Green May: a person with celiac disease may have neurological impairment

Celiac disease is triggered by the ingestion of gluten, a protein found in grains such as wheat, oats, rye and barley. (photo: Beatrice Schmuki / Pixabay)

Celiac disease is an autoimmune and genetic disease triggered by the ingestion of gluten (a protein found in grains such as wheat, oats, rye and barley). It attacks the body’s defense cells, causing an inflammatory process that mainly affects the small intestine, resulting in villous atrophy of the organ and decreasing the ability to absorb nutrients.

Since 2016, a bill from the National Federation of Celiacs (Fenacelbra) is still being considered in the Chamber of Deputies, so that today, May 20, becomes the National Day of People with Celiac Disease. celiac disease officially with the government. .

Marcelo Valadares, neurosurgeon, physician at Israelita Albert Einstein Hospital (SP) and researcher in the discipline of neurosurgery at the Faculty of Medical Sciences of the State University of Campinas (Unicamp), explains that “celiac disease is considered multisystemic, so it can affect many areas of the body, including the brain”. the neurological manifestations of the disease are headache, peripheral neuropathy and ataxia”.
The neurosurgeon teaches that the complete suspension of gluten from the diet is only recommended when the patient has a diagnosis of celiac disease or gluten sensitivity in the celiac (NCGS). “The first is an autoimmune, multisystemic and hereditary disease. The second (NCGS) is ‘intolerance’, which can only be diagnosed after celiac disease has been ruled out.”

Marcelo Valadares, Mr.
Marcelo Valadares, neurosurgeon, physician at Israelita Albert Einstein Hospital, says celiac disease is autoimmune, multisystem and hereditary (photo: Personal Archives)

And for this diagnosis to occur, Marcelo Valadares points out that the patient must consult a gastroenterologist, who will prescribe the necessary examinations (serology and upper digestive endoscopy with biopsy of 6 to 8 fragments of the duodenal portion of the intestine). “Before taking the examinations, the patient should not restrict gluten, as this may interfere with the diagnosis. This is the only way to achieve a reliable result. When there is a mild headache or migraine as a symptom, the neurologist consulted can be an ally in reaching the diagnosis, correctly evaluating the symptoms and, above all, considering the possibility of this disease.”

The neurosurgeon reminds us that migraine is not always linked to the ingestion of gluten. “There are many other causes. However, when associated with celiac disease, patients typically show significant improvements shortly after permanently stopping gluten.”

Marcelo Valadares specifies that the headache caused by celiac disease is linked to inflammatory cytokines: “Contact with gluten triggers a systemic response with the production of inflammatory irradiators which would cause, for example, the symptoms of headache. This is why a diagnosed celiac who reduces gluten and has migrainefor example, reduces the frequency of pain with the removal of protein from food”.

The neurosurgeon says that for a long time it was believed that the neurological manifestations of celiacs were linked to the loss of vitamins caused by gluten damage to the small intestine. “In 1966, however, a research performed a biopsy of brain tissue and peripheral nerves, and it was observed that there was inflammation. This inflammation is believed to have originated from the appropriate immune response, attacking the very structures of the nervous systems central and peripheral”, he explains.

Among the main forms of neurological manifestation observed in celiacs is ataxia. “Ataxias are symptoms of motor incoordination in the cerebellum, which is responsible for several functions. Patients with celiac disease can often have an inflammatory process in the cerebellum, which can lead to incoordination of speech and movement arms or legs”, explains the neurosurgeon.

Marcelo Valadares warns that “ataxia is a serious problem. But most of the clinical manifestations associated with celiac disease can be potentially serious if left untreated, especially gastrointestinal manifestations.”

In addition, another common reaction is peripheral neuropathy, which affects the nerves of the hands and feet: “It can mainly cause changes in sensitivity, such as the perception of touch, temperature, vibration and even changes in strength. The disease can also cause changes in peripheral sensitivity. neuropathy and diabetes mellitus”. In this case, the neurologist doctor will be able to correctly assess and guide what is responsible and how to treat.

Exact diagnostic confirmations excluding do glten da diet

Marcelo Valadares says it’s very important to remember that celiac disease isn’t just a simple food intolerance and therefore needs to be treated seriously. “There are no palliative treatments: the only treatment available today is the total exemption of gluten from the diet and cross-contamination. A minimum percentage of ingested gluten (a bran, for example) can already be harmful for the celiac both at the time of ingestion and in the future.”

The doctor warns: “It is by no means a medical recommendation that these patients continue to ingest gluten. It is even described in studies. Total exclusion from the mandatory diet. There are now excellent gluten-free options on major markets. , which are increasingly accessible. There are also ways to eat healthy at home. Always remember that the patient should never remove gluten from himself before taking the examinations with advice. physician: this may affect the diagnosis.”

there is no cure

Wheat forbidden sign
Although it is not a rare disease, this disease is still poorly understood, especially in Brazil. (photo: Kurious/Pixabay)

There is no cure for celiac disease and so far the only possible treatment is complete withdrawal from foods containing gluten.

The classic form of the disease, better known even among self-diagnosed celiacs, presents mainly with intestinal symptoms, such as: diarrhea, weight loss, excess gas and abdominal distention. Often, when symptoms are not obvious, it is difficult to identify them through other manifestations, such as neurological changes.

Although it is not a rare disease, this disease is still poorly understood, especially in Brazil. It is estimated that 1% of the world’s population has celiac disease. However, in the country there are still no official statistics that define the number of celiacs, according to the National Federation of Celaco Associations of Brazil (Fenacelbra)mainly due to the difficulty that many patients have in obtaining an adequate diagnosis.

Marcelo Valadares points out that “although the figures are not exact in Brazil, Fenacelbra estimates that 2 million people have celiac disease in the country. It is therefore not a rare disease”. The lack of knowledge on the subject, including in the medical field, usually brings difficulties so that, in many cases, the correct diagnosis is reached, especially when the symptoms are not classic”.

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