As a rule, what is out of sight disturbs men’s minds more seriously than what they see.
IF SUGARS AND GLUTEN-FILLED CARBS, including your daily whole-grain breads and favorite comfort foods, are slowly impinging on your brain’s long-term health and functionality, what else can these ingredients do on a more short-term basis? Can they trigger changes in behavior, seize control of focus and concentration, and underlie some tic disorders and mood conditions like depression? Can they be the culprit in chronic headaches and even migraines?
Yes, they can. The facts of “grain brain” go far beyond just hampering neurogenesis and increasing your risk for cognitive challenges that will progress stealthily over time. As I’ve already hinted at throughout the previous chapters, a diet heavy in inflammatory carbs and low in healthy fats messes with the mind in more ways than one—affecting risk not just for dementia but for common neurological ailments such as ADHD, anxiety disorder, Tourette’s syndrome, mental illness, migraines, and even autism.
Up until now, I’ve focused primarily on cognitive decline and dementia. Now, let’s turn to gluten’s destructive effects on the brain from the perspective of these common behavioral and psychological disorders. I’ll start with the afflictions that are often diagnosed in young children, and then move on to cover a wider array of issues that are found in people of every age. One thing will be clear: The removal of gluten from the diet and the adoption of a grain-brain-free way of life is often the surest ticket to relief for these brain ailments that plague millions, and this simple “prescription” can often trump drug therapy.
GLUTEN’S ROLE IN BEHAVIORAL AND MOVEMENT DISORDERS
I first saw Stuart when he had just turned four years old. He was brought to my center by his mother, Nancy, whom I had known for several years; she was a physical therapist who had treated many of our patients. Nancy began by describing her concerns about Stuart and reported that although she really hadn’t noticed anything wrong with her son, his preschool teacher felt he was unusually “active” and felt it would be a good idea to have him evaluated. I was not the first doctor to see him because of this concern. The week before visiting us, Stuart’s mom had taken him to their pediatrician, who proclaimed that Stuart “was ADHD” and had written a prescription for Ritalin.
Nancy was rightfully concerned about placing her son on the drug, and this prompted her to look into other options. She began by explaining that her son had frequent anger outbursts and that he “shook uncontrollably when frustrated.” She described how the preschool teacher complained that Stuart was unable to “stay on task,” making me wonder exactly what tasks require undivided focus in a four-year-old.
Stuart’s past medical history was revealing. He had suffered lots of ear infections and had been on countless rounds of antibiotics. At the time I evaluated him, he was on a six-month course of prophylactic antibiotics in hopes of reducing his risk for continued ear infections. But beyond the ear problems, Stuart persistently complained of joint pain, so much so that he was now also taking Naprosyn, a powerful anti-inflammatory, on a regular basis. I assumed Stuart hadn’t been breast-fed and learned that my assumption was correct.
Three things of importance were noted during his examination. First, he was a mouth-breather, a sure indication of ongoing inflammation in the nasal passages. Second, his face demonstrated classic “allergic shiners,” dark circles under the eyes that correlate with allergies. And third, he was indeed very active. He couldn’t sit still for more than ten seconds, getting up to explore every inch of the exam room and tearing up the crinkly paper that adorns most doctors’ examination tables.
Our laboratory evaluation wasn’t extensive. We did a simple test for gluten sensitivity that measures the level of antibodies against gliadin, one of the wheat proteins. Not surprisingly, Stuart’s level was 300 percent higher than the level considered normal by the laboratory.
Rather than reach for a drug to treat symptoms, we decided instead to target the cause of this child’s issues, namely inflammation. Inflammation was playing a central role in virtually everything going on in this young boy’s physiology, including his ear problems, joint issues, and inability to compose himself.
I explained to Nancy that we had to go gluten-free. And to help rebuild a healthy gut after his extensive antibiotic exposure, we needed to add some beneficial bacteria, probiotics, to his regimen. Finally, the omega-3 fat DHA was added to the list.
What happened next couldn’t have been scripted any better. After two and a half weeks, Stuart’s parents received a phone call from his preschool teacher thanking them for deciding to put him on medication as he had “vastly improved” in his demeanor. And his parents noted that he had become calm, more interactive, and was sleeping better. But his transformation wasn’t due to medication. It was purely through diet that he was able to realize “vast” improvements in his health and attitude.
I received a note from Nancy two and a half years later stating: “We have been able to start him in school as the youngest student in the class. He has been able to excel in reading and math, and we do not anticipate any further problems with him being hyperactive. He has been growing so fast that he is one of the tallest kids in his class.”
Attention deficit hyperactivity disorder (ADHD) is one of the most frequent diagnoses offered in the pediatrician’s office. Parents of hyperactive children are led to believe that their children have some form of a disease that will limit their ability to learn. The medical establishment too often convinces parents that medication is the best “quick fix.” The whole notion that ADHD is a specific disease easily remedied by a pill is convenient but alarming. In several schools throughout the United States as many as 25 percent of students are routinely receiving powerful, mind-altering medications, the long-term consequences of which have never been studied!
