Neurogluten: neurological diseases and gluten intolerance

Neurogluten is understood as the set of neurological diseases related to the presence of a permanent intolerance to associated gluten , which usually occurs in celiac patients, (known or not, previously) and also in people who present a non-celiac gluten sensitivity knew or not), which is a minor variant of celiac disease.

It is not a new concept, as it was first described about 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.

The neurological diseases most associated with gluten

The best known in adults and are associated with gluten neurological diseases are Cerebellar Ataxia, all polyneuropathy, multiple sclerosis, some epilepsies, migraine headaches, optical neuritis, some forms of schizophrenia, some cases of parkinson and of parcolepsy .

In childhood, the most common are autism spectrum disorders (ASDs), obsessive-compulsive disorders (OCDs), Tourette syndrome (ST) and various forms of psychomotor retardation.

The list is very wide and varied and continues to expand continuously and progressively.

The message to be conveyed is that there is a small but important percentage, between 10-20% of neurological patients, that can benefit in their treatment and prognosis of the establishment of a gluten-free diet (DSG) , which has to 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 contaminations with gluten.

The overall risk estimated for people with celiac disease to develop neurological or psychiatric disorders is between 10-20% of all neurological processes. In principle there are no differences by age or sex, so it should always be investigated routinely before any neurological process at the time of its appearance or as soon as possible to try to stabilize or recover first.

How is the relationship between food with gluten and neurological disorders diagnosed?

The diagnosis is made in a simple and practical way, trying to find out if that person has a celiac disease (EC) or has a sensitivity to non-celiac gluten (SGNC) , by the usual methods available.

For this the specialist in Digestive System has to make a good clinical history trying to collect all type of family antecedents, digestive annoyances of all type and associated diseases. Comprehensive blood chemistry, including a complete blood count, extensive biochemistry with liver and thyroid function tests, iron and calcium metabolism, serum vitamin D levels, etc.

It is desirable to determine circulating antibodies related to gluten, such as anti-transglutaminase 2. The genetic markers of predisposition such as HLA-DQ2 and HLA-DQ8, complemented with the accomplishment of a gastroscopy with the taking of multiple duodenal biopsies.

The interpretation of the results of these tests has to be flexible, since the antibodies against celiac are frequently negative in adult celiacs (up to 80%) and this naturally does not rule out that the patient is gluten intolerant or have an associated SGNC and are accepted as such.

Other extradigestive manifestations cause celiac disease

Celiac disease, due to its autoimmune nature, is frequently associated with multiple extra-digestive manifestations of various types. In addition, due to its genetic character, celiac disease has a high familial incidence, both in first-degree relatives and a little further from the second degree.

Among them, the presence of various cutaneous manifestations of varied types is very frequent, being the most frequent dermatitis herpetiformis , characterized by the presence of vesicular and crustal lesions , of diverse location, very pruriginous and with predominance in zones of friction. They appear in up to 25% of celiac patients.

Associated thyroid affections are also very common, especially in the form of autoimmune hypothyroidism (Hashimoto's disease) and less frequently as hyperthyroidism. Both are markedly improved with the gluten-free diet.

Iron deficiency anemia of chronic character is the hematological alteration most commonly associated, being frequently refractory to the substitution treatment with oral iron, due to the deficient present intestinal absorption.

In women, menstrual disorders of all kinds, including prolonged periods of amenorrhea, are very common and are also frequently associated with fertility disorders, such as repeat abortions and premature births, among others.

Disorders of calcium metabolism manifest as generalized bone pain, osteopenia, multiple fractures, teething disorders with frequent caries, and an increased prevalence of early and maintained osteoporosis.

Abundant hair loss, as well as nail brittleness , are quite frequent, in relation to chronic iron deficiency, which is valued with prolonged drops of ferritin in the blood by decreasing body deposits of iron.

There is often a feeling of exhaustion, easy fatigue and delayed physical recovery, with slight memory loss, mental haze and frequent sleep disorders.

There may be dry eyes and mouth in relation to a decrease in lacrimal and salivary secretion due to an associated Sjögren syndrome .

The presence of several associated extra-intestinal disorders speaks in favor of the presence of an underlying celiac disease and, if associated with a neurological disease of any type, is conducive to the diagnosis of CD.

The establishment and follow-up of a gluten-free diet produce a significant and continuous improvement, not only in terms of alleviating the digestive discomfort present, such as pain, abdominal swelling and intestinal habit alteration, but also of all associated diseases, including naturally those corresponding to Neurogluten.