Rebuttal to Dr. Dave Wilson’s post in the RGJ regarding “Gluten-free diet is disservice to athletes.”

The following is a response from Dr. Gates to a letter to the editor stating that going on a gluten free diet was a disservice to the athletes on the Nevada football team.  The letter can be found hereThe original article can be found here.

Dr. Wilson, first and foremost thank you for expressing your expert opinion on the subject of the Wolf Pack football team going gluten free. The original article in the RGJ chronicled individual accounts of players, coaches, and training staff of our Nevada football team who are experiencing benefits from a gluten free diet. In your response to the original article, you stated that several nonfactual statements were made. Additionally, you pointed to there being a complete lack of research regarding gluten and its association with depression or Alzheimers. You then went on for several paragraphs to generally say that removing gluten from one’s diet is a fad, and that this fad has been propagated by celebrities who have claimed to feel better being gluten free, which in it of itself lacks scientific validity.

The Northern Nevada community is fortunate to have your skepticism presented in a public forum. For those individuals attempting to go gluten free or already on a gluten free diet, they are frequently presented with assertions similar to yours, and often in my experience do not know what to say except “that I feel better being gluten free.”

The intent of this rebuttal is to provide facts for those in the lay public who are already gluten free or considering the gluten free lifestyle, and to present data that juxtaposes your opinions. I will note, that due to time constraints, each statement outlined herein will not be noted with the specific attached research article. Rather, 39 articles have been selected which support the data I am presenting, and when appropriate, a specific citation will be referenced.

The first item to address is that you stated “nor is there any connection I can find between gluten intake and depression.” Using PubMed, which in your words “the largest database of peer-reviewed biomedical journals,” one can find 99 articles when a search query of “gluten and depression” is employed. I only had time this evening to go through 40 of these. Many of these articles go on to state clearly that those suffering with celiac or gluten related sensitivity have a variety of cognitive symptoms including depression and anxiety. In addition, those with bipolar disorder and schizophrenia have been shown to have elevated antibodies (allergic and immune chemicals) to gluten, different than the antibody profile typically seen in celiac disease patients. Furthermore, there is data suggesting that those with gluten sensitivities have improved psychological well being as well as improvements in depression when on a gluten free diet. It is recommended that the readers review the attached articles to further learn about the associations regarding gluten sensitivities and cognitive symptoms such as depression.

Next, it would be fitting to present data from the neurologic literature regarding gluten. That data is overwhelming thanks in large part to British Neurologist Dr. Hadjivassiliou, who has authored or co-authored 116 articles on gluten being associated with neurologic diseases ranging from peripheral neuropathy (where individuals have numbness, tingling, and or burning in their hands or feet), ataxia (where an individual has lack of balance), and conditions of muscle weakness termed polymyositis and dermatomyositis. Dr. Hadjivassiliou has demonstrated that a significant number of those with peripheral neuropathy and ataxia, who’s cause of their condition was “unknown,” is actually due to an autoimmune problem involving gluten. The prevalence of neurologic conditions in celiac disease cannot be overemphasized. Without being pedantic, it is recommended that the readers go to the article attached from the journal Movement Disorders that was published in 2009, where the statistics on migraine, carpal tunnel syndrome, vestibular dysfunction, seizures, and myelitis in celiac disease patients are presented. Furthermore, in this article it was asserted that “interestingly, 35% of patients with CD (celiac disease) reported a history of psychiatric disease including depression, personality changes, or even psychosis.” Lastly, in the journal European Neurology published in 1999, the authors stated that in a neurology based practice, memory disturbance was one of the presenting symptoms which frequently led to the diagnosis of celiac disease. Though I was not the one to claim in the original RGJ article that gluten causes Alzheimers, it is fair to say that neurologists from recognized journals have observed gluten mediated autoimmune reactions to be associated with memory disturbance.

Let’s address your general statement that gluten affects 5% of the population, and the other 95% do not have to worry about this dietary protein. First of all, this by some estimates is a low number. According to the January 2014 edition of the journal Clinical Experiments in Gastroenterology “once believed to be relatively rare, particularly in the US, it is now thought that gluten-related disorders affect nearly 10% of the population.”

