Dementia: Is Gluten the Culprit?

Bret S. Stetka, MD; David Perlmutter, MD


January 21, 2014

In This Article

Giving Up Gluten, and the Paleo Diet Fad

Medscape: Why do you feel that gluten is particularly detrimental to our brain health?

Dr. Perlmutter: Gluten-containing foods stimulate inflammatory reactions in a significant number of individuals, well beyond the 1.8% of the population that has celiac disease. This may lead to increased bowel permeability and even increased blood/brain barrier permeability, as described by Dr. Alessio Fasano (formerly at the University of Maryland, now at Harvard).[7] The mechanism deals with the expression of the protein zonulin brought on by gluten exposure. What is so compelling about this newer research is the fact that this reaction to gluten may occur in all humans.

This may explain to some degree the array of neurologic issues now correlated with gluten sensitivity in nonceliac patients, as described by Dr. Anna Sapone and colleagues.[8] So we have to look at gluten sensitivity in a new light, recognizing that its manifestations may extend well beyond the gut. Writing in the Journal of Neurology, Neurosurgery & Psychiatry,[9] Dr. Marios Hadjivassilou stated, "That gluten sensitivity is regarded as principally a disease of the small bowel is a historical misconception. Gluten sensitivity can be primarily and at times exclusively a neurological disease."

That said, many people shop the gluten-free aisle of the grocery store, thinking that those gluten-free breads, pastas, pizza doughs, crackers, and so on are much better because they're gluten-free. The bottom line is these are still powerful sources of carbohydrates.

Even fruit is a source of aggressive carbohydrate in the human diet. Take a simple 12-ounce glass of freshly squeezed orange juice -- what could be better, right? As a matter of fact, that's about 34-36 grams of pure carbohydrates. That's 9 teaspoons of pure sugar with breakfast before your breakfast cereal has even arrived.

My recommendation is to try to keep the total carbohydrates per day to 60-80 grams. If you have 2 glasses of orange juice, you've already consumed 72 grams of pure carbohydrate.

It's really fundamentally important that we address this mechanism of glycation of proteins as being a cornerstone of brain degeneration pathology, and recognize that beta-amyloid itself is a protein that can become glycated and as such can become a powerful nexus for the production of free radicals in inflammation.

We have watched with dismay over the past several years the failure of the drugs designed to rid the brain of beta-amyloid. Most recently, as published in NEJM,[10] a higher dosage of the experimental drug semagacestat was associated with increased cognitive decline of individuals compared with placebo.

Medscape: How does your diet compare with the paleo diet -- the idea that we should be following the presumed diet of Paleolithic humans?

Dr. Perlmutter: They are very similar. It's basically focused on very low carbohydrates and the aggressive addition of good fats: by all means, avoiding modified fats, trans fats, and hydrogenated modified fats, but welcoming back to the table such things as extra virgin olive oil, nuts, seeds, and grass-fed beef (not typical beef).

My diet is not a big beef, go out and eat a lot of meat, kind of diet. When Drs. Campbell and Campbell published The China Study[11] about the possible health consequences of eating meat, their report was valid because by and large, the type of meat that people are eating is derived from animals that have been fed genetically modified corn and soy and high levels of omega-6 fatty acids, which are proinflammatory. Therefore, clearly the idea that there's a relationship between that type of meat consumption and cardiovascular disease, and even cancer, is valid.

We're talking about specifically small amounts of grass-fed beef and wild fish. We're moving the meat, chicken, and fish away from being the centerpiece of the meal to being the side dish, the garnish. Lots of above-ground leafy green vegetables, colorful vegetables, and welcoming back good fats, because that's what the brain is desperate for.

Medscape: So, it's in line with a review published by the American Society for Nutrition[12] last year, as well as other recent data[13] suggesting that a little saturated fat, particularly from free-range red meat, might not be so bad for our brain health and may protect against anxiety and depression?

Dr. Perlmutter: Absolutely. And not just from grass-fed beef, but from the dreaded egg as well. There is no relationship in the current peer-reviewed literature between egg consumption and cardiovascular risk -- none whatsoever. Yet, there is still the ubiquitous egg-white omelet on every restaurant menu that you can find.


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