The Gluten-Free Diet for POTS, EDS, and MCAS

The Gluten-Free Diet for POTS, EDS, and MCAS

The intersection of gluten-related issues and chronic conditions such as Postural Orthostatic Tachycardia Syndrome (POTS), Ehlers-Danlos Syndrome (EDS), and Mast Cell Activation Syndrome (MCAS) has gained increasing attention in recent years. Although research is still evolving, many individuals with these conditions report improvements in symptoms when adopting a gluten-free diet (GFD). Let's take a closer look at how gluten might affect these conditions and whether a gluten-free diet could offer symptom relief.

Gluten Sensitivity, Celiac Disease, and EDS

In individuals with hypermobile Ehlers-Danlos syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD), gastrointestinal (GI) issues are prevalent. Functional gut disorders like irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and dysmotility are common​​. Some studies suggest a potential link between celiac disease—a condition triggered by gluten—and EDS. For instance, individuals with EDS may have a higher prevalence of celiac disease than the general population, and small studies suggest that gluten sensitivity may exacerbate EDS symptoms​​.

Celiac disease and non-celiac gluten sensitivity both involve immune responses to gluten, and their overlap with EDS could be linked to shared mechanisms, such as connective tissue fragility or immune dysregulation​​. Celiac disease also increases the risk of small intestinal bacterial overgrowth (SIBO), a condition that may overlap with symptoms of EDS-related GI dysfunction​.

Gluten and POTS

POTS, a form of dysautonomia characterized by an abnormal increase in heart rate when standing, often co-occurs with EDS and MCAS​. Some patients with POTS report worsening symptoms after consuming gluten, including gastrointestinal discomfort, bloating, and fatigue. One case study found that gluten ingestion exacerbated POTS symptoms, suggesting that gluten could trigger or amplify autonomic dysregulation in susceptible individuals​.

Moreover, certain GI conditions like gastroparesis, which are common in POTS and EDS patients, can be aggravated by gluten-containing foods, as they may slow digestion or lead to bloating and discomfort​​.

MCAS and Gluten Sensitivity

MCAS is a condition where mast cells release excessive amounts of histamine and other inflammatory substances, leading to widespread symptoms ranging from allergic reactions to GI distress and fatigue​​. Gluten and other food triggers are common culprits in activating mast cells, making it plausible that a gluten-free diet could alleviate some of the GI and systemic symptoms associated with MCAS​.

Histamine intolerance is often seen in people with MCAS, and gluten can trigger a histamine response in sensitive individuals. Additionally, proton pump inhibitors (PPIs) used to treat GERD in MCAS patients may interfere with nutrient absorption, exacerbating gluten sensitivity​​.

Benefits of a Gluten-Free Diet

Although definitive research is still lacking, anecdotal evidence and small studies suggest that many patients with EDS, POTS, and MCAS experience symptom relief after switching to a gluten-free diet. Key benefits include:

• Reduced Gastrointestinal Symptoms: Studies show that a gluten-free diet can help alleviate IBS-like symptoms, particularly diarrhea and bloating, which are common in POTS and EDS patients​​.
• Decreased Fatigue: Many patients report that gluten-free diets lead to improvements in fatigue, a major symptom in all three conditions​​.
• Improved Nutrient Absorption: For patients with malabsorption issues, a gluten-free diet may enhance nutrient uptake, improving overall health​.

However, it's essential to approach the diet carefully. A gluten-free diet can be restrictive, and cutting out gluten may lead to deficiencies in fiber, vitamins, and minerals, making it important to work with a healthcare provider to ensure balanced nutrition​​.

Conclusion

While more research is needed, the gluten-free diet has shown promise for managing symptoms in people with POTS, EDS, and MCAS. Its role in reducing inflammation, improving gut health, and minimizing mast cell activation could make it a valuable dietary intervention for those struggling with these complex conditions. If you're considering a gluten-free diet, it's always a good idea to consult with your doctor or a nutritionist to ensure it's right for your specific needs.

References:

• Laszkowska, Monika, et al. “Nationwide Population-Based Cohort Study of Celiac Disease and Risk of Ehlers-Danlos Syndrome and Joint Hypermobility Syndrome.” Digestive and Liver Disease, vol. 48, no. 9, 2016, pp. 1030-1034, https://doi.org/10.1016/j.dld.2016.05.019.
• Weinstock, Leonard B., et al. “Mast Cell Activation Syndrome: A Primer for the Gastroenterologist.” Digestive Diseases and Sciences, vol. 66, no. 4, 2021, pp. 965-982, https://doi.org/10.1007/s10620-020-06264-9.
• Fikree, Asma, et al. “Gastrointestinal Involvement in the Ehlers-Danlos Syndromes.” American Journal of Medical Genetics Part C: Seminars in Medical Genetics, vol. 175, no. 2, 2017, pp. 181-187, https://www.ehlers-danlos.com/wp-content/uploads/2022/03/Fikree_et_al-2017-American_Journal_of_Medical_Genetics_Part_C-_Seminars_in_Medical_Genetics.pdf.
• Shah, Neha D., et al. "Nutritional Considerations for Hypermobile Ehlers-Danlos Syndrome." Practical Gastroenterology, May 2024, pp. 38-39, https://doi.org/10.1007/s13668-021-00373-1.
• Pinto-Sanchez, María Inés, et al. “Gluten-Free Diet Reduces Symptoms, Particularly Diarrhea, in Patients with Irritable Bowel Syndrome and Antigliadin IgG.” Clinical Gastroenterology and Hepatology, vol. 19, no. 11, 2021, pp. 2343–2352, https://doi.org/10.1016/j.cgh.2020.08.040.
• Fikree, Asma, et al. Gastrointestinal Involvement in the Ehlers-Danlos Syndromes. American Journal of Medical Genetics Part C: Seminars in Medical Genetics, vol. 175, no. 2, 2017, pp. 181-187, https://doi.org/10.1002/ajmg.c.31546.
• Do, Toan, et al. “Nutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes.” Current Nutrition Reports, vol. 10, no. 4, 2021, pp. 324-333, https://doi.org/10.1007/s13668-021-00373-1.

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