Sunday, February 11, 2007

Gluten causes brain dysfunction and gluten free diet may be for everyone with neurological and psychiatric symptoms

Brain dysfunction may be only 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. The most common neurological sign is ataxia, a condition of impaired balance. It was present in almost half. 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.

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 b 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. If long standing, the 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 because once a gluten-free diet is initiated the tests may be falsely negative, even within 2-3 weeks of the diet. Even if the tests are negative for celiac sprue a gluten free diet is suggested.

For those of you following the Food Doc Journal or have written me recently please accept my apology for the delay in a new post and answering e-mails. While seeing patients in my busy practice I was working on my annual presentation to the local Pikes Peak Chapter of the Celiac Sprue Association this week and a new booklet I am preparing to publish on Celiac and Gluten Sensitivity. I have also been working on the launch of the premier version of my educational website Thank you for your continued interest as we journey together looking for the links between food, bacteria, yeast and the gut. Sincerely, Dr. Scot Lewey, the Food Doc.

J. Neurol. Neuropsychiatry 2006;77:1262-6
J. Neurol. Neuropsychiatry 2003;74:1121-4
Brain 2003;126:685-9
Muscle Nerve 2006;34:762-6

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