Gluten and Brain Health: Secret Symptoms of Gluten Sensitivity – Part 2

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM

Read Part 1 | Part 3

Gluten-Related Disorders

Gluten sensitivity can manifest in many different ways. These are the conditions that fall under the approved nomenclature for gluten and brain health disorders:

Celiac Disease

Gluten and brain health, the causes of Celiac diseaseCeliac disease is a genetic disorder, with a one in ten chance of inheriting it, if an immediate family member has it. If you have a parent or sibling with the condition, you should get tested.

However, hereditary factors are not the most reliable way to assess risk because many people with celiac disease are not aware they have it. You may have a family member with celiac disease who does not even know it.

Underdiagnosis is especially common because most people think that digestive symptoms are the only sign of celiac. Though digestive issues are among the more obvious symptoms in children, adults are more likely to experience other symptoms including:

  • Fatigue
  • Brain fog
  • Pain in the bones or joints
  • Bone loss
  • Arthritis
  • Anemia
  • Liver problems
  • Tingling or numbness in the hands and feet
  • Skin rashes or sores
  • Fertility issues
  • Irregular periods
  • Headaches
  • Seizures
  • Depression
  • ADHD-like behavior
  • Anxiety

These symptoms fall under the non-classical cases of celiac disease. There are also those who do not experience any symptoms, and only find out later when their health has sustained heavier damage. That is called asymptomatic celiac disease.

Typically, with the classical cases of celiac disease symptoms of leaky gut syndrome begin when the immune system antibodies attack the tTG enzyme, causing damage and atrophy to the microvilli. These symptoms include diarrhea, constipation, malabsorption, bloating, and abdominal pain.

If there is malabsorption, further issues can develop, including vitamin and mineral deficiencies. This is one of the reasons why many people with celiac disease and gluten sensitivity suffer from anemia and vitamin B12 deficiency as well.

Non-Celiac Gluten Sensitivity

Non-Celiac Gluten Sensitivity, gluten and brain healthIf you experience some of the symptoms of celiac disease, yet your tests for it come out negative, you might have what is called non-celiac gluten sensitivity. If you are sensitive to gluten, removing it from your diet should bring relief from your symptoms.

A good way to test this is by going gluten-free for one month to see how you feel. After one month, you can reintroduce gluten back into your diet to see if you feel worse. If your symptoms return after reintroduction, then you’re better off without gluten.

Just because you don’t have an autoimmune reaction to gluten doesn’t mean that it is not causing you health damage. Recent studies show that even non-celiac gluten sensitivity can cause harm to intestinal walls and create inflammation and systemic immune reactions. In these cases as well, gluten and brain health can have negative impacts.

Gluten Ataxia

Ataxia is a neurological condition that affects the body’s ability to control muscular coordination. It causes an array of other symptoms as well, such as fatigue, dizziness, difficulty walking, nausea, vomiting, tremors, difficulty swallowing, difficulty speaking, clumsiness, and more.

Ataxia has many causes, including trauma to the head, infections, brain surgery, tumors, alcoholism, and physical defects in the brain, spine, or brain stem.

However, some of its causes can be traced back to gluten, known as gluten ataxia. Gluten ataxia is the most obvious example of a negative relationship between gluten and brain health.

Among all ataxias, gluten ataxia has 15% prevalence, so it is somewhat common. However, it is a major cause of idiopathic (of unknown cause) sporadic ataxias, with a 40% prevalence.

Dermatitis Herpetiformis

Gluten and brain health, in relation to dermatitisDermatitis herpetiformis, also called Duhring’s disease, is a non-celiac skin condition caused by gluten sensitivity that creates itchy, burning blisters. Most often, these skin bumps are concentrated around the elbows, forearms, knees, and buttocks. Though from the name it sounds like it is a type of herpes, it is actually not related to the herpes virus. It is also sometimes confused with eczema.

Although up to 15% of patients with celiac disease will also have dermatitis herpetiformis, many patients with this skin condition will actually have normal gastrointestinal and celiac blood test results. That is because, just like gluten and brain health, gluten can also affect the skin without manifesting other symptoms.

Dermatitis herpetiformis is another example where, just because celiac blood tests come out normal, it doesn’t mean that you are not gluten sensitive. Further testing and observation should be done if you have any kind of skin, joint, neurological, or gastrointestinal symptoms that don’t seem to have a specific cause. There is a possibility it’s just gluten.

Gluten and Brain Health

Neurological symptoms associated with celiac disease have been reported as far back as 1966. However, it wasn’t until 30 years later that a case of celiac disease with solely neurological symptoms was reported.

Many celiac patients experience neurological symptoms, especially those associated with a malfunctioning autonomic nervous system. Only recently has the wider medical community has accepted the possibility that these kinds of extraintestinal presentations of gluten sensitivity can appear without gastrointestinal symptoms.

For every symptomatic patient with celiac disease, there are eight patients with no gastrointestinal symptoms. This should further underline why we need to pay more attention to gluten’s and brain health effects when there are no gastrointestinal symptoms.

These patients usually find they have celiac when they go to the doctor with joint, skin, or neurological symptoms, or some vague autoimmunity. Sometimes, even their test results will not show any gluten sensitivity. Still, it is possible they might be suffering from celiac disease or gluten sensitivity, especially if the cause of their ailment is not identified.

In the case of patients with a known neurological conditions, 5% of them have elevated gluten antibodies. But for those whose neurological symptoms have no known cause, the percentage is up to 57%.

