Low bone mineral density and non-coeliac gluten sensitivity and autism?

"An elevated frequency of bone mass loss in NCWS [non-celiac wheat sensitivity] patients was found; this was related to low BMI [body mass index] and was more frequent in patients with NCWS associated with other food sensitivity".

There is no Easter Bunny. There is no Tooth Fairy.
There is no Queen of England.

That was the conclusion reached by Antonio Carroccio and colleagues [1] (open-access) looking at a small group of participants diagnosed with something which seems to fall into a growing spectrum of gluten-related conditions (gluten being the protein found in various cereal crops). The eagle-eyed out there will have spotted how the authors talk about non-celiac 'wheat' sensitivity over and above non-celiac gluten sensitivity as per the idea that: "it is not known what component of wheat causes the symptoms in NCGS patients".

Whilst interesting results, I was actually more intrigued at their possible implications for something like parts of the autism spectrum, on the back of other peer-reviewed research on a possible link with gluten/wheat. I'll take you back to the paper by Ludvigsson and colleagues [2] - discussed in this post - as a starting point and the idea that something not-quite-coeliac-disease (the archetypal autoimmune gluten related condition) might be linked to some cases of autism. The paper by Caio and colleagues [3] (see this post) then suggested that for those presenting with anti-gliadin antibodies as part of NCGS, the use of a gluten-free diet might help dissipate said antibodies, which although not specific to such a scenario with autism in mind, was potentially 'transferable' in light of gluten antibodies being reported in some autism.

Low bone mineral density talked about in the Carroccio paper as being potentially linked to NCWS (or NCGS if you so wish) is also something that has been discussed with autism in mind down the years. I've covered a few papers in this area on this blog, most notably the paper from Hediger and colleagues [4] (see here for the blogpost) and the paper by Neumeyer and colleagues [5] (see here for my take) which indicated that bone mineral density might be lower in cases of autism. Although the gluten (and casein) free diets have been 'blamed' for these results, it appears that nutritional deficiency related to such dietary interventions might not be as serious as some would lead us to expect. If you don't believe me, take a look at my discussion of some peer-reviewed work in this area. The idea also that vitamin D might be lower in quite a few cases of autism is also worthwhile mentioning too bearing in mind the connection between calcium, vitamin and 'strong bones'. Exercise as also playing a role in good bone health also comes into view with autism too.

Marrying the two area together - NCGS and low bone mineral density - with a perspective on at least some autism, may then not seems as outlandish as you might think. Carroccio et al suggest "the role of malnutrition seems very important in our study group" based on their BMI findings. Further they suggest that: "Dietary support should be strongly recommended at the time of NCWS diagnosis, whatever is its pathogenesis." BMI is a bit of mixed bag when it comes to autism as per some of my own work in this area [6] but I'd struggle to argue with their suggestion of appropriate dietary support as and when something like NCGS (or NCWS) is detected on top of a diagnosis of autism.

And then there's gut permeability issues to also consider...

Music: Katie Melua - The Flood.

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[1] Carroccio A. et al. Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study. BMC Med. 2014 Nov 28;12(1):230.

[2] Ludvigsson JF. et al. A Nationwide Study of the Association Between Celiac Disease and the Risk of Autistic Spectrum Disorders. JAMA Psychiatry. 2013. Sept 25.

[3] Caio G. et al. Effect of gluten free diet on immune response to gliadin in patients with non-celiac gluten sensitivity. BMC Gastroenterol. 2014 Feb 13;14(1):26.

[4] Hediger ML. et al. Reduced bone cortical thickness in boys with autism or autism spectrum disorder. J Autism Dev Disord. 2008 May;38(5):848-56.

[5] Neumeyer AM. et al. Bone density in peripubertal boys with autism spectrum disorders. J Autism Dev Disord. 2013 Jul;43(7):1623-9.

[6] Whiteley P. et al. Body mass index of children from the United Kingdom diagnosed with pervasive developmental disorders. Pediatr Int. 2004 Oct;46(5):531-3.

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Carroccio A, Soresi M, D Alcamo A, Sciumè C, Iacono G, Geraci G, Brusca I, Seidita A, Adragna F, Carta M, & Mansueto P (2014). Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study. BMC medicine, 12 (1) PMID: 25430806