Spina Bifida 

What Is Spina Bifida?

[dropcap]S[/dropcap]pina bifida is a congenital defect of neural tube closure and among the commonest and most severe disorders of the fetus and newborn.¹

Spina bifida is a defect in the walls of the spinal canal in the lumbar section (waist level) of the spine in which the backbone and spinal canal fail to close before birth.

Normally, during the first month of a pregnancy, the two sides of the spine join together to cover the spinal cord, spinal nerves and meninges. Meninges are tissues that cover the spinal cord. Spina bifida refers to any birth defect involving incomplete closure of the spine.

Q: What are the birth defects involving incomplete closure of the spine?

A: Myelomeningocele is the most common type of spina bifida. It is a neural tube defect in which the bones of the spine do not completely form, resulting in an incomplete spinal canal. This causes the spinal cord and meninges (the tissues covering the spinal cord) to stick out of the child’s back. Myelomeningocele may affect as many as 1 out of every 800 infants.

The rest of spina bifida cases are most commonly of these two types:

• Spina bifida occulta, a condition in which the bones of the spine do not close but the spinal cord and meninges remain in place and skin usually covers the defect.
• Meningoceles, a condition where the tissue covering the spinal cord sticks out of the spinal defect but the spinal cord remains in place.²

Spina bifida in the unborn results from deficiency of folic acid and/or vitamin B12 in the mother.³

Intervention trials have demonstrated conclusively that oral ingestion of extra folic acid can prevent the majority of cases of spina bifida and other neural tube defects (NTDs). Data from these studies offer conclusive evidence that the intake of 400 μg/day folic acid provides this benefit.⁴

What Is Spina Bifida In Celiac Disease and/or Gluten Sensitivity?

• Spina bifida is a symptom of celiac disease and an uncommon presenting feature of untreated celiac disease in the mother due to malabsorption of folic acid and/or vitamin B12.

How Prevalent is Spina Bifida In Celiac Disease and/or Gluten Sensitivity?

No adequate studies are available on the rate of birth defects in the progeny of celiac disease affected women.⁵

What Are The Symptoms Of Spina Bifida?

Spina bifida is marked by these symptoms in a newborn:

• Weakness of the hips, legs, or feet.
• Urinary incontinence.
• Partial to total loss of feeling in saddle (lower back) or limb.
• Partial or complete paralysis of the legs.
• Gait (walking) disturbances.
• Structural changes in the pelvis.
• There may be abnormalities of the feet or legs such as clubfoot.

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

• Spina bifida results from celiac disease induced malabsorption and folic acid deficiency in the mother. Folic acid is essential for organogenesis (organ production) in the unborn⁶ although the embryonic mechanism of folate action remains unclear.⁷
• Vitamin B12 deficiency with or without folic acid deficiency in the mother increases the risk spina bifida in the newborn.³
• Iron deficiency does not cause spina bifida but may contribute to the increased risk.⁸

Does Spina Bifida Respond To Gluten-Free Diet?

Yes. Gluten Free diet with folic acid supplements for the mother is preventive for celiac-disease related spina bifida in the infant. Vitamin B12 status should be evaluated before pregnancy and supplementation for blood levels below 300 ng/L.

6 Steps To Decrease Risk of Spina Bifida Related To Celiac Disease:

• [dropcap]1[/dropcap]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 reproductive 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[/dropcap] 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[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs can cause nutritional deficiencies that promote folic acid and/or vitamin B12 deficieny. Ask your doctor or pharmacist about this possible adverse effect. Do not stop without supervision – this is mandatory:

FEMALE HORMONES disrupt intestinal permeability.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B12, Folic Acid.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin B12, Folic Acid.

DIURETICS

• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Folic Acid.

DIABETIC DRUGS 

• Metformin® depletes Folic acid, Vitamin B12.

ANTI-INFLAMMATORIES – Disrupt Intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin B12, Folic Acid.
• NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
• Aspirin and Salicylates deplete Folic acid.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Folic Acid, Vitamin B12.

MAJOR TRAQUILIZERS  

Thorazine®, Mellaril®, Prolixin®, Serentil® and others deplete Vitamin B12.

ANTIBIOTICS  disrupt intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Folic Acid, Vitamin B12.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Folic Acid, Vitamin B12.
• Prevacid®, Prilosec® depleteVitamin B12.
• Alka Seltzer®, Baking Soda deplete Folic Acid.