For the reader to fully understand this, we have to compartmentalize celiac disease, wheat allergies and a new diagnostic entity termed non celiac gluten sensitivity. Celiac disease and wheat allergies have been acknowledged in the literature for some time. However, non celiac gluten sensitivity has risen out of the rubble due to patient accounts that they “feel better when not eating gluten.” Some studies have shown antibody reactions to gluten proteins among those with non celiac gluten sensitivity, however the diagnosis is primarily predicated on the individual going off gluten and observing to see if there are improvements in their symptoms. From the journal of BMC Gastroenterology in February of 2014, it was specifically stated that “NCGS (non celiac gluten sensitivity) is characterized by gastro-esophageal reflux disease” commonly known as GERD, “irritable bowel syndrome (IBS) like symptoms (i.e., abdominal pain, bloating, diarrhea, constipation and alternating bowel) along with extra-intestinal manifestations (“foggy mind”, headache, fatigue, joint and muscle pain, leg/arm numbness, eczema/rash, depression/anxiety and anemia) that occur soon after gluten ingestion, rapidly improving after gluten withdrawal and relapsing in a few hours or days after gluten challenge.” Perhaps many of our tried and true football players have features of non celiac gluten sensitivity.

Thus your comments that a gluten free diet is a disservice to athletes, it is a fad, and that gluten has no association with depression, do not seem to represent the entire issue. The information and references outlined in this response, as well as those attached should give the public a better understanding of some of the literature on this topic. Also, gluten free supporters should have a better idea of the broad spectrum of diseases and symptoms with which gluten can be associated with. Speaking from a purely philosophical point of view, I would rather have an athlete eat a sweat potato for carbohydrate consumption than having pizza and beer. The science strongly supports Matt Eck’s and Coach Polian’s position on the topic and I look forward to a probable improvement in endurance and injury recovery time for their players in the coming years. And on a somewhat related topic I’d like to say to the football team “Go Pack!”

Respectfully,
Randall Gates, D.C., D.A.C.N.B.
Board Certified Chiropractic Neurologist

 

References:

