Neurogluten is understood as the set of neurological diseases related to the presence of an associated permanent intolerance to gluten, which generally appears in celiac patients (known or not, previously) and also in people who present a non-celiac gluten sensitivity (also known or not), which is a minor variant of celiac disease.
It is not a new concept, since it was first described around 1960 (more than 50 years ago), when the first descriptions of the relationship between a neurological disease such as Cerebellar Ataxia and gluten intolerance were made by a group of neurologists working in Sheffield (England) led by Prof. Marios Hadjivassiliou.
Neurological diseases most associated with gluten
The best known neurological diseases in adults that are associated with gluten are Cerebellar Ataxia, all types of polyneuropathies, multiple sclerosis, some epilepsies, migraine headaches, optic neuritis, some forms of schizophrenia, some cases of Parkinson’s disease and parcolepsy.
In childhood, the most frequent are some autism spectrum disorders (ASD), obsessive-compulsive disorders (OCD), Tourette’s syndrome (TS) and various forms with associated psychomotor retardation.
The list is very long and varied and continues to grow steadily and progressively.
The message to be conveyed is that there is a small but important percentage, between 10-20% of neurological patients, who can benefit in their treatment and prognosis from the establishment of a gluten-free diet (GFD), which must be very strict and followed in a maintained and rigorous way for life, avoiding as far as possible the presence of cross-contamination and all possible types of contamination with gluten.
The estimated overall risk for people with celiac disease of developing neurological or psychiatric disorders is between 10-20% of all neurological processes. In principle, there are no age or gender differences, so all neurological processes should always be routinely investigated at the time of onset or as soon as possible to try to stabilize or recover first.
How is the relationship between gluten-containing foods and neurological disorders diagnosed?
The diagnosis is made in a simple and practical way, trying to find out whether or not that person has celiac disease (CD) or presents a non-celiac gluten sensitivity (NCGS), by the usual methods available.
To do this, the Digestive System specialist has to take a good medical history, trying to collect all kinds of family history, digestive discomfort of all kinds and associated diseases. A comprehensive blood test should be carried out, including a complete blood count, a comprehensive biochemistry with liver and thyroid function tests, iron and calcium metabolism, serum vitamin D levels, etc.
Circulating gluten-related antibodies, such as anti-transglutaminase 2, should be determined. Genetic markers of predisposition such as HLA-DQ2 and HLA-DQ8, complemented by gastroscopy with multiple duodenal biopsies.
The interpretation of the results of these tests must be flexible, as celiac antibodies are frequently negative in adult celiac patients (up to 80%) and this of course does not rule out the possibility that the patient is gluten intolerant or has an associated NCGS and is accepted as such.
Other extra-digestive manifestations caused by celiac disease
Given its autoimmune nature, celiac disease is frequently associated with multiple extra-digestive manifestations of various types and, in addition, because of its genetic nature, it has a high family incidence, both in direct first-degree relatives and somewhat more distant second-degree relatives.
The most frequent manifestation is dermatitis herpetiformis, characterized by the presence of vesicular and crusty lesions of various locations, very pruritic and predominantly in rubbing areas. They appear in up to 25% of celiac patients.
Associated thyroid disorders are also very frequent, especially in the form of autoimmune hypothyroidism (Hashimoto’s disease) and less frequently as hyperthyroidism. Both improve markedly with a gluten-free diet.
Chronic iron deficiency anemia is the most commonly associated hematological disorder, often refractory to oral iron replacement therapy, due to poor intestinal absorption.
In women, menstrual disorders of all types are very frequent, including prolonged amenorrhea periods, and are also frequently associated with fertility disorders, such as repeated miscarriages and premature births, among others.
Calcium metabolism disorders manifest themselves as generalized bone pain, osteopenia, multiple fractures, dental disorders with frequent caries and an increased prevalence of early and sustained osteoporosis.
Abundant hair loss, as well as brittle nails, are quite frequent, in relation to the state of chronic iron deficiency, which is assessed by prolonged decreases in blood ferritin due to a decrease in the body’s iron deposits.
There is often a feeling of exhaustion, easy fatigue and delayed physical recovery, with slight memory loss, mental fogginess and frequent sleep disturbances.
There may be dryness of the eyes and mouth, in relation to a decrease in lacrimal and salivary secretion, due to an associated Sjögren’s syndrome.
The presence of several associated extra-intestinal disorders speaks in favor of the presence of an underlying celiac disease and if they are associated with a neurological disease of any type, they guide the diagnosis of CD.
The establishment and follow-up of a gluten-free diet produces a significant and continuous improvement, not only in the aspect of alleviating the digestive discomfort present, such as pain, abdominal bloating and altered bowel habit, but also of all associated diseases, including of course those corresponding to Neurogluten.