CHOLESTEROL DRUGS

• Colestid® and Questran® Folic acid, Vitamin B12.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Vitamin B12.

ANTI-DEPRESSANTS

• Adapin®, Aventyl®, Elavil®, Pamelor®, and others deplete these nutrients: Vitamin B12.[/box]

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

[box type=”shadow” ]

• Before pregnancy: 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.
• After pregnancy: Prenatal multivitamin/mineral combination as prescribed by your doctor.
• Folic acid if deficient as prescribed following a blood test for serum level.
• Vitamin B12 if deficient as prescribed following a blood test for serum level.

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]

[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:

• Chamomile 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.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Gentle 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 Spina Bifida?

“Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic Acid fortification.” This study investigating the effect of low vitamin B12 status on neural tube defect risk in a high-prevalence, unfortified population found that deficient or inadequate maternal vitamin B12 status is associated with a significantly increased risk for neural tube defects.

Pregnancy vitamin B12 status concentrations was assessed in blood samples taken at an average of 15 weeks’ gestation from 3 independent nested case-control groups of Irish women within population-based cohorts, at a time when vitamin supplementation or food fortification was rare. Group 1 blood samples were from 95 women during a neural tube defect-affected pregnancy and 265 control subjects. Group 2 included blood samples from 107 women who had a previous neural tube defect birth but whose current pregnancy was not affected and 414 control subjects. Group 3 samples were from 76 women during an affected pregnancy and 222 control subjects.

Mothers of children affected by neural tube defect had significantly lower vitamin B12 status. In all 3 groups those in the lowest B12 quartiles, compared with the highest, had between two and threefold higher adjusted odds ratios for being the mother of a child affected by neural tube defect. Pregnancy blood B12 concentrations of less than 250 ng/L were associated with the highest risks.
Researchers suggest that women have vitamin B12 levels of greater than 300 ng/L (221 pmol/L) before becoming pregnant. Improving B12 status beyond this level may afford a further reduction in risk, but this is uncertain.¹¹

Sources:

1. Copp AJ, Greene ND. Genetics and development of neural tube defects. J Pathol. 2010 Jan;220(2):217-30. doi: 10.1002/path.2643. [↩]
2. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002525/ [↩]
3. Molloy AM, Kirke PN, Troendle JF, Burke H, Sutton M, Brody LC, Scott JM, Mills JL. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic acid fortification. Pediatrics. 2009 Mar;123(3):917-23. doi: 10.1542/peds.2008-1173. [↩] [↩]
4. Scott J. Folic acid consumption throughout pregnancy: differentiation between trimesters. Ann Nutr Metab. 2011;59(1):46-9. doi: 10.1159/000332127. Epub 2011 Nov 25.

   The American Academy of Pediatrics endorses the US Public Health Service (USPHS) recommendation that all women capable of becoming pregnant consume 400 microgram of folic acid daily to prevent neural tube defects (NTDs). Studies have demonstrated that periconceptional folic acid supplementation can prevent 50% or more of NTDs such as spina bifida and anencephaly. ((Folic acid for the prevention of neural tube defects. American Academy of Pediatrics. Committee on Genetics. Pediatrics. 1999 Aug;104(2 Pt 1):325-7. [↩]

5. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [↩]
6. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [↩]
7. Copp AJ, Greene ND. Genetics and development of neural tube defects. J Pathol. 2010 Jan;220(2):217-30. doi: 10.1002/path.2643. [↩]
8. Molloy AM, Einri CN, Jain D, Laird E, Fan R, Wang Y, Scott JM, Shane B, Brody LC, Kirke PN, Mills JL. Is low iron status a risk factor for neural tube defects? Birth Defects Res A Clin Mol Teratol. 2014 Feb;100(2):100-6. doi: 10.1002/bdra.23223. Epub 2014 Feb 18 [↩]
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. Molloy AM, Kirke PN, Troendle JF, Burke H, Sutton M, Brody LC, Scott JM, Mills JL. Maternal vitamin B12 status and risk of neural tube defects in a population with high neural tube defect prevalence and no folic acid fortification. Pediatrics. 2009 Mar;123(3):917-23. doi: 10.1542/peds.2008-1173. [↩]