Alkaline Reflux Esophagitis: definition

What Is Epilepsy?

[dropcap]E pilepsy is a dysfunctional disorder of the brain characterized by recurring seizures also called convulsions.

Q: What happens in a seizure?

A: During a seizure  abnormal electrical discharges occur within the brain. Not all seizures have the same intensity or involvement.

Seizures can be generalized, partial  or unclassified.

• Generalized siezures affect both sides of the brain and the individual usually loses consciousness.
• Partial affect one part of the brain and the individual usually is awake.

What Is Epilepsy In Celiac Disease and/or Gluten Sensitivity?

• Epilepsy is an associated neurologic disorder in celiac disease.
• Recurring seizures (convulsions) in the occipital area of the brain, with or without calcification, can develop without the more classic malabsorptive symptoms of celiac disease. The majority of patients have complex partial attacks.
• Recurring seizures may involve areas of the brain other than the occipital area.¹
• Research investigating celiac disease-associated antibodies and gluten sensitivity in patients with refractory focal epilepsy demonstrated a previously unrecognized link between gluten sensitivity and temporal lobe epilepsy with hippocampal sclerosis. Researchers state, “This association was very robust in this well-characterized group of patients; thus gluten sensitivity should be added to the list of potential mechanisms leading to intractable epilepsy and hippocampal sclerosis.”²
• There is also a subgroup of patients who develop the syndrome of celiac disease, epilepsy, and cerebral calcifications which may be related to underlying folate deficiency.³
• A study conducted in a tertiary center (hospital) investigating the occurrence celiac disease in living patients with epilepsy of unknown etiology demonstrated the prevalence of celiac disease was increased among patients with epilepsy of unknown etiology and of them 80% had supratentorial brain atrophy vs. 26% of controls.
• Screening of celiac disease seems warranted in patients with epilepsy of unknown etiology, particularly when there is co-existent cerebral atrophy of unknown etiology.⁴

How Prevalent Is Epilepsy In Celiac Disease and/or Gluten Sensitivity?

• The prevalence of celiac cases in people with epilepsy ranges from approximately 0.8–6%.¹
• The prevalence of epilepsy is 5.5% in patients with celiac disease. The prevalence of celiac disease in patients with epilepsy is 8.1% on the basis of a flat intestinal mucosa.⁵
• In a study of 72 patients with biopsy proven celiac disease, Bürk et al. found seizures in 6%.⁶

What Are The Symptoms of Epilepsy?

• Epilepsy in celiac disease is marked by recurrent seizures with, or without, digestive symptoms of gluten sensitivity.

How Does Epilepsy Develop In Celiac Disease and/or Gluten Sensitivity?

• Although the mechanism remains obscure underlying the processes that result in the development of epilepsy in celiac disease, they appear related to  immunological effects of gluten exposure in the brain and trace vitamin deficiency involving calcium, magnesium, and folate.⁷
• The syndrome of celiac disease, epilepsy, and cerebral calcifications may be related to underlying folate deficiency.³

Does Epilepsy Respond To Gluten-Free Diet?

Yes. Epilepsy in celiac disease responds to a nutritious gluten free diet.⁸

6 Steps To Improve Epilepsy In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1 Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both epilepsy and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁹
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2  Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹⁰
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹⁰
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹⁰.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹⁰
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹⁰
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹⁰[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3  Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4  Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs cause deficiencies of  calcium, magnesium, and folate that can promote epilepsy in celiac disease. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Calcium, Folic Acid, Magnesium.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Calcium, Folic Acid, Magnesium.
• Alka Seltzer®, Baking Soda deplete Folic Acid.

ANTIBIOTICS disrupt intestinal permeability.

•  Tetracyclines deplete Calcium, Magnesium.

ANTI-INFLAMMATORIES disrupt intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Calcium, Magnesium, Folic Acid.
• NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
• Aspirin and Salicylates deplete Calcium, Folic acid.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Calcium, Folic Acid.

