Gluten intolerance may not damage your gut but it could still mess with your brain: What doctors want you to know
Celiac disease, traditionally considered an autoimmune disease largely localised in the gastrointestinal tract, is an underappreciated simultaneous brain disorder. Neurological or psychiatric symptoms may affect about 22% of patients and may occur at the same time as or even precede digestive complaints.
In an interview with HT Lifestyle, Dr Rohit Pai, Consultant Neurologist at KMC Hospital in Mangalore's Dr BR Ambedkar Circle, said, 'Gluten ataxia is the most obvious condition and it is thought to be cerebellar through anti-gliadin antibody. It is frequently marked by slurring speech and loss of limb coordination when walking.'
He revealed, 'Epilepsy may develop in a minority of cases, usually related to occipital lobe calcification, following visual symptoms. These cognitive brain fog/memory loss and (occasionally) progressive dementia symptoms, when combined with other non-cognitive neurological complications constitute an additional significant burden of celiac disease on the brain.'
Bringing his expertise to the same, Dr Amrut SD, Consultant Neurologist at Manipal Hospital in Goa, noted that peripheral neuropathy occurs in about half of celiacs. He shared, 'This tends to be manifest as distal sensory neuropathy, with symptoms of tingling, numbness, or burning in the hands and feet. Gluten sensitivity is an umbrella term encompassing celiac disease, non-celiac gluten sensitivity (NCGS) and wheat allergy.'
Dr Amrut SD added, 'In particular, NCGS can 'mimic' multiple neurologic phenomena seen in celiac disease despite lack of autoantibodies or enteropathy. Patients may complain of unexplained chronic fatigue, ataxia, or peripheral neuropathy too, all being related to an altered gut-brain axis. The diagnosis of NCGS is clinical and primarily a diagnosis of exclusion that needs very thorough exclusion of celiac disease, wheat allergy and others.'
Dr Meghna Potluri, Consultant - Allergy and Immunology, discussed the immuno-pathophysiology of gluten-related disorders. She highlighted, 'Wheat, barley and rye contain gluten, a protein that may cause an immune response in people who are sensitive to it. In celiac disease, this can also damage the small intestine (but wiring) and can even extend to neural tissue.'
The expert informed, 'Specific antibodies to test for include IgA-tTG, EMA and DGP, and genetic testing to determine HLA-DQ2 or DQ8 status is beneficial in confirming the diagnosis. For those patients already on a gluten-free diet, these markers may not be sensitive and upper GI endoscopy with biopsy will need to be considered.'
Non-celiac gluten sensitivity, on the other hand, does not include the immune-mediated gut damage that characterises celiac disease. Dr Meghna Potluri said, 'Instead, it can cause symptoms that go on to include nausea, bloating, headache, joint pain and neurocognitive impairment. The diagnosis is established when celiac disease and wheat allergy are excluded, usually by a combination of antibody tests and a clinical assessment.'
Celiac disease as well as NCGS is currently treated most effectively with a gluten-free diet. Dr Meghna Potluri said, 'In celiac disease, strict, lifelong adherence is required to avoid complications. NCGS might be associated with a continuum of dietary response related to symptom intensity. Individuals should be encouraged to eat whole, gluten-free foods, including fresh fruits and vegetables, dairy and unprocessed meat and avoid foods made with gluten-containing grain, and if needed, high-FODMAP foods.'
The prompt recognition of gluten-related neurological syndromes and an interdisciplinary approach among neurologists, gastroenterologists and immunologists are mandatory. Correct diagnosis, followed by individualised dietary management, markedly improves patient's quality of life.
Note to readers: This article is for informational purposes only and not a substitute for professional medical advice. Always seek the advice of your doctor with any questions about a medical condition.
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