For me, the fog did not roll in as I stood at the prow of a great ship, peering toward the midnight shore. It was pierced by no guiding beacon drawing me forth. Nor did I walk into it as it cloaked a serene meadow. The sun did not cut it, and left no glistening jewels of dew upon vast expanses of rolling green.
No, for me, the fog arrived surreptitiously. It edged its way into my consciousness with the subtlety of a thief. It rolled in over my vocabulary, my memories, and my associations. It cloaked my orientation, my recognition, and my alertness. And by the time I noticed how hazy I felt, I was already lost within it.
After a diagnosis of celiac disease, the fog became a part of my life that would clear only to condense once more, clouding over so much I had taken for granted, and would never visualize with complete clarity again.
I noticed its advance in minuscule ways. Formerly eloquent, I began becoming tongue-tied, my mind stalling out as, for the first time in my life, I struggled to find the correct words with which to communicate. Eventually, I began forgetting the content of a sentence by its end, and would so easily lose my train of thought that I became anxious to initiate conversation in the first place.
When driving, I would sometimes snap to in mid-route, realizing that even along a road I had driven dozens of times, I was suddenly lost. Or, if I were not lost, that I had no recollection of beginning the journey, or may have forgotten why I was taking it at all.
My short-term memory was completely frayed. I clearly remember one incident in which I was sitting in my car, reaching to buckle my seat belt. Only when my fingers closed around the buckle did I realize that I had literally just done so. I would repeat this action about four times, and by the last, the fog had become so thick, it began to condense, to leak from my eyes in a soft, persistent rain.
What is wrong with me, I agonized. Have I been drugged? Am I having a stroke?
And, perhaps, worst of all: What if this is all in my head?
With the fog swirling about me, I didn’t understand how close to the truth any of these crazed speculations could possibly be.
Perhaps you’d recognize this insidious symptom by one of its other names.
“Chemo brain.” “Baby brain.” “Fibro fog.”
These flippant terms describe a debilitating side effect of many processes (the above being chemotherapy, pregnancy (and nursing), and fibromyalgia, respectively). An individual suffering from one of these can experience difficulty concentrating, remembering, and even communicating. The phenomenon has also been reported in various autoimmune diseases, such as rheumatoid arthritis, and in MS.
In celiac disease, the anomaly is referred to most commonly as “brain fog,” and is a symptom as ethereal and indefinable as its name implies. It may strike as a result of gluten ingestion, or may pervade an individual’s life more thoroughly. In my own case, my “fog” becomes much worse if I am accidentally exposed to gluten, but I maintain a low level at all times (perhaps as a result of additional autoimmune diagnoses).
Technically, brain fog is a cognitive impairment affecting an individual’s short-term memory, orientation, and reasoning skills, as well as language choice and creativity. A celiac disease patient in the throes of brain fog may have difficulty concentrating or paying attention, may be forgetful, or may become easily confused.
At times a person with celiac disease may suffer from pervasive tiredness, an exhaustion surpassing fatigue, and may feel as if they are attempting to function from within this type of fog. Others compare the feeling to attempting to reason while slightly intoxicated (minus any accompanying amusement alcohol would impart to the situation). Indeed, researchers have discovered that those operating within a “celiac fog” are performing their cognitive functions at the level of someone with a 0.05 blood alcohol level (the equivalent of two drinks, which is considered “drunken” in Europe, and is a step removed from that state in the U.S… Or several steps removed, if you are a writer). At the least, living with brain fog can be a disruptive nuisance, and at the worst, a disorienting burden. It can affect an individual’s ingenuity, one’s interpersonal relationships, and even the ability to perform one’s job.
Because of its multifaceted manifestations and tenuous origins, research into the causes and cures for celiac brain fog had not, until recently, been conducted. In 2014, however, an Australian study finally addressed the phenomenon that, aside from physical pain, has been one of the most frequently reported symptoms of our complex disease.
The aptly-named article describing this study, “Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity,” was published in Alimentary Pharmacology and Therapeutics. In the study, researchers examined the intestinal biopsies and blood antibody levels of 11 recently-diagnosed celiac disease patients. In addition, these patients were administered cognitive tests challenging information processing, memory, concentration, motor function, and visual-spatial orientation. The patients were then followed over a period of 12 months, during which they adhered to a gluten-free diet, and were subsequently re-tested.
Amazingly, as the intestinal damage and antibody levels of the patients began to improve on the gluten-free diet, their cognitive function appeared to do so equivalently. Statistically significant improvements were noted in motor function, verbal acuity, and concentration, with additional parameters also improving, to lesser degrees.
Although the topic begs further research, at a basic level, two things were scientifically proven for the first time by this study.
- There is a link between celiac disease and cognitive impairment, and
- This can be reversed through diet.
