As of February 2024 we found no new information that would warrant any TOE grade change
As of July 2023 we found no new information that would warrant any TOE grade changes
Since our review, there was a population-based study that looked for a potential relationship between celiac disease and ALS in large numbers of people, using antibody testing and genetics (J Neurol 2017;264:694-700). No evidence for any relationship was found. We found no other new studies. Our TOE grades and our conclusions remain unchanged
Key Information
Theoretically, gluten-induced autoimmunity could trigger ALS. However, the data supporting this link are weak, consisting of two association studies and a single case-report. Further studies are needed to confirm the relationship between GRDs and ALS, and the utility of the GFD in patients with both conditions. In spite of the fact that GFD is reasonably safe, it is a complex undertaking and is more expensive than a standard diet. While we wait for better data, it would be reasonable to screen PALS who have GI symptoms, iron-deficiency anemia, or an abnormal brain MRI for the antibodies associated with GFDs. Those with elevated antibodies could be referred to a gastroenterologist for further work-up, and if this is consistent with a GRD, then GFD could be tried under the guidance and monitoring of a dietician.
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