Randomized controlled trial of a gluten-free diet in patients with schizophrenia positive for antigliadin antibodies (AGA IgG): a pilot feasibility study

Abstract

Background: Approximately one-third of people with schizophrenia have elevated levels of antigliadin antibodies of the immunoglobulin G type (AGA IgG) -a higher rate than seen in healthy controls. We performed the first double-blind clinical trial of gluten-free versus gluten-containing diets in a subset of patients with schizophrenia who were positive for AGA IgG. Methods: In this pilot feasibility study, 16 participants with schizophrenia or schizoaffective disorder who had elevated AGA IgG (≥ 20 U) but were negative for celiac disease were admitted to an inpatient unit for a 5-week trial. All participants received standardized gluten-free meals and were randomized in a double-blind fashion to receive a shake containing 10 g of gluten flour or 10 g of rice flour each day. Participants were rated for psychiatric, cognitive and gastrointestinal symptoms at baseline and end point. Results: Of the 16 participants, 14 completed the 5-week trial (2 discontinued early for administrative reasons). Compared with participants on the gluten-containing diet, participants on the gluten-free diet showed improvement on the Clinical Global Impressions scale (Cohen d = -0.75) and in negative symptoms (Cohen d = -0.53). We noted no improvement in positive or global cognitive symptoms, but did observe an improvement in attention favouring the gluten-free diet (Cohen d = 0.60). Robust improvements in gastrointestinal adverse effects occurred in the gluten-free group relative to the glutencontaining group. Adverse effects were similar between groups. Limitations: This study was limited by its small sample size; larger studies are needed. Conclusion: This feasibility study suggests that removal of gluten from the diet is associated with improvement in psychiatric and gastrointestinal symptoms in people with schizophrenia or schizoaffective disorder. of the Treatment Research Program (TRP) at the Maryland Psychi atric Research Center (MPRC). The authors thank the nursing staff, who were instrumental in helping to maintain a gluten-free environment and helping with blood draws for screening, and the Outpatient Research Program (ORP) at the MPRC for their help in recruitment and screening. They also thank the many students, residents and fellows who spent countless hours with participants that helped with cooking classes and study integrity. They thank numerous students and trainees for their help over the years

Gluten, Inflammation, and Neurodegeneration

“…1 Interestingly, a number of neurodegenerative conditions have been associated with grain intake or respond favorably when gluten is restricted from the diet. [2][3][4] Additionally, rates of comorbid CD/ NCGS and neurodegenerative disorders, including bipolar, major depressive disorder, anxiety, and autism spectrum disorders (ASD), have been observed in unusually high rates. [5][6][7][8] These findings raise the question as to whether gluten may be implicated in the pathogenesis of neurodegenerative conditions.…”

The Differences between Gluten Sensitivity, Intestinal Biomarkers and Immune Biomarkers in Patients with First-Episode and Chronic Schizophrenia

“…Studies conducted in recent years indicate a higher prevalence of clinically significant anti-gluten antibody titers (AGA IgA and AGA IgG) among patients with schizophrenia compared to healthy individuals [23][24][25][26][27][28]. This relationship seems to also be confirmed by the clinical cases which describe a partial or complete remission of schizophrenia symptoms after following a gluten-free diet [29][30][31] and the results of the first randomized, double-blind clinical study [32]. The data on the prevalence of positive results and differences in the concentration of anti-gluten antibodies among patients in the first episode of schizophrenia remain inconsistent.…”

“…This may, at least in part, explain discrepancies in the literature about gluten antibodies in patients with psychotic disorders. In studies not taking the duration of the disease into account, a large majority confirm the existence of a higher concentration of at least one subclass of AGA [ 27 , 32 , 48 ].…”

“…In addition, as shown by the results described above, there are numerous differences in the immune response to gluten proteins between patients in the first episode of the disease and those who are chronically ill. To better understand the importance of immunological processes and the gut–brain axis in the development of schizophrenia and methods for its prevention, further studies should take into consideration the duration of the disease, people in high-risk groups, and people predisposed to the development of psychotic disorders. The results of an interventional pilot study that applied an elimination (gluten-free) diet in patients with schizophrenia are promising [ 32 ]. Confirmation of the results within a larger group, in practical terms, would allow a more personalized form of co-therapy of psychotic disorders.…”

Komplementarna Medicina U Psihijatriji

“…To ih je potaknulo na opširnije istraživanje koje je pokazalo da ti narodi ne jedu žitarice. Radikalniji znanstvenici smatraju da se shizofreničarima kod kojih bolest nije genetski uvjetovana može značajno pomoći izbacivanjem kruha, riže, paste, škroba i rafiniranih šećera (13)(14)(15).…”