Connections between celiac disease, gluten sensitivity, and psychosis

Connections between grain consumption and psychosis have been known for the last 80 years. Although it has never been well investigated in large clinical trials, several smaller studies suggest that grain-free diets can help reduce symptoms of psychosis.

There have also been reports of symptoms identical to schizophrenia that turned out to be the initial stages of celiac disease. The psychiatric symptoms in these cases did not respond to antipsychotic medication, but symptoms did subside completely after the celiac disease was diagnosed and the patients were placed on a gluten-free diet.

This article will give a short overview of celiac disease and gluten sensitivity, and will mention their connections to neuropsychiatric conditions that can include mood disturbance or psychosis. For an in-depth examination of the literature on this topic, see this previous blog post on the connection between gluten and schizophrenia, and watch this video lecture titled gluten sensitivity, celiac disease, and psychosis.

What is celiac disease?

Celiac disease is an autoimmune disorder, meaning that the body starts to make antibodies against its own tissues. In celiac disease, the antibodies are directed against a protein from the lining of the small intestine. People with celiac disease also produce antibodies against a protein (gliadin) formed from wheat and some other grains. The antibody reactions in celiac disease lead to damaging inflammation in the lining of the small intestine.

Clinical signs of celiac disease include malabsorption of nutrients and malnourishment, abdominal pain, diarrhea, vomiting, unexplained weight loss, and fatigue.

What is gluten sensitivity?

Gluten sensitivity involves antibodies against the gliadin proteins but does not involve the damaging intestine antibodies. Even though there is not antibody damage to the small intestine, people with gluten sensitivity may experience a variety of other symptoms.

In gluten sensitivity, the symptoms are either aggravated by the presence of gluten in the diet or alleviated by the removal of gluten from the diet. This is the defining feature of gluten sensitivity.

Neuropsychiatric manifestations of celiac disease and gluten sensitivity

Intestinal symptoms are the most commonly thought-of presentations of celiac disease and gluten sensitivity, but these conditions can involve other body systems. Studies have shown that neurological changes are quite common.

For example, up to 36% of adult-onset celiac disease cases present with neurological changes, and 57% of patients with neurological symptoms of unknown cause despite a full neurological workup had anti-gliadin antibodies, as opposed to only 5% of patients with neurological symptoms whose cause could be identified.

Results from neuropsychiatric studies suggest that some people with schizophrenia will have celiac disease or gluten sensitivity and their symptoms of psychosis may be a sign of intestinal disease.

Learn more:

You can find a video lecture with more information on gluten sensitivity, celiac disease, and psychosis on my YouTube channel, 15-Minute Pharmacology. The lecture was given at the October 13, 2020 meeting of the SZconsult learning community.

You can also read more about this topic in an older blog post discussing gluten and schizophrenia, which contains an examination of several case studies and review articles on the topic of grain-free or gluten-free diet studies in schizophrenia.

Disclaimers

This article summarizes the results and conclusions of articles published in the medical literature. It is for general information. It is not a substitute for medical advice, and readers are admonished not to enact or change treatments based on this article. Always seek the advice of your doctor before starting or changing treatment.

The thoughts, views, and opinions expressed in this article are my own and do not reflect or represent the policy or position of Northeast Ohio Medical University.

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