Although the American Psychiatric Association states in its Diagnostic and Statistical Manual of Mental Disorders that 3 to 7 percent of school-aged children have ADHD, studies have estimated higher rates in community samples, and data from surveys of parents collected by the Centers for Disease Control and Prevention paint a different picture.1 According to new data from the CDC that came out in March 2013, nearly one in five high school–age boys in the United States and 11 percent of school-age children overall have been diagnosed with ADHD. That translates to an estimated 6.4 million children ages four through seventeen, reflecting a 16 percent increase since 2007 and a 53 percent rise in the past decade.2 As reported by the New York Times, “About two-thirds of those with a current diagnosis receive prescriptions for stimulants like Ritalin or Adderall, which can drastically improve the lives of those with ADHD but can also lead to addiction, anxiety, and occasionally psychosis.”3 This has prompted the American Psychiatric Association to consider changing its definition of ADHD so more people are diagnosed… and treated with drugs. Dr. Thomas R. Frieden, the director of the CDC, has said that the rising rates of stimulant prescriptions among children are like the overuse of pain medications and antibiotics in adults, and I agree. In the words of Dr. Jerome Groopman, a professor of medicine at Harvard Medical School and the author of How Doctors Think, who was interviewed for the Times, “There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal—if they’re not sitting quietly at their desk—that’s pathological, instead of just childhood.”4 So what does it mean when our definition of childhood gets trampled by fuzzy diagnoses like ADHD?
Aside from the dramatic rise in the use of medications to treat ADHD over the past decade, the use of antianxiety drugs soared between 2001 and 2010: In children up to age nineteen, the use of antianxiety medication increased 45 percent in females and 37 percent in males. According to a report by Express Scripts called “America’s State of Mind,” the overall number of Americans taking mental health drugs to treat psychological and behavioral disorders has substantially increased since 2001. In 2010, the most recent data indicated that more than one in five adults was on at least one medication, up 22 percent from ten years earlier. Interestingly, women are far more likely to take a drug for a mental health condition than men. More than a quarter of the adult female population was on these drugs in 2010, as compared to just 15 percent of men.5 (Harvard researchers theorize that this could be due to hormonal changes in women that are linked to puberty, pregnancy, and menopause. Although depression can affect men and women equally, women are typically more likely to seek medical help.)
Percent of population using mental health medications 2001 vs. 2010
Eleven percent of Americans over age twelve take antidepressants, but the percentage skyrockets when you look at the number of women in their forties and fifties who have been prescribed antidepressants—a whopping 23 percent.
Given the soaring rates of mental and behavioral disorders for which powerful drugs are increasingly used, why isn’t anyone drawing attention to the underlying reasons for this trend? And how can we propose solutions that don’t entail hazardous pharmaceuticals? At the root of the problem? That sticky wheat protein, gluten. Although the jury is still out on the connections between gluten sensitivity and behavioral or psychological issues, we do know a few facts:
· People with celiac disease may be at increased risk for developmental delay, learning difficulties, tic disorders, and ADHD.6
· Depression and anxiety are often severe in patients with gluten sensitivity.7, 8 This is primarily due to the cytokines that block production of critical brain neurotransmitters like serotonin, which is essential in regulating mood. With the elimination of gluten and often dairy, many patients have been freed from not just their mood disorders but other conditions caused by an overactive immune system, like allergies and arthritis.
· As many as 45 percent of people with autism spectrum disorders (ASD) have gastrointestinal problems.9 Although not all gastrointestinal symptoms in ASD result from celiac disease, data shows an increased prevalence of celiac in pediatric cases of autism, compared to the general pediatric population.
The good news is that we can reverse many of the symptoms of neurological, psychological, and behavioral disorders just by going gluten-free and adding supplements like DHA and probiotics to our diet. And to illustrate the impact of such a simple, drug-free prescription, consider the story of KJ, whom I met more than a decade ago. She was five years old at the time and had been diagnosed with Tourette’s syndrome, a type of tic spectrum disorder characterized by sudden, repetitive, non-rhythmic movements (motor tics) and verbal utterances that involve discrete muscle groups. Science says that the exact cause of this neurological anomaly is unknown, but we do know that, like many neuropsychiatric disorders, it has genetic roots that can be worsened by environmental factors. I think future research will bear out the truth behind many cases of Tourette’s and show gluten sensitivity at play.
At KJ’s initial office visit, her mother explained that in the previous year her daughter had developed involuntary contractions of her neck muscles for unknown reasons. She had received various types of massage therapy, which provided some improvement, but the problem would come and go. It eventually worsened to the point that KJ had aggressive movements in her jaw, face, and neck. She also persistently cleared her throat and produced various grunting noises. Her primary doctor had diagnosed Tourette’s syndrome.
When taking her history I noted that three years prior to the onset of her serious neurological symptoms, she’d begun to have bouts of diarrhea and chronic abdominal pain that were still with her. As you might expect, I ran a test for gluten sensitivity and indeed confirmed that this poor child had been living with undiagnosed sensitivity. Two days after starting a gluten-free diet, all of the abnormal movements, throat clearing, grunting sounds, and even abdominal pain had vanished. To this day, KJ is symptom-free and can no longer be considered a person with Tourette’s syndrome. So compelling was her response that I often use this case when lecturing to health care professionals.
Warning: Drugs used to treat ADHD have resulted in cases of permanent Tourette’s syndrome. Science has been documenting this since the early 1980s.10 Now that we have the research to prove the powerful effect of going gluten-free, it’s time we change—no, make—history.
Another case I’d like to share brings us back to ADHD. The parents of KM, a sweet nine-year-old girl, brought her to me because of classic signs of ADHD and “poor memory.” What was interesting about her history was that her parents described her difficulties with thinking and focusing as “lasting for days,” after which she would remain “fine” for several days. Academic evaluations indicated she was functioning at a mid-third-grade level. She seemed very composed and engaged, and when I reviewed her various achievement tests, I confirmed that she was indeed functioning at a mid-third-grade level, typical for her age.
