Several years ago, parents of a lovely nine-year-old girl, Karen, brought her to see me because she had poor memory. They indicated that she had difficulty in thinking and focusing, and because of these issues she was falling further and further behind in her school work. Interestingly, they stated that at times she was fine, while clearly at other times her brain function seemed to be different. They indicated that she had difficulty keeping her thoughts together and that she became profoundly frustrated when this would occur.
Because of her significant issues with academic performance, her parents elected to home school her. Her academic testing revealed that she was functioning at or below a third grade level in a variety of areas, including math skills, reading fluency, story recall and overall academic skills. Fortunately, she had no significant medical problems in her past and her overall physical, as well as neurological examinations were entirely normal. Routine, typical blood studies were unrevealing, so I was left to reconsider her history to see if there were any clues as to what might be causing this child's problems.
What caught my attention was the interesting fact that her problems were not constant, indicating that basically her brain was intact but something seemed to be detrimentally influencing her from time to time, causing her to have these significant issues with respect to how her brain functioned. In considering what factors change day to day in terms of someone's exposure, certainly diet is at the top of the list.
Recognizing that gluten sensitivity (a protein found in wheat, barley and rye) is extremely common, I decided to perform a simple blood test to determine if this child was gluten sensitive. When the laboratory studies were completed, we were surprised to learn that she was profoundly sensitive to gluten. So at that point I instructed her parents to put her on a gluten-free diet. While they considered this diet to be challenging, eliminating all wheat, barley and rye from her diet, nevertheless they complied. Over the next two weeks, her parents observed a remarkable change in her cognitive function. Karen suddenly was able to focus much more readily on her school work and indicated to her parents that she suddenly noticed she was thinking much more clearly. Her parents maintained her on a gluten-free diet and over the next several months continued to notice further improvements in her school work. At the end of the school year, she was tested and her grade level equivalent for math calculation skills was 5.1, reading fluency 5.6 and story recall 8.4, which is to say, functioning at a level considered "normal" midway through the year for an eighth grader.
A brief note from her parents reported:
"Karen is completing third grade this year. Prior to removing gluten from her diet, academics, especially math, were difficult. As you can see, she is now soaring in math. Based upon this test, entering the fourth grade next year, she would be at the top of her class. The teacher indicated that if she skipped fourth grade and went to fifth grade, she would be in the middle of her class. What an accomplishment!"
Louis Pasteur stated, "Chance favors the prepared mind." I am certainly grateful that chance favored us several years ago when Karen came to be evaluated. Because of this experience, I became deeply involved in research exploring the effects of gluten sensitivity on the brain. I learned that gluten sensitivity, known as celiac disease, is actually an extremely common human affliction. In fact, it has been described as "one of the most common human diseases." Current studies indicate that about one percent of Americans are gluten sensitive. This is an astounding statistic when you consider that at the time of this writing, there are approximately 297,000,000 Americans. That means, about 3 million Americans are gluten sensitive. When you consider the population from birth to age five years is 23 million children, that means that approximately 230,000 of these children are gluten sensitive.
It seems astounding that a disease that is so common, is nevertheless, fairly obscure. Despite the fact that it was originally described in 1888, we still don't hear much about it. Standard medical text books typically describe celiac disease (gluten sensitivity) as being primarily a gastrointestinal problem. I recall in medical school being taught that celiac disease was characterized by abdominal pain, abdominal distention with bloating and gas, decreased appetite, diarrhea, nausea, unexplained weight loss and growth delay in children. Newer research indicates that celiac disease can have a profound effect on the nervous system.
Dr. Maios Hadjivassiliou of the United Kingdom, a recognized world authority on gluten sensitivity, has reported in the journal, The Lancet, that "gluten sensitivity can be primarily and at times, exclusively a neurological disease." That is, people can manifest gluten sensitivity by having issues with brain function without any gastrointestinal problems whatsoever. Dr. Hadjivassiliou indicates that the antibodies that a person has when they are gluten sensitive can be directly and uniquely toxic to the brain.
Since his original investigations in 1996, the recognition that gluten sensitivity can lead to disorders of brain function has led to a virtual explosion of scientific papers describing this relationship. Researchers in Israel have noted neurological problems in 51 percent of children with gluten sensitivity and further, describe a link between gluten sensitivity and attention deficit/hyperactivity disorder (ADHD). As authors in a recent issue of the journal, Pediatrics, stated in their research, "This study suggests that the variability of neurologic disorders that occur in celiac disease is broader than previously reported and includes softer and more common neurologic disorders including chronic headache, developmental delay, hypotonia and learning disorders or ADHD."
The link between gluten sensitivity and problems with brain function, including learning disabilities, difficulty staying on task and even memory dysfunction, is actually not that difficult to understand. Gluten sensitivity is caused by elevated levels of antibodies against a component of gluten, gliadin. This antibody (anti-gliadin antibody) combines with gliadin when a person is exposed to any gluten containing food like wheat, barley or rye. Testing for the antibody can be performed in any doctor's office. When the antibody combines with this protein, specific genes are turned on in a special type of immune cell in the body.
When these genes are turned on, inflammatory chemicals are created called cytokines, which are directly detrimental to brain function. In fact, elevated cytokines are seen in such devastating conditions as Alzheimer's disease, Parkinson's disease, multiple sclerosis and even autism. Basically, the brain does not like inflammation and responds quite negatively to the presence of cytokines. Another problem with anti-gliadin antibody is that it can directly combine with specific proteins found in the brain. Specific brain proteins can look like the gliadin protein found in gluten-containing foods and the anti-gliadin antibody just can't tell the difference. This direct role of anti-gliadin antibody in combining with specific proteins in the brain, has been described for decades and again leads to the formation of cytokines, the chemical mediators of inflammation. This is an example of turning on genes that ultimately function in a negative way in relation to brain health and function.