Friday, 25 February 2011

Gluten relations

As this blog develops you will see that I have a bit of a penchant for all things related to diet and particularly gluten. Don't get me wrong; I am not anti-gluten (or anti-casein for that matter); indeed quite the opposite, acknowledging the significant part gluten has had, and continues to play, in feeding our ever increasing populations. I do however believe in 'horses for courses' - what is suitable for one might not necessarily be suitable for another.

For many years I have been struck by the number of people, groups, studies outside of autism who have suggested a possible link between their symptoms (whatever they may be) and their diet - that is what they eat seemed to go hand-in-hand with how they felt or what illness/condition they developed. Diet mediating physical health is of course well-recognised; diet mediating mental health and development is perhaps another story. From the outset I will admit that I am a fan of the notion that correlation does not imply causation; that is just because 2 events occur close together does not necessarily mean that one causes the other. I also however believe that if two events do happen close together, it is the responsibility of science to investigate any possibility of a relationship, if nothing else just to disprove it.

I digress. One of the more interesting conditions where reports of a link between presented symptoms and diet have surfaced was with a group of people who had been diagnosed with myalgic encephalomyelitis (ME) or Chronic Fatigue Syndrome (CFS). First and foremost I will admit that I am not an expert on ME/CFS (add it to the list of my non-expertise). I know a little bit about the symptoms; a little bit about the various hypotheses on aetiology and pathology; and a little bit about the variability and heterogeneity involved (similar to autism). That's it. I have corresponded with a few people who have ME/CFS and got a flavour of how much it impacts on their lives.

My interest in ME/CFS and diet was perked after reading a newspaper article recently. The article described the daughter of quite a famous UK TV personality who has ME and a purported link to gluten. OK it is a newspaper and things tend to get a little sensationalised (to sell more newspapers perhaps?), but it was a very interesting read. The summary is that this young lady struggled with ME for many years, presented also with some other 'somatic' conditions and eventually was led through to the possibility that she could have a problem with gluten. The article mentions coeliac disease (quite extensively) but a connection between the two in this case has been queried. I have since done a little hunting around and found a couple articles suggesting that routine screening for coeliac disease should be carried out in cases of CFS given indications of about 2% of patients presenting with CFS also being endomysial antibody (EMA) positive, whether co-morbid or as an alternate diagnosis to explain fatigue. What I was unable to find was good scientific questioning of what happens to ME/CFS symptoms when those with positive EMAs went on a gluten-free diet, and whether the recent newspaper story suggestive of positive effects potentially outside of coeliac disease has been examined.
 
Set against the recent PACE study published in the Lancet and the various discussions around the trial design and results, it is perhaps timely that the UK Medical Research Council (MRC) have this week set aside funds to conduct further research into ME/CFS. I wonder if anyone will chose to look at the potential connection between diet and ME/CFS?