1. Neuropathy associated with gluten sensitivity.
Hadjivassiliou M, Grünewald RA, Kandler RH, Chattopadhyay AK, Jarratt JA, Sanders DS, Sharrack B, Wharton SB, Davies-Jones GA.
J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6. Epub 2006 Jul 11.
PMID: 16835287 [PubMed – indexed for MEDLINE] Free PMC Article
Related citations 
2. Non-Celiac Gluten sensitivity: the new frontier of gluten related disorders.
Catassi C, Bai JC, Bonaz B, Bouma G, Calabrò A, Carroccio A, Castillejo G, Ciacci C, Cristofori F, Dolinsek J, Francavilla R, Elli L, Green P, Holtmeier W, Koehler P, Koletzko S, Meinhold C, Sanders D, Schumann M, Schuppan D, Ullrich R, Vécsei A, Volta U, Zevallos V, Sapone A, Fasano A.
Nutrients. 2013 Sep 26;5(10):3839-53. doi: 10.3390/nu5103839.
PMID: 24077239 [PubMed – in process] Free PMC Article
Related citations 
3. Non-celiac gluten sensitivity: clinical relevance and recommendations for future research.
Mooney PD, Aziz I, Sanders DS.
Neurogastroenterol Motil. 2013 Nov;25(11):864-71. doi: 10.1111/nmo.12216. Epub 2013 Aug 12.
PMID: 23937528 [PubMed – in process]
Related citations 
4. Non-celiac gluten sensitivity: questions still to be answered despite increasing awareness.
Volta U, Caio G, Tovoli F, De Giorgio R.
Cell Mol Immunol. 2013 Sep;10(5):383-92. doi: 10.1038/cmi.2013.28. Epub 2013 Aug 10. Review.
PMID: 23934026 [PubMed – indexed for MEDLINE]
Related citations 
5. Non-celiac gluten sensitivity. Is it in the gluten or the grain?
Nijeboer P, Bontkes HJ, Mulder CJ, Bouma G.
J Gastrointestin Liver Dis. 2013 Dec;22(4):435-40.
PMID: 24369326 [PubMed – in process] Free Article
Related citations 
6. Diagnosis and classification of celiac disease and gluten sensitivity.
Tonutti E, Bizzaro N.
Autoimmun Rev. 2014 Apr-May;13(4-5):472-6. doi: 10.1016/j.autrev.2014.01.043. Epub 2014 Jan 15.
PMID: 24440147 [PubMed – in process]
Related citations 
7. Biomarkers of gluten sensitivity in patients with non-affective psychosis: a meta-analysis.
Lachance LR, McKenzie K.
Schizophr Res. 2014 Feb;152(2-3):521-7. doi: 10.1016/j.schres.2013.12.001. Epub 2013 Dec 22.
PMID: 24368154 [PubMed – in process]
Related citations 
8. Non-celiac gluten sensitivity: literature review.
Mansueto P, Seidita A, D’Alcamo A, Carroccio A.
J Am Coll Nutr. 2014;33(1):39-54. doi: 10.1080/07315724.2014.869996.
PMID: 24533607 [PubMed – in process]
Related citations 
9. Autoantibodies in gluten ataxia recognize a novel neuronal transglutaminase.
Hadjivassiliou M, Aeschlimann P, Strigun A, Sanders DS, Woodroofe N, Aeschlimann D.
Ann Neurol. 2008 Sep;64(3):332-43. doi: 10.1002/ana.21450.
PMID: 18825674 [PubMed – indexed for MEDLINE]
Related citations 
10. Sensory ganglionopathy due to gluten sensitivity.
Hadjivassiliou M, Rao DG, Wharton SB, Sanders DS, Grünewald RA, Davies-Jones AG.
Neurology. 2010 Sep 14;75(11):1003-8. doi: 10.1212/WNL.0b013e3181f25ee0.
PMID: 20837968 [PubMed – indexed for MEDLINE]
Related citations 
11. GAD antibody-associated neurological illness and its relationship to gluten sensitivity.
Hadjivassiliou M, Aeschlimann D, Grünewald RA, Sanders DS, Sharrack B, Woodroofe N.
Acta Neurol Scand. 2011 Mar;123(3):175-80. doi: 10.1111/j.1600-0404.2010.01356.x.
PMID: 20456245 [PubMed – indexed for MEDLINE]
Related citations 
12. Immune-mediated acquired ataxias.
Hadjivassiliou M.
Handb Clin Neurol. 2012;103:189-99. doi: 10.1016/B978-0-444-51892-7.00011-5. Review.
PMID: 21827889 [PubMed – indexed for MEDLINE]
Related citations 
13. Should we be ‘nervous’ about coeliac disease? Brain abnormalities in patients with coeliac disease referred for neurological opinion.
Currie S, Hadjivassiliou M, Clark MJ, Sanders DS, Wilkinson ID, Griffiths PD, Hoggard N.
J Neurol Neurosurg Psychiatry. 2012 Dec;83(12):1216-21. doi: 10.1136/jnnp-2012-303281. Epub 2012 Aug 20.
