Most people typically think of celiac disease as a condition affecting the gut. Indeed, the autoimmune disorder is often diagnosed after a biopsy reveals damage to the intestinal lining, caused by the body’s immune response to the complicated chain of proteins called gluten.
However, for about 10 percent of people with the disease, celiac symptoms occur not only in the gut but also in the brain. The neurological and psychiatric symptoms of celiac disease can range from “brain fog,” or general cognitive impairment, to headaches, seizures, dementia, ataxia (a condition that affects muscle coordination) – and even psychotic episodes.
This may not be surprising, given the intimate connection between the gut and the brain. Some doctors have hypothesized that “the autoimmune firestorm ignited in the gut [in celiac disease] may descend on other organs, including the brain,” according to author and journalist Moises Velasquez-Manoff, in an opinion piece published in The New York Times.
As Velasquez-Manoff describes, a number of cases have been documented in which doctors initially aimed to address patients’ neurological symptoms with treatments directed at the brain. Only when those failed, and the underlying problem of celiac disease was finally discovered, were patients able to recover by following a gluten-free diet.
Celiac Symptoms in the Brain: Autoimmune Condition or Nutrient Deficiency?
To test patients for celiac disease, doctors look for the presence of a particular antibody that binds to a specific enzyme in the blood. British scientists have identified a similar antibody found in the brain that binds to a version of this enzyme. They found that when celiac patients suffering from ataxia followed a gluten-free diet, the levels of this antibody in the brain diminished, and ataxia symptoms subsided. This finding led the researchers to propose that celiac disease may contribute to autoimmune conditions in the brain as well.
Other doctors, however, suppose that neurological celiac symptoms are not the result of an autoimmune mechanism; but rather, that they are caused by deficiencies in nutrients like copper that are crucial to brain function, but unable to be absorbed by the patient’s damaged gut lining.
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Since only 1 percent of the U.S. population is diagnosed with celiac disease, and about 10 percent of those experience psychiatric or neurological symptoms, we’re talking about a relatively small number of cases. However, it’s unknown how many people may be suffering silently. According to the National Foundation for Celiac Awareness, about 83 percent of Americans who have celiac disease are undiagnosed or misdiagnosed – many of them waiting six to 10 years before they discover what is afflicting them.
“There are people out there who are very ill and in nursing homes, and their condition is treatable and reversible,” said Sean J. Pittock, a neurologist at Mayo Clinic. “And they’re being missed.”
Feature Image Credit (CC) © G. Schuster/zefa/Corbis
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