The Gluten Schizophrenia Connection
Updated: Jun 19, 2020
Nearly 1% of the general population have celiac disease, an autoimmune disorder triggered by gluten that manifests as gastrointestinal distress; however, nearly a quarter of those with schizophrenia have also been found to test positive for celiac biomarkers even without any digestive issues (Cascella et al., 2011). Schizophrenia is a brain disorder that manifests into auditory or visual hallucinations, delusions, paranoia, depression, difficulty with abstract thinking, and faulty perceptions in thought, emotions, and behavior. Though, if an autoimmune response is so prevalent in the schizophrenic population, then removing gluten may be a potential solution for managing schizophrenia. A gluten-free diet should be trialed in people with schizophrenia as it may help improve symptoms, reduce brain inflammation, and improve overall quality of life.
Symptoms of schizophrenia may be the manifestation of brain inflammation caused by gluten consumption. In most people, when wheat gluten is eaten it is easily digested, but in some individuals, gluten passes through a permeable intestinal wall and triggers an immune response (Sapone et al., 2012). This in turn causes damage to the intestinal tract and is known as celiac disease; however, in some people the intolerance to gluten can manifest into signs and symptoms other than digestive issues. Some examples are arthritis, skin rash, anemia, or disorders of the brain including gluten ataxia and schizophrenia. While IgA (immunoglobulin A) is the classic laboratory marker a doctor uses to assess for celiac disease, other laboratory tests may also be useful for gluten-associated neurological disorders such as IgG (immunoglobulin G) and TG6 (transglutaminase 6) (Hadjivassiliou et al., 2015; Cascella et al., 2013). IgG associated with gluten ataxia, can cause brain cell death, specifically of the Purkinje cells (Hadjivassiliou et al., 2015). Since gluten causes an inflammatory response in schizophrenia as well, it raises the question of whether a gluten-free diet can improve symptoms.
Several studies have demonstrated an improvement of schizophrenic symptoms when adhering to a gluten-free diet. One study in particular found an improvement in schizophrenic symptoms, specifically in preoccupied behavior, hostile or fearful social avoidance, tension state, anxiety, poor judgment and insight, and difficulty in abstract thinking. Interestingly, when gluten was secretly added back in, the schizophrenic symptoms returned (Singh & Kay, 1976). Other studies have shown an earlier release from hospitalization for schizophrenia when trialing a gluten-free diet during a psych ward hospital stay (Dohan, Grasberger, Lowell, Johnston & Arbegast, 1969; Dohan & Grasberger, 1973). A limitation is that a study examining the effects of the gluten-free diet for the treatment of schizophrenia hasn’t taken place since the ‘80s, and more recent research is needed. If a gluten-free diet improves symptoms of schizophrenia, then results could truly be life changing.
For some people with schizophrenia, following a gluten-free diet can profoundly improve quality of life. Schizophrenia is among one of the most disabling conditions in the world with a 20% shorter lifespan and 9% higher suicide rates than the general population (Hennekens, 2007; World Health Organization [WHO], 2009). Schizophrenia can also lead to serious disability (Ergun, Urhan, & Ayer, 2018). Antipsychotic drugs to treat schizophrenia are effective in improving some but not all symptoms, are not a cure, are only effective in 70% of patients (Stroup & Marder, 2017), and come with serious side effects such as weight gain and the metabolic syndrome. Removing gluten from the diet may help improve psychosis and depressive symptoms of schizophrenia and potentially reduce dependence on antipsychotic medications in some people (Singh & Kay, 1976). Therefore, the gluten-free diet holds tremendous value in benefiting gluten-associated schizophrenia by improving quality of life.
