celiac disease – Notes of a Neuropsychiatry Amateur

Celiac disease and dairy proteins – summarization of articles

I want to address the issue of whether dairy could be an issue for those with celiac disease. I don’t think that I will be able to arrive at an exact answer with this post, but I do wish to summarize existing articles and evidence on this topic. From my personal experience, I get all the same symptoms from dairy products as from foods containing gluten. The symptoms include pains in the lower abdomen, bloating, constipation, fatigue, inflammation of the eyelids, as well as psychiatric symptoms including panic attacks, anxiety, and depression. Gathering anecdotal evidence by speaking to reddit users in the gluten-free subreddit, multiple individuals have also expressed the same experience with dairy causing similar symptoms to gluten. Also these individuals noticed that the same symptoms were caused by lactose-free products, therefore likely the culprit is not the sugar (lactose), but the proteins in dairy (casein). Below I will summarize several articles addressing the consumption of casein by individuals with celiac disease.

The first study that I found looking at the correlation between gluten and casein is from 2007, Mucosal reactivity to cow’s milk protein in coeliac disease. This article discusses the fact that some celiac patients on a gluten-free diet still experience gastrointestinal symptoms. The authors then examine whether these patients have an inflammatory immune response to the protein in cow’s milk. The results of this study indicated that in fact in a fraction of celiac patients did experience a similar reaction to the milk protein as to gluten. As usual, I used python to create article summaries, including this one.

Summary:
On clinical grounds cow’s milk (CM) protein sensitivity may be suspected. Here, using rectal protein challenge, we investigated the local inflammatory reaction to gluten and CM protein in adult patients with CD in remission.
In 18 of 20 patients gluten challenge induced neutrophil activation defined as increased MPO release and increased NO synthesis.
A mucosal inflammatory response similar to that elicited by gluten was produced by CM protein in about 50% of the patients with coeliac disease.

Summary using LexRank (graph-based method for computing relative importance of sentences):

Mean rectal ΔMPO was 303 ± 27 µg/l after casein challenge and 16 ± 27 µg/l after challenge with α-lactalbumin.
Compared to healthy controls, patients with CD showed significant increases in rectal NO and MPO concentrations measured 15 h after challenge with both CM and gluten (P < 0·001), while ECP was increased to a similar extent in the two groups ( ).
The major finding in this study is that rectal challenge with CM protein frequently induced a local inflammatory mucosal reaction in patients with CD but not in healthy controls.
Our patients with CD had normal serum levels of IgA, IgG and IgE against casein and α-lactalbumin, which might be explained by the fact that they were on a gluten-free diet and therefore had improved the mucosal integrity.
Our finding that, in a fraction of coeliac patients, CM protein challenge may induce an inflammatory reaction of the same magnitude, as did gluten challenge, may also suggest an innate as well as adaptive immune response to CM, and casein in particular.

There were several other studies on the topic of gluten-free and casein-diet, but they all investigated whether this diet would help patients on the autism spectrum, which is not the topic of my post. I did find another short article on gluten-free and casein-free diet helping with psychotic symptoms. Personally I have a similar experience, as consuming any gluten or dairy increases my paranoia, panic attacks, and intrusive thoughts. The authors claim that there is a following mechanism for psychosis:

“In autism and schizophrenia, incomplete digestion of certain proteins, gluten and casein, cause an autoimmune response as indicated by elevated levels of IgA and IgG antibodies. This intestinal malabsorption also causes pathogenic elements (peptide fractions), which bind to opioid receptors by crossing the blood-brain barrier. This releases exorphins (opiate-like substances, similar to certain drugs) that cause psychotic symptoms.”

Evidence-Based Practice: Introduction of a Gluten-Free and Casein-Free Diet to Alleviate Psychotic Symptoms
A case review of a young boy yielded an unexpected resolution of psychotic symptoms after the introduction of a gluten-free, casein-free (GFCF) diet.
The purpose of this paper is to show that health care professionals may use a gluten-free and casein-free diet (GFCF) as an additional element to standard treatment methods, to alleviate psychotic symptoms.
Additionally noted were similarities between autism and schizophrenia.
Introduction of a GFCF diet helps reduce psychotic symptoms, and gives another option for patients resistant to traditional treatment methods, especially adolescents and young adults.
Keywords: autism, gluten-free, casein-free diet (GFCF), psychosis, schizophrenia

Great toxicology YouTube channel… and celiac disease misdiagnosed as paranoid schizophrenia?

A really great guy – a toxicologist with his own YouTube channel telling real life ER stories. Here is a link to one of his episodes. A woman with delusions read on the internet about a specific colon cleanse, which led her to drinking 1 liter of soy sauce in two hours. 1 liter of soy sauce contains 200 grams of salt. What happened then to her brain? Why did she choose to drink the soy sauce in the first place? Was it due to paranoid schizophrenia, or was something else also going on?

A Woman Drank 1 Liter Soy Sauce Colon Cleanse In 2 Hours. This Is What Happened To Her Brain.

