From Brain Fog to Psychosis: The Powerful Effects of This Everyday Food

You don't have to have coeliac disease to experience the effects of gluten

Imagine eating something that quickly causes a dramatic change in personality and behaviour. Or perhaps just creates a mental fog, or a depressed mood. Does that sound like a powerful drug, or mind-altering substance? It’s neither of those. It’s something most people eat every day.

In 2018, researchers published a disturbing case history in the journal Nutrients. They told the story of a 14-year-old girl who in 2012 developed psychosis, after recovering from a fever. Her symptoms included headache, irritability, crying episodes, apathy and trouble concentrating.

The child was referred to a local neuropsychiatric outpatient clinic and treated with the psychoactive drug benzodiazepine. It had no effect, and her mental health deteriorated, with the onset of complex hallucinations. At the same time, she developed gut problems: bloating and severe constipation.

After months of tests, misdiagnoses, scans, a lumbar puncture, and several hospitalizations for psychotic episodes, her symptoms not only remained a mystery, they got worse. By September 2013, she was experiencing severe abdominal pain together with depression, “distorted” and paranoid thinking, and suicidal thoughts.

Two months later, a nutritionist was consulted — not for the child’s psychiatric symptoms, but for her gastrointestinal problems. A gluten-free diet was prescribed, and within a week both intestinal and psychiatric symptoms “dramatically improved”.

The child’s mother later reported that, after remaining on a gluten-free diet, her daughter had returned to being a “normal girl”.

So good, but so bad

Gluten is a protein, found in wheat, rye, and barley, that can trigger a broad range of symptoms and conditions, from brain fog to schizophrenia. Bread is the most commonly consumed source of gluten.

In some people, the effect of gluten on the mind is so powerful that the term gluten-psychosis has been coined, as described in the paper Gluten Psychosis: Confirmation of a New Clinical Entity.

Until very recently, gluten intolerance (or sensitivity) was considered the preserve of the “worried well”, an attention-seeking trend outside the peripheral vision of medics.

The only diagnosis you were ever going to get was a self-diagnosis; the only treatment available was the one you self-administered, as best you could. All that has now changed, and gluten sensitivity is taken much more seriously by the medical community. The scientific term is now “non-celiac gluten sensitivity” (NCGS).

NCGS symptoms may be relatively mild, compared to gluten psychosis, but they are also surprisingly common. Around 1% of the population has celiac disease. The prevalence of NCGS is harder to establish, due to lack of diagnostic methods, but it is estimated to be as much as 13% of the general population.

Gluten sensitivity is not the same as coeliac disease, or wheat allergy, which until recently were the only gluten-related conditions recognised by the medical community. Coeliac disease is a debilitating autoimmune condition caused by damage to the small intestine by gluten. It results in malabsorption and a range of symptoms that can affect the whole body. Like NCGS, it is associated with increased risk of depression and psychosis.

One significant clue that you may have NCGS is the typical combination of gut and mental health problems, as in the case described above. It is a consistent theme, though not a given. I once had a client whose only symptom was pain in his legs. It vanished when gluten-containing foods were removed from his diet.

Another client, a 29-year old man, came to see me with various health problems, the main ones being fatigue, depression, poor concentration, and anxiety. He also had a history of gastroenteritis, and regularly experienced bloating and indigestion.

This looked to me like a classic case of NCGS, especially when I saw his food questionnaire. In response to the question “What food or drinks would you find hard to give up?” he had written “pasta and sandwiches”. It is a callous irony that we often crave the very foods that are making us ill.

I advised a period of gluten exclusion, which he was happy to try. He was astonished by the changes he saw in himself, within just a few days. His anxiety and depression had vanished, and his concentration and energy levels were “much better.” He said he felt really well when off gluten, but “groggy” when he ate it again.

That’s a common scenario in clinic. It’s only the extreme cases that make it to the medical journals, but they serve to remind us of just how powerful food can be.

The case of a 23-year-old woman with a long history of hallucinations was described in the journal Gastroenterology Research and Practice in 2014. The visual and auditory hallucinations began at an early age when she simultaneously began to experience gastrointestinal problems. The hallucinations were explicit and vivid — sometimes friendly ghosts, fairies and at other times terrifying, threatening creatures. Her gut symptoms were seen as a separate issue and diagnosed as irritable bowel syndrome.

It was only when she was at university studying biology that the woman attended nutrition lectures and was introduced to the idea of gluten sensitivity. She experimented with eliminating gluten-containing foods — and when she did, both gastrointestinal symptoms and hallucinations “completely abated”. She also described being able to concentrate at length for the first time in her life.

Although she continued to follow an entirely gluten-free diet, she would occasionally accidently eat something containing gluten and this would trigger both vivid hallucinations (such as the appearance of alien beings on her computer screen) and severe abdominal pain.

“An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia.”

One theory is that NCGS is caused by intestinal permeability, or “leaky gut”. Gluten makes the gut more permeable and allows gluten proteins and all sorts of undesirable elements from the digestive tract to leak into the blood, cross the blood-brain barrier and enter the brain.

Know your nemesis

Here is where you’ll find gluten:

• Wheat, and wheat species: spelt, kamut and durum flour.

• Wheat derivatives: semolina, couscous, bulgar

• Rye and rye products

• Rye and barley products

• Products made from wheat, including bread, cakes, biscuits, savoury snacks, croissants.

Note that oats are not gluten grains, but can become contaminated if grown near wheat or other gluten crops. Therefore seek out oat products that state on the packaging that they are gluten-free.

Bread is the food that most people eat most of the time. Gluten is useful in breadmaking because when dough is kneaded the gluten creates elasticity and facilitates fermentation and rising of the dough. Modern wheat varieties are those that contain the most harmful gluten. They are also the most common.

The researchers who described the case history of the 14-year-old child conclude their paper by stating:

“Until a few years ago, the spectrum of gluten-related disorders included only CD (celiac disease) and wheat allergy, therefore our patient would be turned back home as a “psychotic patient” and receive lifelong treatment with anti-psychotic drugs.”

Who knows how many people are affected by NCGS without knowing it.

It really is quite unnerving, and desperately sad, to think of all the gluten-sensitive people for whom antipsychotic drugs have indeed been their only treatment. Even today, there must be countless people facing a future of life-long antipsychotics.

And even more people that although not suffering from psychosis, experience the debilitating effects of fatigue, brain fog, and depression on a daily basis.

Gluten sensitivity is just one potential cause of all these mental health issues, but it is surely the simplest to treat, with results that are better than any medication.

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