Lab work identified two potential culprits in her challenges—gluten sensitivity and below-normal blood levels of DHA. I prescribed a strict gluten-free diet, 400 milligrams of supplemental DHA daily, and asked her to stop consuming aspartame, or NutraSweet, as she drank several diet sodas a day. Three months later, mom and dad were thrilled with her progress, and even KM was smiling ear to ear. New academic testing had her math calculation skills at the early fifth-grade level, overall academic skills at the mid-fourth-grade level, and story recall ability at the mid-eighth-grade level.
To quote a letter I received from her mother:
[KM] is completing third grade this year. Prior to removing gluten from her diet, academics, especially math, were difficult. As you can see, she is now soaring in math. Based upon this test, entering the fourth grade next year she would be at the top of her class. The teacher indicated if she skipped fourth grade and went to fifth grade, she would be in the middle of the class. What an accomplishment!
Stories like this are commonplace in my practice. I’ve known about the “achievement effect” from going gluten-free for a long time, but thankfully the scientific proof is finally catching up to the anecdotal evidence. One study that really stood out for me was published in 2006; it documented a very revealing “before” and “after” story of people with ADHD who went gluten-free for six months. What I love about this particular study is that it examined a broad spectrum of individuals—from the age of three to fifty-seven years—and it employed a well-respected behavioral scale for ADHD called the Conner Scale Hypescheme. After six months, the improvements were significant:11
“No close attention to details” was reduced by 36 percent.
“Difficulty sustaining attention” was reduced by 12 percent.
“Fails to finish work” diminished by 30 percent.
“Easily distracted” diminished by 46 percent.
“Often blurts out answers and quotes” diminished by 11 percent.
The overall “average score” for those studied was lowered by 27 percent. My hope is that more people will join my crusade and take action to make us all healthier—and smarter.
HOW C-SECTIONS INCREASE RISK OF ADHD
Babies who are born via Cesarean section have a higher risk of developing ADHD, but why? Understanding the links in the chain give credence to the importance of healthy gut bacteria to sustain intestinal health and overall wellness. When a baby passes through the birth canal naturally, billions of healthy bacteria wash over the child, thereby inoculating the newborn with appropriate probiotics whose pro-health effects remain for life. If a child is born via C-section, however, he or she misses out on this shower of sorts, and this sets the stage for bowel inflammation and, therefore, an increased risk of sensitivity to gluten and ADHD later in life.12
New research is also giving moms another reason to breast-feed, as babies who are regularly breast-fed when they are first introduced to foods containing gluten have been shown to cut their risk of developing celiac disease by 52 percent, compared with those who are not being breast-fed.13 One of the reasons for this might be that breast-feeding cuts the number of gastrointestinal infections, lowering the risk of a compromised lining of the bowel. It may also curb the immune response to gluten.
CAN AUTISM BE TREATED WITH A GLUTEN-FREE DIET?
I get a lot of questions about the possible relationship between gluten and autism. As many as 1 in 150 children born today will develop a form of the condition across a wide spectrum; in 2013, a new government report indicated that 1 in 50 school-age children today—or about a million children—have been diagnosed with some sort of autism.14 A neurological disorder that usually appears by the time a child is three years old, autism affects the development of social and communication skills. Scientists are trying to figure out the exact causes of autism, which is likely rooted in both genetic and environmental origins. A number of risk factors are being studied, including genetic, infectious, metabolic, nutritional, and environmental, but less than 10 to 12 percent of cases have specific causes that can be identified.
We know there is no magic-bullet cure for autism, just as there isn’t for schizophrenia or bipolar disorder. These brain maladies are uniquely different, but they all share one underlying characteristic: inflammation, some of which could simply be the result of sensitivity to dietary choices. While it remains a topic of debate, some people who suffer from autism respond positively to the removal of gluten, sugar, and sometimes dairy from their diets. In one particularly dramatic case, a five-year-old diagnosed with severe autism was also found to have serious celiac disease that prevented him from absorbing nutrients. His autistic symptoms abated once he went gluten-free, prompting his doctors to recommend that all children with neurodevelopmental problems be assessed for nutritional deficiencies and malabsorption syndromes like celiac. In some cases, nutritional deficiencies that affect the nervous system may be the root cause of developmental delays that mirror autism.15
I’ll admit that we lack the kind of gold-standard scientific research that we need to draw any conclusive connections, but it’s worth taking a sweeping view of the topic and considering some logical inferences.
Let me begin by pointing out a parallel trend in the rise of autism and celiac disease. That is not to say the two are categorically linked, but it’s interesting to note a similar pattern in sheer numbers. What these two conditions do indeed have in common, however, is the same fundamental feature: inflammation. As much as celiac is an inflammatory disorder of the gut, autism is an inflammatory disorder of the brain. It’s well documented that autistic individuals have a higher level of inflammatory cytokines in their system. For this reason alone, it’s worthwhile to ponder the effectiveness of reducing all antibody–antigen interactions in the body, including those involving gluten.
One study from the United Kingdom published in 1999 showed that when twenty-two autistic children on a gluten-free diet were monitored over a five-month period, a number of behavioral improvements were recorded. Most alarming, when the children accidentally ingested gluten after they’d started their gluten-free diet, “the speed with which behavior changed as a result… was dramatic and noticed by many parents.”16 The study also noted that it took at least three months for the children to show an improvement in their behavior. For any parent regulating a child’s diet, it’s important to not lose hope early on if behavioral changes don’t occur right away. Stay the course for three to six months before expecting any noticeable improvement.
