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The Heartbreak of Wheat-Related Disorders
Published in Stephen T. Sinatra, Mark C. Houston, Nutritional and Integrative Strategies in Cardiovascular Medicine, 2022
The 8:1 ratio of extraintestinal versus intestinal symptoms is not limited to celiac disease. In a prospective 1-year study of suspected non-celiac gluten sensitivity (NCGS)–related disorders from 38 Italian centers (27 centers of adult gastroenterology, 5 of internal medicine, 4 of pediatrics, and 2 of allergy)—all recognized as referral centers of excellence and included in the register of the Italian Health Ministry for the diagnosis of gluten-related disorders—53% of patients presented with non-abdominal complaints. The most frequent extraintestinal manifestations were fatigue and lack of well-being, reported by 64% and 68%, respectively, of the enrolled subjects. In addition, a high prevalence of neuropsychiatric symptoms including headache (54%), anxiety (39%), ‘foggy mind’ (38%), and arm/leg numbness (32%) was recorded. Other extraintestinal manifestations emerging from the analysis of the survey responses were joint/muscle pain often misdiagnosed as fibromyalgia (31%), weight loss (25%), anemia (22%), due both to iron deficiency and low folic acid, depression (18%), dermatitis (18%), and skin rash (29%).52 With its global impact in the body and lack of isolated tissue vulnerability, a high degree of suspicion is required for a clinician to investigate a presenting patient for a WRD. Any of the above comorbidities, in a presenting cardiovascular patient, may emphasize the value of screening for a WRD.
Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
The gluten-free diet is not without nutrition and non-nutrition risks (Table 16.16). It should be recommended only when necessary for gluten-related disorders and should be supervised by a dietitian. A number of nutrients, notably vitamin D and folate, are at risk for deficiency on a GFD, with lack of nutrient fortification being a contributing factor. In comparison to gluten-containing equivalents, the sugar and fat added into processed gluten-free foods to increases palatability, increases energy content and glycemic load, reduces diet quality, and contributes to the risk of becoming overweight or obese. Processed gluten-free foods have an acceptably low gluten content (<20 ppm) that nevertheless cumulatively, with excess daily intake, can lead to persistent enteropathy. Children may be uniquely at risk given processed foods remain a significant component of their diet. An all-natural GFD is healthiest and may strictly be required, at least in the short term, for patients with refractory celiac disease reporting dietary compliance.
Gastroenterology
Published in Hilary McClafferty, Integrative Pediatrics, 2017
Overlap with symptoms of gluten-related disorders such as celiac disease, non-celiac gluten sensitivity, and wheat allergy can make diagnosis more challenging. Even adoption of a gluten-free diet can improve IBS symptoms in those without a formal diagnosis of gluten-related disorder, making a low threshold for screening for celiac disease appropriate (Makharia, Catassi, and Makharia 2015).
Fibromyalgia and Nutrition: An Updated Review
Published in Journal of the American College of Nutrition, 2021
Laura Tomaino, Lluís Serra-Majem, Stefania Martini, Maria Rosaria Ingenito, Paola Rossi, Carlo La Vecchia, Fabrizia Bamonti, Luisella Vigna
Among the gastrointestinal manifestations of FM, patients often suffer from nonceliac gluten sensitivity symptoms and FM spectrum of symptoms may overlap with gluten-related disorders. The role of a gluten-free diet (GFD) on patients with FM and gluten-sensitivity (but negative antitransglutaminase antibodies) was evaluated on gastrointestinal symptoms. In particular, the effects of a GFD were compared with the effects of a hypocaloric diet (HCD) in FM patients in a single-center, randomized, open-label, parallel-group trial (40). The 74 subjects enrolled in the study were randomly assigned to the dietary interventions and observed for twenty-four weeks. The first group followed a GFD (n = 35, all females), while the second group an HCD (n = 40, of which 2 males). At the end of the treatment, both interventions were associated with an improvement of symptoms. However, the effects of GFD were not superior to HCD (40).
Coeliac disease: beyond genetic susceptibility and gluten. A narrative review
Published in Annals of Medicine, 2019
Giovanni Mario Pes, Stefano Bibbò, Maria Pina Dore
Gluten-degrading microbiota, especially if located in the upper gastrointestinal tract, could have a role in the pathophysiology of gluten-related disorders. Rothia strains, in particular, R. mucilaginosa and R. aeria, have the ability to produce gliadin-degrading enzymes that cleave immunogenic gluten [116]. Additional microbial species capable of cleaving gluten, such as Actinomyces odontolyticus and Streptococcus spp. were isolated in the upper gastrointestinal tract [117]. In an experimental model, Bifidobacteria spp. were able to attenuate the pro-inflammatory effect of gliadin on Caco-2 cells, together with a significant reduction in secretion of inflammatory mediators like NF-kB, TNF–α and IL–1β [118]. Furthermore, Bifidobacteria spp. also protected the tight junctions of Caco-2 cells against the effects of gliadin, enhancing Zonulin-1 (ZO-1) expression [119]. Moreover, Shigella, E. coli and Bifidobacteria spp. influence the production of cytokines by monocytes [120] and, Bifidobacteria spp., in particular, modulate the phenotypic and functional maturation of dendritic cells [121]. Although a growing number of studies are reporting statistically significant differences between the faecal microbiota in CD patients and that of normal subjects, doubts remain as to whether CD patient microbiota is distinct since birth and has a causative role, or the alteration is merely a consequence of the intestinal inflammation triggered by the disease.
Nitric oxide pathway as a plausible therapeutic target in autism spectrum disorders
Published in Expert Opinion on Therapeutic Targets, 2022
Rishab Mehta, Anurag Kuhad, Ranjana Bhandari
Autism spectrum disorder (ASD) is an intricate neurodevelopmental disorder that is typically characterized by deficient social interaction and communication skills, restrictive, rigid, pervasive, as well as stereotypic behavior. ASD involves complex etiology where there is an amalgamation of genetic factors, epigenetic, and environmental factors, as suggested by current research reports. Patients who have ASD are also associated with co-morbidities such as anxiety, depression, aggression, epilepsy, and the most commonly seen gastrointestinal complications. Dysregulation of microbiome of gut has seen to be involved in modulating functions of GI tract with the ability to affect intestinal permeability, mucosal immune function, and intestinal motility and sensitivity. Research and clinical studies have indicated that these gastrointestinal complications are further responsible for immune system deregulation, mitochondrial dysfunction leading to oxidative and nitrosative stress leading to neuroinflammation, which worsens the behavioral complexities of ASD patients. Many pathophysiological mechanisms possibly link ASD and GI disturbances which is shown by most recent studies including intestinal inflammation with or without autoimmunity, immunoglobulin E-mediated or cell-mediated GI food allergies as well as gluten-related disorders (celiac disease, wheat allergy, non-celiac gluten sensitivity). However, this is a controversial topic and one of the major controversies surrounding ‘leaky gut syndrome’ is the proposed association with autism. While there is research exploring the brain-gut connection and autism, there is no definitive evidence that a ‘leaky gut’ alone causes autism or worsens the condition of autistic patients.