By Karen Graham, RD
There are three main conditions that react negatively to gluten; wheat allergy, celiac disease and gluten sensitivity. A wheat allergy involves the immune system by triggering histamines, basophils and mast cells, similar to a peanut allergy. Celiac disease is an autoimmune disorder, creating antibodies (tTG) that attack the small intestines. Then there is gluten sensitivity, which is neither an allergic nor an autoimmune reaction and it does not damage the small intestines. The tTG antibodies used to diagnose celiac disease are not present with gluten sensitivity but any one of these conditions can manifest symptoms that are GI related or they can be completely free of GI symptoms. Symptoms involving reactions to gluten are not always isolated in the gut. Many people only experience neurological symptoms that involve the brain, such as vertigo, migraine headaches, anxiety, depression, tingling in the fingertips, numbness in the legs, foggy brain, nystagmus (fast involuntary eye movements) or gluten ataxia. This is very important for gastroenterologists, neurologists and patients to understand because a patient that is experiencing neurological symptoms but is free of GI symptoms may be lacking the treatment that is required for their disorder.
The doctor or the patient themselves may not associate neurological symptoms with a gluten intolerance. This could result in years of unnecessary and ineffective treatments, testing and medications, not to mention the frustration and anxiety experienced by the patient.
One neurological disorder that is commonly caused by gluten sensitivity is Sporadic/idiopathic ataxia. This involves the area of the brain known as the cerebellum. Ataxia can cause difficulty with balance and incoordination of arms and legs, thick or slurred speech, difficulty swallowing or double vision. These symptoms usually occur in middle to older adult life but have been seen in younger people as well. Ataxia is a neurodegenerative disease, meaning; the nerve cells in this area of the brain gradually disappear over time.
According to one study, gluten sensitivity accounts for up to 40% of the cases of idiopathic sporadic ataxia. These people have idiopathic sporadic ataxia with positive antigliadin antibodies. When gluten causes the symptoms, the disease is known as gluten ataxia1.
The researchers involved in this study consider a strict gluten free diet to be vital for this condition as it is one of the very few treatable causes for gluten ataxia. They recommend a strict gluten free diet for a period of one year as improvement in symptoms can take months 1.
If someone is experiencing chronic neurological symptoms that are not readily explained, it would be wise to test for a wheat allergy and celiac disease. Even if these tests come back negative there may still be an underlying gluten sensitivity that can be identified by simply eliminating gluten from the diet. If the symptoms resolve then the answer is clear.
1. Hadjivassiliou M, et al. Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry 2003;74:1221–1224.