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Celiac.com 01/23/2013 - Can going gluten-free bring about a major improvement in mental health for some children? This question is addressed in recent article by Mary Lochner. In the article, Lochner talks about the challenges she faced in trying to raise her daughter who, for the first couple of years, seemed to become more and more emotionally volatile and unstable, even while her daughter's twin brother seemed just fine. Lochner details her trips to multiple pediatricians and behavioral therapists in an effort to get an answer for her daughter's behavior. Initially, the behavioral therapists pretty much dismissed her concerns and, when Lochner asked what she could do to calm her daughter down, told her to “Try distracting her…Give her a toy that makes noise. Or sit her down in front of the T.V. for a while.” Unimpressed with the advice, Lochner says she knew, as a mother often does, that something was, in fact, wrong with her child. In the mean time, her daughter's temper was becoming progressively more volatile. She began having behavioral episodes during the night, as well as during the day. The first time it happened, she woke up screaming hysterically at 2 a.m. Lochner found a new pediatrician for her daughter, one who took her concerns seriously. He ran Mary Jean through a test or screening for everything from iron deficiency to autism. At the same time, she continued to do her own research, and began to wonder if the problem might be Sensory Processing Disorder. It was during this time that Lochman stumbled onto the writings of nutritionist, Kelly Dorfman, who had co-authored an article in the Huffington Post which claimed that gluten intolerance sometimes manifests with “neurological symptoms.” The basic thrust of the article was that, for some people, gluten-sensitivity can cause neurological symptoms. While she was investigating that possibility, s came across an article from the March 2012 Huffington Post called “Is Sensory Processing Disorder the New Black?” The article described the case of a child whose extreme behavioral symptoms disappeared after her mother put her on a gluten-free diet after consulting a nutritionist. For Lochman, the article hit close to home, and led her to read Kelly Dorfman’s book concerning nutritional origins of childhood illnesses: What’s Eating Your Child? Initially, Lochman says she was skeptical of claims of major behavioral improvement in children who had gone gluten-free, and regarded much of what she'd heard about gluten-free diets with some doubt. However, she did bring up the book with her pediatrician, and, rather than dismissing her, the doctor confirmed that gluten can cause behavioral problems in some gluten-sensitive children. He suggested that her daughter go gluten-free for a month, then back on gluten for a month, then gluten-free a second month, and that she keep a journal of her daughter's behavior. By doing the gluten-free trial twice, she and the doctor would be able to confidently confirm that any improvement in my daughter’s behavior was due to the removal of gluten, and not to coincidence. During the first month on a gluten-free diet, her daughter’s episodes decreased sharply, but Lochman was still skeptical. However, when she went back to eating gluten during the second month, the emotional outbursts and episodes came back in less than a week. By the end of that second month, she found herself looking forward to returning her daughter to the gluten-free diet for month three of the trial. In the third month, her daughter’s episodes rapidly decreased during the first two weeks. By the end of the month, they were down to only two or three times a week. This is when Lochman really knew something was up. She says that she thought that her daughter was seeing a major shift, if not a miracle cure. She quick to tell people how she was wrong to think that. That's because, Lochmans says that taking gluten out of her daughter's life was, in fact, a miracle cure. She says that after just six weeks on the gluten-free diet, "her daughter's 'awful screaming and flailing episodes, the ones that would last for hours and come out of nowhere, were gone. Vanished. A thing of the past. It was like she was a completely new, and different, person." Lochman describes a daughter who now only gets upset with good reason, and who is highly responsive…a daughter who now looks her in the eyes again, who easily relaxes to snuggle, and who is ebullient, curious, affectionate, and "so thoroughly level-headed you would be hard pressed to connect her to her former self." For her part, Kelly Dorfman notes that non-celiac gluten-sensitivity has only recently been identified as a distinct medical condition, one that resists conventional tests for diagnosing celiac disease. She says that she commonly sees patients in her practice for whom behavior and mood issues are the only symptoms of gluten intolerance. Dorman's new book is due to be re-released in April under a new title, Cure Your Child With Food, and includes a new chapter with more on information on 'bizarre' gluten-related effects on behavior and more. Read Mary Lochner's full article in the Anchorage Press.

