Last month I wrote about one of my patients. Roy is a second-grade boy with ADHD whose symptoms improved 90% with the removal of gluten from his diet. I hope you’ll read that article before continuing here.
When people read about Roy’s turn around they almost always ask, “How could gluten make such a difference?” My answer: inflammation
Inflammation is behind many childhood illnesses
The inflammatory effects of gluten and dairy on the body are similar, which is why I usually talk about them together. The impact is three-fold:
- An inflammatory effect
- An opiate-like effect
- The glutamate effect
The main inflammatory protein in dairy is casein (whey is the other protein in dairy), and in wheat it is gluten. Gluten is also in barley and rye and it is hidden in many foods, including sauces and packaged products. So what we’re really talking about is inflammation and its effects.
If a child is eating foods that inflame their system, it can cause things like:
- Bumps on the back of their arms or cheeks
- Chronic runny nose
- Recurrent ear infection and sinus infections
- Mouth breathing and snoring
- Stomach pain
We don’t have fences in the body, and this is why inflammation in one area of the body means inflammation in other areas.
Our wonderful patient Roy did have a few of the above listed symptoms so I think a decrease in his overall inflammation was part of the reason he improved so significantly when we removed gluten from his diet.
Inflammation, constipation and ADHD
Another good example of how inflammation affects the body as a system is a child who has constipation and ADHD. Constipation is just another sign of inflammation.
We are going to have a much better chance of improving their ADHD-type symptoms if we concurrently address their constipation.
To address their constipation we look at foods the child may be sensitive to (this is different than foods they may be allergic to), like dairy. We increase magnesium-rich foods like green leafy vegetables, we increase foods high in fiber like chia, flax and hemp seeds, and we make sure they are drinking plenty of water.
Laxatives can be a great short-term solution for constipation, but it’s much better to figure out what foods work best for their particular system, so we can find a long-term solution.
The opiate-like effect of gluten and dairy on the nervous system was first described in children with autism by K. Reichect, MD in the 1980’s. In individuals who have gut inflammation, which is commonly referred to as “leaky gut”—the medical term is “increased intestinal permeability”—the enzymes in their gut are not fully breaking down casein and gluten.
The resultant compounds are called casomorphines for casein and gliadomorphines for gluten. Their protein structure is similar to morphine. These proteins get absorbed into the blood stream through the gut, they cross the blood-brain barrier and bind to opiate receptors in the brain as well along the GI tract.
They create an “opiate-like” effect on the body and the nervous system, and once you see one child improve so dramatically after removing this impact, you want to scream it from a mountain top. And this is exactly what Roy’s teacher said once she saw the big improvement in him.
Behaviors of children with opiate-like effects
The children I suspect are being impacted by the opiate-like effect are the one’s whose parents describe them like this:
When Sally has a melt down, it’s as if she is not in control herself, almost like a switch has been flipped.
Some of these kids can’t seem to follow multiple step instructions and once they seem “off” there is no reasoning with them. At other times, these same children might be perfectly capable of handling challenging situations, transitions, sitting still, tending to certain cognitive tasks like math homework or cleaning up their bedroom AND brushing their teeth.
As you will recall, with Roy, he experienced a 90% improvement in the following symptoms:
- His energy was more controlled and calm
- He handled transitions better
- He was better able to focus and sit still at school and at home when doing his homework
He was more coordinated with physical activity (even though he was already a great athlete!)
- His headaches resolved
- Best of all, he was more content with himself, was no longer in constant motion (thumping his feet or twirling his books) and his class was gaining a new respect for him
If you suspect your child might be under the influence of the “opiate-like” effect from dairy and/or gluten, you may want to consider tapering off of these foods or doing an elimination diet. How to do an elimination diet in kids will be a topic for a subsequent blog!
In Roy’s case, he had a big improvement off of gluten alone. Do I think dairy may also be impacting Roy? Yes I do, however, his mother was brilliantly able to read the situation and know that gluten would be easier for Roy to remove at this point in time.
Because his mother understood Roy so well, they implemented the elimination of gluten and instead of feeling deprived, Roy felt empowered. He also felt so much better that he took ownership of his new way of eating and mom doesn’t have to police him constantly.
Roy continues to be AMAZING and very cooperative. In fact he readily offers other kids in his class nutrition advice:)
The glutamate effect
Glutamate is an amino acid. Amino acids are the basic building blocks of proteins. This means that the proteins we eat are comprised of many amino acids strung together.
Casein and gluten just happen to have a high amount of glutamate in their protein chain. Once we eat them and digest them, we have a great deal of free glutamate in our system.
One form of glutamate is commonly known as MSG (mono sodium glutamate). It is a compound many of us know we should avoid, thanks to the popular press, but many of us aren’t exactly sure why.
