I have long thought that gluten free diets are way over-prescribed for Lyme patients. Celiac disease, the most extreme form of gluten intolerance is relatively rare. Wheat, the primary source of gluten, was the first grain cultivated by our ancestors dating back more than 10,000 years. We have be eating a lot of guten for thousands of years, I have been interested in the "island where people forget to die," a small Greek island with more men per-capita living over the age of 100 than any place else on earth - and coarse bread is a staple in their diet. But perhaps my logic is a bit flawed. Gluten intolerance is part of the spectrum of autoimmune diseases. The incidence of autoimmune diseases is climbing, including celiac disease. It seems mainstream science is catching up to what many "holistic" practitioners already knew. Gluten sensitivity is a real disorder, apart from celiac disease, per researches from the University of Maryland. There is no reliable diagnostic test for the disorder. Saliva samples and stool samples for anti-gliadin antibodies may be helpful but may also over-call the diagnosis. There may be other clues: the presence of markers for autoimmunity such as a slightly elevated ANA, B12 or folic acid deficiencies may suggest a maladsorption issue. I think all minimal or borderline abnormalities on a standard celiac disease panel should be considered. Classic celiac disease with significant gastrointestinal symptoms or the characteristic, dermatitis herpetiformis rash may be completely absent. Patients may experience fatigue, chronic fatigue syndrome, generalized pain, fibromyalgia, brain fog or peripheral neuropathy. As mentioned in my last post, gluten sensitivity should always be considered in chronic fatigue syndrome, known to be associated with immuno-dysregulation. A celiac test, for what its worth, is always included in my initial workup of new patients.
A young woman recently came to see me with complaints compatible with chronic Lyme. On closer questioning she admitted that a gluten free diets had resolved nearly all of her symptoms. As I tried to figure out what to do her sagacious father suggested she stay on a gluten free diet to find out what symptoms, if any, remained. Great idea.
That having been said, I still think that most Lyme patients do not need a gluten free diet. It is required for a relatively small percent of patients and it is an onerous undertaking.
There are genetic factors which predispose patients to have the illness, HLA types, DQ2 and DQ8 may be checked. Ultimately, in many cases, the only way to know if the diet will help is to try it for 8-12 weeks.
There remains the question of whether Lyme causes gluten problems. The answer is, I don't know, maybe. There is evidence that infections may precipitate the appearance of celiac disease, the frequency or which increases with age.