A gluten-free diet in people with schizophrenia and anti-tissue transglutaminase or anti-gliadin antibodies

Jackson, Jessica; Eaton, William W.; Cascella, Nicola G.; Fasano, Alessio; Warfel, Dale; Feldman, Stephanie; Richardson, Christopher A.; Vyas, Gopal; Linthicum, Jared; Santora, Debby; Warren, Kimberly R.; Carpenter, William T.; Kelly, Deanna L.

doi:10.1016/j.schres.2012.06.011

Cited by 53 publications

(35 citation statements)

References 8 publications

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“…However, both risperidone and minocycline have since been discontinued. This leaves the distinct possibility that the withdrawal of gluten from the diet was the crucial factor in the patient’s recovery, which fits with our previously reported finding (24) that improvements in symptoms begin as soon as 2 weeks after a gluten-free diet is started in persons with schizophrenia who have antigliadin antibodies. However, the basis for the response of the patient’s schizophrenia symptoms to a gluten-free diet is not completely clear.…”

Section: Discussionsupporting

confidence: 89%

Improvement in Psychotic Symptoms After a Gluten-Free Diet in a Boy With Complex Autoimmune Illness

Eaton¹,

Chen

Dohan

et al. 2015

AJP

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CASE PRESENTATION At age 8, “Chris,” a Caucasian boy, experienced intermittent auditory and visual hallucinations, but without bizarre behaviors or much deterioration in functioning. At age 15, he developed a depressed mood, started talking to himself, and became socially withdrawn, and his academic performance declined. He was hospitalized and diagnosed as having major depressive disorder with psychotic features. MRI and EEG showed no abnormalities. Treatment with escitalopram (10 mg/day) and aripiprazole (5 mg/day) had little effect. Several weeks after discharge, he was admitted for a second time with the same diagnosis; a third admission, again with the same diagnosis, occurred several months after that. At age 16, Chris developed visual and auditory hallucinations with homicidal ideations. He cut himself superficially following the command of voice hallucinations, and he was hospitalized again, with the diagnosis changed to schizophrenia, paranoid type. During this inpatient stay, he was treated with venlafaxine (150 mg/day) and risperidone (1.5 mg/day). During the same admission, a blood test showed the presence of antinuclear antibodies (ANAs), but the patient had no symptoms of any autoimmune disease. In the meantime, he was also receiving clindamycin/benzoyl peroxide and adapaline gels and minocycline for acne and fluticasone nasal spray and albuterol for asthma. An allergy to gluten was demonstrated by an assay (Accessa Labs) that showed only IgE antigluten antibodies. Chris’sparents reported that he developed anallergy to peanuts and soy at about the same time. Gluten was removed from his diet at the suggestion of the mother, a licensed dietitian. After the dietary change, the intensity of Chris’s auditory hallucinations declined dramatically and the violent element diminished, and he was discharged after 9 weeks. During the next 2 years, Chris remained on a gluten-free diet, which he and his family associated with the disappearance of his psychotic symptoms. Sensitivity to gluten was demonstrated by an assay (Metametrix Clinical Laboratory) of a stool sample that yielded a value of 10.6 mg/dL of IgA antigliadin antibodies, in the top quintile of the reference range. The dosage of risperidone was tapered to 0.5 mg/day, and no auditory or visual hallucinations occurred, although when the dosage was lowered to 0.25 mg/day, Chris reported feeling anxious, and the dosage was returned to 0.5 mg/day for a time. Eventually the risperidone was discontinued completely. Chris was able to return to school, where his academic performance was normal and he joined several athletic teams. At age 16, after his hospital stay, Chris lost his hearing suddenly and was fitted with a hearing aid. His ANA level was high, and the diagnosis of autoimmune inner ear disease was made. He was treated with prednisone and then methotrexate over a 2-month period. Despite his hearing loss, he has maintained a high level of functioning, including learning to read lips, and he has continued to play competitive sports. Both of Chris’s p...

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Section: Discussionsupporting

confidence: 89%

Improvement in Psychotic Symptoms After a Gluten-Free Diet in a Boy With Complex Autoimmune Illness

Eaton¹,

Chen

Dohan

et al. 2015

AJP

Self Cite

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“…This is of critical importance as this AGA-positive group with schizophrenia may benefit from the removal of gluten from the diet. A recent pilot study of two subjects who were AGA-positive showed that the removal of gluten may have rapid and robust effects on positive and negative symptoms of the illness (Jackson et al, 2012a); (Feldman et al, 2013). While the exact relationship is not yet understood, a number of mechanisms have been proposed in light of the many associations between gluten and schizophrenia and the immune pathway is leading with regard to understanding how antibodies to gluten may play a role in symptoms.…”

Section: Discussionmentioning

confidence: 99%

Gluten sensitivity and relationship to psychiatric symptoms in people with schizophrenia

Jackson¹,

Eaton²,

Cascella³

et al. 2014

Schizophrenia Research

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The relationship between gluten sensitivity and schizophrenia has been of increasing interest and novel mechanisms explaining this relationship continue to be described. Our study in 100 people with schizophrenia compared to 100 matched controls replicates a higher prevalence of gluten sensitivity and higher mean antigliadin IgG antibody levels schizophrenia (2.9 ± 7.7 vs. 1.3 ± 1.3, p = 0.046, controlled for age). Additionally, we examined symptoms within the schizophrenia group and found that while positive symptoms are significantly lower in people who have elevated antigliadin antibodies (AGA; 4.11 ± 1.36 vs. 6.39 ± 2.99, p = 0.020), no robust clinical profile differentiates between positive and negative antibody groups. Thus, identifying people in schizophrenia who may benefit from a gluten-free diet remains possible by blood test only.

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“…The dietary removal of gluten has met with varied results in schizophrenia and also autism, most likely a reflection of the extreme heterogeneity of both disorders. The most success in improving symptomatology was observed in those instances where inclusion criteria required that candidates have evidence of gluten or diet-related sensitivity [59][60][61].…”

Section: Diet-based Immune Sensitivitymentioning

confidence: 99%

Gastroenterology issues in schizophrenia: Why the gut matters

Severance

2016

Eur. psychiatr.

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Genetic and environmental studies implicate immune pathologies in schizophrenia. The body's largest immune organ is the gastrointestinal (GI) tract. Historical associations of GI conditions with mental illnesses predate the introduction of antipsychotics. Current studies of antipsychoticnaïve patients support that gut dysfunction may be inherent to the schizophrenia disease process. Risk factors for schizophrenia (inflammation, food intolerances, Toxoplasma gondii exposure, cellular barrier defects) are part of biological pathways that intersect those operant in the gut. Central to GI function is a homeostatic microbial community that early reports show is disrupted in schizophrenia. Bioactive and toxic products derived from digestion and microbial dysbiosis activate adaptive and innate immunity. Complement C1q, a brain-active systemic immune component, interacts with gut-related schizophrenia risk factors in clinical and experimental animal models. With accumulating evidence supporting newly discovered gut-brain physiological pathways, treatments to ameliorate brain symptoms of schizophrenia should be supplemented with therapies to correct GI dysfunction.

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A gluten-free diet in people with schizophrenia and anti-tissue transglutaminase or anti-gliadin antibodies

Cited by 53 publications

References 8 publications

Improvement in Psychotic Symptoms After a Gluten-Free Diet in a Boy With Complex Autoimmune Illness

Improvement in Psychotic Symptoms After a Gluten-Free Diet in a Boy With Complex Autoimmune Illness

Gluten sensitivity and relationship to psychiatric symptoms in people with schizophrenia

Gastroenterology issues in schizophrenia: Why the gut matters

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