Reversal of IgM deficiency following a gluten-free diet in seronegative celiac disease.
Lucia Montenegro, Domenico Piscitelli, Floriana Giorgio, Claudia Covelli, Maria Grazia Fiore, Giuseppe Losurdo, Andrea Iannone, Enzo Ierardi, Alfredo Di Leo, Mariabeatrice Principi
World J Gastroenterol 2014 December 14; 20(46): 17686-17689
Hey guys, this weeks article they present an 18 year old male with Selective IgM deficiency (sIGMD, which is quite rare found in approximately 5% of celiac disease patients) masking seronegative celiac disease (seronegative is where some celiac patients antibodies are negative). His symptoms included abdominal pain, diarrhea and weight loss which had been present for a year. Laboratory tests showed reduced IgM, DQ2-HLA and negative anti-transglutaminase. Villous atrophy and diffuse immature lymphocytes (lymphocrytes are one subset of white cells and they are the main type of cell found in lymph) were observed at histology. Tissue transglutaminase mRNA mucosal levels showed a 6-fold increase. The course of treatment was a gluten-free diet.
Following are key points taken directly from the article which takes you step by step into the studies thoughts and what tests and markers that they found.
- Ruled out Crohn’s disease, ulcerative colitis, Helicobacter pylori infection, intestinal bacterial overgrowth, allergy to food proteins other from gluten, connective tissue diseases, chronic use of non-steroidal anti-inflammatory drugs or Olmesartan
- Infective causes of small bowel inflammation were excluded by specific investigations for bacteria (Sal- monellae species, Shigella, Campylobacter jejuni, enterotoxic E. coli, Yersinia enterocolitica), viruses (Rotavirus, Norovirus, Adenovirus, Astrovirus, Calicivirus and Coro- navirus) and intestinal parasites (Giardia Lamblia). Colonoscopy with histological examination did not reveal any specific picture. No alterations were found at Magnetic Resonance study of the small bowel, nor 99Tc Scintigraphy (to exclude the presence of Meckel’s diverticulum)
- A marked villous atrophy was also evident
- This doubtful picture (i.e., villous atrophy in the absence of a number of intraepithelial CD3 lymphocytes diagnostic for CD) and the possible sIGMD/CD association as well as the family history, led us to perform mucosal tissue transglutaminase mRNA detection by a widely vali- dated method based on reverse transcriptase polymerase chain reaction
- Six months later the symptoms had disappeared, the villous architecture was restored and mucosal tissue transglutaminase mRNA was comparable to that of healthy subjects
- After 1 year of Gluten Free Diet, a complete restoration of normal IgM values was observed and duodenal biopsy showed a reduction of immature lymphocytes and normal appearance of mature immune cells.
- The conclusion of a recent study was that only the response to a Gluten Free Diet offers a reliable diagnostic tool for defining the presence of celiac disease in a patient with CVID. Moreover, an association of celiac disease has been described in 20% of IgA deficiency cases.
The reason this article is so important at least to me is that even in a rare form of celiac disease it shows that a gluten free diet is the way to go in helping celiacs. There are so many celiacs that I know that try to push the boundaries and think that just a little bit of gluten will not hurt them. That it’s okay on special occasions; however, they have no clue what the long term effects this will have on their life.
Can’t tell you how many people I hear who are still looking for short-cuts and who are not willing to put in the work to get themselves healthy. If a gluten free diet after one year completely restored this patients IgM values and showed a reduction of immature lymphocytes, imagine how much better this young man must have felt. Imagine how much more vibrant and full of life he became.
Imagine what sticking to a strict gluten free diet could do for you. Yes, you have to change your eating habits. Yes, it takes time to get use to. Yes, you are going to have to get up close and personal with your kitchen. Yes, you need to create new and better routines. Yes, you will have to learn to be prepared. Yes, you have to get over that it’s hard and that it’s not fair.
It's time to let go of all the reasons why that you can’t do this and start embracing all the reasons why you have to. Lets start focusing on all you have to live for. Focusing on the good is the only way I know how to get through anything that's tough. The proof is in the studies, if this works in the rarest form of celiac disease, it can work for you too. You just have to stick with it and be consistent every day. And, should you need some additional help I'm here to help, check out my blog, or even my book if you need more information (it’s full of goodies) Gluten Free Guide to a Healthy-Do-Over.
* Here’s my little disclaimer, I’m not a doctor, researcher, immunologist, just someone deeply concerned and trying to help as many peeps as I can make conscious, good, healthy choices for their health and their bodies when living life with gluten challenges. I have not been compensated or obligated to write this article, and as always, all thoughts and opinions are honest and my own!