High prevalence of Celiac Disease in autism revealed
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- Italian researchers discover a high rate of Celiac Disease (CD) in children with autism, even in absence of any gastrointestinal complaints.
- Swedish study reveals children with CD are at increased risk for most psychiatric disorders, including autism.
- Columbia University researchers find biological explanation for wheat sensitivity: systemic immune activation due to breakdown of intestinal barrier.
A team of Italian researchers reviewed data from pre-school 382 children with confirmed diagnosis of autism who had previously undergone screening for CD. Their study reported the prevalence of CD in their sample to be 2.62%, which is significantly higher than the rate of CD reported in the general population. Interestingly, half of the CD-positive children had no symptoms or risk factors related to CD when they performed the serological screening, indicating the need for routine screening for CD in autism.
“If replicated, these data suggest the importance of regular screening for CD in young patients with ASD, and are of relevance for clinical and public health.”
The researchers note that children with autism may not show clear signs of CD, but may instead, express their discomfort via challenging behaviours such as aggressive, oppositional and self-injurious behaviours, withdrawal, and sleep problems.
“In these cases, if a diagnosis of CD is confirmed, the treatment of ASD patients for CD with a gluten-free diet may not only alleviate their CD-related symptoms, but also have a positive impact on associated behavioral problems.”
Conversely, a large nation-wide Swedish study found that children with CD are at increased risk for most psychiatric disorders, including autism. The study examined records of 10,903 children under 18 years of age with CD and 12 710 of their siblings, and found that those with CD had a 1.4-fold greater risk of future psychiatric disorders, including mood disorders, anxiety disorders, eating disorders, behavioral disorders, intellectual disability, ADHD and autism. In contrast, siblings of celiac disease patients were at no increased risk of any of the investigated psychiatric disorders.
Emerging research reveals neuropsychiatric manifestations to be amongst a wide range of extra-intestinal symptoms caused by CD and by wheat sensitivity even in the absence of full CD. The possible mechanism for this could be systemic immune activation caused by translocation of microbial and dietary components from the gut into circulation, due to intestinal cell damage and weakening of the intestinal barrier in Non-Celiac Gluten Sensitivity (NCWS), as reported by Columbia University researchers.
“A systemic immune activation model would be consistent with the generally rapid onset of the reported symptoms in people with non-celiac wheat sensitivity…”
The study authors also noted that NCWS patients who followed a diet that excluded wheat and related cereals for six months were able to normalize their levels of immune activation and intestinal cell damage markers. These changes were associated with significant improvement in both intestinal and non-intestinal symptoms.
This article is part of Treating Autism Clinical & Research Newsletter: Issue 2
Calderoni S., Santocchi E., Del Bianco T., et al. (2016) Serological screening for Celiac Disease in 382 pre-schoolers with Autism Spectrum Disorder. Ital J Pediatr. Nov 16;42(1):98. doi: 10.1186/s13052-016-0308-x.
Butwicka A., Lichtenstein P., Frisén L., et al. (2017) Celiac Disease Is Associated with Childhood Psychiatric Disorders: A Population-Based Study. J Pediatr. 2017 May;184:87-93.e1. doi: 10.1016/j.jpeds.2017.01.043.
Uhde M., Ajamian M., Caio G., et al. (2016) Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut. Dec;65(12):1930-1937. doi: 10.1136/gutjnl-2016-311964.
Campagna G., Pesce M., Tatangelo R., et al. (2016) The progression of coeliac disease: its neurological and psychiatric implications. Nutr Res Rev. Dec 15:1-11. doi: 10.1017/S0954422416000214.
Casella G., Pozzi R., Cigognetti M., et al. (2017) Mood disorders and non-celiac gluten sensitivity. Minerva Gastroenterol Dietol. Mar;63(1):32-37. doi: 10.23736/S1121-421X.16.02325-4.
Jericho H., Sansotta N., & Guandalini S. (2016) Extra-intestinal Manifestations of Celiac Disease: Effectiveness of the Gluten Free Diet. J Pediatr Gastroenterol Nutr. Oct 13. doi: 10.1097/MPG.0000000000001420.