It is common to think of celiac disease as a gastrointestinal disease, which causes vomiting, diarrhea, and abdominal pain. However, it may be surprising to learn that celiac disease can cause extraintestinal manifestations such as anemia, problems with dental enamel, and skin disorders.
A less well-known issue caused by gluten is gluten-induced cognitive impairment, which patients describe as “brain fog.” This is a problem that many patients will experience but has not been well studied to date. Its brief mentions in medical literature typically describe the condition as characterized by transient mental confusion accompanied by cognitive impairments to memory, attention, executive function, and processing speed. Symptoms can last a few hours to a few days.
A paper published early online in the Journal of Clinical Gastroenterology reports the results of a nationwide online survey designed to better understand this phenomenon. People with either celiac disease or nonceliac gluten sensitivity were recruited to participate in a survey titled “Gluten Exposure and Brain Fog.” A total of 1,143 persons with celiac disease and 253 with nonceliac gluten sensitivity participated. Ninety percent of respondents reported some type of neurologic impairment. The most common symptoms in decreasing order of reported frequency were difficulty concentrating, forgetfulness, grogginess, and a feeling of detachment. More than half of the participants reported the symptoms lasted one to two days or longer.
While the high percentage of survey participants who reported symptoms of cognitive impairment is undoubtedly a reflection of the title of the survey to which they were recruited, the large absolute number of respondents reporting these symptoms confirms that these symptoms are not rare. Moreover, the prolonged nature of these cognitive symptoms clearly represents a significant impact of gluten exposure on their day-to-day functioning. Better awareness of these symptoms is a necessary first step toward improving the care of those with celiac disease and nonceliac gluten sensitivity. This paper provides an important contribution toward that end.