Gluten and the Brain
Celiac disease is the best studied form of delayed pattern food allergy
caused by eating wheat and other cereal grains. A surprising range of disease is
triggered by the proteins in these foods, collectively referred to as gluten.
Celiac disease may present as a vague illness, even a mental illness.
Patients often complain of dysphoria with fatigue, difficulty in
concentration, loss of recent memory, irritability, loss of pleasure and
interests, often with sleep disturbances. Sleep and dreaming are influenced by
food problems. Most people eat their major meal in the evening and snack at
night. This food is digested and absorbed during the night and symptoms often
emerge as you sleep. Some allergenic effects tend to peak at night - asthma,
migraine, body pains, and itching are often at their worst. Sleep disturbances
include difficulty falling asleep, frequent waking and nightmares.
Luostarinen et al suggested: It is well known that coeliac disease may be
associated with various neurological manifestations. We have had a high index of
suspicion of coeliac disease during recent years in our neurological clinic. As
a result 10 (7%) out of 144 of our new coeliac patients were detected because of
neurological symptoms. The most common neurological manifestations were
neuropathy, memory impairment and cerebellar ataxia. In these patient groups
screening for coeliac disease with serological antibody tests helps to find
patients who may suffer from this disease.
Wills suggested A number of neurological syndromes have been described in
association with coeliac disease. These include disorders of the central nervous
system encompassing epilepsy, myoclonus, ataxia, internuclear opthalmoplegia,
multifocal leukoencephalopathy and dementia. Most of these associated conditions
show a poor response to gluten restriction. Peripheral neuropathies, of axonal
and demyelinating types, have also been reported and may respond to elimination
of gluten from the diet. The mechanism underlying these processes remains
obscure but may be immunological or related to trace vitamin deficiencies.
Controversially, it has also been claimed that occult coeliac disease accounts
for a substantial proportion of patients with neurological dysfunction of
unknown cause. Some authorities recommend that cryptogenic ataxias and
neuropathies should be routinely screened for the presence of gluten-sensitivity
but this remains contentious and has not been universally accepted.
Gluten and Cerebellar Ataxia
One example of specific brain injury from eating gluten is cerebellar ataxia.
The cerebellum looks after the coordination and smoothing of movements so that
problems here show up as movement disorders. Gluten sensitivity, with or without
classical celiac disease symptoms and intestinal pathology, is a treatable cause
of cerebellar ataxia. Bushara et al reported: We investigated the prevalence of
abnormally high serum immunoglobulin A (IgA) and IgG anti-gliadin antibody
titers and typical human lymphocyte antigen (HLA) genotypes in 50 patients
presenting with cerebellar ataxia who were tested for molecularly characterized
hereditary ataxias. A high prevalence of gluten sensitivity was found in
patients with sporadic (7/26; 27%) and autosomal dominant (9/24; 37%) ataxias,
including patients with known ataxia. Patients with hereditary ataxia (including
asymptomatic patients with known ataxia genotype) should be considered for
screening for gluten sensitivity and gluten-free diet trials.
Hadjivassiliouet al reported that patients with gluten ataxia have antibodies
against Purkinje cells. Antigliadin antibodies cross-react with epitopes on
Purkinje cells. Burk et al reported the symptoms of gluten ataxia: The clinical
syndrome was dominated by progressive cerebellar ataxia with ataxia of stance
and gait (100%), dysarthria (100%) and limb ataxia (97%). Oculomotor
abnormalities were gaze-evoked nystagmus (66.7%), spontaneous nystagmus (33.3%),
saccade slowing (25%) and upward gaze palsy (16.7%). Extracerebellar features
also included deep sensory loss (58.3%), bladder dysfunction (33.3%) and reduced
ankle reflexes (33.3%).
See Celiac Disease
Bushara KO, Goebel SU, Shill H, Goldfarb LG, Hallett M. Gluten sensitivity in
sporadic and hereditary cerebellar ataxia. Ann Neurol 2001 Apr;49(4):540-3
The humoral response in the pathogenesis of gluten ataxia. Hadjivassiliou M;
Boscolo S; Davies-Jones GA; Grunewald RA; Not T; Sanders DS; Simpson JE;
Tongiorgi E; Williamson CA; Woodroofe NM. Neurology 2002 Apr 23;58(8):1221-6
Luostarinen L, Pirttila T, Collin P. Coeliac disease presenting with
neurological disorders. Eur Neurol 1999;42(3):132-5
Wills AJ. The neurology and neuropathology of coeliac disease. Department of
Neurology, University Hospital Nottingham, UK. Neuropathol Appl Neurobiol 2000