Evidence on the damaging effect of gluten on the brain is mounting, and conditions like gluten ataxia are becoming more recognised. Gluten ataxia is not a new condition and research in this area has been around for more than a decade. So, what exactly is gluten ataxia?
Ataxia is the name given to group of neurological disorders that affects co-ordination, speech and balance. Swallowing and vision may also be affected. It can occur for many reasons including hereditary reasons, such as Friedreich’s ataxia, or may develop with no known reason (idiopathic). Gluten ataxia involves an auto-immune response after eating gluten containing grains1. The signs and symptoms of ataxia may develop gradually and the age at onset of symptoms may vary for each individual.
Gluten damage to the brain
After eating gluten containing grains, such as wheat, barley, rye and spelt, susceptible individuals are shown to develop antibodies that may attack a particular type of cell in the cerebellum – the purkinje cells. The cerebellum is responsible for co-ordination, balance and controls muscle movements. It is thought that the purkinje cells share similar epitopes (part of antigen to which an antibody binds) to those in gliadin2. So, instead of the antibody binding to the gliadin epitope it accidentally binds to the purkinje cell epitope. This means that eating gluten containing grains can directly influence damage to the brain. The longer the exposure to gluten in the diet, the more likely the effect in the brain. The damage to the brain is irreversible and up to 60% of people with gluten ataxia show cerebellar shrinkage on MRI3.
Getting a diagnosis of gluten ataxia may prove difficult. Antibodies typically seen in those with celiac disease are present in fewer than 38% of people with gluten ataxia and are usually at lower levels than seen in celiac disease patients. There is some evidence to show that a combination of antibodies may show up in gluten ataxia including tTG2, tTG6 antibodies and anti-gliadin antibodies4. It is still unclear as to whether the detection of the combination of these antibodies is enough to give a diagnosis, however they should be considered in cases of unexplained ataxia3. Even though less than 10% of patients with gluten ataxia will have any gastrointestinal symptoms an intestinal biopsy may be useful3.
There may be a genetic link to gluten ataxia and some research has shown that up to 70% of those with gluten ataxia have HLA-DQ2, HLA-DQ8 and HLA-DQ1 haplotypes 5(A haplotype is a group of genes inherited together from a single parent). These haplotypes are also present in many cases of celiac disease.
Gluten free diet in gluten ataxia
Eliminating all sources of gluten in cases of gluten ataxia may be vital for reducing the damage to the brain. There is evidence to show that a diet free from all sources of gluten may assist with ataxic symptoms6. Some may argue that the damage is already done or that eliminating gluten does not give any benefits. A strict elimination of every source of gluten in the diet, including those “free from” foods contaminated with trace amounts of gluten, may give the best results in the long term.
- Gluten containing grains can directly influence damage to the brain
- Specific cells in the cerebellum are attacked by antibodies produced in response to eating gluten
- Damage to the cerebellum may cause signs such as loss of balance, slurring of speech or poor co-ordination
- There may be a genetic link to gluten ataxia
- Gluten ataxia may, or may not, present with gastrointestinal symptoms or issues
- A long term, strict gluten free diet may be the best course of action
- Hadjivassiliou, M., Sanders, D. S., Grünewald, R. A., Woodroofe, N., Boscolo, S., & Aeschlimann, D. (2010). Gluten sensitivity: from gut to brain. The Lancet Neurology, 9(3), 318-330.
- Hadjivassiliou M, Boscolo S, Davies-Jones GA, Grunewald RA, Not T, Sanders DS, et al. (2002) The humoral response in the pathogenesis of gluten ataxia. Neurology. 58:1221–1226.
- Sapone et al. (2012) Spectrum of gluten related disorders: consensus on new nomenclature and classification. BMC Medicine 10:13
- Hadjivassiliou M, Mäki M, Sanders DS, Williamson CA, Grünewald RA, Woodroofe NM, Korponay-Szabó IR (2006) Autoantibody targeting of brain and intestinal transglutaminase in gluten ataxia. Neurology 66:373-377.
- Hadjivassiliou M, Grunewald R, Sharrack B, Sanders D, Lobo A, Williamson C, et al. (2003) Gluten ataxia in perspective: Epidemiology, genetic susceptibility and clinical characteristics. Brain. 126:685–691.
- Hadjivassiliou, M., Davies-Jones, G. A. B., Sanders, D. S., & Grünewald, R. A. (2003). Dietary treatment of gluten ataxia. Journal of Neurology, Neurosurgery & Psychiatry, 74(9), 1221-1224.