PMID: 22906616 [PubMed – indexed for MEDLINE]
Related citations 
14. MR spectroscopy and atrophy in Gluten, Friedreich’s and SCA6 ataxias.
Hadjivassiliou M, Wallis LI, Hoggard N, Grünewald RA, Griffiths PD, Wilkinson ID.
Acta Neurol Scand. 2012 Aug;126(2):138-43. doi: 10.1111/j.1600-0404.2011.01620.x. Epub 2011 Nov 10.
PMID: 22070551 [PubMed – indexed for MEDLINE]
Related citations 
15. Transglutaminase 6 antibodies in the diagnosis of gluten ataxia.
Hadjivassiliou M, Aeschlimann P, Sanders DS, Mäki M, Kaukinen K, Grünewald RA, Bandmann O, Woodroofe N, Haddock G, Aeschlimann DP.
Neurology. 2013 May 7;80(19):1740-5. doi: 10.1212/WNL.0b013e3182919070. Epub 2013 Apr 10.
PMID: 23576621 [PubMed – indexed for MEDLINE]
Related citations 
16. Gluten-related neurologic dysfunction.
Hadjivassiliou M, Duker AP, Sanders DS.
Handb Clin Neurol. 2014;120:607-19. doi: 10.1016/B978-0-7020-4087-0.00041-3. Review.
PMID: 24365341 [PubMed – indexed for MEDLINE]
Related citations 
17. Gluten and wheat intolerance today: are modern wheat strains involved?
de Lorgeril M, Salen P.
Int J Food Sci Nutr. 2014 Feb 13. [Epub ahead of print]
PMID: 24524657 [PubMed – as supplied by publisher]
Related citations 
18. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity.
Caio G, Volta U, Tovoli F, De Giorgio R.
BMC Gastroenterol. 2014 Feb 13;14:26. doi: 10.1186/1471-230X-14-26.
PMID: 24524388 [PubMed – in process] Free PMC Article
Related citations 
19. US perspective on gluten-related diseases.
Leonard MM, Vasagar B.
Clin Exp Gastroenterol. 2014 Jan 24;7:25-37. eCollection 2014. Review.
PMID: 24493932 [PubMed – as supplied by publisher] Free PMC Article
Related citations 
20. Genetic etiology of schizophrenia: possible role of immunoglobulin ? genes.
Pandey JP.
Psychiatr Genet. 2014 Apr;24(2):83-6. doi: 10.1097/YPG.0000000000000017.
PMID: 24572972 [PubMed – in process]
Related citations 
21. Coeliac disease presenting with neurological disorders.
Luostarinen L, Pirttilä T, Collin P.
Eur Neurol. 1999;42(3):132-5.
PMID: 10529537 [PubMed – indexed for MEDLINE]
Related citations 
22. Clinical findings and anti-neuronal antibodies in coeliac disease with neurological disorders.
Volta U, De Giorgio R, Petrolini N, Stangbellini V, Barbara G, Granito A, De Ponti F, Corinaldesi R, Bianchi FB.
Scand J Gastroenterol. 2002 Nov;37(11):1276-81.
PMID: 12465725 [PubMed – indexed for MEDLINE]
Related citations 
23. Seroreactive marker for inflammatory bowel disease and associations with antibodies to dietary proteins in bipolar disorder.
Severance EG, Gressitt KL, Yang S, Stallings CR, Origoni AE, Vaughan C, Khushalani S, Alaedini A, Dickerson FB, Yolken RH.
Bipolar Disord. 2013 Dec 6. doi: 10.1111/bdi.12159. [Epub ahead of print]
PMID: 24313887 [PubMed – as supplied by publisher]
Related citations 
24. Discordant patterns of bacterial translocation markers and implications for innate immune imbalances in schizophrenia.
Severance EG, Gressitt KL, Stallings CR, Origoni AE, Khushalani S, Leweke FM, Dickerson FB, Yolken RH.
Schizophr Res. 2013 Aug;148(1-3):130-7. doi: 10.1016/j.schres.2013.05.018. Epub 2013 Jun 6.
PMID: 23746484 [PubMed – indexed for MEDLINE]
Related citations 
25. Markers of gluten sensitivity in acute mania: a longitudinal study.
Dickerson F, Stallings C, Origoni A, Vaughan C, Khushalani S, Yolken R.
Psychiatry Res. 2012 Mar 30;196(1):68-71. doi: 10.1016/j.psychres.2011.11.007. Epub 2012 Mar 3.
PMID: 22386570 [PubMed – indexed for MEDLINE]
Related citations 
26. Randomised clinical trial: gluten may cause depression in subjects with non-coeliac gluten sensitivity – an exploratory clinical study.
Peters SL, Biesiekierski JR, Yelland GW, Muir JG, Gibson PR.
Aliment Pharmacol Ther. 2014 May;39(10):1104-12. doi: 10.1111/apt.12730. Epub 2014 Apr 1.
