Gluten and the Brain: Dementia and Mental Illness

In the October 2006 issue of Archives of Neurology, the Mayo Clinic presented multiple case studies of cognitive decline and dementia within two years of having celiac disease. If caught soon enough before permanent damage is done, the dementia can completely reverse.

I had a man come into my office who had just dicovered, after several years of suffering, that he had celiac disease. He had chronic pain, high blood pressure, severe rashes, edema, depression, and could not concentrate, focus, or remember enough to do his work as an engineer any longer. He was in the process of applying for disability because he couldn't think well enough to do his work.

This man discovered he had a gluten sensitivity, or celiac, not from any doctor testing him. He had been to multiple doctors and none had considered the possiblity of celiac disease or gluten sensitivity. He discovered it through his own experimentation of striving to become gluten free, and how that began to improve his symptoms. His family practice doctor was not supportive of his efforts, and he came to me to assist him in his journey towards health. He was extremely sensitive, even to the point where xantham gum in a product would set off severe edema. But now he is completely gluten free, he is back at work, lost weight, normalized blood pressure, no depression, rashes are gone, and his pain is gone except in an area of injury, which is much improved. But most of all, his brain is functioning again. He says that the loss of brain function was so subtle that he didn't realize how bad it was until it returned again.

Studies have shown increased levels of celiac disease in those with schizophrenia, and increased levels of IgG antibodies (which is gluten sensitivity without celiac disease) in those with bipolar disease, than compared to a population without mental illness. Gluten free diets have been shown to improve symptoms of these disorders in people with gluten sensitivities. Gluten sensitivities can also increase levels of depression.

Another Mayo Clinic study in the July 2009 issue of Gastroenterology shows that Celiac disease is four times more common today than it was in the 1950s. And this doesn't count the people who are gluten sensitive without celiac disease. It is a growing epidemic. It also showed that those with undiagnosed celiac disease were four times more likely to die than those that were gluten free during the 45 years of the study. This is a much more serious problem than even most physicians realize.

There are blood tests that show gluten sensitivity and possible signs of celiac disease, but the gold standard has always been an intestinal biopsy that shows destruction of the intestinal villi. However, another study out of Mayo Clinic has shown that those with the blood markers but no villi destruction still show metabolic changes of gluten sensitivity and should go on a gluten free diet to reduce their risk of further damage.

Celiac disease used to be considered a children's disease. It is now shown that the elderly are much more likely to have problems caused by gluten sensitivities than children. Celiac disease can start at any age. But any child or adult with "brain problems" should be tested for anti-gliadin IgG and IgA antibodies, and for endomysial antibodies. Or better yet, make the supreme effort to go gluten free for a month, then spend one day eating a lot of gluten, and see what happens. It may save your brain, your sanity and your life.

Until we meet again,

Dr. Judi

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