Liver Disease in Celiacs

Liver disease can be very scary. It applies to any disease or disorder that causes the liver to function improperly or stop functioning. This can be diagnosed by checking for the level of liver enzymes in the blood. There are two primary types of liver disease that may be associated with autoimmune diseases, particularly celiac disease.

Primary biliary cirrhosis is an inflammation of the bile ducts of the liver resulting in narrowing and obstruction. The cause of inflamed bile ducts within the liver in this condition is not known. The disease more commonly affects middle-aged women. The onset of symptoms is gradual, with fatigue and itching skin as the most common first symptom. Long-standing bile obstruction is believed to lead to liver cirrhosis. The disease may be associated with autoimmune disorders. Symptoms can include: Itching, jaundice, enlarged liver, abdominal pain, fatty deposits under the skin, soft yellow spots on the eyelid and fatty stools.

Another common disease is called autoimmune hepatitis, which is inflammation of the liver caused by immune cells that mistake the liver’s normal cells as harmful invaders. A person with autoimmune hepatitis has autoantibodies circulating in the bloodstream that cause the immune system to attack the liver. Autoimmune hepatitis sometimes occurs in relatives of people with autoimmune diseases, suggesting a genetic cause. This disease is most common in young girls and women. Symptoms can include: dark urine, loss of appetite, fatigue, malaise, abdominal distention, generalized itching, pale or clay-colored stools, nausea and vomiting.

However, other liver diseases have also been associated with celiac disease. These include reactive hepatitis, which is just an irritation of the liver that sometimes causes permanent damage. Autoimmune cholangitis, which is inflammation of the bile ducts of the liver without a specified cause. Non-alcoholic fatty liver disease an occur where there is a build-up of excess fat in liver cells in patients who drink little to no alcohol. Acute liver failure is severe deterioration of liver function. Another disease is called cryptogenic cirrhosis, which can result in a liver transplantation. Cirrhosis is a chronic problem that makes it hard for the liver to remove toxins from the body. Regenerative nodular hyperplasia is a rare disorder that is often associated with connective tissue disorders and is a cause of non-cirrhotic portal hypertension. And finally, hepatocellular carcinoma which is a primary cancer of the liver.

I find it fascinating that most of these diseases or conditions are related to inflammation.  Could it be that the immune system is stressed from dealing with all the gluten in the body that it cannot tolerate to begin with?  Could it be that the body, being on high alert fighting gluten, starts attacking other systems of the body as well, especially the liver, an organ that is highly involved in the metabolic processes of the body?
There is growing evidence that a many liver diseases in children and adults may be related to celiac disease. The disease-causing mechanism of liver damage in celiac patients is poorly understood. The different types of liver disease described may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, early exposure and duration of exposure to gluten may influence the reversibility of liver damage. In fact it has been found that 6.4% of patients with autoimmune hepatitis have celiac disease. And in 5-10% of celiac patients, they find chronically abnormal liver tests and no obvious cause of liver disease. And a scary 6-8% of celiac patients have autoimmune liver diseases. Finally, research has shown a 3% prevalence of primary biliary cirrhosis in people with celiac disease.

To test for liver damage, a simple blood test can be performed. You see inside the cells of your liver, there are metabolic enzymes that are crucial for your body to store and use energy. When liver cells are damaged, some of these enzymes leak out into the bloodstream. The two most common enzymes tested for are alanine aminotransferase, also called ALT, and aspartate aminotransferase, AST. Having elevated liver-enzyme tests signifies that there has been some damage to cells in your liver, allowing the enzymes to escape.

A review in “Alimentary Pharmacology and Therapeutics” in 2005 looked at several studies of liver enzymes in people with celiac disease. The authors concluded that elevated liver enzymes are common in people who are diagnosed with celiac disease. Up to half of all patients with celiac disease had high AST and ALT levels. This finding suggests that something about celiac disease causes some damage to liver cells. However, very few people go on to develop serious liver disease.

The good news is that treatment with a gluten-free diet in patients with both celiac disease and liver disease can lead to prevention of hepatic failure even in severe cases where liver transplantation is being considered. Treating your celiac disease by eating a gluten-free diet should cause your liver enzymes to return to normal. If you have celiac disease and are completely avoiding gluten but your liver enzymes remain elevated, it is likely that another process is damaging the liver. Remember my article last week? Be sure to discuss the management of your celiac disease and your liver enzyme levels with your doctor.

Salmon Patties
Ingredients:
2 cans Alaskan Wild Salmon
1 egg
1 T Parmesan cheese
1/3 cup Glutino Bread crumbs
1/8 tsp pepper
1/8 tsp garlic salt
1/8 tsp ginger

Directions:
Mix above ingredients with a fork.
Form into 5 patties.
Brush with olive oil.
Bake at 350 degrees for 20 minutes.
Serve in a rice tortilla on a bed of spinach.

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One Response to Liver Disease in Celiacs

  1. Terry says:

    Thank-you for all your hard work,and keeping us informed.

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