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Gluten-free diet improved 'brain fog' associated with celiac disease
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Mild cognitive impairment or “brain fog” associated with celiac disease improved in tandem with mucosal healing in newly diagnosed patients who adhered to a gluten-free diet, according to recent study data.
Researchers from Australia conducted a longitudinal pilot study of 11 patients (mean age, 30 years; eight women) who were newly diagnosed with celiac disease (CD) and beginning adherence to a gluten-free diet (GFD). Participants underwent eight cognitive evaluations at the beginning of the study and at 12 and 52 weeks. Duodenal biopsies also were performed, and Marsh scores were assigned to the most severe lesion found. Dietary compliance was assessed by prospective 7-day food diaries. Cognitive test results were analyzed alongside biopsy outcomes and other factors, including intestinal permeability (IP) and serum concentrations of tissue transglutaminase (tTG) antibodies.
Adherence to GFD was considered excellent in all patients, and Marsh scores improved throughout the study. Median scores dropped to 1 by week 52 (P=.001), and histological improvement occurred in the first 12 weeks (P=.01) but not significantly between weeks 12 and 52 weeks (P=.371). Serum concentrations of tTG decreased in all patients (mean, 58.4 U/mL at initiation to 16.8 U/mL by week 52; P=.025). Four patients achieved mucosal remission by the end of the study, and five achieved mucosal response.
Four of the cognitive tests that assessed verbal fluency, attention and motor function improved concomitantly with Marsh scores and tTG concentrations (r=0.377-0.735; all P<.05). No significant trends were observed in relation to nutrition, biochemical markers or IP.
“The study demonstrated the presence of cognitive impairment that improved with therapy and was correlated with histological evidence of mucosal recovery and/or healing,” the researchers concluded. “These results support patient reports of brain fog in untreated CD, and demonstrate that impairments in cognitive performance are an additional extra-intestinal or systematic manifestation of CD. Our findings introduce the possibility that cognitive tests have the potential to provide a noninvasive, cost-efficient marker of intestinal healing.”
Disclosure: See the study for a full list of relevant financial disclosures.
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