reflections
THE HUMAN SIDE OF OPTOMETRY

Wheating out Celiac Disease

The latest diet craze's influence on me as an optometrist.

Jason Seligman, O.D., P.C.
Riverhead, NY

The “Gluten-free” diet has become all the rage (many claim it provides an energy boost), appearing on several foods, in various periodicals, and most recently in my own practice.

Gluten and the eye

A “gluten-free” diet can promote ocular health in celiac disease (CD) patients. In CD, the immune system attacks the small intestine's tissue in response to gluten ingestion.¹ (Gluten is a specific complex of proteins that forms when wheat flour is mixed with a liquid and physically manipulated [e.g. kneading of bread]. It is present in all wheat, rye, barley and triticale.^1,2) The aftermath: food malabsorption, which causes nutritional deficiencies and may result in anemia, osteopenia, osteoporosis and other autoimmune conditions, such as insulin-dependent Type 1 diabetes mellitus.^2,3

The small intestine's lining houses up to 70% of our immune system.⁴ Some of the immune system tissue that becomes damaged in CD produces Secretory IgA antibodies—extremely important for killing pathogens that encounter mucosal tissue, such as the eyes.⁵ Therefore, CD patients are at higher risk than non-CD patients for ocular conditions.

For example, a three-year-old girl with a hemorrhagic conjunctival lesion OD was subsequently diagnosed with CD, and the conjunctival tumor completely regressed via a gluten-free diet.⁶ Further, a nine-year-old girl with diabetes mellitus type 1 who presented with uveitis OS, which didn't respond to topical or systemic corticosteroids was diagnosed with CD, and the uveitis recovered with a gluten-free diet.⁷

In practice

I've begun looking for suspect CD patients, so I can refer them to their primary-care doctor for the necessary blood panel test or an intestinal biopsy. These patients present with ocular health issues and abdominal cramping, intestinal gas, stomach distention and bloating, chronic diarrhea and constipation (or both), steatorrhea (fatty stools) and unexplained weight loss with large appetite, or weight gain.⁸ (Suspect CD children may exhibit growth failure, vomiting, a bloated abdomen, behavioral changes and failure to thrive.⁸ )

As recent research shows 6% of the U.S. population has gluten sensitivity (fatigue, headaches, “foggy mind,” extremity tingling and abdominal pain similar to irritable bowel syndrome, without signs of small intestine damage), I've begun encouraging patients who have unexplained migraines to try a gluten-free diet for a week.⁹ Many have told me their symptoms have resolved with this diet. OM

References available upon request.