Can Sleep Apnea Cause Celiac Disease?
December 30, 2009
I know that the topic of this post may inflame a lot of readers out there, but please hear me out.
Celiac disease is a well-defined autoimmune condition that was originally described in children with chronic, severe gastrointestinal symptoms (diarrhea, cramping, abdominal pain and bloating). It’s known to exist in around 1/100 people in this country (97% don’t know they have it), and it’s responsible for various non-gastrointestinal symptoms, including a specific skin rash called dermatitis herpetiformis, migraines, ADHD, numbness, depression, chronic fatigue, and seizures. Others have reported a link between celiac disease and migraines, PCOS, and infertility. Only 1 out of 6 people have classic abdominal and gastrointestinal symptoms. For unexplainable reasons, the incidence has been reported to have increased 4x in the past 50 years.
The theory behind this widespread condition is that the in susceptible people, antibodies in the small intestines attack gluten, a common protein in wheat-based food. Humans don’t have the enzyme to digest gluten, so it passes harmlessly, but in people with celiac, an immune response is created which causes severe inflammation in the small intestines, leading to the classic symptoms. The only known effective cure is to avoid eating anything that contains wheat, in favor of alternatives such as rice, flax, oats, quinoa, teff, and buckwheat.
People who are eventually diagnosed and who go gluten free have remarkable success stories, with more awareness within the medical community and the lay public. One proposed explanation as to why this condition is so underdiagnosed in the US compared to other developed countries is that there’s no pharmaceutical drug that treats this condition, and that in other countries with centralized medical systems, prevention is stressed, rather than just treating the symptoms.
So far, pretty basic information, right?
Here’s my take on celiac disease: For the past few years, whenever I see patients with known celiac disease who come to see me for various ear, nose and throat symptoms, they all have various degrees of sleep-breathing problems. Almost invariably, they have small jaws, cold hands, can’t sleep on their backs, are tired all the time, and have at least one parent that snores heavily. If you look at the space behind the tongue, the airway is extremely narrow. I’ve always suspected that there’s a link between celiac disease and a sleep-breathing disorder such as upper airway resistance syndrome, but I’ve been waiting to accumulate enough studies and evidence before adding celiac disease to my sleep-breathing paradigm.
Various other gastrointestinal conditions have been linked to sleep-breathing problems such as irritable bowel syndrome, Chron’s and ulcerative colitis, so why not celiac? Remember that with upper airway resistance syndrome (UARS), repeated micro-obstructions and arousals prevents deep sleep, which causes a chronic low-grade physiologic stress response. Stress shuts down blood flow to the intestines, which leads to the food just sitting in your intestines without proper digestion and nutrient absorption. After a while, the food becomes an irritant, which causes an inflammatory reaction, creating antibodies in the process, and food being rapidly expelled in the form of diarrhea. Chronic low-grade stress heightens your nervous system and immune system, where your body tends to over-react to normal stimulants or irritants. Just like in the nose, not only will you have an allergic reaction, you’ll also have a nervous system reaction (since your gut has a lot of nerves).
It’s no surprise that every symptom that you see with celiac disease is also seen with upper airway resistance syndrome, including hypothyroidism, migraines, PCOS, dizziness, low blood pressure, and cold hands. There’s even anecdotal evidence that breastfeeding lessens the chance that you’ll develop celiac, which is consistent with what I’ve been saying about how bottlefeeding can increase your risk of upper airway resistance syndrome and obstructive sleep apnea.
I’m not discounting the significant strides made in celiac disease research. There needs to be more awareness and more screening to treat this all-too-common condition. However, even when people go on completely gluten-free diets, they continue to have many of the various other non-gastrointestinal symptoms, including chronic fatigue, migraines, and poor sleep. The way I see celiac is that it’s kind of like a bad allergy, where your main reaction occurs in the intestines. Removing gluten definitely can help, similar to removing a cat from your house if you’re strongly allergic. But ultimately, you’re not treating what’s making you allergic in the first place. Celiac is possibly one of the early signs of an underlying sleep-breathing disorder, just like hypertension, ADHD, depression and heart disease. In modern medicine, we only tend to treat the end result, rather than the cause.
If you have celiac disease, ask yourself the following:
1. Do you prefer to sleep on your side or stomach?
2. Are you tired, no matter how long you sleep?
3. Do you have cold hands or feet?
4. Do you get frequent sinus headaches or nasal congestion?
5. Do either of your parents snore heavily?
What’s your take on my theory? Please enter your feedback in the comments box below.