Your Brain on Gluten
There may be a simple explanation for your woes.
By Lisa James
Problems with gluten often range well beyond intestinal issues to affect other parts of the body, including the brain. For example, scientists have known for decades that people with celiac disease, in which gluten triggers an abnormal immune response, are prone to ataxia, a neurological disturbance marked by unsteady balance and jerky, uncoordinated movements.
However, the association between gluten and the brain has been found to go far deeper. Memory slippages, fuzzy thinking and low mood may all be linked to this troublesome protein.
Connecting the Dots
The linkage between gluten and a variety of brain dysfunctions is only now becoming a matter of concern among the general public. “It has awaited critical mass,” says David Perlmutter, MD, board-certified neurologist, president of the Perlmutter Health Center in Naples, Florida, and author (with Kristin Loberg) of Grain Brain (Little, Brown). “We now understand there is a powerful relationship between the gut and the brain.”
For example, “depression is found in as many as 52% of gluten-sensitive individuals,” says Perlmutter. He notes that up to 90% of the body’s serotonin, which helps regulate mood, is produced in nerve cells found in the gut (known as the “second brain”). Gluten has also been linked to anxiety and schizophrenia (The Psychiatric Quarterly 3/12).
Children with celiac disease have a higher risk for developmental delays, learning disabilities, seizures and headaches. In fact, Doni Wilson, ND, who maintains a three-location practice in the metropolitan New York area, says the most common signs of gluten sensitivity among her younger patients are “headaches and stomachaches. When a child has these, right away I’m thinking gluten.”
In one study, 11 people with celiac disease went on a gluten-free diet. After a year they showed sharper thinking skills, indicating less of the “brain fog” often reported by gluten-sensitive people (Alimentary Pharmacology & Therapeutics 7/14). “More studies are needed to determine the exact mechanism for how untreated celiac disease leads to cognitive impairment, but it is clear from just this one relatively small study that there is significant impairment,” states the Celiac Disease Foundation (celiac.org).
For some people, mental cloudiness may be the first symptom. “I think it started when I was about 17. My world kind of closed in on me and my head was in a fog. It was a peculiar sensation,” says Michael Simpson, 52, an engineer from Ramona, California. “I had my mom take me to the doctor but the fog just persisted.”
Jessica Caragliano also started feeling unwell in high school. “I knew there was something abnormal about the way my body was metabolizing and processing foods,” says Caragliano, 32, CEO of Terrorbird Media, a music marketing/licensing agency in Brooklyn, New York. Her problems intensified in college, when “I had trouble focusing, my long-term memory suffered and any time I was sitting still my body would shut down into sleep mode.”
Perlmutter believes the experiences of people such as Simpson and Caragliano, often spread through social media, have fueled interest in going gluten-free for better brain health. “People never thought gluten could be tied to depression, for example,” he says. “This stuff has a lot of traction.”
The culprit that links gluten and brain ailments is a process increasingly seen as a prime source of disease: chronic inflammation.
“Inflammation resulting from gluten sensitivity plays a key role in the release of cytokines, immune chemicals that, when they affect the brain, are related to things like depression,” Perlmutter says. He notes that elevated cytokines are also seen in disorders such as multiple sclerosis, Parkinson’s disease and Alzheimer’s.
This process can be triggered by leaky gut syndrome. “Gluten opens up the space between the intestinal cells, like grout cracking in a tile floor,” explains Wilson. “It ends up creating an inflammatory response.” Stress, antibiotics and exposure to pesticides and herbicides can also promote gut leakiness; in turn, leaky gut can add to the body’s overall stress burden.
An overly permeable intestinal wall allows not only gluten into the bloodstream but other misplaced substances as well. As a result the body may become sensitized to additional foods, such as the proteins found in dairy or eggs. At the same time, inflammation can reduce the intestinal tract’s ability to absorb nutrients such as the tryptophan used to produce serotonin.
You don’t have to have celiac disease to be affected by gluten. That’s because exposure to this protein can cause a condition known as gluten sensitivity, in which symptoms occur in the absence of an allergic response.
Perlmutter calls celiac disease “an extreme manifestation of gluten sensitivity,” one that causes actual tissue damage to the small intestine. But just because there’s no intestinal damage in gluten sensitivity doesn’t mean it can’t have devastating effects on people’s lives. “The key to understanding gluten sensitivity is that it can involve any organ,” says Perlmutter. “So while a person may not have celiac disease by definition, the rest of the body—including the brain—is at great risk if that individual is gluten sensitive.”
If people have been eating wheat and other gluten-bearing grains for thousands of years, why is gluten causing problems now?
For one thing, difficulties associated with gluten are not as modern as they may appear; Perlmutter says the first descriptions of celiac disease date back more than 2,000 years. In the 19th century it was called celiac sprue, a word denoting the chronic diarrhea that often marks this disorder.
In addition, gluten itself has changed in recent years to render it more troublesome. People like bread and other baked goods for their soft chewiness, and this quality comes from gluten and its elasticity. Therefore, “wheat has been extensively hybridized to increase its gluten content,” says Perlmutter. But as he also points out, “Wheat provides 20% of the calories in Western cultures.
We’ve never eaten gluten for more than 99% of our time on this planet; agriculture only began 10,000 years ago.” And bakers often use deamidated gluten, “which means that they’ve made it water soluble so it works better,” says Wilson. “Once deamidated gluten hits the intestines, the immune system attacks it.”