Some experts have questioned whether or not gluten-containing foods and milk proteins can impart morphine-like compounds (exorphins) that stimulate various receptors in the brain and raise the risk not just for autism but for schizophrenia as well.17 More research is needed to flesh out these theories, but we can potentially reduce the risks of developing these conditions and better manage them.
Despite the lack of research, it is clear that the immune system plays a role in the development of autism, and that the same immune system connects gluten sensitivity to the brain. There’s also something to be said for the “layering effect,” where one biological issue ushers in another down a chain of events. If a child is sensitive to gluten, for instance, the immune response in the gut can lead to behavioral and psychological symptoms, and in autism this can lead to an “exacerbation of effects,” as one team of researchers put it.18
DOWN AND OUT
It’s a heartbreaking fact: Depression is the leading cause of disability worldwide. It’s also the fourth leading contributor to the global burden of disease. The World Health Organization has estimated that by the year 2020, depression will become the second largest cause of suffering—next only to heart disease. In many developed countries, such as the United States, depression is already among the top causes of mortality.19
What’s even more disquieting is the white elephant sitting in the medicine cabinets of many depressed people: the bottles of so-called antidepressants. Drugs like Prozac, Paxil, Zoloft, and countless others are by far the most common treatments for depression in the United States, despite the fact that they have been shown in many cases to be no more effective than a placebo and in some cases can be exceedingly dangerous and even lead to suicides. New science is starting to show just how murderous these drugs can be. To wit: When researchers in Boston looked at more than 136,000 women between the ages of fifty and seventy-nine, they discovered an undeniable link between those who were using antidepressants and their risk for strokes and death in general. Women on antidepressants were 45 percent more likely to experience strokes and had a 32 percent higher risk of death from all causes.20 The findings, published in the Archives of Internal Medicine, came out of the Women’s Health Initiative, a major public health investigation focusing on women in the United States. And it didn’t matter whether people were using newer forms of antidepressants, known as selective serotonin reuptake inhibitors (SSRIs), or older forms known as tricyclic antidepressants, such as Elavil. SSRIs are typically used as antidepressants, but they can be prescribed to treat anxiety disorders and some personality disorders. They work by preventing the brain from reabsorbing the neurotransmitter serotonin. By changing the balance of serotonin in the brain, neurons send and receive chemical messages better, which in turn boosts mood.
Unsettling studies have reached a tipping point, and some Big Pharma companies are backing away from antidepressant drug development (though they still make a lot of money in this department—to the tune of nearly 15 billion dollars a year). As recently reported in the Journal of the American Medical Association, “The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms.”21
This isn’t to say that certain medications aren’t helpful in some severe cases, but the implications are huge. Let’s briefly review some other intriguing findings that will inspire anyone thinking of taking an antidepressant to try another route to happiness.
Low Mood and Low Cholesterol
I’ve already made my case for cholesterol in nourishing the brain’s health. As it turns out, innumerable studies have demonstrated that depression runs much higher in people who have low cholesterol.22 And people who start taking cholesterol-lowering medication (i.e., statins) can become much more depressed.23 I’ve witnessed this myself in my own practice. It’s unclear if the depression is a direct result of the drug itself, or if it simply reflects a consequence of a lowered cholesterol level, which is the explanation I favor.
Studies dating back more than a decade show a connection between low total cholesterol and depression, not to mention impulsive behaviors including suicide and violence. Dr. James M. Greenblatt, a dually certified child and adult psychiatrist and author of The Breakthrough Depression Solution, wrote a beautiful article for Psychology Today in 2011 in which he summarized the evidence.24 In 1993, elderly men with low cholesterol were found to have a 300 percent higher risk of depression than their counterparts with higher cholesterol.25 A 1997 Swedish study identified a similar pattern: Among 300 otherwise healthy women aged thirty-one to sixty-five, those in the bottom tenth percentile for cholesterol levels experienced significantly more depressive symptoms than the others in the study with higher cholesterol levels.26 In 2000, scientists in the Netherlands reported that men with long-term low total cholesterol levels experienced more depressive symptoms than those with higher cholesterol levels.27 According to a 2008 report published in the Journal of Clinical Psychiatry, “low serum cholesterol may be associated with suicide attempt history.”28 The researchers looked at a group of 417 patients who had attempted suicide—138 men and 279 women—and compared them with 155 psychiatric patients who had not attempted suicide, as well as 358 healthy control patients. The study defined low serum cholesterol as less than 160. The results were quite dramatic. It showed that individuals in the low-cholesterol category were 200 percent more likely to have attempted suicide. And in 2009, the Journal of Psychiatric Researchpublished a study that followed nearly forty-five hundred U.S. veterans for fifteen years.29 Depressed men with low total cholesterol levels faced a sevenfold increased risk of dying prematurely from unnatural causes such as suicide and accidents than the others in the study. As noted earlier, suicide attempts have long been shown to run higher in people who have low total cholesterol.
I could go on and on showcasing studies from all around the world that arrive at the same conclusion for both men and women: If you’ve got low cholesterol, you’ve got a much higher risk of developing depression. And the lower you go, the closer you are to harboring thoughts of suicide. I don’t mean to say this in a casual manner, but we have documented proof now from many prestigious institutions of just how serious this cause-and-effect relationship is. This relationship is also well documented in the field of bipolar disorder.30 Those who are bipolar are much more likely to attempt suicide if they have low cholesterol.
