Dr. Marie Borum, director of the division of gastroenterology and liver diseases at George Washington University, is the co-author of the paper in question, about a 28-year-old celiac patient who had been on a gluten-free diet for about five years. The woman came to Borum’s office with a recurrence of her gastrointestinal issues and she had developed an unsightly rash that turned out to be dermatitis herpetiformis, one of the symptoms that is linked to celiac disease.
Borum and the patient exhaustively reviewed what the woman had been doing differently. Was she cheating on her diet? Was she dining at restaurants or being careless while eating at friends’ homes?
“It was none of those,” the gastroenterologist says. “This woman is hyper-conscious and responsible about what she puts in her body, whether it is food, vitamins or any prescriptions she is given. She read labels and actually called pharmaceutical companies to find out what was in any product she was prescribed.”
Mystified, they continued to explore – when Borum asked her about lotions, soaps and detergents, the woman remarked that she had recently switched to a moisturizing lotion that was advertised as having “all natural ingredients“.
“Stop using it – now!” Borum told her, even though the very idea of this seemed at odds with everything Borum knew about the disease. It turned out the lotion’s ingredients included oats (which often get cross-contaminated with gluten). Once the patient gave up the lotion, her symptoms were gone within a month.
Since gluten couldn’t penetrate the skin, the only plausible explanation seemed to be that the woman applied the lotion, then her hand had touched her face and mouth. After all, that’s something people do all the time, unconsciously, as a nervous tic or simply when putting a hand to the mouth to express: “You’re kidding me!”
At the ACG meeting, Borum was caught off guard by the response to this case. She had presented other papers too, but all people wanted to talk about was cosmetics and celiac disease. While not familiar with Borum’s case, Dr. Peter Green, head of the Celiac Disease Center at Columbia University, notes that a controlled study of more than a single patient is needed before drawing conclusions.
That seems a good idea, especially since that one case has led Borum’s office to receive many more calls from people with similar stories who are seeking appointments. “One of the good things that has come from this paper is that these people feel they have a place to turn,” Borum says.
Dr. Daniel Leffler, director of clinical research for the Celiac Center at Beth Israel Deaconess Medical Center in Boston, says he keeps an open mind when his celiac patients complain of reactions to cosmetics.
“It’s not a traditional celiac-type reaction, but it may be that some people have a higher likelihood of being hypersensitive or they have other food intolerances that are undiagnosed,” he says. “You can’t be 100 per cent certain it’s a reaction to gluten but does it really matter? You still tell them to stop using the product.”
There is infinite variability in human disease, too – perhaps other conditions that share similar pathways to celiac disease. “We diagnose people all the time with conditions that don’t have a name or a reason but that doesn’t stop us from prescribing a reasonable treatment for it,” he continues. “That is the bottom line.”
Kelly Courson, a New York holistic health coach who founded the CeliacChicks.com blog, had horrible bouts with dermatitis herpetiformis before she learned 16 years ago that she had celiac disease. When she continued to have the occasional similar outbreak after she cut gluten from her diet, she did her own detecting.
“I linked it to vitamin E oil, which unbeknownst to me, can contain wheat derivatives,” she says. “The point is, you have to listen to your own body. Be more conscious about your choices. It’s a good thing!”
Next: Sourcing gluten-free cosmetics