Study: Gluten Antibodies Associated with ALS

Could the Gluten-Free Diet Help to Treat Lou Gehrig's Disease?

Could the gluten-free diet eventually treat ALS?. Hans Neleman/Getty Images

Some people with the frightening neurological condition amyotrophic lateral sclerosis — also known as ALS, or Lou Gehrig's disease — have high levels of a particular antibody to gluten circulating in their bodies, raising the question of whether a gluten-free diet might help in treatment of the disease, a study shows.

However, the researchers who conducted the study cautioned that its findings are preliminary and must be confirmed by further investigation before physicians consider treating their ALS patients with gluten-free diets. The scientists, based at Tel Aviv Medical Center in Israel, currently are conducting a follow-up study testing the effects of going gluten-free on ALS patients with antibodies to gluten.

"The data from this study indicate that, in certain cases, an ALS syndrome might be associated with autoimmunity and gluten sensitivity," the researchers wrote in the study, published in April 2015 in the medical journal JAMA Neurology. "Although the data are preliminary and need replication, gluten sensitivity is potentially treatable; therefore, this diagnostic challenge should not be overlooked."

Treatment for ALS Would Be Significant

ALS is a progressive neurological disease that ultimately results — usually within a few years of diagnosis — in paralysis and death. About 5,600 people are diagnosed with ALS each year in the U.S., and the condition is most common between the ages of 40 and 60. The disease causes deterioration in the part of the spinal cord responsible for movement.

You may be familiar with the condition from the massive publicity generated in the summer of 2014 by the ALS Ice Bucket Challenge, which went viral on social media and raised more than $100 million for ALS support and research.

Finding a treatment for ALS that helps some people improve — even if that treatment is only effective in a small subset of those with ALS — would be significant. At present, there's only one drug approved for ALS, and treatment tends to focus on slowing progression of symptoms while helping patients handle their symptoms better.

This isn't the first time that clinicians have suggested a connection between celiac disease and/or non-celiac gluten sensitivity and ALS. Two published case reports describe patients initially diagnosed with ALS, but who later were diagnosed instead with celiac disease and whose symptoms improved once they went gluten-free.

However, a large study published in 2014 failed to find any connection between celiac disease, specifically, and subsequently diagnosed ALS.

Tel Aviv Study Looked for Abnormal Gluten Antibodies

This most recent study from the Israeli researchers included 150 ALS patients diagnosed consecutively between July 2010 and December 2012, plus 115 healthy control subjects included for comparison.

Researchers performed blood tests for the gluten antibodies associated with celiac disease and found that none of the people in either group had those antibodies, meaning they almost certainly did not have celiac disease.

The researchers also looked for a different type of gluten antibody known as IgA-Transglutaminase-6 (IgA-TG6), which isn't implicated in celiac disease. However, IgA-TG6 is linked in some studies to gluten ataxia, an autoimmune neurological condition in which the body responds to gluten consumption by attacking its own neurons. Gluten ataxia can lead to significant, progressive disability in severe cases.

The study found that 23 ALS patients — or 15.3% — had high IgA-TG6 gluten antibodies, compared with only 4.3% of control subjects. In addition, about 59% of the ALS patients with gluten antibodies also carried at least one of the genes for celiac disease.

Those ALS patients who had the IgA-TG6 gluten antibodies circulating in their bloodstreams showed what the team called a "classic picture of ALS," similar to ALS patients without the gluten antibodies — in other words, doctors couldn't tell the two groups apart. 

So What Does This All Mean?

That's not clear yet. As I wrote above, the researchers involved in this study strongly cautioned against reading too much into it, although they're testing whether going gluten-free might help treat ALS, at least in the subset of people with these IgA-TG6 gluten antibodies.

If their findings are replicated, a likely next step would be to conduct a clinical trial to see whether a gluten-free diet might benefit patients with both ALS and IgA-TG6. Plans for such a study are underway. "Our study suggests that an ALS syndrome related to gluten sensitivity may occur in a subgroup of patients and that TG6 IgA autoantibodies may be a marker for identifying gluten-sensitive patients," the researchers concluded.

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