The Gluten Blues
Science has long observed an overlap between celiac disease and depression, much like the overlap between celiac and ADHD and other behavioral disorders. Reports of depression among celiac disease patients began appearing in the 1980s. In 1982 Swedish researchers reported that “depressive psychopathology is a feature of adult celiac disease.”31 A 1998 study determined that about one-third of those with celiac disease also have depression.32, 33
In one particularly large study published in 2007, Swedish researchers again evaluated close to fourteen thousand celiac patients and compared them to more than sixty-six thousand healthy controls.34 They wanted to know the risk of being depressed if you have celiac disease as well as the risk of having celiac disease if you are depressed. It turned out that celiac patients had an 80 percent higher risk of depression, and the risk of actually being diagnosed with celiac disease in individuals who were depressed was increased 230 percent. In 2011, another study from Sweden found that the risk of suicide among people with celiac disease was increased by 55 percent.35 Yet another study done by a team of Italian researchers found that celiac disease ups one’s risk of major depression by a stunning 270 percent.36
Today, depression is found in as many as 52 percent of gluten-sensitive individuals.37 Adolescents with gluten sensitivity also face high rates of depression; those with celiac disease are particularly vulnerable, with a 31 percent risk of depression (only 7 percent of healthy adolescents face this risk).38
A logical question: How does depression relate to a damaged intestine? Once the lining of the gut is injured by celiac disease, it is ineffective at absorbing essential nutrients, many of which keep the brain healthy, such as zinc, tryptophan, and the B vitamins. What’s more, these nutrients are necessary ingredients in the production of neurological chemicals such as serotonin. Also, the vast majority of feel-good hormones and chemicals are produced around your intestines by what scientists now call your “second brain.”39 The nerve cells in your gut are not only regulating muscles, immune cells, and hormones, but also manufacturing an estimated 80 to 90 percent of your body’s serotonin. In fact, your intestinal brain makes more serotonin than the brain that rests in your skull.
Some of the more critical nutritional deficiencies that have been linked to depression include vitamin D and zinc. You already know the importance of vitamin D in a multitude of physiological processes, including mood regulation. Zinc similarly is a jack-of-all-trades in the body’s mechanics. In addition to aiding the immune system and keeping memory sharp, zinc is required in the production and use of those mood-friendly neurotransmitters. This helps explain why supplemental zinc has been shown to enhance the effects of antidepressants in people with major depression. (Case in point: A 2009 study found people who hadn’t been helped by antidepressants in the past finally reported improvements once they started to supplement with zinc.40) Dr. James M. Greenblatt, whom I mentioned earlier, has written extensively on this topic and, like me, sees a lot of patients whose antidepressants have failed them. Once these patients avoid foods containing gluten, their psychological symptoms resolve. In another article for Psychology Today, Greenblatt writes: “Undiagnosed celiac disease can exacerbate symptoms of depression or may even be the underlying cause. Patients with depression should be tested for nutritional deficiencies. Who knows, celiac disease may be the correct diagnosis and not depression.”41 Many physicians ignore nutritional deficiencies and don’t think about testing for gluten sensitivity because they are so used to (and comfortable with) writing prescriptions for medication.
It’s important to note that a common thread in many of these studies is the length of time needed to turn things around in the brain. As with other behavioral disorders, such as ADHD and anxiety disorder, it can take at least three months for individuals to feel a total sense of relief. It’s critical to stay the course once embarking on a gluten-free diet. Don’t lose hope if you don’t have significant improvements right away. But do realize that you’re likely to experience a dramatic improvement in more ways than one. I once treated a professional tennis instructor who was crippled by depression and not improving despite the use of multiple antidepressant medications prescribed by other doctors. When I diagnosed his sensitivity to gluten and he adopted a gluten-free diet, he was transformed. His depressive symptoms evaporated, and he returned to peak performance on the court.
MENTAL STABILITY THROUGH DIET
All this talk about gluten’s insidious connection to common psychological disorders no doubt raises questions about gluten’s role in virtually every ailment that involves the mind, from the most common mental disorder in America—anxiety, which affects approximately forty million adults—to complex afflictions such as schizophrenia and bipolar disorder.
So what does the science say about gluten and our more perplexing mental illnesses such as schizophrenia and bipolar disorder? These are complicated maladies for which genetic and environmental factors are in play, but study after study demonstrates that people with these diagnoses often show gluten sensitivity as well. And if they have a history of celiac disease, they are at much higher risk of developing these psychiatric disorders than anyone else. What’s more, we now have documented evidence that mothers who are sensitive to gluten give birth to children who are nearly 50 percent more likely to develop schizophrenia later in life.
The study, published just last year in the American Journal of Psychiatry, adds to a growing body of evidence that many diseases that show up later in life originate before and shortly after birth. The authors of the study, who hail from Johns Hopkins and Sweden’s Karolinska Institute, one of Europe’s largest and most prestigious medical universities, stated the facts beautifully: “Lifestyle and genes are not the only factors that shape disease risk, and factors and exposures before, during, and after birth can help pre-program much of our adult health. Our study is an illustrative example suggesting that a dietary sensitivity before birth could be a catalyst in the development of schizophrenia or a similar condition twenty-five years later.”42
If you’re wondering how in the world they managed to make this connection, look no further than the details of their analyses, which entailed a look at birth records and neonatal blood samples of children born between 1975 and 1985 in Sweden. About 211 of the 764 kids examined developed mental disorders later in life characterized by a significant derangement of their personality and a loss of touch with reality. The team measured levels of IgG antibodies to milk and wheat in the blood samples to figure out that the “children born to mothers with abnormally high levels of antibodies to the wheat protein gluten were nearly 50 percent more likely to develop schizophrenia later in life than children born to mothers with normal levels of gluten antibodies.”43 This association remained true even after the scientists ruled out other factors known to increase the risk of developing schizophrenia, such as the mother’s age during pregnancy and whether the child was born vaginally or via C-section (by and large, genetic factors and environmental impacts in utero weigh much more heavily into one’s risk for schizophrenia than environmental factors encountered later in life). But children born to mothers with abnormally high levels of antibodies to milk protein didn’t appear to be at an increased risk for psychiatric disorders.
