Brain Blood Flow Abnormalities 

What Are Brain Blood Flow Abnormalities?

[dropcap]B[/dropcap]rain blood flow abnormalities, or cerebral perfusion abnormalities, such as spasm of blood vessels causing inadequate blood flow to the brain, are characterized by impaired brain function and thinking.

Q: What is cerebral perfusion?

A: Cerebral perfusion is the flow of blood in the brain. Blood supply to the brain comes from 4 major vessels: 2 carotid arteries and 2 vertebral arteries.

Cerebral perfusion abnormalities can be diagnosed using perfusion computed tomography (CT). CT scan is a technique that allows rapid qualitative and quantitative evaluation of cerebral perfusion by generating maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The technique is based on the central volume principle (CBF = CBV/MTT) and requires the use of commercially available software employing complex deconvolution algorithms to produce the perfusion maps.

Perfusion CT has been found to be useful for noninvasive diagnosis of cerebral ischemia (diminished blood flow) and infarction (no blood flow) and for evaluation of vasospasm (intermittent blood flow through vessels).¹

What Are Brain Blood Flow Abnormalities In Celiac Disease and/or Gluten Sensitivity?

• Cerebral perfusion abnormalities are a vascular sign of celiac disease, indicating blood vessel involvement.
• Brain atrophy causes reduced cerebral blood flow.²
• Malabsorption, especially niacin, pyridoxine and thiamin, causes brain atrophy which is a degenerative condition of the brain characterized by loss of brain tissue, causing the brain to shrink as does vitamin B12 as shown by Vogiatzoglou et al.³

How Prevalent Are Brain Blood Flow Abnormalities In Celiac Disease and/or Gluten Sensitivity?

Cerebral perfusion abnormalities are a common phenomenon, occurring in 1% of untreated patients with celiac disease.⁴

What Are The Symptoms of Brain Blood Flow Abnormalities?

Cerebral perfusion abnormalities are marked by neurological and psychiatric disorders that stem from inadequate blood supply to the brain.

These include the following:

• Brain fog.
• Irritability.
• Anxiety.
• Altered ability to interact socially.
• Impaired or altered thinking and reasoning skills that involve judgment, mathematics, memory, learning, and abstract thought.

How Do Brain Blood Flow Abnormalities Develop In Celiac Disease and/or Gluten Sensitivity?

• Cerebral perfusion abnormalities in celiac disease result from exposure to gluten.⁴
• Gluten irritates and inflames blood vessels, thus the swelling that result interferes with the amount and speed of blood flow required by the brain and hampers the capacity and ability of vessels to carry blood to brain tissue.
• Malabsorption causing deficiencies of niacin, pyridoxine, thiamin, and vitamin B12 which promote brain atrophy or shrinkage cause reduced blood flow to brain tissues.

Do Brain Blood Flow Abnormalities Respond To Gluten-Free Diet?

Yes. Celiac disease-related perfusion abnormalities normalize on a gluten free diet.⁴

6 Steps To Improve Brain Blood Flow Abnormalities In Celiac Disease and/or Gluten Sensitivity:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both brain perfusion abnormalities and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.⁵
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.⁶
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.⁶
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.⁶.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.⁶
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.⁶
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁶[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes green leafy vegetables such as lettuce and kale, also onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Some antipsychotic medications affect blood brain flow.⁷. Other medications deplete niacin (vitamin B3), pyridoxine (vitamin B6), thiamin (vitamin B1), and vitamin B12 which promote brain atrophy, a cause of impaired blood flow in the brain. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.

This is not a complete listing.

DIABETIC DRUGS 

• Metformin® depletes Vitamin B12.

CHOLESTEROL DRUGS

• Colestid® and Questran® deplete Vitamin B12.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Vitamin B12.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Vitamin B12.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) Vitamin B12.
• Prevacid®, Prilosec® deplete Vitamin B12.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.
• Tetracyclines deplete Vitamin B6.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin B6, Vitamin B12.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin B1, Vitamin B12.

CARDIOVASCULAR DRUGS

• Antihypertensives (Catapres®, Aldomet) deplete Vitamin B6, Vitamin B1.

DIURETICS

• Loop Diuretics (Lasix®, Bumex®, Edecrin®) deplete Vitamin B1, Vitamin B6.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B3, Vitamin B6, Vitamin B12..
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin B6, Vitamin B12..

MAJOR TRANQUILIZERS  

• Thorazine®, Mellaril®, Prolixin®, Serentil® and others deplete Vitamin B12.[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• B-Complex as prescribed following blood test for status.
• Vitamin B12 as prescribed following blood test for status.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration:

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Brain Blood Flow Abnormalities In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

“Frontal cortical perfusion abnormalities related to gluten intake and associated autoimmune disease in adult celiac disease: 99 mTc-ECeliac Disease brain SPECT study.” This study investigating whether gluten intake and associated autoimmune diseases may be considered risk factors in causing cerebral impairment demonstrated that the more significant abnormalities were localized in frontal regions, and were significantly different from controls only in Celiac Disease patients on an unrestricted diet. The prevalence of single-photon emission CT abnormalities was similar in Celiac Disease patients, 74% with associated autoimmune disease and 69% without associated autoimmune disease. This phenomenon is similar to that previously described in other autoimmune diseases, but does not appear to be related to associated autoimmunity and, at least in the frontal region, may be improved by a Gluten Free Diet.⁴

CASE REPORT SUMMARIES

“Gluten encephalopathy with psychiatric onset: case report.” A 38-year-old man was admitted as to our department an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and low iron anemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.⁸

Sources:

1. Hoeffner E, Case I, Jain R, et al. Cerebral Perfusion CT: Technique and Clinical Applications. June 2004 Radiology, 231, 632-644. [↩]
2. Sabri O, Erkwoh R, Schreckenberger M, Cremerius U, Schulz G, Dickmann C, Kaiser HJ, Steinmeyer EM, Sass H, Buell U. Regional cerebral blood flow and negative/positive symptoms in 24 drug-naive schizophrenics. J Nucl Med. 1997 Feb;38(2):181-8. [↩]
3. Vogiatzoglou A, Refsum H, Johnston C, Smith SM, Bradley KM, de Jager C, Budge MM, Smith AD. Vitamin B12 status and rate of brain volume loss in community-dwelling elderly. Neurology. 2008 Sep 9;71(11):826-32. doi: 10.1212/01.wnl.0000325581.26991.f2. [↩]
4. Usai P, Serra A, Marini, et.al. Frontal cortical perfusion abnormalities related to gluten intake and associated autoimmune disease in adult celiac disease: 99 mTc-ECeliac Disease brain SPECT study. Digestive Liver Disease. Aug 2004;36(8):513-8. [↩] [↩] [↩] [↩]
5. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
6. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
7. Goozée R, Handley R, Kempton MJ, Dazzan P. A systematic review and meta-analysis of the effects of antipsychotic medications on regional cerebral bloodflow (rCBF) in schizophrenia: association with response to treatment. Neurosci Biobehav Rev. 2014 Jun;43:118-36. doi: 10.1016/j.neubiorev.2014.03.014. Epub 2014 Mar 29 [↩]
8. Nicola Poloni, Simone Vender, Emilio Bolla, Paola Bortolaso, Chiara Costantini, and Camilla Callegari. Gluten encephalopathy with psychiatric onset: case report. Clin Pract Epidemiol Ment Health. 2009; 5: 16. Published online 2009 June 26 [↩]