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Migraines, Carpal Tunnel Syndrome, Depression, Personality Change, and Psychosis Common in Celiac Disease 01/19/2010 - A new study says that migraines and carpal tunnel syndrome may point to celiac disease. Moreover, 35% of people with celiac disease report a history of depression, personality changes, or psychosis. Others commonly suffer from neurological issues that are not improved with a gluten-free diet.

Researchers recently screened a cohort of 72 patients with biopsy-proven celiac disease, recruited through advertisements and interviewed using a standard questionnaire.

Nearly one in three celiac patients (28%) reported a history of migraine, though numerous patients showed a decrease in frequency and intensity of migraine attacks after adopting of a gluten-free diet.

While about 20% of patients suffered from carpal tunnel syndrome, epilepsy was, surprisingly, less common than expected," report the researchers. "Only 4 individuals presented with a history of generalized or focal seizures."

In general, doctors believe about 6% to 10% of celiac patients show typical neurological presentations, the study authors note. Prior studies have shown cerebellar ataxia to be the most common celiac disease-associated neurological symptom.

This new study found cerebellar ataxia in 6% of patients, and vestibular dysfunction in another 6%. In all, 26% of patients showed afferent ataxia.

About a third of patients had problems with stance and gait, with numerous cases of deep sensory loss and reduced ankle reflexes.

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"Gait disturbances in celiac disease do not only result from cerebellar ataxia but also from proprioceptive or vestibular impairment," report investigators led by Katrin Bürk, MD, from the University of Marburg in Germany.  The bad news is that such neurological problems may develop "despite strict adherence to a gluten-free diet," says Burke.

"Most studies in this field are focused on patients under primary neurological care," the researchers note. "To exclude such an observation bias, patients with biopsy-proven celiac disease were screened for neurological disease."

Motor problems, such as basal ganglia symptoms, pyramidal tract signs, tics, and myoclonus, were not common. A total of 14% of patients reported problems with bladder function.

The underlying causes for neurological problems in celiac disease are not yet understood.

There has been some evidence to implicate deficiencies in folic acid, vitamin E, and biopterin in the pathogenesis. However, the investigators note that, in most patients, replacement therapy does not resolve clinical symptoms. They note also that hypo-vitaminosis rarely causes obvious abnormalities in celiac patients, and most with neurological symptoms show no evidence of any nutritional deficiencies.

"The prevalence of neurological manifestations in celiac disease is striking and must be considered more than accidental," they say. "The patients' gluten-free diet had resolved intestinal symptoms but had not prevented the development of neurological deficits."

The investigators suggest that, because of the considerable clinical variability, neurological and psychiatric dysfunction in celiac disease is likely the result of numerous pathogenic mechanisms.

Source: Mov Disord. 2009;24:2358-2362. welcomes your comments below (registration is NOT required).

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8 Responses:

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said this on
19 Jan 2010 6:46:34 PM PDT
Wow - good information, even if it isn't very comforting. I wonder how they determined that the patients weren't nutritionally deficient - that was my first thought, that maybe the continued symptoms were due to a nutritional deficit.... Maybe there is a problem with uptake - ie. the blood values are normal, but the cells aren't taking in the nutrients appropriately. I guess a follow up study could be nutrient transport across cell membranes.
Thanks for the good summary.

Jeff Kelly
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said this on
21 Jan 2010 7:21:40 AM PDT
If a doctor believed in the tooth fairy, I doubt reporting that would be such a notable thing:similarly, what doctors "believe" is irrelevant in the entire issue of celiac disease, because they have as a whole wholly rejected the entire condition based on total ignorance and usually no desire to relieve themselves of this malady of hyperignoranceimitosis, so as a result, they lack credibility on the entire topic. Once a study published what patients believe in any manner on celiac disease--whether it be on symptoms or what foods do or some basic elementary level quite apart from the physiologic details thought of as reflective of a higher learning process--THEN I'll accept the phrase of what anyone "believes."

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said this on
30 Jan 2010 2:29:21 PM PDT
Celiac runs on my whole dad side of the family we found out several yrs ago. Most of my family have intestinal symptoms, a few have the skin rash that goes with it. I had migraines at least 6 days a wk for yrs and was just trying to deal with them.
When my sister encouraged me to change my diet. I soon stopped having them except with an occasional one w my period. the first couple of weeks on the diet I wasn't convinced and had 1 piece of pizza i had a migraine several hrs later that lasted for 3 days and couldn't get out of bed. That was enough to convince me. If I accidentally eat wrong I definitely feel it!My grandmother has also been in a nursing home since her late 20s w schizophrenic symptoms which I've read might be related but we have never had her diet changed to see if they might improve. We think it might have been caused by severe emotional stress for her.

