Links Between Celiac Disease and Multiple Sclerosis

You may have heard that there's a potential link between celiac disease and multiple sclerosis (MS). People with celiac disease may have neurological manifestations and people with MS may be more likely to have celiac disease. In fact, some people with MS claim to feel better on a gluten-free diet. What does the research tell us about this possible association?

Links Between Celiac Disease and MS

The links between celiac disease and multiple sclerosis may seem clear at first. Both are T-cell mediated 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 healthcare providers, in large part due to that wide range of symptoms.

Given all that, plus growing anecdotal evidence of improvements some people with MS 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 people with multiple sclerosis, or whether following a gluten-free diet actually can help people with MS manage their condition. Let's look at the potential for common characteristics of these conditions and then evaluate the research into an association.

MS Symptoms

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

It's tough to diagnose multiple sclerosis. Your healthcare provider may suspect MS on the basis of your symptoms, but first, must rule out other conditions with similar symptoms.

Symptoms Common with Both MS and Celiac Disease

Symptoms which are common with both MS and celiac disease include constipation, brain fog (feelings of fogginess, inattention or difficulty reasoning), depression, and problems with vision.

Making the matter even more confusing is that many of these potential symptoms (such as brain fog, sexual dysfunction, mild depression, and fatigue), can also be caused by stress. this may further contribute to delays in diagnosis.

Celiac Disease Symptoms and Neurological Conditions

Common symptoms of celiac disease may include constipation or diarrhea, food intolerance, and abdominal pain, but as noted, other symptoms may crossover with MS, including brain fog, depression, and even peripheral neuropathy.

It's fairly well known that celiac disease can be associated with other neurological and psychological disorders. Overall, neurological manifestations of celiac disease occur in around 20% of people with celiac disease. Conditions that have been found include:

• MS
• Cerebellar ataxia
• Gluten encephalopathy
• Peripheral neuropathy
• Hearing loss (sensorineural)
• Epilepsy
• Depression
• Developmental disorders, learning disabilities, ADHD
• Cognitive dysfunction

One Study Shows Possible Definitive Link

Knowing the symptoms of both conditions, how they can be similar in certain ways, what is the relationship between these disorders?

The research is mixed, as we will discuss, but perhaps the strongest link between the two disorders is found in a 2011 study.

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 people with MS, 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 people with multiple sclerosis 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 people with MS 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," according to the study's authors.

Other studies have not found such an association, according to a paper published in 2008.

Research on Links Is 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 found in 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 the specific anti-gluten antibody tTG-IgA in people with multiple sclerosis 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 published in 2007 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 people and ultimately diagnosed celiac disease in 17%.

Nutrition and MS

A question to be asked when considering the role of gluten sensitivity in multiple sclerosis is whether or not there are other dietary factors which may be involved in the onset or progression of the condition. It is fairly clear that vitamin D can have an effect on MS both on the incidence and clinical course of MS, though there are sources of vitamin D outside of food (such as sun exposure). Other nutrients which have been looked at along with gluten, include milk products, probiotics, antioxidants, polyphenols, Ginkgo biloba, and curcumin, but it remains uncertain whether any of these (including gluten) plays a role in the progression of MS.

Can You Treat MS 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 people with MS report they feel much better when they keep gluten out of their diets.

Bottom Line

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. If you test positive, it's thought that you should talk to your healthcare provider about interferon as well as 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 healthcare provider about trying an elimination diet to identify potential dietary culprits.