The study raised a multitude of questions regarding the mechanism behind cognitive impairment in celiac disease. Potential possible causes of brain fog currently being discussed include the following:
- It is well-known that nutrient deficiencies can cause cognitive dysfunction (especially low levels of iron, vitamin D, folate, calcium, magnesium, and the B vitamins). Since celiac disease patients typically suffer from impaired absorption and malnutrition, this might be contributing to the phenomenon of “brain fog.” No evidence, however, was found for this in the 2014 study.
- It is possible that inflammation may be solely responsible for the cognitive defects associated with celiac disease, specifically the cytokines released during this process.
- Alternatively, there are various methods by which the gluten substance itself could be causing defective cognition. Gluten has the ability to inhibit serotonin production in the brain. It also is broken down into opioid proteins during digestion, which can cause their own disruptive mental effects. And although intestinal permeability occurs in celiac disease (and this is the method by which gluten enters the bloodstream), no link was found between intestinal permeability (and therefore gluten itself) and cognitive dysfunction in this study.
- The intestinal microbiome may change due to the elimination of gluten from the diet. Though still being heavily investigated, it is known that changes in the gut’s bacteria do affect mood and behavior.
- In certain patients, gluten-induced antibodies have previously been shown to have the potential to bind to proteins in the brain, and could be causing cognitive symptoms in this way.
Despite the study’s inability to pinpoint the cause of celiac brain fog, Gregory W. Yelland, PhD, one of the study’s authors, speaks of the study’s utility: “We would like to think that clinicians would use this to inform their patients of the cognitive risks of remaining untreated and of the benefits of adhering to a strict gluten-free diet for not only their physical [health,] but their mental health also.”
Also implied by the study is the potential for cognitive testing as a diagnostic tool for celiac disease in the future, as it appears to directly correlate with intestinal damage and antibody involvement.
Connections between celiac disease and other mental and neurological impairments have already been established. Both anxiety and depression have been linked to celiac disease. A gluten-free diet has improved the conditions of some individuals with Autism Spectrum Disorders and schizophrenia, and in certain cases has transformed the lives of those presenting with psychotic or severe neurological diagnoses. There is also a devastating condition called gluten ataxia, in which physical neurological dysfunction has been linked to gluten ingestion. The mechanisms behind all of these interactions are presently being investigated, but demonstrate even further the link between celiac disease and the patient’s nervous system.
Although the nebulous brain fog looms for some of us as a result of gluten ingestion, there are steps that can be taken to minimize its effects:
- Take your supplements. If you require vitamin supplementation to keep your levels within normal ranges, keep your supplies stocked and take them as instructed. Avoiding vitamin deficiencies will keep your body functioning optimally, and will prevent the additional brain fog that occurs as a symptom of malabsorption and malnourishment in celiac disease.
- Minimize your stress. This is, of course, easier said than done, but stress has been proven to contribute to the brain fog phenomenon. Take some time to sit down, and enjoy even a quiet few minutes, a cup of tea, or some breathing exercises. Take a bath. Prioritize and set limits for your errands and daily duties. Investing some time in your own wellness through relaxation can work wonders for your body, and your mind.
- Get enough sleep. Also easier said than done, sleep is one of the major facets of health neglected by overworked adults today. Lack of sleep is also one of the clearest contributors to brain fog as a general symptom. Assess your nighttime ritual, and determine if you are able to halt your nightly activities a little earlier. Rest may be just what your brain needs.
- Eat enough. Low blood sugar can wreak havoc on your body, and your mental acuity pays the price for this. Make sure you are eating at mealtimes, and snacking to keep your body functioning adequately all day long.
- Try some brain exercises. From playing word games to learning a new skill or language, anything you can do in spare moments to challenge your mind in novel ways will enable it to adapt, and will help you to function within the haze of brain fog.
- Most importantly: stay gluten-free. A gluten-free diet is essential for celiac disease patients, and the 2014 study has proven that remaining gluten-free can ease the impact of (or reverse) celiac brain fog.
When I am “glutened,” I know I’ll be wandering through the fog for a while. But the gluten-free diet is my lantern, and with it, I know I will find my way out once again. With rest, adequate nutrition, and a little (or a lot) of hard work, we can adapt, and cope with anything celiac disease sends our way. In the end, we will emerge from the clouded landscape stronger for the journey we have taken through it.
Works referenced, and further reading:
“Cognitive impairment in coeliac disease improves on a gluten-free diet and correlates with histological and serological indices of disease severity,” by I.T. Lichtwark and E. D. Newnham, et al. In Alimentary Pharmacology and Therapeutics, 28 May 2014. Available on Wiley Online Library.
All photos copyright Alexis, aka GF Lex, 2015.