A patient with glutamate problems
I saw the glutamate effect about a year ago when one of my patients with some developmental delays had a HUGE change in the course of his health when his parents removed glutamate from his diet. They figured out this glutamate connection by working with an incredible woman, biochemist and mother out in California, Katherine Reid, PhD. Dr. Reid who brought her own daughter out of the path of autism by removing glutamate from her diet.
Dr. Reid is doing a tremendous amount of work to educate parents and healthcare professionals on the detrimental effects glutamate can have on the nervous system of certain susceptible children. I highly recommend you check out her website.
And please share this video with everyone you know—it needs to go viral!
MSG isn’t the only source of glutamate: it’s in dairy and gluten too
Glutamate is excitatory to our nervous system and this is why I also talk about the high glutamate content of dairy and gluten when I am talking to families of children who have difficulty with sitting still and focusing.
If we are eating foods that are excitatory to our nervous systems, we are adding to an already very active brain. We want the food that we feed our children to be anti-inflammatory, natural and nutrient dense.
Many foods on the market today have a very high glutamate content and although glutamate is needed for proper functioning of our nervous system, we are getting it in excess with the high amounts of dairy, wheat, and packaged, processed foods we eat.
Celiac Disease and Non-Celiac Disease Gluten Sensitivity
It is well known that individuals who are sensitive to gluten also have a high degree of neurologic and psychiatric complications (like ADHD, headaches, schizophrenia, depression, anxiety, ataxia, seizures, neuropathy and multiple sclerosis,).
In many of these studies however, patients with celiac disease were not distinguished from those who had Non-Celiac Disease Gluten sensitivity. Some research has found that up to 51% of children with gluten sensitivity also have neurologic problems (like headaches and ADHD).
This is why I still recommend my patients do a trial off of gluten even if they test negative for celiac disease. I think removing a pro-inflammatory food group for a delineated period of time is one of the safest ways you could begin to treat a patient with ADHD.
With my patient Roy, we have not done any laboratory testing yet. Once I educated them on the three-fold impact that dairy and gluten can have on the body, brain and entire nervous system, his parents wanted to make the dietary changes before drawing blood.
At some point in time, we may re-introduce gluten back into Roy’s diet for a few weeks so we can test him for celiac disease. But for right now, we will simply keep him on a gluten free diet. If we do this, it will definitely be something we do during the summertime!
Does your child really have ADHD?
This is also why I LOVE to see children BEFORE they get diagnosis with ADHD. If their symptoms resolve with a change in their nutrition, do they really have ADHD?
Is it possible that a percent of children diagnosed with ADHD in reality only have have some food sensitivities coupled with a diet filled with highly processed, inflammatory foods?
I look at ADHD the same way I look at heart disease. With heart disease, the research is irrefutable that it improves with nutrition. In one study, researchers took patients who had a heart attack and split them into two groups. In one group they received standard nutrition education. In the other group they were placed on the Mediterranean Diet (AKA an anti-inflammatory diet).
The second group had such a large risk reduction of having a second heart attack that the study was stopped early because they felt it was unethical not to tell the first group the benefits of changing to an anti-inflammatory diet.
The bottom line is that food effects all systems of our body. If you or a loved one has some challenges with focus and attention, changing your nutrition may be a great place to start!
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With much gratitude,
Hadjivassiliou et al. “The Lancet Neurology”journal; Gluten Sensitivity: From Gut to Brain. 2010;9 (3):318-330.
M Hadjivassiliou et al. “Does cryptic gluten sensitivity play a part in neurological illness?” Volume 347, No. 8998, p369–371, 10 February 1996
Jackson et al. “Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity.” Psychiatrity Q. 2012; 83(1):91-102.
Egger J et al. “Controlled Trial of Oligoantigenic Treatment in the Hyper Kinetic Syndrome”. Lancet. 1985: Vol 1.
Pelsser LM et al. “A Randomised Controlled Trial into the Effects of Food on ADHD”. European Child & Adol Psych J. Jan 2009.
Zelnik et al. “Range of Neurologic Disorders in Patients With Celiac Disease.” Pediatrics. 2004; 113:6 1672-1676.
Branski D et al. “Extraintestinal manifestations and associated disorders of celiac disease.” Front Gastrointest Res.1992;19:110– 121.
Cooke WT, Smith WT. “Neurological disorders associated with adult celiac disease.” Brain.1966;89 :683– 722.
Wills AJ. “The neurology and neuropathology of coeliac disease.” Neuropathol Appl Neurobiol.2000;26 :493– 496.
“The Neurologic Profile of Children and Adolescents With Inflammatory Bowel Disease” J Child Neurology 2015; 30:5 551-557.
de Lorgeril M et al. “Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study.” Circulation. 1999;99:779-785.
de Lorgeril M et al. “Mediterranean alphalinolenic acid-rich diet in secondary prevention of coronary heart disease.” Lancet. 1994;343:1454-1459.
Herbert M. ” Autism: a brain disorder or, a disorder that affects the brain? Clinical Neuropsychiatry. 2005;2;6:634-279.