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Celiac.com 07/25/2023 - Non-celiac gluten sensitivity is a gluten-related disorder that results from immune-mediated reactions in predisposed people. Non-celiac gluten sensitivity usually manifests with gastrointestinal symptoms. However, in rare cases, it might present with psychiatric symptoms that could be severe enough to impair functioning. We've done a number of articles on the psychological and psychiatric manifestations of celiac disease, which can include, anxiety, depression, and eating disorders. There are also studies linked celiac disease to neurological manifestations, along with schizophrenia. Every so often, we cover a case study that may be relevant to celiac disease, in general. Our latest case involves a 15-year-old Sudanese girl, with no prior psychiatric history, who visited the emergency department due to anxiety, behavioral changes, and hallucinations of her deceased father. Girl Treated for Psychosis and Delusions After witnessing her father's burial, she started experiencing flashbacks and intrusive images of him, along with anxiety about death and paranoia towards others. The patient was agitated and psychotic, requiring rapid tranquilization. She was later diagnosed with hyperthyroidism due to Grave's disease. A team of clinicians, including Olfa Selmi, Banan Khalid, and Saleem Al-Nuaimi, present the girl's case report. They are variously affiliated with the Department of Psychiatry and the Mental Health Service at Hamad Medical Corporation and Hospital in Doha, Qatar. Despite receiving appropriate thyroid medication, her psychiatric symptoms did not improve, leading to further investigations. Blood tests revealed positive anti-transglutaminase IgA antibodies, suggesting possible celiac disease. Psychosis Improves on a Gluten-Free Diet A gastroscopy showed mild duodenal changes, and she began a gluten-free diet. Within weeks of starting the gluten-free diet, the patient's psychotic symptoms improved significantly. Whenever she consumed gluten in large quantities, her delusions resurged, and they subsided again with a return to the gluten-free diet. The case suggests a potential link between gluten and psychosis, although the exact mechanism remains uncertain. Prior case reports also show improvements in psychotic symptoms after adopting a gluten-free diet in patients with gluten allergies or sensitivities. As a gluten-free diet is safe and low-cost, it may be considered as part of the treatment plan for reducing psychotic symptoms in patients with gluten-related disorders or autoimmune diseases. This case adds to the growing literature exploring the role of gluten in atypical psychotic presentations and the potential benefits of a gluten-free diet in such cases. It also highlights the importance of considering nonconventional treatments when standard therapeutic interventions do not yield satisfactory results, as aggressive treatments may carry higher risks. The significant improvement of the girl's psychosis upon starting on a strict gluten-free diet suggests a potential connection between gluten ingestion and psychiatric disorders. However, further research is needed to better understand the relationship between gluten and psychiatric symptoms, and to guide the use of a gluten-free diet in appropriate cases. Read more at Cureus 15(7): e41807.

Celiac.com 01/19/2021 - Typically, when people with celiac disease eat gluten, they experience gastrointestinal discomfort, or even symptoms like a skin rash, anemia, and headaches. In some extreme cases, though, the side effects could be much, much worse. But, in rare cases, celiac disease can manifest with psychiatric symptoms and behavioral disturbances. Interestingly, celiac disease in children often manifests mainly as behavioral disturbance, such as increased aggression or anxiety, with milder or absent gastrointestinal symptoms. That was the case with a 37-year-old, successful PhD student, from Massachusetts. Woman Begins to Have Delusions The woman began experience severe unexplained hallucinations, paranoia. She became convinced that everyone she knew were conspiring against her, and that friends, family members and even strangers were acting out pre-scripted scenes in some kind of a “game.” Her dissociation from reality became so severe that she alarmed those around her, and they sought to get her help. Doctors Suspect Psychotic Disorder The woman was admitted to a psychiatric hospital, where doctors diagnosed a psychotic disorder, and prescribed powerful antipsychotic drugs in order to control her symptoms. However, the drugs had practically no effect. On follow-up, the doctors found the woman suffered from numerous mineral and vitamin deficiencies, along with thyroid problems. She had also lost a substantial amount of weight. Eventually, they screened her for celiac disease, and discovered that she had it. Doctors Confirm Gluten Causing Woman's Delusions Once the doctors confirmed celiac disease, they advised the woman to avoid gluten, and eat a standard gluten-free diet. However, the woman's delusions had not subsided, and she regarded the doctors as just another part of the conspiracy of people working against her. This belief led her to completely disregarded the gluten-free diet. Sadly, the woman's condition spiraled out of control, and she soon lost her job, her home, and became alienated from her family and friends. After becoming homeless and desperate, the woman unsuccessfully attempted suicide. Fortunately, she was returned to the hospital, where she began to embrace a gluten-free diet. Return to Normal on a Gluten-Free Diet According to Dr. Alessio Fasano, Director of the Center for Celiac Research and Treatment at Massachusetts General Hospital, the woman's condition improved quickly. In no time, she was able to think clearly, and to understand that gluten had been causing her to have serious mental problems. The woman was remorseful, and apologetic for causing so much trouble. Eating Gluten Leads to Murder Attempt The woman began to follow her prescribed diet, but, after accidentally eating gluten, her psychosis returned, and she attempted to kill her parents. Thankfully, she did not succeed, but she was arrested, tried, and sent to prison. The woman's case proves that, in rare cases, celiac disease can cause severe psychotic and other behavioral symptoms. The Link Between Gluten and Psychosis Researchers don't have much good information on the connection between gluten disease and mental disorders. Dr. Fasano suspects a connection lies in the human immune system. When people with celiac disease eat gluten, they typically experience inflammation of the gut. Dr. Fasano believes that, in some cases, such as with the woman in question, gluten-triggered inflammation moves beyond the gut to the brain, which could explain the kind of psychotic delusions experienced by the woman. A better understanding of the connection between gluten and psychosis in such cases could help improve the treatment of celiac disease and gluten sensitivity. Until then, cases such as this are a reminder of just how much we don't know, and how much further we have to go in learning about and treating celiac disease in all its manifestations. Read more at oddee.com and nejm.org

