Psychiatric Symptoms Associated With Celiac Disease

People sometimes post questions on celiac forums about the relationship between gluten intolerance and neurologic disorders. A person with intestinal tract symptoms does not expect problems with his central nervous system (brain) or peripheral nerves (those going to the body). In fact, there are at least two ways in which celiac patients can have neurologic abnormalities. One is due to a lack of vitamins that are important to keep the nervous system healthy. People with celiac disease can have too little of these key vitamins. The other is that some of the specific abnormalities, like antibodies, that are part of celiac disease can affect the brain and nerves.

Let’s begin by explaining some of the terms related to the nervous system as well as diseases affecting it that people with celiac disease may experience, including ataxia, dementia, peripheral neuropathy, and seizures. These are the most common neurologic problems associated with celiac disease.

Ataxia
Ataxia means that a person is not able to coordinate his muscle movement or keep himself balanced. This often shows up when walking. When associated with celiac disease, it usually affects both sides of the body equally and does not go away. As an example, a person who is drunk frequently demonstrates ataxia. Ataxia seizures are more common in children with celiac disease than adults.  A gluten-free diet does not usually improve seizures or ataxia.

Dementia
Dementia is a loss of cognitive abilities. Cognitive abilities include memory, language, and the ability to make judgments and solve problems. With dementia, a person may have difficulty with normal, every-day activities. As an example, people with Alzheimer’s disease have dementia. A gluten-free diet has helped some people with dementia who have celiac disease.

Peripheral Neuropathy
The peripheral nerves are long nerves that go from the spinal cord out to the arms, legs, hand and feet. They carry messages to the muscles to move (motor nerves) and they carry sensations back to the brain (sensory nerves). General damage to these nerves is called peripheral neuropathy. This frequently occurs with vitamin deficiency. An example is the loss of sensation in the feet that happens to many diabetics.

Seizures
Seizures are caused by abnormal activity of a group of nerve cells in the brain. They can appear as generalized shaking and twitching or can be much smaller. As an example, people with epilepsy have seizures.

Vitamin Deficiencies
Anyone who is losing weight and having a lot of diarrhea with their celiac disease may not be absorbing enough of needed vitamins, although it is considered relatively rare in celiac patients. However, celiac patients with other autoimmune diseases may be more likely to become deficient. If they also drink a lot of alcohol, they may be more likely to have low levels of vitamins. The B vitamins, as well as niacin, riboflavin, and vitamin E may be affected.

Vitamin B12 deficiency may be the best known. People with this usually have low red blood cells but can have neurologic symptoms that appear first. B12 deficiency can cause peripheral neuropathy, dementia, ataxia, weakness, worsening of vision, and more. Some or all of this can be reversed by taking enough vitamin B12.

Vitamin E deficiency can also damage the sensory nerves so that the person loses the ability to know what position his joints are in. There can also be a head tremor. Lack of niacin is associated with seizures, ataxia, and dementia, while lack of vitamin B6 can cause confusion, sleepiness and peripheral neuropathy

Thiamine (B1) deficiency is usually seen in alcoholics, but can be seen in people with celiac disease who drink. They may become confused, have difficulty walking, and lose coordination of their eye muscles. Memory can be damaged, and there can be psychiatric symptoms. Damage to the nerves in the feet causes a sensation of burning.

However, most people with celiac disease are not vitamin deficient. They have neurologic abnormalities that seem to be directly connected to the disease itself. Why this happens is not completely understood.  It may be that the antibodies celiac patients make can also damage other parts of the body.

People with celiac disease may develop a sensory neuropathy, but there can also be damage to motor nerves. These patients may make antibodies directed at parts of the nerves. Sometimes patients will improve on a gluten-free diet.

With all of these neurologic abnormalities, vitamin levels should be checked and supplements given if needed. Treating celiac disease with a gluten-free diet, of course, must also be done. These steps may cause improvements in some people’s symptoms however there are others who do not improve.

It is important to know that neurologic problems can occur before the celiac disease is recognized. If you are a family member of someone with gluten intolerance and you have any of these problems, it would be good to tell your doctor so that you can be checked for celiac disease.

There is active research looking into the causes and possible treatments of neurologic problems in patients with celiac disease.