Can celiacia affect mental health

“Fog in the brain” - who thinks of a gluten-related problem?

BERLIN. Celiac disease is a chameleon: "It can develop at any point in life and present very differently," reminded Professor Dr. Martin Begemann from the University of Göttingen at the Psychiatry Congress in Berlin. The symptoms also include neuropsychiatric complaints.

Begemann reported on a 43-year-old doctor who reported cognitive complaints with mild hemiparesis and hemiataxia. She said she tired quickly and had trouble concentrating, and complained of problems with memory and attention. In addition, she felt “foggy” and impaired in her perception.

Neuropsychological tests actually showed slight deficits in logical thinking and working memory. The brain MRI was also conspicuous with lesions on the left in the bar and on the right cerebellar. The doctors assumed an autoimmune disease, especially since a SAPHO syndrome * was known from a previous history. They treated with prednisolone shock therapy for three days, with some of the neurological symptoms receding.

Gluten-free diet made hemiparesis go away

The crucial clue, however, came from the laboratory: elevated levels of antibodies to gliadin and tissue transglutaminases. The doctors therefore assumed a gluten intolerance and recommended a gluten-free diet. This cleared the “fog in the head” of the woman, and the hemiparesis also largely disappeared. You can now drive the car again and stay on track, she told the doctors.

The special thing about it: the gastroscopy was completely inconspicuous. Begemann therefore spoke of gluten ataxia or a "gluten-related disorder".

It was completely different with a young man who suddenly changed a lot at the age of 20, no longer pursued his hobbies, withdrew from his friends. At the same time he developed diarrhea, excruciating gas, palpitations and an overactive bladder.

Here, too, there were immunological pre-existing diseases with Graves disease and neurodermatitis. During the examination, the man appeared psychomotor slowed down and disinterested. The doctors found high levels of antibodies against gliadin and transglutaminases in the serum, and slight villus atrophy in the intestine and abnormal lymphocytic infiltrates.

"Brain fog" described as an extraintestinal manifestation

On the gluten-free diet, abdominal complaints decreased within a week, and with antidepressants, drive and mood improved after a while. There was only one relapse of diarrhea after the man was given an antidepressant containing wheat starch.

In such patients, doctors should strictly ensure that the medication also remains gluten-free, warned the psychiatrist.

Extraintestinal manifestations of gluten diseases are not that rare. In addition to nervousness, inner restlessness, fears, depression and “brain fog”, ataxias, polyneuropathies, headaches and epilepsy as well as joint and back pain, osteoporosis and herpetiform dermatitis were also described.

However: A real gluten disease occurs in less than 1 percent of the population. Psychological and neurological symptoms can therefore only rarely be traced back to an intolerance to the grain protein. However, a history of immune disorders could indicate co-morbid gluten disease. Ultimately, the decisive factor is the detection of specific antibodies in the serum, explained the psychiatrist.

* SAPHO syndrome: synovitis, acne, pustulosis, hyperostosis and osteitis / osteomyelitis