Sunday, December 14, 2008

Celiac Disease causes ADHD Symptoms

One of the biggest challenges in diagnosing and treating ADHD is trying to separate it out from other disorders that often present similar-looking symptoms. One such disorder is known as celiac disease. When gluten (a type of plant protein found in corn and wheat) is ingested in individuals with celiac disease, an inflammatory response in the upper portion of the small intestine occurs. When repeatedly challenged by gluten exposure, damage can occur to this portion of the digestive system, which leads to painful symptoms and impaired digestive and absorptive function.

The latter is of particular interest, since we have seen in other posts that nutrient deficiencies can lead to or exacerbate the onset of certain ADHD symptoms. For example, iron has been shown to be a useful supplement in treating certain underlying factors in ADHD, as seen in previous posts. It is thought that a celiac disease-damaged system can contribute to iron deficiency, likely through impaired iron absorption, thus presenting a challenge to the ADHD patient.

Interestingly, celiac disease has also been linked to other neurological disorders such as depression and depressive-like symptoms. This may be due to poor absorption of the amino acid tryptophan (which is found in high concentrations in turkey, and is a big reason why turkey can make a person sleepy). Tryptophan is converted to another important agent in the body called serotonin, which is often found to be reduced in patients with depression and other related symptoms (sugar and milk can also give a temporary rise in serotonin levels, which is why ice cream and chocolate are often "comfort foods").

In addition to depressive behaviors, possible connections have been identified between celiac disease and other metabolic disorders such as diabetes and thyroid problems. We have explored the possible connection between ADHD and thyroid dysfunction in a previous post. Additionally, there is a possible connection between celiac disease and other symptoms or common ADHD comorbid disorders such as epilepsy, dyslexia (which is thought to be a possible result of impaired gluten breakdown), anxiety disorders and social phobias and impaired sensory functions.

The good news to all this is that a gluten-free diet (which, unfortunately, can be very difficult to administer due to the prevalence of wheat in the Western diet) has been shown to ameliorate most of these negative symptoms. A study done on celiac disease patients and ADHD symptoms found that after treating patients with a gluten-free diet for 6 months, a number of ADHD-like symptoms subsided. The study used a method called Hypescheme, which is a type of computerized checklist used to quantify and analyze data involving ADHD and related disorders in a statistically significant fashion.

Statistically-significant improvements were seen in the following areas: attention to detail, duration of attention span, ability to complete tasks, distractibility, fidgety behavior, leaving a seat (when expected to remain seated), noisy disruptions and answering questions prematurely.

However, statistically significant improvements were not seen in other categories characteristic of ADHD. These include: losing/forgetting materials as well as restless and interruptive behaviors.

In previous posts, we have seen that certain treatments may be favorable for either inattentive ADHD type behaviors, hyperactive-impulsive ADHD behavior, or a combination of the two, called the ADHD Combined Subtype. It is interesting to note that the gluten-free diet results in improvements in characteristics that may be considered either "inattentive" (task completion, attention to detail, distractibility) or "hyperactive-impulsive" (fidgeting, noisy behavior and blurting out answers prematurely). While many studies on the possible connection between food additives and ADHD (see last paragraph of this post for more on this) seem to highlight the hyperactive side of the disorder, this celiac disease study seems to indicate a more mixed improvement across the whole spectrum of the disorder when a gluten-free diet is introduced.

Given the fact that many individuals who have celiac disease lack many of the outward signs of digestive symptoms of the disorder, and the fact that there are so many potential overlapping factors between the symptoms of ADHD and celiac disease, it is quite possible that you or your child's ADHD may be a misdiagnosis of an underlying cause of celiac disease or a related disorder. I therefore strongly recommend individuals who are diagnosed with the disorder of ADHD (especially those who have had poor or adverse responses to previous treatments) to consider testing for celiac disease. This of course, is not meant to knock the competence of most physicians and other professionals, but rather a plea to eliminate a potentially common misdiagnosis through a relatively simple procedure. Several antibody-based tests can be used to detect celiac disease or related disorders with relative ease.

In general, there has been a lengthy debate over the connection between ADD and ADHD and food allergies. While previous studies had certainly performed, a landmark study was done in the mid 1970's by Dr. Benjamin Feingold which sought to link the relationship between food additives and food coloring and hyperactivity. Numerous studies have since followed on this topic, many of which have supported Feingold's hypothesis and many which have refuted it. As a result, a number of physicians began to recommend elimination diets in an attempt to control attention deficits and hyperactive behavior. We will be investigating the original Feingold article and summarize the effectiveness of these elimination diets in treating ADHD symptoms in the near future.