Celiac.com 10/29/2021 - Ron Hoggan's book Dangerous Grains has been an enormous help toward understanding something bizarre that happened to my 19 year old son, Lee, in the past year. Lee suddenly began acting psychotic one day last October and eventually had what appeared to be some kind of seizure. He lay on the couch, tensed up, and started shaking violently. His eyes were rolling back into his head and he was vocalizing loudly. After a period of time he came out of it and was somewhat lucid but seemed dazed, and very confused. We took him to the emergency room where he underwent a battery of tests that revealed nothing out of the ordinary. During the wait, he had two more of the seizure-like episodes. A psychiatrist was phoned and he was given neuroleptic drugs. He went to the epilepsy ward for further testing -EEG, CT scans and MRI's that did not reveal anything obviously wrong. Fortunately, we were able to stay with him. On the morning of the second day he seemed better and we talked while he ate breakfast. Thirty minutes later he was having an episode- again shaking and vocalizing, and after a couple of hours started to come out of it. We noticed this pattern- eating, followed shortly afterward by seizure-like episodes and psychosis which gradually cleared enough to converse. I started to notice what he was eating and the common denominator was wheat. I gave him some rice and vegetables from home and there was no reaction, but bagels, bread, muffins and gravy all seemed to bring about the same violent reaction. I have food allergies and am aware that wheat is a common allergen (I learned to avoid it years ago), but I couldn't understand how he could be affected in such an extreme manner, so quickly after eating. He was moved to a locked psychiatric ward, diagnosed with possible bipolar disorder or non-specific schizophrenia, and the neuroleptics were continued. Of course, his psychiatrist didn't want to hear about my observations regarding Lee's apparent reaction to wheat. (My wife and daughter also witnessed it on several occasions.) I told the psychiatrist that Lee hadn't been having any mental changes lately but had been complaining about digestive problems and I requested a biopsy to confirm celiac disease. It was promptly denied, but I was able to get the hospital dietitian to put him on a gluten-free diet (unknown to the psychiatrist who rarely saw him, but was happy to prescribe ever increasing doses of neuroleptics). The seizures stopped the very next day- the staff no doubt assumed the drugs were having an effect in spite of my revelation about the gluten-free diet. Over the next several weeks Lee became more psychotic and suffered terrible side-effects from the drugs. The county brought him to court and had him committed. He was ordered to continue the neuroleptics, and there seemed to be little we could do. Eventually he was sent to a halfway house, but a couple of weeks after arriving he started to become catatonic. (I had told the staff about the wheat reaction but they were unable to provide a gluten-free diet). We took him to the emergency room where we learned that he was extremely dehydrated. He had lost the urge to eat or drink and was becoming very psychotic. The hospital was full, so he was sent to a sister hospital. By the time the ambulance arrived, he was completely catatonic - unable to speak and incontinent. At the new hospital, he had a new psychiatrist. She was alarmed at the dosages of drugs he was receiving and felt he was probably experiencing the beginning of ‘neuroleptic malignant syndrome,' a potentially fatal reaction to neuroleptics. The drugs were discontinued but he remained catatonic and was given Electro Convulsive Treatment several times a week. (I also spoke with the dietician when he was admitted and had Lee placed on a gluten-free diet - which was halfheartedly followed). After a few ECT treatments (and a mostly gluten-free diet) he started to come out of it. His new doctor began to realize that he didn't seem to have any mental illness at all (now that the neuroleptics had been discontinued, the catatonia was lifting and diet was improving) and called in several specialists for a more thorough evaluation. I told her about the reaction to wheat but she refused to believe there could be a connection. Finally, another neurologist was brought in and he had the insight to give him a gliadan antibody test and found that he was extremely reactive. He was finally "officially" put on a gluten-free diet (we had been bringing him food from home and doing everything we could behind the scenes to keep gluten from him). He continued to improve, in spite of the side effects of the ECT. His psychiatrist couldn't really understand what was going on with him but began to trust us enough to release him, drug-free, into our care. Three months after the ordeal began, he finally came home and is clearer now than he's been in years. He's always been kind of quiet and we realize now that gluten has probably been affecting him for years. He has done an excellent job of following the gluten-free diet, is working full time, and starts college in a few weeks. Shortly after he came home, my mother came across Dangerous Grains and bought it for me. It all finally makes sense and I plan to send copies to Lee's psychiatrist and neurologist. We saw countless people in the locked psychiatric wards who were suffering and, with the exception of the chemical dependencies everyone was on some type of drug or drugs. Many were receiving ECT on a routine basis. I know my son is not unique - testing and gluten-free diets could save many of these poor souls from a lifetime of drugs and suffering. I want to do everything I can to increase the knowledge of these professionals and Dangerous Grains seems the perfect vehicle. So great thanks to Ron Hoggan (and Dr. Braly and the rest) for doing what you're doing. I know it's only a matter of time before the people that control the mental health system become enlightened enough to stop doing harm and truly begin to heal these patients. It was a close call for us and I realize Lee is a living example.