Brain dysfunction may be the only or the main sign of gluten related disease. Dr. Mario Hadjivassiliou recently reported at the International Celiac Symposium that his neurology clinic has followed over 300 patients with gluten sensitivity presenting with various symptoms. In his clinic the most common gluten related neurological disorder is ataxia, a condition of impaired balance, present in almost half. However peripheral neuropathy, myopathy, headaches, and seizures are also neurological manifestations of gluten related brain disorders.
Gluten ataxia, the most common cause of previously unexplained ataxia, is associated with gut disease in only about a third. Usually there is an absence of the specific antibodies in the blood diagnostic for celiac disease but elevated gliadin antibodies. Brain tissue examined after brain biopsies or an autopsy has been found to contain deposits of gliadin and/or tissue transglutaminase in the absence of antibodies in the blood.
About 60% of patients with gluten ataxia have shrinkage of the cerebellum portion of their brain. They also may have irreversible loss of brain Purkinje cells. MRI scans of the brain often reveal bright white spots in this area rather than the area where this occurs in multiple sclerosis, a condition that may be mimicked by gluten injury.
Gluten causes 34% of all unexplained sporadic axonal neuropathies. Gluten sensitive enteropathy is 10 times more common in these people. I recently treated a woman who had years of a known diagnosis of such a neuropathy though she had never been tested for celiac disease. She came to me after I diagnosed her daughter’s celiac disease. Though she does not meet strict criteria for celiac disease she has the major gene for celiac and has elevated gliadin antibodies in her stool and blood. Increased intraepithelial lymphocytes were seen on duodenal biopsy but not sufficient to confirm celiac disease. Yet she is improved on a gluten free diet. Dr. Hadjivassiliou has confirmed to me personally by e-mail that these neuropathies will get worse with continued gluten ingestion but most improve with gluten free diet though it may take several years to do so. Long standing symptoms may never completely reverse.
This makes it very important not to delay considering gluten as a cause of neurological symptoms nor delay diagnostic testing or institution of a gluten free diet. In my opinion a gluten free diet trial should be offered or considered for all neurological and psychiatric symptoms. However, I encourage anyone considering such a diet to first undergo adequate testing for celiac disease first because once a gluten free diet is initiated the tests may be falsely negative within 2-3 weeks of the diet. Even if the tests are negative for celiac disease before restricting gluten then a trial of gluten free diet is suggested. Regarding gluten and the brain Dr. Hadjivassiliou was quoted as saying “there is a historical misconception that gluten sensitivity is solely a disease of the gut…to recognize the neurological impact, you have to appreciate it is a systemic disorder.” This is my personal and professional experience as a gastroenterologist who is Food Allergies Specialist – the Food Doc and celiac disease expert who is regularly corresponding with people from all over the world as the Food Doc.
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