ANTIVIRAL AGENTS

• Foscanet depletes Calcium, Magnesium. 

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Folic Acid.

DIABETIC DRUGS 

• Metformin® depletes Folic acid.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Magnesium.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Calcium, Magnesium.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Calcium, Folic Acid.

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Folic Acid, Magnesium.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Folic Acid, Magnesium.[/box]

• [dropcap]5 Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
• Folic acid as prescribed following blood test for status.
• Chelated magnesium  as prescribed but do not take at same time as calcium because they compete for absorption.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6 Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Epilepsy In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Celiac disease with neurologic manifestations in children.” This study investigating the incidence of neurologic manifestations in 48 children aged 2-18 years diagnosed with celiac disease found that 16 children presented one or more neurologic symptoms as the onset manifestation of celiac disease. Brain CT-scan showed cerebral calcifications in 3 patients with epilepsy, and atrophy in 2 cases with cerebellar ataxia.

The diagnosis of celiac disease was made by serological tests and intestinal biopsy. The study protocol included: measurement of weight and height, biological and immunological tests, histological examination, questionnaires filled out by parents about their child motor development and some neurologic signs, psychological exam, electroencephalogram, and brain CT-scan.

All children received gluten free diet, but a favorable course was noticed only in the children with migraine and epilepsy, in the other patients this diet having no influence on neurologic symptoms.¹¹

“Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with gluten sensitivity.” This study investigating celiac disease-associated antibodies and gluten sensitivity in a well-characterized group of patients with refractory focal epilepsy demonstrates a previously unrecognized link between gluten sensitivity and temporal lobe epilepsy (TLE) with hippocampal sclerosis HS. Researchers state, “This association was very robust in this well-characterized group of patients; thus gluten sensitivity should be added to the list of potential mechanisms leading to intractable epilepsy and HS.”

A-gliadin, anti-tissue-transglutaminase and anti-endomysium antibodies, and coeliac-type human leukocyte antigen (DQ2 and DQ8) were measured in 48 consecutive patients with therapy-resistant, localization-related epilepsy. The patients were categorized into the following three groups on the basis of ictal electro-clinical characteristics and the findings of high resolution MRI: 16 TLE patients with HS, 16 TLE patients without HS and 16 patients with extratemporal epilepsy. Patients with suspected celiac disease or gluten sensitivity underwent duodenal biopsies.

Seven patients in total were gluten sensitive; all of these patients fell in the TLE with HS group. On the other hand, none of the TLE without HS patients or those with extratemporal epilepsy were gluten sensitive (p<0.0002). The results of duodenal biopsies showed that three of the seven gluten-sensitive patients had histological evidence of celiac disease (biopsy) and four had inflammatory changes consistent with early celiac disease without villous atrophy. Four of the patients with gluten sensitivity had evidence of dual pathology (HS + another brain lesion), whereas none of the remaining patients did (p<0.0002).²

“Neurological symptoms in patients with biopsy proven celiac disease.” This study investigating the prevalence  of neurological problems in celiac disease found that seizures are common, occurring in 6% of these patients.

Most studies in this field are focused on patients under primary neurological care. To exclude such an observation bias, patients with biopsy proven celiac disease were screened for neurological disease. A total of 72 patients with biopsy proven celiac disease were recruited through advertisements. All participants adhered to a gluten-free diet.

