Gluten Ataxia

Immune Mediated Disease

Gluten ataxia is a controversial diagnosis. Progressive cerebellar ataxia is a severe imbalance that worsens over time, due to gradual destruction of neurons in the balance center of the brain, the cerebellum.  The cerebellum noticeably shrinks as this occurs, and this shrinkage can be seen on MRI.  It can be associated with slurring of speech, drifting of the eyes (nystagmus), tremor, and poor coordination in the hands.  In many of these people, an abnormal test result, anti-gliadin antibodies, can be found in the blood.  These antibodies are already known to be associated with an intestinal disorder, celiac disease or sprue, that causes abdominal pain and diarrhea and can interfere with absorption of nutrients from the intestines.  Most of the people with ataxia, however, do not have any sign of this intestinal disease.  These antibodies are also found in more than 10% of normal people. Some researchers feel that these antibodies cause an autoimmune disease because the antibodies can react with, and damage, special neurons in the cerebellum called Purkinje cells.  Other researchers feel that the association between these antibodies and ataxia is meaningless, because the antibodies are so common even in normal people.  

Gluten is a protein found in wheat, barley, and rye and is present in most bread products.  For people with celiac disease, intestinal problems can be prevented by eliminating all gluten from the diet.  It is a component of this protein, gliadin, that causes anti-gliaden antibodies to form and damage the intestinal lining.  Once they are no longer eating any gluten, the diarrhea improves and they are able to absorb vitamins and other nutrients, relieving many of their symptoms.  Some studies suggest that some people with anti-gliadin antibodies and cerebellar ataxia also improve when gluten is removed from the diet.  However, research studies have shown mixed results.  A neurologist should be consulted to determine which treatments to follow if this disorder is suspected.

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Author: Dr. Carol Foster