Science Sounds Alarm on Brain Symptoms
Should we be nervous about celiac disease?” That dire-sounding question is the headline over a research paper that Dr. Marios Hadjivassiliou co-wrote in 2012 about celiac disease’s potential effects on the brain.
The study’s answer is a resounding “yes” – although not to make people alarmed so much as to underscore the critical importance of both early diagnosis and following the gluten-free diet.
The study involved analysis of the MRI scans of 33 celiac patients at Royal Hallamshire Hospital in Sheffield, England. The patients, who all had biopsy-proven celiac disease, were between 19 and 64 years old and had all been referred for a neurological examination after complaining of symptoms such as headaches or an inability to walk in a straight line.
Compared to a control group, the results showed the patients had “significantly less” brain density. There were also changes to the cerebellum, or balance center, and to the thalamus, which conveys sensory and motor signals to the cerebral cortex, and to areas of the brain associated with depression.
Hadjivassiliou estimates that at least 10 percent and as many as 30 percent of all celiac patients have varying degrees of neurological dysfunction. Consider that one in every 100 people is thought to have celiac disease in the first place and you begin to grasp the potential enormity of the problem. “It certainly gives one pause,” he says.
Some patients have lived for years without a diagnosis of either celiac disease or gluten sensitivity, consuming gluten with no idea of the damage being done. Others are diagnosed more quickly, able to more easily reverse the protein’s deleterious effects once a gluten-free diet is started. Since those with cognitive symptoms often do not have the gastrointestinal complaints common to these conditions, the gluten connection can be overlooked.
“The thing is, if you have a predominant bowel complaint, your physician is more likely to think about the possibility of celiac disease while if you present with a neurological issue, the reverse is true,” Hadjivassiliou says. By the time you consult a neurologist, your condition is far advanced and the nervous system doesn’t regenerate like a bowel does.
When patients finally get to Hadjivassiliou, they tend to be much older, with brains that are less elastic and adept at healing than they once were. This means that for some of them, at least, going on a gluten-free diet may only halt the damage in its tracks but not reverse it.
Some of his adult patients, like the man in his 40s whose bosses insisted he go to hospital for tests after he fell at work, are lucky and able to walk away. Others, not so much – like the elderly man who had suffered from a gross lack of coordination for 20 years, along with gastrointestinal symptoms such as bloating and diarrhea.
Once he was diagnosed with celiac disease and on the correct diet, the motor control condition called ataxia stabilized. But still he never walked again; the part of the brain that controls movement had shrunk too much, and he spent the rest of his life confined to a wheelchair.
As a pioneer in the research on gluten effects on the brain, Hadjivassiliou is the first to admit that his work has generated controversy, and some doubt the severity of gluten’s effects on the brain. But he notes that medicine is not a religion with fixed tenets; knowledge is growing and changing all the time.
“We have to think of the bowel, not as where the disease occurs, but as an innocent bystander where the gluten crosses to do its damage,” Hadjivassiliou says. “It’s imperative that we change the mindset about celiac disease and brain dysfunction.”
As a first step, Hadjivassiliou advocates for gastroenterologists and general practitioners to include questions about headaches and loss of balance when they go over the checklist of celiac symptoms with their patients. Backed by a growing body of research, that’s how change begins.
This series of articles was first published in the Spring 2013 edition of Allergic Living magazine. To subscribe affordably and get more great articles, click here.