According to Wilson, some people carry genetic variations that make them more susceptible to gluten’s effects on the body. Another risk factor is being born cesarean, in which infants have less exposure to their mother’s protective microbes (Pediatrics 6/10).
Because gluten sensitivity affects so many body systems, symptoms can vary widely. “Anxiety is quite a common one. There can also be skin rashes, such as eczema, or someone may feel overly tired or can’t lose weight,” says Wilson. Caragliano says that as a teen she “became overweight, particularly around my stomach, and would be visibly bloated in my face depending on what I ate”; she was told she had an eating disorder.
Cooling the Flames
The most direct way to cut the connection between gluten and the brain is to stop consuming the stuff, which isn’t as easy as it sounds. “Gluten is our generation’s tobacco,” says Perlmutter, who explains that gluten breaks down into substances which cross the brain-blood barrier and bind to the same receptors that opiate drugs use to produce their effects. “Sometimes it’s hard for people to give up bread and pasta until they feel terrible,” Wilson adds.
What also makes gluten difficult to get away from is the fact that baked goods and pasta aren’t the only dietary sources. Gluten is used to give thickness and creaminess to soups, sauces and gravies. It can be found in cold cuts and processed cheeses, ice cream, ketchup and baked beans—even some personal care products and supplements. (For advice on going gluten-free, visit celiaccentral.org.)
“Right now the standard testing for gluten sensitivity is to avoid gluten for at least three weeks, see how you feel, then reintroduce it to your diet and see how you feel,” says Wilson. “Some people need to avoid gluten for three to six months.”
Wilson notes that how patients react to gluten testing doesn’t always reflect how going gluten-free will affect them. “Some patients have relatively low reactivity to gluten but they wind up seeing significant improvements in their health if they avoid it. So I’ve started paying attention to even the mild gluten reactions,” she says.
In addition to eliminating gluten, Wilson also recommends “digestive enzymes; if food is better digested it won’t leak through. Glutamine is known to help the intestinal cells.” In addition, Wilson checks patients for intestinal yeast overgrowth as well as heavy metal toxicity.
Both Wilson and Perlmutter recommend probiotics; in fact, Perlmutter says, “Probiotics are front and center.” He also recommends DHA, an omega-3 fatty acid, as well as curcumin, resveratrol, coconut oil, alpha lipoic acid and vitamin D.
Dietary changes work best if bolstered by other lifestyle adjustments. “Exercise is an epigenetic modulator, which means it is able to turn on the genes that code for the regrowth of brain cells.
There’s no drug that can do that,” says Perlmutter, who adds that adequate sleep also influences genetic activity. “I look at how the patient’s body has been affected by stress; are you getting enough breaks during the day, enough sleep, things like that,” says Wilson.
How does treatment for gluten sensitivity make Wilson’s patients feel? “The way people usually phrase it is that they feel more themselves; they have better sleep, less anxiety, more energy and focus, better memory. They’ll say, ‘I’m no longer bloated and I’ve lost at least 10 pounds.’”
Three weeks after Simpson cut gluten out of his diet, “my head cleared up; it was clearer than it had been in years. I became pretty aware of everything around me again.” What’s more, “I lost weight. My blood pressure was up; now it’s 120/80,” Simpson adds.
For Caragliano, recovery was a multistep process. After being treated for toxicity and insulin resistence in her early 20s, she felt much better. However, “there were still other symptoms that I had just gotten used to and accepted—the inability to focus, the tendency to completely fall asleep when sitting still.”
Caragliano visited Wilson about two years ago after developing skin rashes, numbness and a worsening struggle with focus. After Wilson tested her for gluten sensitivity, Caragliano stopped eating gluten, dairy and eggs, “and felt like the healthiest version of myself.” Besides dropping 15 to 20 pounds, she says her mind “is so much clearer, my memory has improved and my body no longer shuts down and falls asleep when I am sitting still.”
“What cutting-edge research is finally revealing is that the human brain is far more responsive to nutritional choices than we ever imagined,” says Perlmutter. Avoiding gluten is one of those choices that can help keep your brain healthy for life.
“This is my version of a dish that on Italian menus is known as ‘scampi.’
It is usually served with lots of bread, but I think it more than stands on its own.
Like almost every protein, scampi works well with a side of sautéed greens,” says
David Perlmutter, MD, in The Grain Brain Cookbook (Little, Brown.)
6 tbsp clarified butter, ghee or unsalted butter
1/4 cup finely chopped garlic
1/4 cup dry white wine
3 tbsp freshly squeezed lemon juice
1 lb large shrimp, peeled and deveined
salt and pepper
2 tbsp minced fresh flat-leaf parsley
1. Heat the butter in a large frying pan over medium heat. Add the garlic and cook, stirring, just until soft but not colored, about 2 minutes.
2. Stir in the wine and lemon juice and, when blended, add the shrimp. Season with salt and
pepper to taste and bring to a simmer. Simmer just until the shrimp are firm and pink, about
2 minutes. Do not overcook or the shrimp will be tough.
3. Remove from the heat and stir in the parsley. Serve immediately.
Serves 4. Nutritional analysis per serving:
281 calories, 5g carbohydrates , 0g fiber,
20g protein, 18g fat, 819 mg sodium
Recipes reprinted from The Grain Brain Cookbook.
Copyright 2014 by Dr. David Perlmutter. All rights reserved.
No part of this excerpt may be reproduced or printed
without permission in writing from the
publisher. Reprinted by arrangement with Little,
Brown and Company.