Some may argue that gluten doesn’t cause schizophrenia. Schizophrenia caused by a gluten autoimmune disorder has been indicated in only a subset of the schizophrenic population. In a study by Vissilides et al. (1986), 22 participants with psychotic disorders underwent a gluten-free diet for 16 weeks and were told to drink a particular gluten-free beverage daily. During the 11th week, the beverage had gluten added without the participants’ knowledge. In 20 of the 22 participants, symptomology remained fairly stable; however, the two remaining participants, both diagnosed with psychosis schizophrenia, had remarkable improvement specifically in perception and mood during the gluten-free period but then had schizophrenic relapses when the gluten was secretly introduced back into their diet. Therefore, a gluten-free diet may only benefit some people with schizophrenia.
Following a gluten-free diet may make all the difference between schizophrenic episodes and a complete remission of symptoms. The diet includes avoiding anything made from wheat flour, barley, or malt which includes cookies, breads, pasta, beer, and looking at the nutrition label of processed foods in search of gluten-containing ingredients. Many people have never heard of the association between schizophrenia and gluten and could be easily missed by both patient and medical professional. Testing certain biomarkers (i.e. IgG, TG6) may be helpful in finding those that are sensitive to gluten as well as trialing a gluten-free diet is recommended for everyone with schizophrenia to at least rule in/out a gluten disorder. A gluten-free diet has the potential to reverse symptoms, calm brain inflammation, and ultimately improve quality of life in individuals with schizophrenia. The gluten-free diet as a treatment for schizophrenia, if proven beneficial, may completely reverse the potentially devastating and life-altering effects of schizophrenia.
Cascella, N., Kryszak, D., Bhatti, B., Gregory, P., Kelly, D., McEvoy, J., Fasano, A., Eaton, W. (2011). Prevalence of celiac disease and gluten sensitivity in the United States clinical antipsychotic trials of intervention effectiveness study population. Schizophrenia Bulletin. Volume 37. pp 94–100. https://doi.org/10.1093/schbul/sbp055
Cascella, N., Santora, D., Gregory, P., Kelly, D., Fasano, A., & Eaton, W. (2013). Increased prevalence of transglutaminase 6 antibodies in sera from schizophrenia patients. Schizophrenia Bulletin, 39(4), 867-871. doi:10.1093/SCHBUL/SBS064
Dohan, F., & Grasberger, J. (1973). Relapsed schizophrenics: earlier discharge from the hospital after cereal-free, milk-free diet. American Journal of Psychiatry, 130(6), 685–688.
Dohan, F., Grasberger, J., Lowell, F., Johnston, H., Jr, & Arbegast, A. (1969). Relapsed schizophrenics: more rapid improvement on a milk- and cereal-free diet. British Journal of Psychiatry: The Journal of Mental Science, 115(522), 595–596.
Hadjivassiliou, M., Sanders, D. D., & Aeschlimann, D. P. (2015). Gluten-related disorders: gluten ataxia. Digestive Diseases,33(2), 264-268. doi:10.1159/000369509
Hennekens, C. (2007) Increasing global burden of cardiovascular disease in general populations and patients with schizophrenia. Journal of Clinical Psychiatry, 68(4). 4-7.
Sapone, Bai, Ciacci, Dolinsek, Green, Hadjivassiliou, Kaukinen, Rostami, Sanders, Schumann, Ullrich, Villalta, Volta, Catassi, Fasano. (2012). Spectrum of gluten-related disorders: consensus on new nomenclature and classification. BMC Medicine, 10(13), 1741-7015.
Singh, M., & Kay, S. (1976). Wheat gluten as a pathogenic factor in schizophrenia. Science (New York, N.Y.), 191(4225), 401–402.
Stroup, T. & Marder, S. (2017). Pharmacotherapy for schizophrenia: Acute and maintenance phase treatment. In R. Hermann (Ed.), UpToDate.
Vlissides, D., Venulet, A., & Jenner, F. (1986). A double-blind gluten-free/gluten-load controlled trial in a secure ward population. British Journal of Psychiatry: The Journal of Mental Science, 148, 447–452. World Health Organization. (2009). Global health risks. WHO Press. Switzerland.