The authors added a fascinating historical note to their paper as well. It wasn’t until World War II that a suspicion about the connection between psychiatric disorders and maternal food sensitivity started to surface. U.S. Army researcher Dr. F. Curtis Dohan was among the first scientists to notice a relationship between postwar Europe’s food scarcity (and, consequently, a lack of wheat in the diet) and considerably fewer hospitalizations for schizophrenia. Although the observation couldn’t prove the association at the time, since then we’ve had the benefits of long-term studies and modern technologies to verify the case against gluten.
Studies have also shown that a low-carb, high-fat diet just like the one I outline in chapter 7 can improve symptoms of not only depression but also schizophrenia. One woman who has been chronicled in the literature, known by the initials CD, had a complete resolution of her schizophrenia symptoms when she adopted a gluten-free, low-carb diet.44 She was first diagnosed at the age of seventeen, and experienced paranoia, disorganized speech, and daily hallucinations throughout her life. Before adopting a low-carb diet at the age of seventy, she’d been hospitalized multiple times for suicide attempts and increased psychotic symptoms. Medication failed to improve her symptoms. Within the first week on the new diet, CD reported feeling better and having more energy. And within three weeks, she was no longer hearing voices or “seeing skeletons.” Over the course of a year, CD also lost weight, and even when she cheated once in a while by eating pasta, bread, or cake, her hallucinations never returned.
A FIX FOR THE COMMON HEADACHE?
I can’t imagine what it would be like to suffer from daily headaches, but I’ve treated many patients who’ve shouldered the weight of that kind of suffering throughout their lives. Take, for example, a sixty-six-year-old gentleman whom I first saw in January of 2012. I’ll call him Cliff.
Cliff had endured thirty long years with pretty much the same unrelenting headache, and he wins a gold medal for trying his best to extinguish the pain. His attempts included a litany of drugs from those designed for migraines, like Imitrex, to narcotic painkillers such as Vicodin, prescribed after consultations with top headache clinics—all to no avail. Aside from being ineffective, he found that many of these medications slowed him down significantly. Although Cliff mentioned that he thought his headaches were related to foods, he couldn’t say this was always the case. Nothing in his medical history jumped out at me, but when we discussed his family history, he said that his sister also experienced ongoing headaches and had significant food intolerances. This bit of information led me to probe a little further. I learned that Cliff had a twenty-year history of muscle stiffness, and that his sister carried a specific antibody related to gluten sensitivity that is also associated with what is called “stiff-person syndrome.”
When I checked Cliff’s blood work for gluten sensitivity, several things stood out. He was highly reactive to eleven proteins related to gluten. Like his sister, he showed a strong reaction with respect to the antibody associated with stiff-person syndrome. I also noted that he was quite sensitive to cow’s milk. As with so many of my patients, I placed him on a diet that restricted gluten and dairy. After three months, he told me that he hadn’t needed to use Vicodin at all the previous month, and on a scale from 1 to 10 his worst headache was now a manageable 5 rather than a screaming 9. Best of all, his headaches no longer lingered all day; they only lasted three or four hours. While Cliff was not totally cured, his relief was substantial and, for him, very gratifying. In fact, he was so pleased with his outcome that he has allowed me to use his photograph when I present his case, now published, to health care practitioners.
I’ve had plenty more patients come through my doors and leave with a pain-free head, thanks to the adoption of a gluten-free diet. One woman with a similar experience had been to countless doctors, tried innumerable prescription drugs, and undergone high-tech brain scans. Nothing worked until she met me and my prescription pad for a gluten sensitivity test. And lo and behold her villain—and cure—was identified.
Headaches are one of our most common maladies. In the United States alone, more than forty-five million people suffer from chronic headaches, twenty-eight million of whom suffer from migraines.45Incredibly, twenty-first-century medicine remains focused on treating symptoms for what is often a fully preventable problem. If you’re a chronic headache sufferer, why not try a gluten-free diet? What have you got to lose?
Big Headaches in Brief
For purposes of this discussion I include all types of headaches in one category. So whether you’re dealing with tension headaches, cluster headaches, sinus headaches, or migraines, for the most part I refer to headaches as a collective basket of conditions that share the same characteristic: pain in the head due to physical and biochemical changes in the brain. For the record, migraines tend to be the most painful kind and are often accompanied by nausea, vomiting, and sensitivity to light. But a headache is a headache, and if you’ve got one, your top priority is finding a solution. Once in a while, however, I will specifically refer to migraines.
An untold number of things can trigger a headache, from a bad night’s sleep or changes in the weather to chemicals in foods, sinus congestion, head trauma, brain tumors, or too much alcohol. The exact biochemistry of headaches, especially migraines, is under active study. But we know a lot more today than we ever did before. And for those sufferers who can’t nail down a reason (and thus a likely solution) for their headaches, my bet is that nine times out of ten that reason could be undiagnosed gluten sensitivity.