PMID: 24689456 [PubMed – in process]
Related citations 
27. Glyphosate, pathways to modern diseases II: Celiac sprue and gluten intolerance.
Samsel A, Seneff S.
Interdiscip Toxicol. 2013 Dec;6(4):159-184. Review.
PMID: 24678255 [PubMed – as supplied by publisher] Free PMC Article
Related citations 
28. [Psychological alterations in patients with adult celiac disease].
Martínez Cerezo FJ, Castillejo G, Guillen N, Morente V, Simó JM, Tena FJ, Marsal J, Pascual D.
Gastroenterol Hepatol. 2014 Apr;37(4):240-5. doi: 10.1016/j.gastrohep.2013.12.006. Epub 2014 Feb 25. Spanish.
PMID: 24576676 [PubMed – in process]
Related citations 
29. Reduced quality of life in coeliac disease is more strongly associated with depression than gastrointestinal symptoms.
Sainsbury K, Mullan B, Sharpe L.
J Psychosom Res. 2013 Aug;75(2):135-41. doi: 10.1016/j.jpsychores.2013.05.011. Epub 2013 Jun 25.
PMID: 23915769 [PubMed – indexed for MEDLINE]
Related citations 
30. Depressed mood associated with gluten sensitivity–resolution of symptoms with a gluten-free diet.
Carr AC.
N Z Med J. 2012 Nov 23;125(1366):81-2. No abstract available.
PMID: 23254531 [PubMed – indexed for MEDLINE]
Related citations 
31. Prevalence of migraine in patients with celiac disease and inflammatory bowel disease.
Dimitrova AK, Ungaro RC, Lebwohl B, Lewis SK, Tennyson CA, Green MW, Babyatsky MW, Green PH.
Headache. 2013 Feb;53(2):344-55. doi: 10.1111/j.1526-4610.2012.02260.x. Epub 2012 Nov 5.
PMID: 23126519 [PubMed – indexed for MEDLINE]
Related citations 
32. Absence of somatization in non-coeliac gluten sensitivity.
Brottveit M, Vandvik PO, Wojniusz S, Løvik A, Lundin KE, Boye B.
Scand J Gastroenterol. 2012 Jul;47(7):770-7. doi: 10.3109/00365521.2012.679685. Epub 2012 Apr 23.
PMID: 22519894 [PubMed – indexed for MEDLINE]
Related citations 
33. Serological tests in gluten sensitivity (nonceliac gluten intolerance).
Volta U, Tovoli F, Cicola R, Parisi C, Fabbri A, Piscaglia M, Fiorini E, Caio G.
J Clin Gastroenterol. 2012 Sep;46(8):680-5. doi: 10.1097/MCG.0b013e3182372541.
PMID: 22138844 [PubMed – indexed for MEDLINE]
Related citations 
34. Psychiatric comorbidities in women with celiac disease.
Arigo D, Anskis AM, Smyth JM.
Chronic Illn. 2012 Mar;8(1):45-55. doi: 10.1177/1742395311417639. Epub 2011 Sep 20.
PMID: 21933881 [PubMed – indexed for MEDLINE]
Related citations 
35. Psychiatric comorbidities in patients with celiac disease: Is there any concrete biological association?
Sharma TR, Kline DB, Shreeve DF, Hartman DW.
Asian J Psychiatr. 2011 Jun;4(2):150-1. doi: 10.1016/j.ajp.2011.03.001. Epub 2011 Jun 10.
PMID: 23051084 [PubMed]
Related citations 
36. Positive serum antigliadin antibodies without celiac disease in the elderly population: does it matter?
Ruuskanen A, Kaukinen K, Collin P, Huhtala H, Valve R, Mäki M, Luostarinen L.
Scand J Gastroenterol. 2010 Oct;45(10):1197-202. doi: 10.3109/00365521.2010.496491.
PMID: 20545470 [PubMed – indexed for MEDLINE]
Related citations 
37. Anxiety and depression in adult patients with celiac disease on a gluten-free diet.
Häuser W, Janke KH, Klump B, Gregor M, Hinz A.
World J Gastroenterol. 2010 Jun 14;16(22):2780-7.
PMID: 20533598 [PubMed – indexed for MEDLINE] Free PMC Article
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38. Neurological symptoms in patients with biopsy proven celiac disease.
Bürk K, Farecki ML, Lamprecht G, Roth G, Decker P, Weller M, Rammensee HG, Oertel W.
Mov Disord. 2009 Dec 15;24(16):2358-62. doi: 10.1002/mds.22821.
PMID: 19845007 [PubMed – indexed for MEDLINE]
Related citations 
39. The gluten syndrome: a neurological disease.
Ford RP.
Med Hypotheses. 2009 Sep;73(3):438-40. doi: 10.1016/j.mehy.2009.03.037. Epub 2009 Apr 29.
PMID: 19406584 [PubMed – indexed for MEDLINE]
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