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David Perlmutter, M.D.

David Perlmutter, M.D.

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Gluten Sensitivity and the Impact on the Brain

Posted: 11/21/10 11:40 AM ET

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.

 
 
 

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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 the...
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 the...
 
 
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05:07 PM on 12/07/2010
I appreciate that this piece is about inflammatory agents (such as cytokines) but is seems a bit odd that the potentially addictive quality of gliadin in gluten (and similarly casein in cheese) is not mentioned when it can significantly affect how easy it is for someone to 'give up' certain foods. Some people who are glute-intolerant (and casein-intolerant) metabolise gliadin (and casein) into morphine-like substances in the brain (gliadomorphin and casomorphin) which act as opioids and are actually, therefore, addictive. Being hooked on bread and cheese may be pretty common, but there's actually a biochemical basis for it in some cases... particularly interesting in cases of autism, fibromyalgia (fibrofog) etc... http://bit.ly/gM9gZY
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WhereIsTheTruth
We need more chlorine in the gene pool!
12:14 AM on 11/28/2010
One percent of the population qualifies as extremely common? I'm also overcome that an MD wrote something that included a quote from someone else referring to celiac disease as "the most common human disease" without setting the record straight. 7.8% of the US population has diabetes. Correct me if I'm wrong, but I think 7.8 is greater than 1.
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03:16 AM on 11/30/2010
You're "overcome"? Well get over it - He actually said "one of the most common diseases," not "the most common." The 7.8% number on diabetes is an estimate of diagnosed and undiagnosed cases, not a definite number. Diabetes as been far more intensely studied that gluten sensitivity, and it is estimated that gluten sensitivity may more common in other parts of the world than in the US.
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WhereIsTheTruth
We need more chlorine in the gene pool!
11:08 PM on 12/01/2010
The 7.8% figure comes from the CDC. Here's another figure to consider: 1/6 of the world's population suffer from one or more neglected tropical diseases according to the WHO. I stand by my initial point - 1% does not qualify as extremely common and, even accepting your correction (my quote was a copy/paste from the article above at the time of my comment), it does not approach the prevalence of tropical diseases to qualify as "one of the most common diseases." He's blowing wind to sell his book.
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TedEjr
How can they be Right when they are wrong so much
09:37 PM on 11/27/2010
The ex wife was gluten intolerant. It took several years of abdominal issues to come to a diagnosis. And, back then, about 6 years ago, the number of gluten free products were minimal to begin with. And labeling was a challenge.

From what I have learned, Australia is light years ahead of the U.S. in addressing this problem. Which, from my last information, is more prevalent than diabetes.
12:07 PM on 11/27/2010
Thank you for this great post! I will be sharing a link to it on my blog. My son is on a GF/CF diet to manage autism symptoms.
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Willow712
democratic socialst
08:55 AM on 11/27/2010
They always say that what you crave is usually your problem. I am a whole wheat bread/cereal craver. I love breads, whole wheat cereals, etc. Whereas my Dad would go to the doctor if he had two bouts of diarrhea, I can have five or ten a day and think nothing of it. With my fibromyalgia, narcolepsy, edema, neuropathy (no diabetes at all), my diet sodas and carbs, I think I am probably killing myself. I am thinking of improving my diet one step at a time over a period of a few months. Hopefully that will make it easier, than cold turkey on everything I eat.
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thepoliticalcat
Eradicate your microbioflora
08:03 PM on 11/27/2010
As someone who has to manage health issues via diet, let me make a few suggestions that might help.

1. Always start with one thing and stick to that till it's completely resolved. If you decide to give up everything at the same time, you're going to lose the battle very soon. Perhaps you can give up diet sodas for a start, then, after you no longer crave them, you can move on to whole wheat cereals.

2. Substitute something good for each bad thing. It takes a while, but it's a lot easier if, for example, you make a big flask of herb tea sweetened with honey (and you can start out with a lot of honey, if that helps, and cut back gradually); or carry around a gallon of apple or other fruit juice.

3. Bread or whole wheat cereal for breakfast is a habit. You can change that habit by substituting different things each day. Start with one scrambled or soft-boiled egg and a fruit salad; or a different, non-allergenic grain with fresh fruit. Do this for one day a week, then two days, then three. Otherwise, your craving for bread will overwhelm your good intentions.

