Celiac Disease and ADHD: A Connection

In recent years, a potential connection between Celiac Disease and ADHD has been suggested by health practitioners, as well as parents of children with ADHD, and adults with ADHD.

Many people have reported significant improvements in their ADHD symptoms after adopting a gluten-free diet.

It appears there is a strong link between Celiac disease and ADHD, with ADHD sufferers being over-represented in the population of Celiac-Disease sufferers.

Many people with ADHD appear to also have Celiac Disease, and the two conditions can present with very similar symptoms.

What is Celiac Disease?

Celiac Disease is an auto-immune condition that affects the way that Gluten, found in cereals and common everyday foods such as bread and pasta, is processed in the body.

It is a chronic condition and has several negative impacts on the body of adults and children. A protein in wheat called Gliadin, causes the immune system to attack the bowel.

This causes irreversible damage inside the bowel and can affect the way that nutrients are absorbed by the body.

The condition is probably caused by a combination of genetic and environmental factors. It has been recently suggested that common types of virus’ called ‘Reovirus’ may trigger the disease in some patients.

The World Gastroenterology Organization describes the main affects as follows:  

Adults

•  – Chronic diarrhea (formerly considered the most common symptom)
•  – Weight loss
•  – Iron-deficiency anemia
•  – Abdominal distension due to bloating
•  – Malaise and fatigue
•  – Edema (hypoproteinemia)
•  – Osteoporosis

Children

•  – Failure to thrive, weight loss, growth failure
•  – Vomiting
•  – Chronic diarrhea
•  – Abdominal distension due to bloating
•  – Iron-deficiency anemia
•  – Muscle wasting
•  – Edema (hypoproteinemia)
•  – Irritability and unhappiness

Celiac disease is diagnosed through different means.

The first step is in requesting a blood test.

This test involves screening the blood for antibodies which are high in response to gluten. Because of this gluten must be present in the diet for at least a month before the blood test is taken for it to be accurate.

If a blood test shows that there are high antibodies present, then doctors need to examine the gut via an endoscopy to check for damage. In some cases, a skin test can be done where a gluten-related rash is present, known as ‘dermatitis herpetirformis.’

There is no known cure for Celiac Disease.

Instead sufferers must make significant changes in diet to alleviate their symptoms. Issues such as difficulty concentrating, ‘brain fog,’ depression and irritability have also been reported.

What about Gluten Sensitivity?

Gluten Sensitivity is a condition which is not as well understood as Celiac disease.

Many similar symptoms are reported by sufferers such as poor concentration, depression, irritability and abdominal pain. It’s thought to affect up to 8% of the population.

Sufferers appear to react badly to ingesting gluten found in foods such as wheat; however their bowels are not attacked in the same way as is found in Celiac Disease.

There is no known test for Gluten Sensitivity, unlike with Celiac Disease. Instead sufferers must eliminate gluten from their diet to see if there is an improvement in symptoms.

Gluten sensitivity is a condition which some medical professionals say doesn’t exist.

Because of this, and the difficulty in testing for it, it may put some people off investigating whether gluten plays an adverse role in their ADHD symptoms.

Celiac disease and ADHD – What is the Evidence?

Although there have been lots of anecdotal reports of a link between ADHD symptoms and Celiac Disease, few studies have been carried out which try to prove the link.

One important study, published in 2011, showed that out of 67 patients on the study, 10 of them tested positive for Celiac disease.

Because the normal rate of Celiac disease in the population is 1 in 133, the study showed a large over-representation of Celiac sufferers amongst the ADHD population.

It was found that patients who stayed on a Gluten-Free diet showed marked improvements in their behavior and functioning, when compared to assessments from before the period of Celiac diagnosis and treatment.

Other studies have included one described in Progressive Health:

“In 2006, a study published in the “Journal of Attention Disorders” looked at 132 people with celiac disease to test for ADHD symptoms using the Conner Scale Hype Scheme. The patients were tested for ADHD symptoms while on a gluten diet, then after 6 months of living gluten-free. The researchers found that the study participants had drastically reduced ADHD scores after removing gluten from their diets.”

