DNC News

Cardiomyopathy and Celiac Disease

November 18, 2005

Subject: Celiac disease has been linked to cardiomyopathy and avoidance of gluten in some cases may improve the condition.

Add heart problems to the growing list of diseases that may be associated with or caused by eating wheat by susceptible individuals. Celiac disease or celiac sprue is triggered by specific proteins found in wheat, barley and rye. The classic presentation is one of chronic indigestion, malabsorption and diarrhea. In recent years we have learned that many people with the disease do not have these classic symptoms. In cases of herpetiformis dermatitis, a skin rash that looks like herpes, less than 15% of those afflicted complain of intestinal problems. The same is true of sporadic ataxia, a condition where people have episodes where they lose muscular control. We have also learned that celiac disease is much more common than we once thought. The current estimate is that about one person in a hundred suffers from this condition. Now current science suggests that patients who present with cardiomyopathy may also benefit from a gluten free diet.

Although typically only one person in a hundred suffers from celiac disease, this incidence is much higher in people with cardiomyopathy. Close to 5% of patients with cardiomyopathy have celiac disease. [i] In other words wheat gluten may trigger an autoimmune reaction not just to the muscle tissue lining the digestive tract but also to the muscle of the heart. Avoidance of wheat and other gluten containing foods can provide benefit in treating the disease. [ii] In fact according to a 2005 Mayo Clinic report, if cardiomyopathy is detected early in a person with celiac disease, treatment with gluten avoidance may fully reverse the disease. [iii]

There is some debate still about what is going on. The obvious explanation that celiac disease triggers production of antibodies which attack the heart muscle may not actually be true. One explanation put forth is that celiac disease badly hinders the absorption of key nutrients in the diet leaving the heart more susceptible to disease. The chief nutrient investigated and theorized for this role is carnitine. People with celiac disease have lower than normal carnitine levels in their blood and celiac disease patients who also have cardiomyopathy have even lower levels. Two years of avoiding wheat and carnitine levels measured in celiac disease people come up toward normal. [iv] This information suggests that people with celiac disease might consider supplementing with carnitine.

Anyone who has gotten this far reading this admittedly boring article either has celiac disease or knows someone who does. So for you few readers, I must mention Deby's Gluten Free Bakery and Restaurant that opened here in Denver a few months ago. They produce an array of those foods that people on a gluten free diet miss eating including cinnamon rolls, waffles and pizza, all gluten free. You can read more about Deby's and find directions at their website:

www.debysglutenfree.com

We overheard a young girl eating at the restaurant asking her mother in disbelief. “I can really pick anything on the menu?”

[i]

 
Celiac disease associated with autoimmune myocarditis.

Frustaci A , Cuoco L , Chimenti C , Pieroni M , Fioravanti G , Gentiloni N , Maseri A , Gasbarrini G .

Department of Cardiology, Catholic University , Rome , Italy . biocard@rm.unicatt.it

BACKGROUND: Both celiac disease (CD) and myocarditis can be associated with systemic autoimmune disorders; however, the coexistence of the 2 entities has never been investigated, although its identification may have a clinical impact. METHODS AND RESULTS: We screened the serum of 187 consecutive patients with myocarditis (118 males and 69 females, mean age 41.7+/-14.3 years) for the presence of cardiac autoantibodies, anti-tissue transglutaminase (IgA-tTG), and anti-endomysial antibodies (AEAs). IgA-tTG-positive and AEA-positive patients underwent duodenal endoscopy and biopsy and HLA analysis. Thirteen of the 187 patients were positive for IgA-tTG, and 9 (4.4%) of them were positive for AEA. These 9 patients had iron-deficient anemia and exhibited duodenal endoscopic and histological evidence of CD. CD was observed in 1 (0.3%) of 306 normal controls (P<0.003). In CD patients, myocarditis was associated with heart failure in 5 patients and with ventricular arrhythmias (Lown class III-IVa) in 4 patients. From histological examination, a lymphocytic infiltrate was determined to be present in 8 patients, and giant cell myocarditis was found in 1 patient; circulating cardiac autoantibodies were positive and myocardial viral genomes were negative in all patients. HLA of the patients with CD and myocarditis was DQ2-DR3 in 8 patients and DQ2-DR5(11)/DR7 in 1 patient. The 5 patients with myocarditis and heart failure received immunosuppression and a gluten-free diet, which elicited recovery of cardiac volumes and function. The 4 patients with arrhythmia, after being put on a gluten-free diet alone, showed improvement in the arrhythmia (Lown class I). CONCLUSIONS: A common autoimmune process toward antigenic components of the myocardium and small bowel can be found in >4% of the patients with myocarditis. In these patients, immunosuppression and a gluten-free diet can be effective therapeutic options.