In 2012, researchers at Columbia University Medical Center in New York finished a yearlong study that documented chronic headaches among 56 percent of people who were gluten sensitive and 30 percent of those with celiac disease (the ones labeled as gluten sensitive had not tested positive for celiac disease but reported symptoms when they ate foods with wheat).46 They also found that 23 percent of those with inflammatory bowel disease also had chronic headaches. When the researchers teased out the prevalence of migraines, they found much higher percentages of sufferers among the celiac group (21 percent) and the inflammatory bowel disease group (14 percent) than in the control group (6 percent). When asked to explain the connection, the lead researcher, Dr. Alexandra Dimitrova, alluded to the ultimate perpetrator of all: inflammation. To quote Dr. Dimitrova:
It’s possible the patients with [inflammatory bowel disease] have a generalized inflammatory response, and this may be similar in celiac disease patients, where the whole body, including the brain, is affected by inflammation…. The other possibility is that there are antibodies in celiac disease that may… attack the brain cells and membranes covering the nervous system and somehow cause headaches. What we know for sure is that there is a higher prevalence of headache of any kind, including migraine headaches, compared to healthy controls.
She went on to say that many of her patients report major improvements in the frequency and severity of their headaches once they adopt a gluten-free diet; for some, headaches completely vanish.
Dr. Marios Hadjivassiliou, whom I’ve referenced throughout this book, has done extensive studies on headaches and gluten sensitivity.47 Among his most astonishing work are the brain MRI scans that show profound changes in the white matter of headache patients with gluten sensitivity. The abnormalities are indicative of the inflammatory process. Most of these patients were resistant to normal drug treatments for their headaches, yet once they adopted a gluten-free diet, they were relieved of their suffering.
Dr. Alessio Fasano, who heads the Center for Celiac Research at Massachusetts General Hospital, is a world-renowned pediatric gastroenterologist and a leading researcher in the area of gluten sensitivity.48When I met with him at a national conference on gluten sensitivity, where we both were speaking, he told me that it’s no longer news to him that gluten-sensitive patients, including those with diagnosed celiac disease, frequently suffer from headaches. We lamented together how unfortunate it is that this type of gluten-triggered headache is misunderstood by the general public. It has such an easy fix, yet few of the afflicted know that they are sensitive to gluten.
When Italian researchers conducted a gluten-free trial experiment on eighty-eight children with celiac disease and chronic headaches, they found that 77.3 percent of them experienced significant improvement in headaches, and 27.3 percent of those who improved actually became headache-free when they maintained a gluten-free diet. The study also found that 5 percent of the kids with headaches who were not previously diagnosed with celiac were indeed found to have celiac disease; this was a much larger percentage than the 0.6 percent researchers had documented in the general kids population studied. Thus the risk of headache in the celiac group was increased by 833 percent. The authors concluded, “We recorded—in our geographical area—a high frequency of headaches in patients with CD [celiac disease] and vice versa with a beneficial effect of a gluten-free diet. Screening for CD could be advised in the diagnostic workup of patients with headache.”49
The prevalence of migraine headache in the pediatric population is increasing. Prior to the onset of puberty, migraine affects girls and boys equally. Thereafter, females outnumber males by about three to one. Children with migraines have a 50 to 75 percent risk of becoming adult migraine sufferers, and the disease is inherited in 80 percent of cases. Childhood migraines represent the third leading cause of school absence.50
Is it coincidence that so many of these kids with chronic headaches also have a strong sensitivity to gluten? And is it fortuity that the removal of gluten from their diets magically ushered their headaches away? No. And no. Unfortunately, many children with chronic headaches are never tested for gluten sensitivity, and they are placed instead on powerful drugs. The standard approach to treating headaches in kids includes the use of nonsteroidal anti-inflammatory medications, aspirin-containing compounds, triptans, ergot alkaloids, and dopamine antagonists. To prevent headaches, some of the drugs used include tricyclic antidepressants; various anticonvulsants including divalproex sodium; and more recently, topiramate, antiserotonergic agents, beta blockers, calcium channel blockers, and nonsteroidal anti-inflammatory medications. Topiramate, which is used to treat epilepsy, comes with awful side effects that would alarm any parent and be distressing to a child. They include weight loss, anorexia, abdominal pain, difficulty concentrating, sedation, and paresthesia (the feeling of “pins and needles,” or of a limb “falling asleep”).51 I don’t know about you, but I wouldn’t want my kid to experience these side effects, even if they are temporary, to manage a headache that has nothing to do with what the drug was designed for. In the last few years, numerous studies have emerged to show that, for the most part, anticonvulsants don’t alleviate headaches in kids any better than a placebo.52 In fact, leading researchers in headaches have been pressing for more studies to be done on children because few drugs have been proven useful, effective, and safe to use. The focus on drugs rather than dietary choices and nutritional supplementation sadly keeps us from addressing the underlying cause of the headache.
