Some people develop osteoporosis, the mineral loss disease that leads to brittle bones, because their bodies cannot tolerate wheat flour.

    A report published in the current issue of the Archives of Internal Medicine said that the intolerance of gluten (a form of protein found in grains such as wheat, barley, and rye), called celiac disease, can be treated, so the damage done by osteoporosis can be reversed in such patients.

Screening people with osteoporosis for a condition that makes it difficult to digest wheat may help improve treatment and reduce the risks associated with the common bone-weakening disease.

　 "Our results suggest that as many as three to four percent of patients who have osteoporosis have the bone disease as a consequence of having celiac disease, which makes them unable to absorb normal amounts of calcium and vitamin D," said William Stenson, a Washington University physician at Barnes-Jewish Hospital in St. Louis.

    The report was based on a look at 840 patients, some of whom had osteoporosis.

    Researchers found that nearly 4.5% (12) of the osteoporosis patients tested positive for celiac disease compared with only 1.0 % (six) of the women without osteoporosis.

    Biopsy-proven celiac disease was confirmed in 3.4% of women with osteoporosis and only 0.2% of women without osteoporosis, according to the report.

    "Bone density ... improved dramatically on a gluten-free diet," Stenson said. "We believe the diet allowed their intestines to heal, and that allowed them to absorb normal amounts of calcium and vitamin D to reverse bone loss." Enditem

What happens to people with celiac disease?

Celiac disease can cause different problems at different times:

• An infant with celiac disease may have abdominal pain and diarrhea (even bloody diarrhea), and may fail to grow and gain weight.
• A young child may have abdominal pain with nausea and lack of appetite, anemia (not enough iron in the blood), mouth sores and allergic dermatitis (skin rash).
• A child could be irritable, fretful, emotionally withdrawn or excessively dependent.
• In later stages, a child may become malnourished, with or without vomiting and diarrhea. This would cause the child to have a large tummy, thin thigh muscles and flat buttocks.
• Teenagers may hit puberty late and be short. Celiac disease might cause some hair loss (a condition called alopecia areata).

What happens in adults with celiac disease?

Comment in:

• Pediatrics. 2004 Dec;114(6):1734; author reply 1734.
• Pediatrics. 2004 Nov;114(5):1371.

 
Range of neurologic disorders in patients with celiac disease.

Zelnik N, Pacht A, Obeid R, Lerner A.

Department of Pediatrics, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. nzelnik@netvision.net.il

OBJECTIVE: During the past 2 decades, celiac disease (CD) has been recognized as a multisystem autoimmune disorder. A growing body of distinct neurologic conditions such as cerebellar ataxia, epilepsy, myoclonic ataxia, chronic neuropathies, and dementia have been reported, mainly in middle-aged adults. There still are insufficient data on the association of CD with various neurologic disorders in children, adolescents, and young adults, including more common and "soft" neurologic conditions, such as headache, learning disorders, attention-deficit/hyperactivity disorder (ADHD), and tic disorders. The aim of the present study is to look for a broader spectrum of neurologic disorders in CD patients, most of them children or young adults.

METHODS: Patients with CD were asked to fill in a questionnaire regarding the presence of neurologic disorders or symptoms. Their medical charts were reviewed, and those who were reported as having neurologic manifestations underwent neurologic examination and brain imaging or electroencephalogram if required. Their neurologic data were compared with that of a control group matched for age and gender.

RESULTS: Patients with CD were more prone to develop neurologic disorders (51.4%) in comparison with control subjects (19.9%). These disorders include hypotonia, developmental delay, learning disorders and ADHD, headache, and cerebellar ataxia. Epileptic disorders were only marginally more common in CD. In contrast, no difference was found in the prevalence of tic disorders in both groups. Therapeutic benefit, with gluten-free diet, was demonstrated only in patients with transient infantile hypotonia and migraine headache.

 CONCLUSION: This study suggests that the variability of neurologic disorders that occur in CD is broader than previously reported and includes "softer" and more common neurologic disorders, such as chronic headache, developmental delay, hypotonia, and learning disorders or ADHD. Future longitudinal prospective studies might better define the full range of these neurologic disorders and their clinical response to a gluten-free diet.

PMID: 15173490 [PubMed - indexed for MEDLINE]

Treatment for celiac disease requires elimination of the storage proteins found in wheat, rye, and barley. The inclusion of oats and wheat starch is controversial. Research supports that oats may be acceptable for patients with celiac disease and can improve the nutritional quality of the diet. However, use of oats is not widely recommended in the United States because of concerns of potential contamination of commercial oats. Studies assessing the contamination of commercial oats are limited. Research indicates no differences in patients choosing a strict wheat starch-containing, gluten-free diet vs. a naturally gluten-free diet. Factors other than trace gluten may be the cause of continued villous atrophy in some patients.

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