PMID: 12045166 [PubMed - indexed for MEDLINE]

[ii]

Idiopathic dilated cardiomyopathy associated with coeliac disease: the effect of a gluten-free diet on cardiac performance.

Curione M , Barbato M , Viola F , Francia P , De Biase L , Cucchiara S .

Policlinico Umberto I, Rome , Italy . mario.curione@uniroma.it

An increased incidence of coeliac disease has recently been reported in patients with idiopathic dilated cardiomyopathy. This report deals with three patients with idiopathic dilated cardiomyopathy and coeliac disease who underwent clinical and laboratory evaluation to establish the effect of a gluten-free diet on cardiac performance. Two patients observed the gluten-free diet regimen very strictly, and, after a 28-month follow-up period, showed an improvement in echocardiographic parameters as well as in cardiological features and quality of life, as evaluated by the Minnesota Living with Heart Failure questionnaire and the Gastrointestinal Symptom Rating Scale questionnaire. The third patient did not observe the gluten-free diet and presented a worsening in the echocardiographic parameters and cardiological symptoms which required supplementary drug therapy. These preliminary data appear to suggest that the gluten-free diet may have a beneficial effect on cardiac performance in patients with idiopathic dilated cardiomyopathy.

[iii]

• 
Cardiomyopathy associated with celiac disease.

Goel NK , McBane RD , Kamath PS .

Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester , Minn 55905 , USA .

Celiac disease or celiac sprue is predominantly a disease of the small intestine characterized by chronic malabsorption in genetically susceptible individuals who ingest grains containing gluten, such as wheat, barley, and rye. Although previously believed to be uncommon, celiac disease may be present in up to 1% of the general population. Celiac disease is associated frequently with iron deficiency anemia, dermatitis herpetiformis, selective IgA deficiency, thyroid disorders, diabetes mellitus, and various connective tissue disorders but is rarely associated with cardiomyopathy. We describe a patient with celiac disease associated with cardiomyopathy whose cardiac function improved substantially after treatment with a gluten-free diet. Cardiomyopathy associated with celiac disease is a serious and potentially lethal condition. However, with early diagnosis and treatment with a gluten-free diet, cardiomyopathy in patients with celiac disease may be completely reversible.

PMID: 15887437 [PubMed - indexed for MEDLINE]

[iv]

 
Carnitine deficiency in patients with coeliac disease and idiopathic dilated cardiomyopathy.

Curione M , Danese C , Viola F , Di Bona S , Anastasia A , Cugini P , Barbato M .

Department of Clinical Sciences, Policlinico Umberto I, University La Sapienza, Rome , Italy . mario.curione@uniroma1.it

BACKGROUND AND AIMS: Idiopathic dilated cardiomyopathy (IDCM) and coeliac disease (CD) are two pathological conditions which may lead, by different mechanisms, to malabsorption of various micronutrients, including carnitine, active in cardiac metabolism. The aim of the present investigation was primarily to evaluate differences in serum concentrations of total carnitine between IDCM patients and patients with IDCM associated with CD and then also to evaluate, in the latter, the effect of a gluten-free diet on serum concentrations of total carnitine. METHOD AND RESULTS: Serum carnitine was determined by enzymatic spectrophotometric assay in three groups of individuals: group A, 10 patients (5 males, 5 females), mean age 46.5+/-10.8 years, presenting isolated IDCM; group B, 3 patients (2 males, 1 female), mean age 34+/-8 years, with IDCM+CD; and group C, 10 healthy subjects (5 males, 5 females), mean age 38.6+/-11.1 years. All patients with IDCM belonged to class NYHA I-II. Mean concentrations of total serum carnitine in the group of patients with isolated IDCM (group A) were found to be lower than in the controls (group C). The concentrations in patients with IDCM associated with CD (group B) were lower than in the control group and also lower than in the isolated IDCM (group A). After 2 years on a gluten-free diet, patients presenting IDCM associated with CD showed a progressive increase in mean serum carnitine levels compared to values observed prior to the diet. CONCLUSIONS: Patients presenting IDCM associated with CD show a greater decrease in serum total carnitine levels than patients presenting the isolated form of IDCM. A gluten-free diet, in these patients, leads to a progressive increase in serum levels of this substance.

PMID: 16054552 [PubMed - in process]