The effects of gluten and brain health can create many neurological manifestations. This is only a partial list:

  • Cerebellar ataxia – inflammation of the part of the brain (the cerebellum) that controls gait and coordination
  • Neuropathy – a disorder of the nerves that can create a loss of sensation or weakness
  • Myopathy – dysfunction of muscle fibers resulting in muscular weakness
  • Autonomic neuropathy/system dysfunction
  • Migraines and other headaches
  • Depression – inflammation drives a serotonin deficiency
  • Myelopathy – neurological problems in the spine
  • Learning disorders
  • Hypotonia in infants – low muscle tone and strength
  • Encephalopathy – brain function disorder caused by toxins
  • Epilepsy
  • Chorea – an abnormal and involuntary movement disorder
  • Brainstem dysfunction
  • Guillain-Barre-like symptoms

With such a wide range of effects, the relationship between gluten and brain health has led some medical professionals to say the blood-brain barrier works the similarly to the mucosal lining of the gut. This means that what’s happening in the gut is also happening in the brain. Thankfully, there are now ways to assess this.

Testing for Gluten Sensitivity: from Gut to Brain

Gluten and brain health testingRecent evidence suggests that patients with newly identified celiac disease do indeed have abnormal MR spectroscopy results showing evidence of subtle cerebellar dysfunction.

There is a possibility of molecular mimicry in the cerebellar tissue after the activation that started in the gut. This means that there could be structural or sequential similarities between the foreign antigens (gluten in this case) and the self-antigens (the body’s own molecules that trigger antibody formation).

This mimicry could result in the cross-activation from the gut to the brain. Interestingly, eye muscles are one of the first things to be activated because they are so small.

Understanding this relationship – between an immune activation at the mucosal level and a molecular mimicry that then attacks other tissues – may end up explaining conditions that we previously thought of as vague processes, including complicated autoimmune, digestive, neurological, joint, and skin issues.

With these kinds of cross-activations, we need to have a more holistic view of the effects of gluten on brain and gut health. This is especially the case with non-celiac gluten sensitivity. We must shift from viewing it as a gut illness to viewing it as a systemic illness.

To make it more complicated, in patients with gluten ataxia and those with celiac disease with no neurological manifestations, the prevalence of antibodies is up to 60%. The levels and positivity of these antibodies can be significantly reduced by switching to a gluten-free diet for both of these patient groups.

Such findings show it is becoming more and more important to go beyond conventional gluten testing.

To test for extra-intestinal manifestations of gluten sensitivity, we need to look for immunoglobulin-G (IgG) antibodies, in addition to the immunoglobulin-A (IgA) antibodies that are more commonly tested for.

That’s because patients without overt gastrointestinal issues can have antibodies that react with different tTG isoenzymes. Isoenzymes are enzymes with the exact same function but different structures. Of these isoenzymes, we know of tTG, which is sometimes called TG2, as well as TG3 which is found in dermatitis herpetiformis, and TG6 which is found in patients with neurological manifestation.

The type of antibody that is presenting shows which systems are affected by gluten, even if symptoms are slight or absent.

Three Case Studies on Gluten and Brain Health

To illustrate how the effects of gluten and brain health can manifest, consider these three case studies that outline different ways this relationship can present.

Case 1: Gluten Ataxia and Multiple Sclerosis

A 42-year old man began experiencing progressive neck, shoulder, and muscle pain with a weakness in the limbs. After three weeks, he developed difficulty urinating, accompanied by a tingling sensation and sensory disturbance in his trunk and legs. At that point, he could not even climb the stairs.

He was referred to a neurologist. After some testing, problems in his visual acuity were discovered. With a pinprick examination, hemisensory loss was found on both sides. The MRI of his brain showed mild abnormalities in his white matter, with a mild generalized atrophy.

Multiple Sclerosis, gluten and brain healthThis picture is a pretty typical multiple sclerosis (MS) diagnosis. However, to exclude the possibility of gluten sensitivity as a cause, he was tested for antibodies and other markers. The results showed he had gluten ataxia.

This patient was then put on a gluten-free diet and given an IV of methylprednisolone, which is a steroid that helps suppress the release of substances that create inflammation. He was also put on Betaseron, a medication that helps reduce the flare-ups that occur with MS.

After 15 days, there was significant improvement.

To repair his gut and brain barriers, he was given other medications including glutathione, glutamine, probiotics, N-acetylcysteine, EPA/DHA, vitamin D, lactoferrin, xylitol, and boswellic acid. Three months later his health had improved significantly.

Case 2: Headaches, CNS White Matter Abnormalities, and Gluten

Ten patients with gluten sensitivity and abnormal MRIs all experienced episodic headaches. Six of them also experienced unsteadiness, and four of them had gait ataxia. All patients were put on a gluten-free diet, and nine of them had symptoms improve.

However, even though their headaches were relieved, the white matter damage did not reverse.

This doesn’t mean brain function is in inevitable decline, though damage was done. By reducing the inflammation around the brain, even if the MRI doesn’t change, brain function can go back to normal, and there are other cases where lesions in the brain have resolved.

Case 3: Epilepsy and Gluten

A 30-year old man who was previously healthy began having headaches with refractory seizures, postictal right hemiparesis, and aphasia. He also had constant hemiparesis or weakness of one side of the body. These symptoms were ongoing for two years. A brain MRI revealed multiple lesions involving white and gray matter.

After going on a gluten-free diet, his symptoms were relieved, and changes were visible in his MRI. This shows it is possible to resolve some cases of epilepsy with a gluten-free diet. However, many medical professionals are unaware of the link, so the option does not cross their minds.

These three cases show that we cannot rely only on gastrointestinal symptoms as a sign of gluten intolerance because gluten can affect brain health without presenting any digestive issues.

Read Part 1 | Part 3

© Copyright 2018 Michael Lam, M.D. All Rights Reserved.

Gluten and brain health