Gluten is well known as a trigger for unwanted gut symptoms, but did you know it can also be connected to neurological disorders? And furthermore, the evidence tells us that this can happen, even in the absence of any gut symptoms!
The Dark Side of Gluten
Problems with gluten are about way more than just coeliac disease, which is an inherited genetic problem with processing the protein portion of gluten called gliadin. Coeliac disease is diagnosed by a blood test that looks for antibodies (a triggered immune response) to gliadin and can also be picked up in genetic screening. However, it’s often wrongly assumed that it’s the only health condition that is connected to gluten. This is not the case at all.
There is actually a plethora of pathological connections to gluten that are unrelated to coeliac disease. Gluten ataxia, gluten neuropathy and gluten encephalopathy are all examples of gluten-related neurological disorders (or GRND) triggered by gluten consumption.
What is Gluten Ataxia?
Ataxia is a medical term used to describe a loss of ability to control movement. Gluten ataxia refers to ataxia that is related to exposure to gluten.
Common symptoms include:
- Problems with gait (functional problems with walking)
- Balance and coordination problems
- Vision disturbances which may be described as ‘jumpy’
- Clumsiness
- Increased chances of falls
- Slurred speech
- Difficulty with swallowing
The cerebellum is at the back of the brain and is responsible for movement, coordination, touch, vision and hearing. It also influences judgement, reasoning, problem-solving, emotions and learning. Damage to this part of the brain can severely impact your quality of life.
What is Gluten Neuropathy?
Gluten neuropathy is defined as peripheral neuropathy (in extremities, such as hands and feet) and pain with test-confirmed evidence of gluten antibodies. Symptoms can typically be categorised into sensory or motor functions.
The exact mechanism behind the nerve damage that is detected in gluten neuropathy remains unclear however, there is evidence of loss of protective myelin in nerves.
What is Gluten Encephalopathy?
Encephalopathy is a medical term used to describe brain dysfunction. Of the gluten-related neurologic disorders, gluten encephalopathy is lesser understood. It is usually characterised by gluten antibodies combined with cognitive impairment and may show in an MRI as white matter abnormalities.
Symptoms may include;
- Confusion
- Brain fog
- Slow thinking
- Headaches
- Seizures
- Amnesia
- Personality changes
- Disorientation
- Ataxia
Patients with gluten encephalopathy show improvement with the avoidance of gluten.
How Does Gluten Damage the Brain?
The precise mechanism by which gluten damages the brain is still being explored. In the case of gluten ataxia, it does appear that once gluten antibodies are made, in certain individuals, there is a cross-reactivity between these antibodies and cells in the cerebellum called Purkinje cells. The antibodies attack these cells leading to the destruction of the tissue (known as atrophy). The longer gluten is consumed, the worse the neurological symptoms become.
According to leading researcher Dr Marios Hadjivassiliou, gluten antibodies can be found in about 57% of people with neurological disorders (compared to only 5-12% in a ‘healthy’ population). He believes that gluten sensitivity represents a spectrum of health conditions and has been educating his professional peers to consider there’s more than just coeliac disease at play. In fact, in his experience, 72% of neurological patients with positive antibodies do not even show signs of damage, irritation or swelling in the small intestine (enteropathy). They will, however, show signs of improvement on a gluten-free diet. Gluten-related neurological disorders are underdiagnosed as many medical professionals still view gluten intolerance as a solely coeliac issue, and Dr Hadjivassiliou’s research certainly challenges this status quo.
When the immune system produces antibodies that attack healthy tissue, it is an autoimmune response. It’s largely driven by inflammation and an over-active immune system. Gluten may not always cause brain tissue destruction, as it does in gluten ataxia, but it can be highly inflammatory, especially to those with autoimmune conditions.
In addition, gluten has been shown to have detrimental effects on the microbiome and increases intestinal permeability. Research has clearly shown that the health of the gut environment has a direct effect on the health of the immune system and central nervous system (the gut-brain connection). Gluten avoidance is often recommended for anyone with gut or immune challenges.
Testing May Be Misleading
According to Dr Hadjivassiliou, one of the challenges with gluten-related neurological disorders is testing. The common antibody test methods are based on sensitivity levels that detect antibodies for the purpose of coeliac disease diagnosis, whereas for neurological disorders, it may need to be more sensitive. He’s been pioneering revised testing to include a test called TG-6, which shows up in up to 96% of gluten ataxia patients. This test is yet to gain wide acceptance and be rolled out on a global basis.
Should We Avoid Gluten in Neurological Disease?
The bottom line is, gluten is best avoided in neurological diseases due to its pro-inflammatory and destructive potential. We’re often consuming way more gluten than we might think because it’s so insidious in processed and packaged foods. By consuming gluten, there is an increased risk of unknowingly causing damage to our gut and nerves, and compromising our immune system.
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REFERENCES
Hadjivassiliou M, et al. Gluten sensitivity: from gut to brain. Lancet Neurol. 2010 Mar;9(3):318-30.
Hadjivassiliou M, et al. Gluten ataxia. Cerebellum. 2008;7(3):494-8
Hadjivassiliou M, et al. Neuropathy associated with gluten sensitivity. J Neurol Neurosurg Psychiatry. 2006 Nov;77(11):1262-6.
Lerner A, et al. Adverse effects of gluten ingestion and advantages of gluten withdrawal in nonceliac autoimmune disease. Nutr Rev. 2017 Dec 1;75(12):1046-1058.
Jacob S, et al. Gluten sensitivity and neuromyelitis optica: two case reports. Journal of Neurology, Neurosurgery & Psychiatry 2005;76:1028-1030.
Zis P, et al. Quality of Life in Patients with Gluten Neuropathy: A Case-Controlled Study. Nutrients. 2018 May 23;10(6):662.
Rouvroye MD, et al. The Neuropathology of Gluten-Related Neurological Disorders: A Systematic Review. Nutrients. 2020; 12(3):822.