The Brain & Gluten

Discovering the connection between gluten and behavioral changes in children

Gluten intolerance is considered one of the most common ailments affecting humans. Nevertheless, it is still one of the least diagnosed medical conditions. In part, there is a discrepancy because gluten intolerance is a great imitator, sharing many of the same symptoms of other conditions and making a proper diagnosis a challenge even for medical professionals.

In general, an early diagnosis of gluten intolerance results in more favorable therapeutic outcomes and a positive long-term prognosis. My adult patients who have gluten intolerance or celiac disease quite frequently ask me whether their children might be affected and what are the early symptoms suggestive of gluten intolerance.

From a simplicity stand point, I divide potential symptoms associated with gluten intolerance into four categories:

1. Physical indicators

2. Gastrointestinal complaints

3. Abnormal laboratory test results

4. Behavioral changes

I will briefly cover the first three categories, but the bulk of the information I’m sharing will be on the fourth category: the connection between gluten, the brain, and behavioral changes.

The visible symptoms and signs indicative for gluten intolerance include:

  • Dermatitis herpetiformis: characterized by an intensely itchy, chronic, blistering skin rash that’s usually distributed symmetrically on the buttocks, back of neck, scalp, elbows, knees, back, hairline, groin, or face
  • Keratosis pilaris (chicken skin): a common skin condition that is manifested in the form of slightly red bumps on the skin of the shoulders, thighs, and buttocks
  • Eczema: dry, crusty skin lesions
  • Vitiligo: areas of acquired pigment loss
  • Poor dental health: cavities, inflamed and bleeding gums
  • Growth retardation
  • Poor quality of nails and hair

The most common gastrointestinal complaints include:

  •  Abdominal pain
  •  Constipation, diarrhea, or both
  • Bloating
  •  Lactose intolerance

Abnormal lab test results include:

  •  Anemia
  •  Iron deficiency
  •  Vitamin B12 deficiency
  •  Vitamin D deficiency   
  •  Low zinc level
  •  Elevated ammonia level
  •  +ANA (Anti-Nuclear Antibodies, a screening test for autoimmune diseases)

Gluten-associated behavioral changes include:

  •  Mood swings
  •  Fatigue without any particular reason
  •  Dyslexia: difficulty with learning to read fluently and with accurate comprehension despite normal or above normal intelligence
  •  Attention deficit
  •  Bipolar disorder: elevated or agitated mood alternating with episodes of depression
  •  Autistic disorders

The connection between gluten and mental disorders is the most intriguing one and represents a complex inter- play between various metabolic, immunologic, and endocrine processes.

While autistic disorders and dyslexia typically become obvious during the first several years of life, bipolar disorder, attention deficit, fatigue, and noticeable mood swings become more pronounced during puberty.

There are several mechanisms that connect gluten to the brain, which can interfere with normal brain function:

Gluteomorphins or gliadorphins

Digestion of gluten results in the formation of small protein fragments known as gluteomorphins or gliadorphins. These fragments behave as morphine-like narcotics. Because individuals with gluten intolerance often have a more porous small intestine, these fragments are absorbed more rapidly and cause extreme fatigue and disruption of the normal brain function. Traditionally, gluteomorphins or gliadorphins have been linked to the development of chronic fatigue, autism, and dyslexia.

Cytokines

Another mechanism of gluten-associated brain dysfunction is based on the ability of gluten to trigger specific inflammatory and autoimmune processes. In susceptible individuals, when their immune cells are exposed to gluten, this results in the production of various pro-inflammatory (unhealthy) molecules known as cytokines. Cytokines affect the normal work of the nerve cells and can change the blood flow in specific areas of the brain. Both processes disrupt the normal function of the brain and cause bipolar disorder and attention deficit.

Antibodies to gliadin and transglutaminase

Recently, it has been noted that antibodies against gliadin and transglutaminase (TTG), frequently found in patients with gluten intolerance and celiac disease, can cross-react with specific molecules in the brain and activate a cascade of biochemical events in human nerve cells, causing deviations in normal brain chemistry.

Malabsorption

Gluten intolerance and celiac disease are also associated with malabsorption of minerals, vitamins, and specific nutrients regulating brain activity. For example, malabsorption of iron is associated with chronic fatigue and a carnitine deficiency is associated with depression, mood swings, and bipolar disorder.

Yeast overgrowth

Gluten intolerance and celiac disease disrupt the composition of normal gut microflora, which frequently results in the intestinal overgrowth of Candida albicans (yeast). Candida overgrowth is associated with a massive histamine release, causing allergic reactions and increased permeability of the blood-brain barrier. Furthermore, the byproducts of metabolizing yeast (for example, ammonia) penetrate into the blood circulation and have a detrimental effect on the brain function causing fatigue, depression, and mood swings.

Endocrine link

The endocrine link is based on the ability of gluten to change (either inhibit or stimulate) the production of certain hormones including thyroid hormones, testosterone, prolactin, and estrogens, which in turn can modify brain activity causing undesirable mental effects.

In addition, the following conditions in children are associated with gluten intolerance:

  • Diabetes type I
  • Juvenile arthritis
  • Psoriasis
  • Asthma
  • Colitis and Crohn’s disease
  • Polycystic ovarian syndrome (PCOS)
  • Delayed puberty
  • Seizures of unknown origin
  • Schizophrenia
  • Recurrent migraine headaches
  • Juvenile osteoporosis

A diagnosis of gluten intolerance is typically based on a combination of laboratory test results including blood, salivary, or fecal antibodies against gliadin or its fragments, antibodies against TTG, and the presence of genetic markers associated with celiac disease.

However, even in the absence of the laboratory markers, gluten intolerance may still be a problem. Therefore, the ultimate diagnosis is based on a three month gluten elimination program followed by a gluten challenge (eating gluten). Reproduction of the underlying symptoms by the gluten challenge is obvious proof of gluten intolerance.

As always, consult a health professional before beginning any new protocol.

Written by Dr. Alexander Shikman