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11 comments:

Ursula said...

Excellent information!

And naturally, due to the outward manifestations of ADHD symptoms, it makes sense that this condition is diagnosed first without looking at celiac disease.

The L-Tryptophan connection is interesting and I plan to give it a try.

Thanks for the post!

dan said...

"This may be due to poor absorption of the amino acid tryptophan (which is found in high concentrations in turkey, and is a big reason why turkey can make a person sleepy). Tryptophan is converted to another important agent in the body called serotonin, which is often found to be reduced in patients with depression and other related symptoms (sugar and milk can also give a temporary rise in serotonin levels, which is why ice cream and chocolate are often "comfort foods")."

Turkey doesn't actually have a very large concentration of TPH. In any case, the TPH in turkey is TPH1, which isn't active in the human brain (TPH2 is).

The way to raise serotonin in the brain is not through turkey, sugar or milk. The easiest way to do it in humans without drugs is by ingesting a large amount of sesame seeds (more than anyone would ever want to on their own).

Either way, the effect of neurotransmitters on the brain is a complex issue and can't be broken down to 'You eat A, so B increases, and then C happens'.

The ADHD Treatment Guide said...

Interestingly, tryptophan is not a very efficient method of boosting serotonin for a couple of reasons (thanks Ursula and Dan for your comments).

In the event of a vitamin B3 (Niacin) deficiency, tryptophan stores can be converted to this essential B vitamin, through a relatively inefficient process. By taking in adequate levels of niacin, you can keep some more of your tryptophan reserves for serotonin conversion. Additionally, niacin, along with another B vitamin, vitamin B6 (present as pyridoxine or related forms), are needed to convert tryptophan to serotonin.

Additionally, as Dan pointed out, turkey is not as high in tryptophan as it typically gets credit for. Sesame seeds (along with milk) have some of the highest percentages of tryptophan compared to other amino acids. Nevertheless, turkey, with all of its holiday affiliations, still seems to be the most familiar tryptophan source to most people.

One of the problems with tryptophan is that it must "compete" with other amino acids (which often occur much more frequently) for access to the brain. Insulin surges from high sugar or other high carbohydrate meals clear some of these "competitors" away more efficiently than tryptophan, resulting in a slightly improved tryptophan ratio access to the brain.

Again, I appreciate both of your comments and insight, Ursula and Dan!

Debbie said...

Corn gluten is not a trigger for celiac disease. While some celiacs may avoid corn, only wheat, rye, and barley are triggers for the autoimmune response of this condition.

Rodger C Bailey, MS said...

From my perspective, most of the developmental disorders (like ADHD, ADD, FTT, APD, LD, PDD, and others) might only be differing symptom sets for the same condition. We theorize that all of them have something blocking their natural developmental process and the varying symptom sets are related to the intensity of the blockage, the developmental stage when the child got stuck, and the level of sensitivity of the child.

When we determine to which environmental factors a child is reacting (non-allergic immune hypersensitive reactions) and then remove those factors from the child's environment, the developmental process naturally re-engages.

From our experience those children who are hypersensitive to those food additives identified by the Feingold research, will be helped by eliminating them. The same goes for the GFCF diet: those children with reactions to wheat and dairy products will be helped by the GFCF diets.

If those children are only reacting to those factors targeted by those diets, their developmental process gets completely re-engaged. If they have other things to which they are reacting, their results are mixed (some improvement but the developmental process remains blocked or sluggish).

I think the new frontier for successful treatment of ADHD will be related to tracking the developmental process (instead of 'symptoms,' and determining the precise processes by which the developmental process gets blocked for these children.

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Rinda said...

Thanks so much for this post- my husband was diagnosed with CD last month and we are still working through implimenting a gluten-free diet for him but recently have been having trouble with our 5-year-old in kindergarten. He is a VERY active child and this article describes him to a T. Rather than having medication prescribed to him at the suggestion of the school I am beginning to think he has inherited CD and I need to test him and try a GF diet FIRST. Thank you!

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luminsmith said...

ADHD symptoms in toddlers are somewhat difficult to diagnose as being indicative of the disorder given the fact that all toddlers are inattentive, easily distracted, hyperactive, etc.

danielthomas said...

ADHD diet will help the brain to function better and reduce symptoms such as agitation or lack of concentration. A solid diet plan can include the foods one normally eat and supplements one can regularly take.
Adhd symptoms