Thursday, May 29, 2008

What does gluten have to do with Lyme?

One of my colleagues, an ILADS member, who treats many chronic Lyme patients told me that her patients all had Celiac disease. That's interesting. None of my patients had this problem. Doctors are conventionally taught that Celiac disease can be reliably diagnosed by a blood antibody test called tTG of the IgA class. Celiac disease is caused by an allergic reaction to a protein found in wheat products called gluten. The gold standard for the diagnosis is a small bowel biopsy, generally obtained via an endoscope, passed through the mouth into the duodenum, which shows the characteristic pathological changes of a loss of villi. The disease is associated with gastrointestinal symptoms including diarrhea, maladsorption of nutrients, abdominal pain and bloating and weight loss. There are also non gastrointestinal manifestations of the disease which may be variable, but include fatigue, muscle and joint pain, peripheral neuropathy or numbness and tingling and cognitive impairments including brain fog. These symptoms are identical to the ones seen in chronic Lyme disease, is there a connection? Celiac disease is supposed to be present in 1% of the general population. I tested all my Lyme patients. None were positive. What's the rub? I did a little more research. Another paradigm bending idea is out there. Gluten sensitivity may be a disorder which exists on a continuum. Perhaps Celiac is the tip of the iceberg. There may be many patients who do not have full blown Celiac but still have gluten sensitivity. Perhaps many of these patients have an exacerbation of "Lyme" symptoms because they have another disorder which dovetails its symptoms with those of Lyme disease. Perhaps gluten sensitive individuals were not terribly symptomatic until they developed Lyme disease. And then the non gastrointestinal symptom complex becomes prominent. Many Lyme patients do in fact have gastrointestinal symptoms. Many patients with gluten sensitivity are diagnosed with such things as irritable bowel syndrome, non-specific or microscopic colitis, gastrointestinal reflux and a host of related disorders. Research has shown that this group of patients has a much higher incidence of gluten sensitivity. So how is this diagnosed. The standard blood test and small bowel biopsy will be normal. A specialty lab, called Enterolab, has pioneered a stool test which detects small amounts of antibodies directed against gluten. Primarily, this is the stool anti-gliaden antibody test. The test can only be ordered on line by patients and costs about $100.00. Again, the concept is that these patients do not have Celiac disease. None the less, they have a gluten allergy or sensitivity which causes many symptoms which overlap with those of Lyme patients. When such patients go on a gluten free diet they feel better and many of their symptoms improve. This is not a replacement for treating Lyme, but may be a helpful adjunct filling in a piece of a complex puzzle. I should caution the reader that this is a difficult diet. Symptom relief may not be seen for about two months. The diet must be continued indefinitely since there is no cure. Gluten has nothing to do with Lyme. A new paradigm suggests that many folks suffer with gluten sensitivity which is not Celiac disease, who may benefit from a gluten free diet.

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