Your Brain On... Gluten

Ayesha Sherzai (0:00)

Gluten, it's a word that stirs up confusion, anxiety and a multi-million dollar industry. Yet, just a couple of decades ago, unless you had a diagnosis of celiac disease, you might not have even heard of it. Since the 2010s, gluten-free products have exploded onto the scene and with them, a wave of conflicting information. Today, we're diving into the science behind gluten, how it affects our health, especially our brain, and clearing up the most common myths and misconceptions. To help us make sense of it all, we're joined by two extraordinary guests. First, Dr. Alessio Fasano, world-renowned pediatric gastroenterologist, research scientist and entrepreneur. He's the chief of pediatric gastroenterology and nutrition at Mass General for Children, where he leads the treatment of gluten-related disorders across all ages. He also directs the Mucosal Immunology and Biology Research Center, where his team explores the molecular roots of autoimmune diseases like celiac disease. And second, Dr. Frank Cusimano, physician scientist and expert in gastroenterology and nutrition with a PhD in nutritional and metabolic biology from Columbia University. He's published extensively on the microbiome and the role of nutrition in brain and body health. And today, he's helping us unpack what gluten really does in the body and the brain. We're Drs. Ayesha and Dean Sherzai, and this is Your Brain On Gluten.

Dean, I think it's a very common question that patients ask us about gluten and how it affects their brain. There's been a lot of posts and talks and conversations around gluten and brain fog and how it damages the brain. It's quite a messy area, isn't it?

Dean Sherzai (1:58)

It is. I remember that around 15 years ago or so, we first saw a wave of people coming into the emergency room and to the clinic with their own paperwork, with their own list of elements that they thought that were leading to their brain pathology. Different kinds, from headaches to cognitive decline to dizziness.

And it was all around what they had heard to be related to gluten. And this started with a few books that actually pointed to the fact that maybe the majority of the diseases of the brain, especially as it pertains to Alzheimer's and dementia, were related to gluten-related pathologies. And from then on, that became a significant, almost social contagion, where every time we go to the emergency room, we would get somebody coming in with some confusion or delirium or any other symptom. And often they had underlying processes, but they would be the first people to say, is this related to gluten? And that was surprising for us to see this wave of consciousness about these molecules.

Ayesha Sherzai (3:02)

Yeah, it's really interesting how this thing just popped up in the scene. And as neurologists not on social media and not really being in that atmosphere, it was quite surprising for us to see how many people actually were doing their own research online and they were bringing all of these papers and conversations or talking points that they had heard from someone into the clinic. And since there was really no good evidence backing it up, it was an opportunity for us to educate ourselves and look into it even more.

Dean Sherzai (3:31)

And this is interesting because we felt the pressure. And you realize when there is an incredible movement going on in the general population as far as certain awareness or consciousness or social contagion as far as a belief, you see the pressure in the clinic. Because when one person insists on this being the underlying cause and then a second person and a third person and a fourth person, after a while it becomes overwhelming.

Ayesha Sherzai (3:55)

It sure does.

Dean Sherzai (3:56)

And you realize the stress and the pressure of this kind of mentality overtaking even the clinical realm.

Ayesha Sherzai (4:02)

Yeah, it sure does. The one case of true gluten-related brain issue that I remember seeing in clinic was this lady who came in. I'm not going to name her or we're just going to call her Maria. And she was in her 40s and she came in with balance issues. They really don't know whether there is solid ground under their feet and they have this weird strange movement and a lot of balance issues, a lot of falls. She was a very successful woman and she had two children, just lovely. And she was doing everything right in life. She was actually in school too, so she was engaged in complex cognitive activity, so on and so forth, and she was exercising and eating right. And she was stumbling. She said that she had been stumbling. She couldn't really tell whether there was a furniture next door or not. It was very difficult for her to go to the bathroom at night because she couldn't really sense the ground and she would like hit herself. I checked her legs. Of course, I did a neurological examination on her. She had a lot of bruises because she kept on bumping herself against things. And she was very, very uncoordinated.