These two studies are important for establishing both the link between ADHD and Celiac Disease, and the possibility of a gluten-free diet positively impacting ADHD symptoms.

Because ADHD is a condition which affects many areas of the brain and behavior, it can be difficult to determine whether Celiac Disease is causing certain symptoms or if it is ADHD. Further research is needed into this link.

How does Celiac Disease Affect ADHD?

Problems with mood-regulation and Executive Functioning are all symptoms of ADHD. They also appear to be symptoms related to both Celiac disease and Gluten Sensitivity.

Some people have argued that problems with Gluten cause ADHD, but this doesn’t appear to be true for the majority of ADHD sufferers. Instead it appears that there is a strong link in some cases.

Because many of the symptoms of ADHD are similar to the symptoms of Celiac Disease, the two conditions could at times run the risk of being confused with one another.

In some cases, Celiac Disease could be mistaken for ADHD, and in others Celiac disease may be present in addition to ADHD but go undiagnosed.

Writing in Psychology Today, Marilyn Wedge describes a case where a mother told her that –

“her daughter had been diagnosed with the inattentive type of ADHD. None of the medications typically used with inattentive ADHD helped her daughter and she continued to struggle at school. Years later, it turned out that her daughter didn’t have ADHD at all. She had vision problems and celiac disease. Both of these real medical conditions can “masquerade” as ADHD by producing learning problems and inattentiveness.”

It appears that in this case ADHD had been confused with Celiac Disease and vision problems, which led to a misdiagnosis and incorrect treatment being prescribed for the child.

Because of the potential for confusion between conditions, or the possibility of both conditions being present, many people are now advising that all children with suspected ADHD are also screened for Celiac Disease.

Can a Gluten-Free diet help ADHD?

The connection between potential issues with processing Gluten and ADHD have led many sufferers of ADHD to cut out gluten from their diets. In many cases this has led to reporting of symptoms which are much more manageable.

Because the negative impacts of gluten are becoming more widely known, many people choose to cut out gluten altogether, without knowing whether they have Celiac Disease or not.

Whilst for some people this can lead to an improvement in symptoms such as bloating and fatigue, it’s important to monitor dietary reactions to cutting out any food carefully.

For many people cutting out gluten may do more harm than good, because doing so can deny the body important nutrients. Writing in Scientific American, Dietician Katherine Tallmadge argues that whole grains containing gluten are a useful source of fiber, vitamins and minerals. Gluten-Free products are often made of grains which are low in nutrients.

In addition, many gluten-free diets have been shown to be low in Fiber, iron, niacin, thiamine, calcium and vitamin B12. Tallmadge argues that some people who begin to feel better on a gluten-free diet may do so because they have cut out foods such as junk food and desserts which can lead to weight-loss.

In these cases, Tallmadge argues that the positive results are mistakenly attributed to a lack of gluten.

For those who have not been diagnosed with Celiac Disease, especially children with ADHD, caution should be used when cutting out gluten or radically altering diet. This is to ensure vital nutrients aren’t lost.

In addition, drastically changing the diet of children with ADHD without being sure of the need (such as in suspected gluten sensitivity) could be detrimental in terms of managing behavior and introducing unfamiliar new foods, of cutting out foods which have become staples.

Because gluten sensitivity has not been shown to damage the intestines in the same way that Celiac Disease does, it may be possible to simply cut down on gluten rather than eliminate it, to see if there are any corresponding changes in ADHD symptoms.

When it comes to Celiac Disease itself, gluten must be completely avoided as all gluten ingested will trigger the damaging autoimmune response.

It appears that, whilst the jury is out regarding gluten sensitivity and ADHD, there is a clear link between ADHD and Celiac Disease.

Because Celiac disease and ADHD can present in ways which appear very similar, it’s important for people who have been diagnosed with ADHD to also ask for tests for Celiac Disease.  A gluten free diet following diagnosis can significantly improve ADHD symptoms in a large minority of sufferers.