Saturday, July 16, 2011

ADHD and Gluten Sensitivities

What could be better for you than a delicious slice of freshly ground, freshly baked whole wheat bread? "Wheat was made for man," right?

That may have been truer 150 years ago than it is now. When I was in medical school the disease I learned about called "celiac sprue" was considered fairly rare, about 1 in 2500 people, mostly found in children. However, now the estimate is 1 in 133 people. The reason it is estimated is that the experts believe that 97% of those with celiac disease are undiagnosed. They have had bowel problems their entire lives, but no one has tested for celiac disease. As they grow older they are at increased risk for chronic fatigue, neurological disorders, arthritis, heart disease, skin rashes, nutritional deficiencies, anemia, acid reflux, nausea, emotional illness, and more. Those doctors and hospitals that are testing are finding much larger numbers of celiac than suspected.

However, most doctors are not testing for wheat allergy that is not celiac disease. Celiac disease is when the villi in the intestinal tract are destroyed by antibodies made to gluten, which causes gastrointestinal symptoms and can cause major health problems. There are many people with allergies to gluten that don't have celiac disease. When my patients come in with chronic problems they tell me they have been tested for celiac and are negative. With the right testing, I am able to show them that indeed they are gluten sensitive, but no, they don't have celiac disease.

In the testing in my office (of course these are people with chronic diseases, so it can't be extrapolated to the general population), 3 out of 5 people show antibodies to gluten in their blood, including me.

So what does this mean for ADHD? Most children with developmental disorders (ADHD, Asperger's, autism and others) have gastrointestinal problems. More than half of those with celiac disease have neurological disorders. I cannot find studies on gluten allergies that are not related to celiac, however, my own experience with patients is that gluten often increases brain fog, difficulty focusing, stomach aches, acid reflux, depression, increased sugar cravings and difficulty sleeping, among other things.

There are no major long term studies that show the effect of gluten on ADHD, as there is no financial incentive to do one. However, there are smaller studies that have shown benefit in both autism and ADHD on a gluten free diet. One study showed that children with celiac disease have twice the amount of ADHD (20.7%) as their control group without celiac disease (10.5%).

Why are there so many more people with gluten sensitivities? Evidence is pointing to newer, genetically altered strains of wheat. There is even a difference of wheat in America with wheat in Europe. American wheat has a lot more gluten that most of the European wheat. Our bodies are not adjusting to the rapid changes in genetically modified grains, and our cells don't recognize the new wheat as good for us. Our immune system treats the food as enemies, making antibodies which affect our health.

I recommend if you have a child with ADHD, autism or another developmental disorder that he/she be tested for gluten allergy. If you ask your doctor to test, he'll most likely just test for celiac disease. Ask your doctor to test for both the IgG anti-gliadin antibody, and the IgA anti-gliadin antibody. The IgA antibody is related to celiac disease, so if that shows up there should be further testing. However, most doctors are not aware of the ability to test for the IgG antibody, which is what most of my patients show up with.

If you can't find a doctor that will do the test, do the following elimination trial: have your child (or even better, you and your entire family) go 30 days completely gluten free. That means no wheat, oats, rye or barley. Be careful with processed foods--most of them have wheat derivatives. If you must use processed foods, they should have the label "gluten-free." With celiac disease, even a small amount can increase antibodies, so no cheating allowed!

After one month, everyone gets to eat their favorite gluten foods all day. Then watch over the next 24 hours what symptoms arise. Watch for increased congestion, increased ADHD symptoms, increased gastrointestinal symptoms, increased joint or muscle pain, increased moodiness, increased weight, etc. It can affect all of these things. If there are no changes in symptoms, your child is probably free to eat gluten. If there are, then you will know if the symptoms are worth the increased work of the diet.

This may seem overwhelmingly hard, and with children who are picky eaters, it can be. But if your child (or you) is gluten sensitive, I believe you and they will come to see that the effort is truly worth it. I know that I feel much better on a gluten-free diet, which I have been following for two years since I discovered that I was sensitive. Besides helping the ADHD symptoms, it increases long-term health and reduces risk of serious illness, both physical and emotional.

Until we meet again,

Dr. Judi


Melanie said...

Do you know anything about the GAPS diet for restoring gut health? What do you think? I've read that soaking or sprouting grains before consumption breaks down gluten and other anti nutrients such as phytic acid in grains. What do you know about this?

Dr. Judi said...

I am aware of the GAPS diet and I put many new patients on a modified GAPS/Candida program with anti-fungal medication and lots of probiotics for a few weeks--no sugar, grains, dairy, yeast.

Soaking and sprouting grains before using is definitely more healthy and can sometimes reduce the sensitivities, but still can be a problem with people that have true celiac disease.