Schizophrenia and Gluten-Free Diet
- Use of a Gluten-Free Diet in Schizophrenia: A Systematic Review
by Anastasia Levinta, Ilya Mukovozov, and Christopher Tsoutsoulas
A large epidemiologic study that used data from a Danish national registry demonstrated that the prevalence of autoimmune disease was significantly higher in individuals with schizophrenia and their parents than in the unaffected controls.
Celiac disease is one of the autoimmune illnesses associated with schizophrenia. Bender was among the first to notice that children with schizophrenia were more likely to have celiac disease. Several years later, a case report described 5 individuals suffering from both celiac disease and schizophrenia, who had been admitted to the same hospital within the same year.
A number of case reports have shown a dramatic improvement in psychotic symptoms after strict adherence to a gluten-free diet.
For instance, a report by Kraft and Westman described a dietary intervention for a 70-y-old female patient with a long-standing diagnosis of schizophrenia and multiple medical comorbidities. Although not explicitly described as such in the original report, the low-carbohydrate diet appears to be significantly lower in gluten content. After 1 wk on the low-carbohydrate diet, the patient noticed a decrease in hallucinations and an overall improvement in energy levels. Over the course of 12 mo on the low-carbohydrate diet the patient reported no recurrence of her schizophrenic symptoms.Another case study discussed a schizophrenic patient with untreated celiac disease who was found to have perfusion abnormalities in the left frontal brain regions on single-photon emission computed tomography imaging (10). After treatment with a GFD, the patient displayed a rapid improvement in her physical and psychiatric symptoms, with a concomitant reversal of the frontal cortex hypoperfusion shown on a single-photon emission computed tomography scan.
2. Celiac-Type Diets in Schizophrenia
Dohan, letter in Am J. Psychiatry 1979
Sir: In ‘Another Look at Gluten in Schizophrenia’ (November 1978 issue) James R. Rice, M.D. , and associates reported that a schizophrenic patient who had been hospitalized for more than 13 years improved substantially on an 8-week experimental ‘gluten-free and milk-free diet’ and was discharged. Another patient, hospitalized for 14 years, regressed when gluten was added to the hospital diet and improved considerably on the subsequent gluten-free and milk-free diet but was not discharged because she discontinued her diet when not supervised. The results in the other 14 chronic schizophrenics in the study were not discussed.
Dr. Rice and associates studied 16 chronic schizophrenics whose current hospitalizations ranged from 6 months to 10 years. My study included over 100 recently relapsed schizophrenics who were randomly assigned to control or experimental diets on the day of their admission to the hospital.
Although the diet used by the South Carolina investigators did not include obvious cereal grains or milk, it did contain some milk protein and wheat gluten. They used butter, and the bread was made with wheat starch that contained 0.2% gluten (personal communication). Symptomatic and morphologic effects of apparently small amounts of wheat gluten in celiac disease, which I have proposed as a possible model (perhaps genetically related) for studying the pathogenesis of schizophrenia, are well known. For example, Dissanayake and associates (3) have stated that for adult celiac patients as little as 0.5 g of wheat gluten a day is a‘ ‘large amount’‘ because even smaller doses prevented the return to near normal of the gluten-damaged intestinal mucosa.)My experiments were designed to eliminate all traces of glutens in all cereal grains because schizophrenia does occur (although possibly less frequently) in societies in which rice and/or other cereal grains but little or no wheat, rye, barley (the grains omitted in the so-called gluten-free diet for celiacs) are eaten. All traces of milk were eliminated because milk sometimes worsens celiac disease. Furthermore, Zioudrou and associates at the National Institute of Mental Health, stimulated by evidence relating cereals to schizophrenia, have reported naloxone-reversible endorphin (‘‘exorphin’ ‘) activity in peptic digests of milk casein and corn and barley glutens and, most notably, anexorphin peptide from wheat gluten that is about as potent as met-enkephalin. Other fractions from all tested glutens had a stimulating effect.Dr. Rice and associates’ study used only 8 weeks of diet, but patients with adult celiac disease, as well as the genetically related chronic disorder dermatitis herpetiformis, often do not show significant clinical improvement (which occurs in most but not all cases) for many months after a celiac-type diet is instituted. For this and other reasons I suggested in 1973 that an experimental therapeutic trial of diet in persistently symptomatic chronic schizophrenics should continue for 6 months to a year.I thank the South Carolina investigators and dietitians for their interest in the food-derived peptide hypothesis of the etiology of schizophrenia and for their generosity in supplying me with the unpublished information I have cited above.
I. Dohan FC, GrasbergeniC: Relapsed schizophrenics: earlier discharge from the hospital after cereal-free, milk-free diet. Am I Psychiatry 130:685-688, 1973
2. Singh MM, Kay S: Wheat gluten as a pathogenic factor in schizophrenia. Science 191:401-402, 1976
3. Dissanayake AS, Truelove SC, Whitehead R: Jejunal mucosal recovery in coeliac disease in relation to the degree of adherence to a gluten-free diet. Q J Med 170:161-185, 1974
4. Dohan FC: Cereals and schizophrenia: data and hypothesis. Acta Psychiatr Scand 42:125-152, 1966
5. Zioudrou C, Streaty RA, Klee WA: Opioid peptides derived from food proteins: the exorphins. J Biol Chem (in press)
3. Relapsed Schizophrenics: Earlier Discharge from the Hospital After Cereal-Free, Milk-Free Diet
by F.C. DOHAN, M.D., AND J.C. GRASBERGER, M.D.
Routinely treated schizophrenics, who on admission were randomly assigned to a diet free of cereal grains and milk while on the locked ward, were discharged from the hospital about twice as rapidly as control patients assigned to a high-cereal diet. Wheat gluten secretly added to the cereal-free diet abolished this effect. These and previous findings suggest that cereal grains may be pathogenic for those hereditarily predisposed to schizophrenia just as they are for celiac disease, a disorder that may be genetically related.
We have previously reported that a cereal-free, milk-free diet hastened the improvement of relapsed schizophrenics (p<.Ol) as judged by the duration of their stay on a locked ward. This was apparently not due to psychological factors affecting staff or patients, since the effect disappeared when wheat gluten was secretly added.