Brain fog and non-coeliac gluten sensitivity: Proof of concept brain MRI pilot study

• Published in: PloS one Vol. 15; no. 8; p. e0238283
• Main Authors: Croall, Iain D, Hoggard, Nigel, Aziz, Imran, Hadjivassiliou, Marios, Sanders, David S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-08-2020; Public Library of Science (PLoS)
• Subjects: Abnormalities; Adolescent; Adult; Aged; Autoimmune diseases; Biology and Life Sciences; Biomarkers; Biopsy; Blood flow; Brain; Brain - diagnostic imaging; Brain fog; Cardiovascular disease; Celiac disease; Cerebral blood flow; Chi-square test; Cognitive Dysfunction - diagnostic imaging; Cognitive Dysfunction - etiology; Complications and side effects; Diagnosis; Diagnostic systems; Diet, Gluten-Free; Female; Fog; Follow-Up Studies; Food allergies; Gastroenterology; Gluten; Glutens - metabolism; Headache; Humans; Intestine; Magnetic Resonance Imaging; Malabsorption Syndromes - diagnostic imaging; Malabsorption Syndromes - diet therapy; Male; Medical imaging; Medicine and Health Sciences; Middle Aged; Neuroimaging; Non-celiac gluten sensitivity; Physiology; Pilot Projects; Polls & surveys; Proof of Concept Study; Prospective Studies; Questionnaires; Research and Analysis Methods; Risk factors; Self Report; Sensitivity; Severity of Illness Index; Signs and symptoms; Supervision; Teaching hospitals; Young Adult; United Kingdom; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0238283

Non-Coeliac Gluten Sensitivity (NCGS) is poorly understood, particularly in terms of its neurological outcomes. We initially conducted a prospective postal survey to investigate its neurological presentation and symptom course. Results from this then motivated a follow-up pilot study utilising brain MRI to characterise potential diagnostic biomarkers for future research.
Patients with NCGS were recruited from a specialist centre and completed a prospective postal questionnaire (N = 125). This summarised symptoms experienced, their severity and their course. Onset time was compared by Chi-squared analysis to data from the same centre concerning coeliac disease patients (N = 224). Five respondents on a strict gluten-free diet who self-reported brain fog then attended a pilot study, completing MR brain imaging/questionnaires before/after a gluten challenge. "Baseline" data were assessed for abnormalities, while symptom severity and cerebral blood flow (CBF) were compared before/after challenge.
Survey participants were aged 47 (85% female). Prevalence of neurological symptoms were: headaches (51%), brain fog (48%), balance issues (31%), tingling (19%). Median symptom resolution time was 48 hours, while onset was 90 minutes; onset pattern was not significantly different compared to CD patients (p = 0.322). Extra-intestinal symptoms worsened by 37%(±28) during a typical reaction. Predominantly non-statistical observations from the brain imaging study are discussed.
Neurological symptoms in NCGS are common, and onset time is comparable to that in CD. Brain imaging may be a useful future means of investigating physiological injury and responses to gluten in further study.