Big Bellies Make for Big Headaches
You already know belly fat is the worst, and that it raises your risk for a medley of health problems (heart disease, diabetes, dementia, to name a few). But people don’t think about their increased risk for headaches just by virtue of their waist circumference. Surprise: Waist circumference is a better predictor of migraine activity than general obesity in both men and women up until age fifty-five. Only in the last couple of years have we been able to scientifically show how strong this link is, thanks in part to researchers from Philadelphia’s Drexel University College of Medicine who mined data amassed from more than twenty-two thousand participants in the ongoing National Health and Nutrition Examination Survey (NHANES).53 The data included a wealth of valuable information to examine, from calculations of abdominal obesity (as measured by waist circumference) and overall obesity (as determined by body mass index) to people’s reports on how often they experienced headaches and migraines. Even after controlling for overall obesity, the researchers determined that for both men and women between the ages of twenty and fifty-five—the age bracket when migraine is most common—excess belly fat was affiliated with a significant increase in migraine activity. Women carrying extra fat around their belly were 30 percent more likely to suffer from migraines than women without excess belly fat. This held true even when the researchers accounted for overall obesity, risk factors for heart disease, and demographic characteristics.
Plenty of other studies show the inexorable bond between obesity and risk for chronic headaches.54 One particularly large study published in 2006 looked at more than thirty thousand people and found that chronic daily headaches were 28 percent higher in the obese group than in the healthy controls of normal weight. Those who were morbidly obese had a 74 percent increased risk of having a chronic daily headache. When the researchers took a closer look at those who suffered from migraines in particular, overweight people had a 40 percent increased risk, and the obese had a 70 percent increased risk.55
By this point in the book you know that fat is a hugely powerful hormonal organ and system that can generate pro-inflammatory compounds. Fat cells secrete an enormous amount of cytokines that trigger inflammatory pathways. Headaches are, at their root, manifestations of inflammation, just like most of the other brain-related ailments we’ve been covering.
So it makes sense, then, that studies examining the relationship between lifestyle factors (e.g., overweight, low physical activity, and smoking) and recurrent headaches connect belly fat and chronic headaches. A few years ago, researchers in Norway interviewed 5,847 adolescent students about their headaches and had them complete a comprehensive questionnaire about their lifestyle habits in addition to a clinical examination.56 Those who said they regularly engaged in physical activity and were not smokers were classified as having a good lifestyle status. These students were compared to those who were deemed to be less healthy due to one or more of the negative lifestyle habits.
The results? The kids who were overweight were 40 percent more likely to suffer from headaches; the risk was 20 percent higher in those who didn’t exercise much; and the smokers had a 50 percent increased risk. These percentages, however, were compounded when a student could check off more than one risk factor. If a student was overweight and smoked and didn’t exercise, he or she carried a much higher risk for chronic headaches. And again, the study pointed to the effects of inflammation in fueling the firestorm.
The bigger your belly, the more at risk you are for headaches. Seldom do we think about our lifestyle and diet when we get a headache. Instead, we turn to drugs and await the next pound in the head. All the studies to date, however, show how important lifestyle is when it comes to managing, treating, and permanently curing headaches. If you can reduce sources of inflammation (lose the extra weight, eliminate gluten, go low-carb and high good fat, and maintain healthy blood sugar balance), you can target and control headaches.
THE RX TO BE HEADACHE-FREE
Numerous things can trigger a headache. I cannot possibly list all of the potential offenders, but I can offer a few tips to end the suffering:
· Keep a very strict sleep-wake cycle. This is key to regulating your body’s hormones and maintaining homeostasis—the body’s preferred state of being, where its physiology is balanced.
· Lose the fat. The more you weigh, the more likely it is that you’ll suffer from headaches.
· Stay active. Remaining sedentary breeds inflammation.
· Watch caffeine and alcohol use. Each of these in excess can stimulate a headache.
· Don’t skip meals or keep erratic eating habits. As with sleep, your eating patterns control many hormonal processes that can affect your risk for a headache.
· Manage emotional stress, anxiety, worry, and even excitement. These emotions are among the most common triggers of headaches. Migraine sufferers are generally sensitive to stressful events, which prompt the release of certain chemicals in the brain that can provoke vascular changes and cause a migraine. Adding insult to injury, emotions such as anxiety and worry can increase muscle tension and dilate blood vessels, intensifying the severity of the migraine.
· Go gluten-, preservative-, additive-, and processed-free. The low-glycemic, low-carb, high–healthy-fat diet outlined in chapter 11 will go a long way to reducing your risk for headaches. Be especially careful about aged cheese, cured meats, and sources of monosodium glutamate (MSG, commonly found in Chinese food), as these ingredients may be responsible for triggering up to 30 percent of migraines.
· Track the patterns in your headache experience. It helps to know when you’re at a greater risk of getting one so you can pay extra attention during those times. Women, for example, can often trace patterns around their menstrual cycle. If you can define your patterns, you can better understand your unique headache and act accordingly.
The idea that we can treat—and in some cases, totally eliminate—common neurological ailments through diet alone is empowering. Most people immediately turn to drugs when seeking a solution, oblivious to the cure that awaits them in a few lifestyle shifts that are highly practical and absolutely free. Depending on my patients’ unique circumstances, some of them need more short-term support for managing certain conditions, and this can come in the form of psychotherapy or even supplemental medication. But by and large many of them respond positively to simply cleaning up their diet and expelling nerve-racking (literally) ingredients from their lives. And those who do require additional medical help often find that they can eventually wean themselves from pharmaceuticals and welcome the rewards that a drug-free life has to offer. Remember, if you do nothing else recommended in this book but eliminate gluten and refined carbohydrates, you will experience profound positive effects beyond those described in this chapter. In addition to watching your mood brighten up, you’ll watch your weight go down and your energy soar in just a few weeks. Your body’s innate healing capacities will be in high gear, as will your brain’s functionality.