Celiac.com 05/06/2008 - In the majority of people with celiac disease,strict adherence to a gluten-free diet can result in a quality of lifethat is on par with non-celiacs. Still a small percentage of celiacsseem to suffer from persistent gastrological discomfort in the form ofirritable bowel or irritable-bowel-like symptoms. Very few studies havebeen done on persistent gastrological problems in adults with celiacdisease. Those that have been done rely upon univariate statisticalanalysis in clinical samples at the secondary or tertiary care leveland fail to assess the potential influence of non-celiac diseasespecific factors, which are considered to be a risk factor of irritablebowel syndrome (IBS), such as mental disorders, or gender. Ateam of researchers made up of doctors Winfried Hauser, Frauke Musial,Wolfgang Caspary, Jurgen Stein, and Andreas Stallmach set out todetermine rates of irritable bowel syndrome, irritable bowelsyndrome-related symptoms, and consecutive health care-seeking behaviorand their influence upon health-related quality of life (HRQL) and anyconceivable bio-psychosocial factors influencing adult patients withceliac disease. The research team made a medical and socio-demographicsurvey of 1000 adult celiac patients from the German Celiac Society bypost. The medical portion of the survey included bowel history. Theteam also had patients fill out a Short Form Health Survey (SFHS),along with the Hospital Anxiety and Depression Scale. 516 ofthe questionnaires came back completed. Respondents were similar ingender ratio and median age from the whole membership directory of theGerman Celiac Society, a group of more than 18,000 people who reportedsuffering from celiac disease at the age of 18. Of these, 213 (41.3%)had a diagnosis of celiac disease that was made by a duodenal biopsy,37 (7.2%) by serological tests (celiac disease-specific antibodies), 34(6.6%) using stool tests for trans-glutaminase antibodies, and 232(45.0%) using intestinal biopsy and serological tests. A totalof 446 patients indicated that they had biopsy-proven celiac disease. Of these 446patients, 18 were excluded because they indicated adherence to agluten-free diet for less than 1 year. Sixteen patients were tossed outbecause they reported a major non-adherence to the gluten-free diet. Thus,the study group was confined to 412 patients with self-reportedbiopsy-proven celiac disease who were on a strict gluten-free diet for at least one year. The survey showed that out of these 412 patients that met the criteria, 96 patients, or just over 23% metmodified Rome I criteria for Irritable Bowel Syndrome. Of those 96patients, 76 patients, or nearly 80%, made an effort to get help, bothmedical and non-medical, as a result of the bowel symptoms (we’ll callthe patients who sought help "irritable bowel syndrome patients"). Irritable bowel syndrome-like symptoms were shown to drive SFHS scores sharply downward. Mentalhealth disorders, being female, falling off the gluten-free dietall contributed to a greater likelihood of irritable bowel syndrome symptoms. Theresults of the study seem strengthen the bio-psychosocial model of irritable bowel syndrome, in which biological and psychological factorsare understood to affect the clinical manifestation of celiac disease.Under this model, irritable bowel syndrome-like symptoms in adults withceliac disease are understood through a combination of clinical andsocio-psychological mechanisms. This model leads doctors to anunderstanding of celiac disease and other gastro-intestinal ailmentsthat goes beyond simple biological or psychological factors alone, andlooks at factors like adverse life events, stress, and hypochondriasisamong others. Limited studies indicate that gender differencesin visceral perception, cardio-autonomic responses, gastrointestinalmotility, and brain activation patterns to visceral stimuli are afactor in irritable bowel syndrome. Gender differences in psychosocialfactors have not been fully studied. The results of this studyalso support the need for further investigation to determine exactly whatfactors contribute to the bio-psychosocial model of what is called’celiac irritable bowel syndrome.’ Future psycho-physiologicalstudies in patients with celiac disease and irritable bowel syndromeshould look to determine if psychological discomfort can prolongmucosal inflammation, reduce visceral pain thresholds, or disturb gutmotility. In the event that the right psychotherapeutictreatment for irritable bowel syndrome-like symptoms and/or mentaldisorder serve to improve reduced HRQOL in adult patients with celiacdisease and irritable bowel syndrome-like symptoms, it might benecessary to take a second look at interventional practices. So,in a nutshell, this all means that things like mental health, gender,and other non-clinical factors might play a role in irritable bowelsyndrome-like symptoms in people with celiac disease, and that furtherstudy is needed to sort out all of the possibilities and determine ifthere might be better ways to treat celiac disease that will reduce oreliminate irritable bowel syndrome-like symptoms. Psychosomatic Medicine 69:370 –376 (2007)