Celiac disease, vitamin and mineral deficiencies, and a beef patty

I’ve done something today that I probably haven’t done for at least a year or more. I bought a beef patty. I felt very guilty because I don’t want to eat large mammals. Ideally I wouldn’t eat any birds or animals, but we have to make practical choices. From my experience, having celiac disease, I don’t absorb vitamins and minerals well. A chicken leg of 100 grams has approximately 6% daily value of cobalamin, 6% DV magnesium, 7% DV potassium, and 25% DV B-6. Without eating meat or fish, you could try to get vitamin B-6 from beans, also fortified cereals contain B-6. Here is the issue – with celiac you cannot eat most fortified cereals and breads since they are not gluten-free, also eating too many beans causes digestive problems. So I had to make a choice and about a year ago I chose to eat seafood and poultry, but not mammals. My reasoning is that compared to chickens and turkeys, large mammals such as pigs and cows have more complex brains and nervous systems and therefore have more complex emotions and might suffer more during their short life in a cage at a factory farm. I have no proof of that, but I had to make a choice.

Unfortunately recently I had to make another choice to start eating red meat again. I was experiencing lethargy and noticed white bands on my nails. Some sources stated that white spots on nails could be a sign of zinc deficiency, while others indicated that there was no correlation. This did lead me to wondering whether I was getting enough zinc, selenium, and B vitamins from chicken and salmon. 100 grams of beef on average contain 43% DV (daily value) of B12, 20% DV of B6. Dietitians of Canada also list beef as top sources of zinc, 75 grams of beef containing 4.0 – 8.6 mg of the mineral (women need 8 mg per day). Chicken is much lower in zinc, 1.3 – 2.2 mg per 75 grams. Salmon was not listed as it is not a good source of zinc, it contains about 0.64 mg per 100 grams. Some studies indicate that it’s harder to absorb zinc from a plant based diet, in addition to that my absorption may be worse due to gut inflammation caused by autoimmune disease.

“With reduced intake of meat and increased intake of phytate-containing legumes and whole grains, movement toward plant-based diets reduces dietary iron and zinc absorption.“

Moving Toward a Plant‐based Diet: Are Iron and Zinc at Risk?

zinc1

Why do we need zinc and what happens if there is a zinc deficiency? Zinc is found in cells throughout the body and is needed to make proteins and DNA. Zinc plays a role in cell division, cell growth, wound healing, and the breakdown of carbohydrates. It is important for the function of the immune system and also the senses of smell and taste.

zinc2

Zinc deficiency can cause appetite loss, poor immune system function, diarrhea, eye and skin lesions, feeling lethargic, strange taste sensations, hair loss, weight loss, poor wound healing. Individuals with chronic conditions and poor absorption are more likely to be zinc deficient.

Zinc performs its biochemical functions as a divalent cation (positively charged ion) primarily when bound to enzymes and other proteins. Zinc is essential as a catalytic, structural, and regulatory ion and is involved in homeostasis (the tendency to maintain a stable, relatively constant internal environment), immune responses, oxidative stress, apoptosis (the death of cells which occurs as a normal and controlled part of an organism’s growth or development), and aging. Zinc is recognized as being important for stabilizing DNA and appears to reside in the nucleus longer than any other cell compartment. Therefore, it is possible that as intracellular levels of zinc increase, more iron will be displaced from nucleoproteins and less OH-driven DNA damage will occur.

Biological consequences of zinc deficiency in the pathomechanisms of selected diseases

A study on zinc deficiency in relation to psychiatry:

“Zinc participation is essential for all physiological systems, including neural functioning, where it participates in a myriad of cellular processes. Converging clinical, molecular, and genetic discoveries illuminate key roles for zinc homeostasis in association with clinical depression and psychosis which are not yet well appreciated at the clinical interface. Intracellular deficiency may arise from low circulating zinc levels due to dietary insufficiency, or impaired absorption from aging or medical conditions, including alcoholism. A host of medications commonly administered to psychiatric patients, including anticonvulsants, oral medications for diabetes, hormones, antacids, anti-inflammatories and others also impact zinc absorption. Furthermore, inefficient genetic variants in zinc transporter molecules that transport the ion across cellular membranes impede its action even when circulating zinc concentrations is in the normal range. Well powered clinical studies have shown beneficial effects of supplemental zinc in depression and it important to pursue research using zinc as a potential therapeutic option for psychosis as well. Meta-analyses support the adjunctive use of zinc in major depression and a single study now supports zinc for psychotic symptoms.”

The Emerging Role for Zinc in Depression and Psychosis

From my own experiment with N=1, I did feel better after eating a beef patty. This could be a coincidence, a placebo effect, or an actual effect of the minerals/vitamins in beef on my mood. I also thought of a substitute for beef that is not a mammal – mussels and clams. A 3-ounce serving of cooked mussels contains about 15% of daily value of zinc. The same amount of moist-cooked clams also provides 15% of the daily value for zinc. Clams and mussels contain high amounts of vitamin B12, selenium, and iron, as well as omega-3 fats. I think therefore it’s possible for me to continue avoiding beef if I include chicken, fish, mussels, and clams.