Psychiatric Issues in Celiac Disease

This has long been a thorny area in celiac research. 40 years ago, Curtis Dohan, a researcher and head of the psychiatric ward in a Philadelphia area veterans hospital first reported on more rapid recoveries of schizophrenic patients on a gluten-free, dairy-free diet (1). More recently, De Santis et. al. reported on a patient with schizophrenia . A brain scan showed reduced blood supply to a frontal lobe in the patient's brain. After developing chronic diarrhea, the patient was investigated for then diagnosed with celiac disease The treatment for celiac disease, a gluten-free diet, resulted in the resolution of intestinal symptoms and villous atrophy. Remarkably, the patient also experienced a normalization of blood flow patterns in the brain as well as a complete resolution of the signs and symptoms of schizophrenia (2).

Relatedly, Knivsberg has reported her investigation of 15 dyslexic children in the 4th grade (3). Within this very small group, she found two cases of undiagnosed celiac disease, one case of gluten sensitivity, and one case of milk protein sensitivity.

Pynnonen et al. investigated a group of adolescents with celiac disease and compared them to matched controls (4). Much higher rates of both depression and disruptive behavior disorders were found among the celiac patients, but most of these resolved following treatment with a gluten-free diet. On the other hand, Fera et. al. report finding evidence suggesting that the increased frequency of affective disorders among celiac patients is the result of the psychological impact of the disease and its treatment, rather than a direct result of the disease itself (5).

A brain imaging investigation of 15 celiac patients (6) showed that 11 of these patients had one or more areas of their brains that were inadequately supplied with blood. Another group of treated celiac patients were also investigated. They showed blood flow patterns similar to members of the normal control group. Clearly, gluten avoidance normalizes blood flow in the brains of celiac patients.

1. Dohan FC, Grasberger JC, Lowell FM, Johnston HT Jr, Arbegast AW.
Relapsed schizophrenics: more rapid improvement on a milk- and cereal-free diet.
Br J Psychiatry. 1969 May;11(522:5956)
2. De Santis A, Addolorato G, Romito A, Caputo S, Giordano A, Gambassi G, Taranto C, Manna R, Gasbarrini G. Schizophrenic symptoms and SPECT abnormalities in a coeliac patient: regression after a gluten-free diet. J Intern Med. 1997 Nov;242(5):421-3.

3. Knivsberg AM. Urine patterns, peptide levels and IgA/IgG antibodies to food proteins in children with dyslexia. Pediatr Rehabil. 1997 Jan-Mar;1(1):25-33.

4. Pynnonen PA, Isometsa ET, Aronen ET, Verkasalo MA, Savilahti E, Aalberg VA. Mental disorders in adolescents with celiac disease.Psychosomatics. 2004 Jul-Aug;45(4):325-35.

5. Fera T, Cascio B, Angelini G, Martini S, Guidetti CS. Affective disorders and quality of life in adult coeliac disease patients on a gluten-free diet. Eur J Gastroenterol Hepatol. 2003 Dec;15(12):1287-92.

6. Addolorato G, Di Giuda D, De Rossi G, Valenza V, Domenicali M, Caputo F, Gasbarrini A, Capristo E, Gasbarrini G. Regional cerebral hypoperfusion in patients with celiac disease.
Am J Med. 2004 Mar 1;116(5):312-7.