2009, Vol. 73, pp. 438 – 440 Rodney Philip Kinvig Ford The Childrens Gastroenterology and Allergy Clinic, Christchurch, New Zealand KEY POINTS FROM DAN MURPHY: 1) Gluten grains (wheat, rye, and barley) have become staples in our diet. Thequantity of gluten in our daily food intake has been steadily increasing withadvances in food processing. 2) Gluten instigates celiac disease (gluten-sensitive enteropathy), which affectsone in every hundred people. Celiac disease is a gastro-intestinal disease;symptoms are due to mucosal damage or malabsorption. In celiac disease there ishistological evidence of mucosal damage. 3) Gluten causes symptoms, in both celiac disease and non-celiac gluten-sensitivity, by its adverse actions on the nervous system. Gluten harms thenervous system. Gluten is linked to neurological harm in patients, both with andwithout evidence of celiac disease. 4) Many celiac patients experience neurological symptoms, frequentlyassociated with malfunction of the autonomic nervous system. 5) Gluten-sensitivity can be associated with neurological symptoms in patientswho do not have any mucosal gut damage (that is, without celiac disease). 6) Gluten can cause neurological harm through a combination of cross-reactingantibodies, immune complex disease and direct toxicity. 7) A host of symptoms outside the gut (extraintestinal symptoms) have beenobserved in gluten sensitive people. 8) Gluten is responsible for significant ill health other than celiac disease (non-celiac gluten-sensitivity or The Gluten Syndrome), such as: Ataxia Eczema Irritable bowel disease Hypotonia Developmental delay Learning disorders Attention deficit hyperactivity disorder Migraine 2 Headache Epileptic disorders Many patients with these problems respond favorably to a gluten-free diet. 9) Gluten intolerance gives rise to a variety of dermatological manifestationswhich may benefit from a gluten-free diet. 10) The smooth uninterrupted function of the body relies upon the autonomicnervous system. The sympathetic and parasympathetic pathways are driven by therespective neuro-transmitters. The regulation of the cardiovascular system, gut,bladder, uterus, and glands (pancreas, gall bladder, sweat, and saliva) all dependson this vast autonomic nerve network. There is evidence that gluten causesintestinal autonomic neuropathy. 11) Gluten-sensitivity without histological gut damage may provoke neurologicaldysfunction; such nerve damage might be through autoimmune damage. 12) Celiac disease is not a mandatory requirement for gluten-sensitivity. This iswhy more than half of patients with negative gut IgG-gliadin antibody tests reportimprovements in a variety of symptoms with a gluten-free diet. These includetiredness, lethargy, irritability, and sleep disturbance. These are likely to beneurological symptoms generated by gluten-sensitivity. 13) Evidence points to the nervous system as the prime site of gluten damage. 14) The histological gut damage in celiac disease is not mediated through thisneurologic system. It is caused by local toxicity to the bowel in susceptible people. 15) Non-gut symptoms related to gluten are mediated through neural networks. COMMENTS FROM DAN MURPHY All of my family and close friends and many patients are gluten free as aconsequence of our direction. My immediate family has been gluten free for manyyears. All of us have noticed substantial improvements in our health and we allavoid gluten like the plague. There are many excellent books of this topic. Myfavorite most recent book is Wheat Belly, by William Davis, MD, 2011. For a number of reasons, wheat has been significantly genetically modified over thepast half century. Reasons include increased crop yields, improved harvestingefficiency, and desirable palliative and baking aesthetics. Sadly, these modificationshave significantly raised modern wheats Glycemic Index and reduced thedigestibility of its gluten.