Wednesday, 24 August 2011

Metabolic syndrome and gluten

I am pretty used to hearing about and using the word 'metabolic' in my day-to-day work. In this context, metabolic refers to a few things: a metabolic pathway, describing some chemical reactions leading to an end compound or other endpoint process; or an in-born error of metabolism, describing some genetic 'malfunction' predominantly with enzymes or enzymatic reactions.

A new term has started to creep into my dictionary over the past few months or so, metabolic syndrome. Whilst sounding like it should have something to do with the other uses I described, metabolic syndrome actually describes a set of risk factors which might predispose a person to subsequent problems of coronary artery disease, stroke and type-2 diabetes. The main risks taken from the various descriptions tend to include:

Why might metabolic syndrome be important to this blog? Well, because of this paper by Garcia-Manzanares and colleagues* published in the World Journal of Gastrointestinal Pathophysiology which reported on a case study of a woman presenting with the features of metabolic syndrome alongside coeliac (celiac) disease, and what happened when a gluten-free (GF) diet was installed.

I am sure that readers can guess what I am going to say. The woman, who was overweight, presented with high cholesterol and triglycerides, alongside iron deficiency was eventually found to present with comorbid metabolic syndrome and coeliac disease. Installation of a GF diet seemed to solve the iron problems (as one would expect it would in coeliac disease) but also seemed to positively affect dyslipidemia and measured glucose levels. In short, some of her metabolic disease risk factors seemed to be reduced.

It would of course be easy to say that all the effects were from the GF diet (and indeed I might try and further that view) but stepping back there are quite a few potential confounders which might also have played a hand in the results. So things like the fact that entering onto a GF diet probably quite fundamentally changed her diet anyway; out goes the wheat and other gluten-containing grains yes, but in comes perhaps more protein, more vegetables and fruits, more dairy products? What about any additional supplementation for all those vitamins and minerals that might be lost from the diet? I dare say that she was also told to do a little more exercise to help reduce her weight burden also. Lots of confounders which could potentially affect her metabolic disease risk factors.

Having said all that, there has for quite a while, been some discussions about how a GF diet might potentially be linked to lots of different things outside of just managing coeliac disease and other gluten sensitivities. I am not going to go down the autism or schizophrenia route too much, but there are some suggestions of potential effects in these areas and for related conditions particularly the health effects of components of our modern diet such as carbohydrates and what happens when you reduce the carbs. Another quite interesting thought (as least to me!) is whether or not the link between gluten removal and subsequent altered gut permeability in coeliac disease might also tie into some of the effects noted. So does a better gut barrier function promote better lipid and glucose measures?

I am going to stop there as I fast approach the limits of my competence in an area which is screaming out for further investigation. I state my disclaimer that I am not providing any medical or dietary advice from the research discussed in this post - that's the job of your healthcare professional, and I strongly suggest you consult them before making any changes to diet or anything else.

* Garcia-Manzanares A. et al. Resolution of metabolic syndrome after following a gluten-free diet in an adult woman diagnosed with celiac disease. World Journal of Gastrointestinal Pathophysiology. June 2011.

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