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Celiac Disease and Multiple Sclerosis

Links Possible But Unproven Between The Two Conditions

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Updated September 09, 2011

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The links between celiac disease and multiple sclerosis (MS) seem clear at first. Both are autoimmune diseases, which means they both involve damage to tissues and organs inflicted by your own immune system, and both occur far more frequently in women than in men.

In addition, both conditions involve a wide range of similar symptoms, many of which are easy to overlook or attribute to something else. And both may elude diagnosis by physicians, in large part due to that wide range of symptoms.

Given all that -- plus growing anecdotal evidence of improvements some MS patients report when following the gluten-free diet -- it's easy to assume there's a link between the two conditions.

Well, there may be a link -- after all, most autoimmune diseases seem to share some common genetic factors. However, it's not clear whether there's truly an increased incidence of celiac disease among multiple sclerosis patients, or whether following a gluten-free diet actually can help MS patients manage their condition.

Multiple Sclerosis Progressively Affects Nerves, Spinal Cord

Multiple sclerosis occurs when your immune system attacks the myelin sheath surrounding your nerves, leading to inflammation and progressive damage. Once this nerve covering is damaged, your nerve impulses slow down or stop.

Multiple sclerosis symptoms can include loss of balance and coordination, problems walking or moving your arms and legs, tremors, muscle spasms or numbness and fatigue. Symptoms also can include constipation, brain fog (feelings of fogginess, inattention or difficulty reasoning), depression and problems with vision.

Most MS patients experience "attacks" or periods of increased symptoms, potentially followed by one or more relapses.

It's tough to diagnose multiple sclerosis; your physician may suspect MS on the basis of your symptoms, but first must rule out other conditions with similar symptoms. As with celiac disease, many of the potential symptoms (brain fog, sexual dysfunction, mild depression and fatigue) can be caused by stress, which may lead to delays in diagnosis.

One Study Shows Definitive Link Between Celiac and MS

Research published in 2011 indicates a strong link between multiple sclerosis and celiac disease.

Clinicians in Spain analyzed the prevalence of positive celiac blood tests and biopsies in people with confirmed multiple sclerosis, and in their first-degree relatives. The researchers included 72 MS patients, 126 of their first-degree relatives, and 123 healthy control subjects.

The study found celiac disease -- with at least Marsh III level villous atrophy -- in 11.1% of the multiple sclerosis patients, compared with just 2.4% of the control subjects.

Celiac disease was even more prevalent in first-degree relatives of those with multiple sclerosis -- the researchers found it in 32% of those relatives.

All the MS patients found to also have celiac disease were put on a gluten-free diet, and all "improved considerably both with respect to the gastrointestinal and to the neurological symptomatology in the follow-up period," the study's authors said.

Research on Links Between Two Conditions Not Clear

Despite the study from Spain, it's still not clear whether people with multiple sclerosis have higher rates of celiac disease. Two other studies -- one from Italy and one from Iran -- tested groups of patients with multiple sclerosis for celiac disease, and did not find rates above those of the general population.

It's also possible to have high levels of certain antibodies against gluten and still not have celiac disease.

For example, an Israeli study published in 2009 found high levels of anti-gluten antibody tTG-IgA in multiple sclerosis patients, but did not find an increased rate of celiac disease. "The specific role of these antibodies in the pathogenesis of multiple sclerosis remains uncertain and requires additional research," the researchers concluded.

Another study looked at test results for AGA-IgG and IGA-IgA anti-gluten antibodies in patients with a variety of neurological diseases, including multiple sclerosis. Those researchers found antibodies against gluten in 57% of those patients, and ultimately diagnosed celiac disease in 17%.

Can You Treat Your Multiple Sclerosis with a Gluten-Free Diet?

Despite anecdotal reports of improvements in multiple sclerosis patients who begin following the gluten-free diet, there's no strong medical evidence that following the diet can help you with your MS symptoms.

Some MS researchers have proposed the idea of The Best Bet Diet for multiple sclerosis, which eliminates gluten, dairy, legumes and refined sugar. There's no firm evidence for the effectiveness of this diet, but some MS patients report they feel much better when they keep gluten out of their diets.

So what's the bottom line? If you have multiple sclerosis plus symptoms of celiac disease, you should consider being tested for celiac. You need to perform any testing first, before you go gluten-free, or you risk inaccurate test results; the testing relies on circulating antibodies, which disappear once you start a gluten-free diet.

Even if your test results are negative, you might still notice benefits to your MS symptoms by going gluten-free or by eliminating other foods, such as dairy or legumes, from your diet. If you think this may be the case, talk to your doctor about trying an elimination diet to identify potential dietary culprits.

Source:

Borhani Haghighi A. et al. Multiple sclerosis and gluten sensitivity. Clinical Neurology and Neurosurgery. 2007 Oct;109(8):651-3.

Hadjivassiliou M. et al. Does cryptic gluten sensitivity play a part in neurological illness? Lancet. 1996 Feb 10;347(8998):369-71.

Nicoletti A. et al. Frequency of celiac disease is not increased among multiple sclerosis patients. Multiple Sclerosis. 2008 Jun;14(5):698-700.

Rodrigo L. et al. Prevalence of celiac disease in multiple sclerosis. BMC Neurology. 2011 Mar 7;11:31.

Shor D.B. et al. Gluten sensitivity in multiple sclerosis: experimental myth or clinical truth? Annals of the New York Academy of Sciences. 2009 Sep;1173:343-9.

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