss
  • Cognitive impairment

The following foods usually or often contain gluten:

  • Breading, coating, Panko (Japanese breadcrumbs) (wheat)
  • Cakes, pastries, cookies, pies, etc. (wheat)
  • Broth, soup bases (barley)
  • Brown rice syrup (barley)
  • Candy, for example, licorice (wheat) and some chocolates (barley)
  • Croutons (wheat)
  • Breakfast cereals (wheat, barley)
  • Imitation bacon (wheat)
  • Imitation seafood (wheat)
  • Processed lunchmeat, sausages, frankfurters (wheat)
  • Marinades (wheat, barley)
  • Pasta (wheat)
  • Sauces, gravies (wheat)
  • Self-basting poultry (wheat)
  • Soy sauce or soy sauce solids (wheat, barley)
  • Stuffing, dressing (wheat)
  • Thickeners (roux) (wheat)
  • Communion wafers (wheat)
  • Herbal supplements (wheat)
  • Drugs and over-the-counter medications (wheat)
  • Nutritional supplements, Vitamins, and mineral supplements (wheat)
  • Play-Doh (wheat)
  • Beer, ale, porter, stout, malt liquor (wheat)

Behind the label

In the last several years, we have seen tremendous growth in gluten-free products available in grocery stores and restaurants, and the number of gluten-free cookbooks has grown exponentially. In 2013, the FDA required that food manufacturers who wished to use a “gluten-free” label on their products had to limit its gluten content to 20 parts per million or less. The FDA chose this standard based on evidence that suggests that most individuals with celiac disease can tolerate “variable trace amounts and concentrations of gluten in foods (including levels that are less than 20 ppm gluten) without causing adverse health effects.”

In 2020, “gluten-free” labeling requirements extended to fermented or hydrolyzed foods. The FDA’s rule requires that manufacturers themselves keep records to support the “gluten free” claim.

Going gluten-free can be tricky; federal law requires wheat and the other top food allergens (milk, eggs, fish, Crustacean shellfish, tree nuts, peanuts, wheat, sesame, and soybeans) to be clearly identified on food labels, but there are no regulations regarding barley, rye, and oats. For example, if you see a label that lists malt extract, malt vinegar, malt flavoring, or brewer’s yeast, that product will contain some barley. Learning what to look for on a food label is essential!

Do oats contain gluten?

Strictly speaking, no, but oats have been found to be at risk of contamination with gluten during its production process. Gluten-free oats are available and should be labeled as such. Many people with CD can eat a small amount of gluten-free oats without a problem. A percentage of people with CD react the same way to the protein in oats as they do to gluten.

Should you go gluten-free without a diagnosis or symptoms?

Important to note is that implementing a gluten-free diet without a Celiac diagnosis or without any symptoms of sensitivity does not come without some risk. A review published in Clinical Nutrition in 2016 found people who follow a gluten-free diet are at higher risk of developing nutritional deficiencies. The reason? Many processed gluten-free foods on the market are lower in vitamins and minerals, such as Vitamin B12, Vitamin D, folate, magnesium, iron, and calcium, than their non-gluten-free counterparts.

What can you eat on a gluten-free diet?

Plenty! In addition to all of the processed gluten-free products on the market, fruits, vegetables, meat and poultry, fish and seafood, dairy, beans, legumes, and nuts are all part of a healthy, gluten-free diet.

The following grains do NOT contain gluten: rice, corn (maize), millet, quinoa, sorghum, buckwheat, amaranth, teff, flax, chia, and nut flours.

In sum, a gluten-free diet is necessary for all patients with celiac disease and highly recommended for patients with a commonly associated autoimmune disorder (Sjogren’s disease, Hashimoto’s thyroiditis). Our experience at the Kaplan Center has also shown that patients with non-Celiac, inflammatory conditions, such as arthritis, chronic muscle pain, chronic fatigue, and fibromyalgia, also see great improvements in their health when implementing a gluten-free diet.

Learning how to dissect food labels and understanding what ingredients indicate the presence of gluten is the key to staying gluten-free! By eliminating your exposure, a GFD can provide a clean slate to curb the cycle of inflammation.

If you are experiencing some of the symptoms above and have not been able to find resolution, please give us a call and make an appointment. We’re here to help you get to the root cause of your symptoms so healing can begin. Call 703-532-4892.

We are here for you, and we want to help.

Our goal is to return you to optimal health as soon as possible. To schedule an appointment please call: 703-532-4892 x2