Celiac.com 07/13/2009 - Doctors are recommending that kids with mental and behavioral disorders, and with low cholesterol be tested for celiac disease. This, after findings from a recent study suggest that low plasma cholesterol levels might have a role in the development and pathogenesis of certain behavioral disorders such as schizophrenia, depression, and obsessional neurosis in people with celiac disease. It is well documented that children with celiac disease face higher rates of certain behavioral disorders such as schizophrenia, depression, and obsessional neurosis. Still, not much is known about the development and pathogenesis of celiac-related mental and behavioral disorders. A team of researchers made up of Italians Luca Mascitelli, M.D., Francesca Pezzetta, M.D., and American Mark R. Goldstein, M.D. set out to investigate the matter. A large scale study of patients aged 6–16 years showed that most people with celiac disease harbored illness of low-grade intensity that was often associated with "decreased psychophysical well-being." Furthermore, a recent study found that adolescents with celiac disease face higher rates of depressive and disruptive behavioral disorders, especially before adopting a gluten-free diet. 2 For some, psychiatric symptoms appear to improve after the patients started a gluten-free diet. Interestingly, children with malabsorption and steatorrhea due to celiac disease often have lower concentrations of blood cholesterol. Moreover, people with celiac disease, but who show no signs of overt cholesterol malabsorption, often show low levels of blood cholesterol, while normal to high cholesterol levels have been shown effective in ruling out celiac disease. Add to that the fact that low cholesterol has been tied to other mental disorders. In particular, a national sample of non-institutionalized, non-African American children of school-age found a statistically significant association between low cholesterol and aggressive behavior. Low cholesterol has also been tied to the onset of conduct disorder during childhood among male criminals. Therefore, they recommend that screening for celiac disease be considered in children and adolescents with mental disorders and low cholesterol. Psychosomatics 50:300-301, May-June

Psychosomatics 45:325-335, August 2004 Celiac.com 07/30/2004 - Past studies have reported a higher prevalence of depressive symptoms in adults with celiac disease, perhaps due to serotonergic dysfunction, and an increased prevalence of depressive and disruptive behavioral disorders in adolescence with the disease, especially before treatment. In an effort to further study any possible connections, researchers looked at 29 adolescents with celiac disease and 29 matched controls. The researchers used semi-structured psychiatric interviews and symptom measurement scales to examine all subjects. Their findings indicate that the subjects with celiac disease had significantly higher prevalence of major depressive disorder compared to the controls--31% versus 7%, and a significantly higher prevalence of disruptive behavior disorders--28% versus 3%. The researchers also found that most of the mental disorders occurred before the patients were diagnosed and treated with a gluten-free diet. The prevalence of current mental disorders was similar in both of the groups studied.

The following was written by Dr. Kalle Reichelt who is a leading celiac disease researcher at the Pediatric Research Institute in Oslo, Norway. Please direct any questions regarding this article to him at: K.L.Reichelt@rh.uio.no What most people ignore is that both peptides and trace (biologically significant amounts) amounts of proteins are taken up across the gut mucosa (1,2). Because one molecule of gluten contains at least 15 opioid sequences it is quite clear that this could cause a problem. Increased peptide excretion is found in the urine of celiacs before treatment (3) (Reichelt et al in prep). This is confirmed by a series of papers that demonstrate intact food proteins in mothers milk (4-7). A Canadian group has confirmed that gluten does change a brain enzyme and monoamine levels in cats (8). Their findings a significant even though cats are not gluten eating animals. There is increasing evidence that components from food can indeed cause serious psychiatric (9-12) and neurological (13-16) diseases. Even rheumatoid arthritis may have a link to food proteins (17), and it well established that stress increases gut permeability. Nobody denies the possibility of reactive depression, but there is little reason why this could not be made worse by dietary factors. Because antibodies are indeed induced by peptides it may even be so that dietary peptides by mimicry to endogenous cell surface peptide sequences, may be responsible for many autoimmune diseases (18). References: Gardner MLG (1994) Physiology of the gastrointestinal tract. Edit: LR Johnson. Raven press 3rd edit. pp 1795-1820. Husby S et al (1985) Scand J Immunol 22:83-92. Klosse JA et al (1972) Clin Chim Acta 42:409-422. Kilshaw PJ and Cant AJ (1984) Inter. Arch Allergy Appl Immunol 75:8-15. Axelsson I et al (1986) Acta paed Scand 75:702-707. Stuart CA et al (1984) Clin Allergy 14:533-535. Troncone R et al (1987) Acta paed Scand 76:453-456. Thibault L et al (1988) J Clin Biochem Nutr. 4:209-221. Hallert C et al (1982) Psychic disturbances in adult celiac disease III.Reduced central monoamine metabolism and signs of depression. Scand J Gastroenterol 17:25-28. Singh MM and Kay SR (1976) Wheat gluten as a pthogenic factor in schizophrenia. Science 191:401-402. Dohan FC and Grasberger JC (1973) relapsed schizophrenics: earlier discharge from the hospital after cereal-free, milk-free diet. Amer J Psychiat 130:685-686. Reichelt KL et al (1990) The effect of gluten free diet on glycoprotein attached urinary peptidee excretion and behaviour in schizophrenics. J Orthomol Med 5:223-239. Gobbi G et al (1992) Celiac disease, epilepsy and cerebral calcifications. The Lancet 340:439-443. Paul K-D et al (1985) EEG-Befunde Zoeliakikranken Kindern in Abh{ngigkkeit von der Ern{hrung. Z Klin Med 40:707-709. Kahn A et al (1987) Difficulty of initiating sleep associated with cows milk allergy in infants. Sleep 10:116-121. Hadjivassiliou M et al (1996) Does cryptic gluten sensitivity play a part in neurological illness? The Lancet 347:369-371. Kjeldsen-Kragh J et al (1991) Controlled trial of fasting and one-year vegetarian diet in rheumatoid arthritis. The Lancet 338:899-902. Karjalainen J et al (1992) Bovine albumin peptide as a possible trigger of insulin-dependent diabetes mellitus. New Eng J Med 327:302-307.