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said this on
31 Jan 2010 3:58:37 AM PDT
I wonder how long they followed people with neurological effects? I have been on the diet now for going on 9 years. My ataxia has improved greatly, my depression is now gone, I have regained reflexes in my legs and while my thought processes are still a bit effected I have come much farther than I expected. I have to wonder how strict the folks they tested were that were still developing or had unresolved neuro issues. How long since diagnosis? Was this study done in Europe where they routinely put Codex Wheat Starch in foods? Something that most US celiacs know better than to eat. I also had 'carpel tunnel' and had surgery for it. It wasn't carpel tunnel at all but parathesias that were misinterpreted by the doctor. But the doc did get lots of $$$ from the unneeded surgery. Oh and I have not had one single migraine since the day I was diagnosed, unless glutened or CC'd. For what it's worth.

rick lenger
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said this on
13 Feb 2010 7:49:31 PM PDT
Your testimony gives me hope. I can't accept that neurological problems don't improve when we adhere to a gluten free diet. I have only been diagnosed for a year, but have noticed improvements with vertigo, and depression. I am determined to get better every day; it's a battle.

Gloria Brown
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said this on
01 Feb 2010 11:12:05 AM PDT
Gluten contamination could be occurring at a molecular level undetectable by current assessments, possibly similar to homeopathy in which an element is diluted to the point at which only the wavelength of that element remains.

tom howley
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said this on
02 Feb 2010 6:52:13 AM PDT
I have read numerous testimonies from people who improve neurological symptoms on a gluten free diet. I was recently diagnosed as gluten sensitive--I'm wondering if a gluten free diet is worth the effort. My symptoms are mostly neurological (left temple ache, left arm pain, right leg weakness, fatigue). Numerous tests have ruled out other conditions. I've also been diagnosed with eosinophilic esophagitis. Any thoughts on this?

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said this on
27 Aug 2010 8:56:20 AM PDT
Definitely go off gluten! As soon as possible. I developed postural orthostatic tachycardia syndrome, had uncontrollable shaking, fainting, brain fog, sudden learning disability, eye and mouth dryness, depression, severe pms, and so much more! Going off gluten improved all conditions and I have completely recovered from most.

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Only GIs can order a complete celiac panel at Kaiser. Your results look negative, but those are just "screening" results. You are not IgA deficient (used only as a control test for celiac disease) so that means the TTG IgA test worked. If you suspect celiac disease, ask for a GI referral. Keep eating gluten!!!! If you go gluten free then all the celiac tests will be invalid. You should rule out other issues like Crohn's, SIBO, etc based on your symptoms and health history. I would ask for a complete celiac panel from the GI. Why? Not all celiacs test positive to the TTG which is a cheaper, but excellent test but does not catch all celiacs like me!!!

Ditto. However, this is what I can never understand about gluten free food. (see the bold bits which I've taken from the article) "We wanted to determine if gluten consumption will affect health in people with no apparent medical reasons to avoid gluten. Gluten-free foods often have less dietary fiber and other micronutrients, making them less nutritious and they also tend to cost more,? I wonder why what so much of what I eat that's gluten free doesn't have added vitamins - we of all people need fortification in our cereals and bread, surely?

Yeah we learned that the hard way. I am inclined to think (as I did initially) that it was JUST the Cheerios but as time is passing and she is not bouncing back I am worried that we need to strip away dairy again for a while.

Oh I have no issue with being dairy free personally but tell that to a 13 year old. We both went gluten-free at the same time and it has been mindlessly easy for me. But I am easy about food and no real food issues. I am far more adaptable. She comes to the table with her own unique set of issues that complicate just easily transitioning to dairy free versions of much loved favorites. To most they are jst that "substitutes" to her they are completely different foods and ones that she has no interest in eating. They don't satisfy her need for XYZ. It is like craving an apple and someone handing you a fish. For her anyway! LOL!

I believe the talk around this forum is that cheerios are not gluten free enough for people with celiac at this time. I don't know if anything has changed on that and when their lawyer calls me I'll quickly delete this. haha