Best of luck, and hope all your health problems resolve.
10:56 AM on 12/06/2010
What you need to do is go get tested for gluten intolerance before you start cutting back your wheat intake. You need to be eating the wheat products if you want the test to be correct. If you are a celiac or have a wheat allergy, you will know that to save your life, you will have to remove that food from your lifestyle. Gluten is a poison to celiacs. It would be like knowing that wheat or gluten is poison to you instead of thinking, 'well its probably not good so I should cut back'. Now which thought would make you quit. If you are celiac, you must remove all gluten right away, not just a little at a time.
03:05 AM on 11/25/2010
Gluten sensitivity is also a significant factor in hypothyroidism and Hashimoto's... I'm reading a ground-breaking book on thyroid problems, causes, and ways to achieve thyroid balance titled "Why do I still have thyroid symptoms? when my lab tests are normal," by Datis Kharrazian. Highly recommended for those with thyroid problems. I'm working with my chiropractor who has been studying with the author. I'm currently doing a 3-week detox nutritional protocol, and being completely gluten-free is a major part of it.
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drvittoriarepetto
03:20 PM on 11/24/2010
As gluten sensitivity also leads to breakdown of the instestinal lining; it is wise to help yr gut w/ probiotics such as lactobacacilli & bifidobacteria (they should be in refrigerator section) and L-glutamate, fructooligosaccharides & inulin.
http://www.wisegeek.com/what-are-fructooligosaccharides.htm
In my practice, I have found Probioplex intensive Care by Metagenics to be very effective http://www.metagenics.com/products/a-z-products-list/Probioplex-Intensive-Care
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VanessaFas
02:56 PM on 11/24/2010
I am sensitive to gluten. I avoid wheat unless there's a birthday party. But I pay the price, with stomach pain and short-term memory issues the next day. Although people are discussing and accepting this diagnosis more and more, there are still so many who say that this, and allergies are 'all in your head'. I would hope for more acceptance, but guess I understand: people often cannot believe what they (or their family) have not experienced. I can only hope that the success stories continue to be written, and more research is done. Thanks for the great article.
02:30 AM on 11/30/2010
You get that too. I get it. I am told I am nuts and other things. I started to stay at home. I don't want the drama over it. I got damage from it as I had it for a very long time and I had to figure it out mostly myself with a few net friends to help me figure it out.
12:16 PM on 11/24/2010
I've been writing about the gluten-brain connection for many years at my www.Celiac.com site. More information on this topic can be found at:
http://www.celiac.com/categories/Celiac-Disease-Research%3A-Associated-Diseases-and-Disorders/Ataxia%2C-Nerve-Disease%2C-Neuropathy%2C-Brain-Damage-and-Celiac-Disease/

Dr. Rodney Ford has also written extensively about this, most notably in his book The Gluten Syndrome - Is Wheat Causing You Harm?
http://www.glutenfreemall.com/catalog/gluten-syndrome-wheat-causing-harm-p-1115.html

Last, I include much about this in a book that I co-wrote with Dr. Ron Hoggan called Cereal Killers:
http://www.glutenfreemall.com/catalog/cereal-killers-celiac-disease-glutenfree-paperback-p-1790.html

I am very glad to see that these ideas are finally becoming mainstream!

Take care,
Scott
10:25 AM on 11/24/2010
great information to have - thank you
10:13 AM on 11/24/2010
My son has regressive autism. Before regression came physical illness and new food intolerances. I had him tested and found he was allergic to many foods but gluten wasn't one of them. Endoscopy, colonoscopy and scope did not find celiac (but extreme redness and inflammation and esophagitis), blood, scratch, etc were all negative for gluten. Eventually I ended up doing a second gluten free trial (more strict than the 1st trial) and 3 months into it he stole some bread and had absence seizures for two days. To this day any gluten infraction causes absence seizures immediately. Gluten effects my son's brain even though allergy testing of all kinds were not positive. Gluten has extreme effects on the brain for some and this is an issue that should garner much more attention. Patient symptoms and parental observation have to be part of a diagnostic process. Most Doctor's now a days scoff at the possibility of gluten involvement in neurological dysfunction and behaviors. Parents are demonized for following gluten free diets for their kids. So I highly appreciate a respected neurologist taking such time and dedication to study and investigate the gluten/brain connection, it's quite refreshing. Thank you.
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commonsense333
10:02 AM on 11/24/2010
I don't have celiac that I know of, but I do know for a fact I am intolerant to gluten/wheat. I read this article because it's so true. When I ingest gluten/wheat, my brain takes a huge turn downward. Also, I get anxiety attacks. My memory sucks, I feel slow and unable to think clearly. I get muscle cramps and pains all over my body. The acid reflux is horrible, as in the pain in my stomach and colon area, going to the bathroom is painful. But definitely it affects the brain as well as the body. It does both.
10:02 AM on 11/24/2010
flag me again if you want, but i still think perlmutter md is just another cog in the gluten free industry.
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TedEjr
How can they be Right when they are wrong so much
09:41 PM on 11/27/2010
Respectfully, you can read my post regarding my ex-wife's gluten intolerance (If it makes it past the censors here.) or I can cliff notes by saying that the condition is very difficult to live with.
09:41 AM on 11/24/2010
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commonsense333
09:58 AM on 11/24/2010
Hey, no advertising here. Cease and desist.
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hismuse
08:34 AM on 11/24/2010
I've been treated for ADHD the last few years and I've wondered if it was gluten that was causing my problems but to be honest, I'm afraid to find out, we are so financially stricken we can't afford to go gluten-free.
09:48 AM on 11/24/2010
Please don't let finances stop you from finding out if you have celiac. I've had celiac most of my life and it's actually cheaper to eat gluten free (you don't have to buy those expensive processed gluten-free foods).
02:35 PM on 11/24/2010
We found a great source for corn (gluten-free pasta) on amazon dot com. Sam Mills makes this line of pasta that is very affordable, but you have to buy in bulk, but it's very tasty.

Finding out you're a Celiac can, in fact, end up being more expensive with groceries, but putting it off and finding out later will be more costly to your health, if it turns out you are. You will save a lot of money on eating out though, since there are fewer places you can go. A bread replacement can be difficult to find on a budget, but potatoes will work for starches and carbs (and are cheap and delicious!)
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TedEjr
How can they be Right when they are wrong so much
09:49 PM on 11/27/2010
Actually, there are restaurant chains that carry Gluten free menus. My ex wife has the condition. Carrabas and Outbacks are two that I can think of off the top of my head. Olive Garden does also, but it is not on their menu per se. Or at least, it didn't used to be. You had to ask them. There are a couple of others, but they escape my memory at this moment.

The ex, when we went to someplace new, would carry a laminated card which addressed the condition, as well as what to avoid. And she would speak with the chef about the preparation requirements. Yeah, it was a pain, but most of the time, the outcome was positive.