Patients were interviewed following a standard questionnaire and examined clinically for neurological symptoms. Medical history revealed neurological disorders such as migraine (28%), carpal tunnel syndrome (20%), vestibular dysfunction (8%), seizures (6%), and myelitis (3%). Physical examination yielded stance and gait problems in about one third of patients that could be attributed to afferent ataxia in 26%, vestibular dysfunction in 6%, and cerebellar ataxia in 6%. Other motor features such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus were infrequent. 35% of patients with celiac disease showed deep sensory loss and reduced ankle reflexes in 14%.¹²

“Association between celiac disease and brain atrophy.” This study conducted in a tertiary center (hospital) investigating the occurrence celiac disease in living patients with epilepsy of unknown etiology demonstrated the prevalence of celiac disease was increased among patients with epilepsy of unknown etiology and of them 80% had supratentorial brain atrophy vs. 26% of controls. Screening of celiac disease seems warranted in patients with epilepsy of unknown etiology, particularly when there is co-existent cerebral atrophy of unknown etiology.⁴

CASE REPORT SUMMARIES

“Celiac disease and epilepsy: favorable outcome in a child with difficult to control seizures.” This case report describes finding celiac disease in a child with difficult to control seizures suggestive of Lennox-Gastaut syndrome. Gluten free diet led to progressive seizure control, allowing significant decrease in dosage of anti-epileptic drugs. Progressive seizure control corroborates the importance of serological screening tests for celiac disease, at least in patients with difficult to control epilepsy.¹³

“Villous atrophy and idiopathic epilepsy.” This case report describes significant reduction in seizures on a gluten free diet for 1 of 4 patients with celiac disease. “Celiac disease should be ruled out in all cases of epilepsy of unknown origin.”¹⁴

Sources:

1. Jessica R. Jackson, William W. Eaton, Nicola G. Cascella, Alessio Fasano, and Deanna L. Kelly Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity. Psychiatr Q. Mar 2012; 83(1): 91–102. doi:  10.1007/s11126-011-9186-y [↩] [↩]
2. Peltola M, Kaukinen K, Dastidar P, Haimila K, Partanen J, Haapala AM, Mäki M, Keränen T, Peltola J. Hippocampal sclerosis in refractory temporal lobe epilepsy is associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2009 Jun;80(6):626-30. doi: 10.1136/jnnp.2008.148221. [↩] [↩]
3. Wills AJ. The neurology and neuropathology of celiac disease. Neuropathology and Applied Neurobiology. 2000:26:493-496. [↩] [↩]
4. Luostarinen, Dastidar, Collin, Peräajo, Mäki, Erilä, Pirttilä. Association between celiac disease and brain atrophy. European Neurology. 2001; 46(4):187-5. [↩] [↩]
5. Essid M, Trabelsi K, Jerbi E, et al. Villous atrophy and idiopathic epilepsy. La Tunisie Medicale. Apr 2003;81(4):270-2. [↩]
6. Bürk K, Farecki ML, Lamprecht G, Roth G, Decker P, Weller M, Rammensee HG, Oertel W. Neurological symptoms in patients with biopsy proven celiac disease. Mov Disord. 2009 Dec 15;24(16):2358-62. doi: 10.1002/mds.22821. [↩]
7. Wills AJ. The neurology and neuropathology of celiac disease. Neuropathology and Applied Neurobiology. 2000:26:493-496. [↩]
8. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. [↩]
9. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
10. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
11. Diaconu G, Burlea M, Grigore I, Anton DT, Trandafir LM. Celiac disease with neurologic manifestations in children. Rev Med Chir Soc Med Nat Iasi. 2013 Jan-Mar;117(1):88-94. [↩]
12. Bürk K, Farecki ML, Lamprecht G, Roth G, Decker P, Weller M, Rammensee HG, Oertel W. Neurological symptoms in patients with biopsy proven celiac disease. Mov Disord. 2009 Dec 15;24(16):2358-62. doi: 10.1002/mds.22821. [↩]
13. Pratesi R, Modelli IC, Martins RC, Almeida PL, Gandolfi L. Celiac disease and epilepsy: favorable outcome in a child with difficult to control seizures. Acta Neurologica Scandanavica. Oct 2003;108(4):290-3. [↩]
14. Essid M, Trabelsi K, Jerbi E, et al. Villous atrophy and idiopathic epilepsy. La Tunisie Medicale. Apr 2003;81(4):270-2. [↩]