Nutrition and Neurodegenerative Diseases: The Role of Carbohydrates and Gluten

Review Article

Int J Nutr Sci. 2016; 1(2): 1007.

Nutrition and Neurodegenerative Diseases: The Role of Carbohydrates and Gluten

Caamao D¹, de la Garza A², Beltrán-Ayala P³ and Chisaguano AM¹*

¹Escuela de Salud Pública. Facultad de Ciencias de la Salud. Universidad San Francisco de Quito

²Department of Nutrition and Food Science, University of Barcelona, Spain

³Colegio de Administración y Economía. Universidad San Francisco de Quito

*Corresponding author: Chisaguano AM, Escuela de Salud Pública. Facultad de Ciencias de la Salud. Universidad San Francisco de Quito

Received: June 01, 2016; Accepted: July 29, 2016; Published: August 01, 2016


Neurodegenerative diseases have both genetic and environmental influences. Nutrition is a non-genetic factor that has a transcendental influence on the prevention and treatment of these diseases. This review mainly emphasizes the effects of dietary gluten and carbohydrates on cognitive functions and development in most common neurodegenerative diseases. Thus, early clinical studies prove an association between high glucose levels (A1C), oxidative stress, and glycation caused by high carbohydrate diets, cognitive impairment, and brain tissue loss. Obesity and brain tissue loss linkage has been proven, using BMI and waist-hip ratio. Gluten has shown to cause inflammation and cognitive impairment because of its association with Alzheimer, Parkinson, Multiple Sclerosis, Autism and Depression. Mostly based on epidemiological and clinical data, we suggest considering this knowledge for an integral treatment of patients.

Keywords: Neurodegenerative Diseases; Cognitive Impairment; Gluten Intolerance; Carbohydrates

Neurodegenerative Diseases

Neuro-Degenerative Diseases (NDD) are pathologies affecting body functions such as balance, movement, respiration and diction. The incidence is increasing and becoming a threat of converting into a pandemic disease. NDD affect nearly a billion people all over the world, without sex, education, or income distinction. Approximately 6.8 million people die each year from NDD, plus great amounts of economic resources are invested for their treatment [1]. The economic costs associated with these diseases can be of several types. On one side, direct costs refer to those costs that are directly related to the disease manifestations, characteristics and particular needs. On the other side, indirect costs refer to those costs resulting from the limitations that the disease produces over the patient’s quality of life. Direct costs include the payment for medical care (doctors, medicines, hospitalization) and the payment for non-medical services (caregivers, home care, etc.). Most of non-medical services are provided by unqualified personnel (volunteers, friends, family members) who do not charge for their help, consequently becoming informal costs. However, from an economic perspective, these are resources that carry an opportunity costs (that could be used for an alternative purpose) which is why they also represent an economic cost. Indirect costs, on the other hand, although more complex at the time of being quantified, may achieve significant amounts for society. These costs account for the loss in labor productivity, replacement costs due to retirement and mortality costs. This group should also include the costs associated to the physical, psychological, and emotional impacts that these diseases have on patients and on their nearest environment, as well as the collateral negative effects on their life expectancy, life quality, and on their personal, social and professional development.

Within the neurodegenerative diseases, currently the one with highest incidence is Alzheimer, a chronic ailment with unknown cure, and highly incapacitating. It generally appears within people who are over 65 years old, that is to say, at the end of their productive life, and due to its slow progression, it may extend throughout time, deeply affecting the total costs. In 2015, just in the United States the total cost was estimated at $226 billion [2]. In Spain, according to the last study released in 2014, the annual total cost per patient was estimated in 6325 Euros, it can reach up to 33 and 56 billion in 2030 and 2050, respectively [3].

In many cases, Alzheimer may lead to Dementia. This disease, according to the Tenth International Classification of Mental Diseases (CIE-109) published by the World Health Organization (WHO) in 1992, is characterized by the deterioration of the memory, the intellectual capabilities and the social conduct, and by the lack of control over emotions and motivations. Although age is the major risk factor, this disease is not exclusive of the senescence but it may also be present in young individuals thus increasing the costs related to lost productivity [4]. In 2010 around 35.6 million people worldwide living with dementia and the figure is expected to double every 20 years [5]. In this way, the cost of NDD just in Europe in 2010 has been estimated at 143.000 million Euros, for dementia has been estimated at 16548 Euros and Parkinson´s disease by 11153 Euros for patient [6].

In Latin America, the costs do not vary significantly. However, the difference is that due to the lack of welfare policies, almost the entirety of costs is directly charged onto the patient and his family members. In this sense, poor people are more defenseless and unprotected against the ravages of these alterations [4].

Furthermore, Dementia is directly related to other neurodegenerative diseases. Around 30% of patients with Parkinson may present dementia [7]. Due to its incidence in the total population, this neurodegenerative disease is the most severe after Alzheimer.

Parkinson is a chronic, progressive and irreversible neurodegenerative disease that generally appears in people who are around 60 years old, producing elevated indirect costs [8]. This disease is not fatal by itself; average life expectancy of a patient with Parkinson is generally the same as the people who do not suffer from it. Therefore, direct costs for the family and for society may reach high amounts [9].

Another disease of neurological origin is depression, which, when recurrent, may become degenerative. It generates grave social incapacities and may achieve high mortality figures, making it an expensive and very costly disease for society [10]. Unlike other diseases whose prevalence is given to people over 60 years old, depression may affect people at the peak of their productive age, in the age range between 30 and 40 years old [11]. Furthermore, at the beginning of the millennium, dementia and depression were recognized as a severe public health issue. This recognition obeys not only to the high morbidity and mortality rates associated with theses, diseases, but also to the decrease in the patient’s healthy life years [11].

The high costs, both human and economic, of neurodegenerative diseases, require the urgent development of public policies that include social, economic and scientific elements, so as to prevent, address, approach and restraint the uncontrolled growth of its prevalence. In this way, the dietary components, which can prevent or promote neurologic health, are the key to future interventions for these pathologies. A healthy nutrition in childhood, adolescence and adulthood can prevent the risk of developing cognitive impairment and NDD at elder stages of life. In this way, research has described the power that nutrition has over prevention and treatment of NDD such as Alzheimer, Parkinson, autism, headaches and depression, even in genetic predisposed individuals [12-16]. The omega-3 lipids are nutrients that have shown to have protective effects [17]. Nutrition´s greatest influence is on prevention of physiological states such as inflammation or oxidative stress, which in chronic conditions, promote brain disrepair, neurodegenerative impairment, and in certain cases NDD. On the other hand, certain dietary nutrients have shown to favor states of chronicle inflammation and oxidative stress, previous stages of NDD. Epidemiological, experimental and animal research have established a close relation between high intake of carbohydrates and brain disrepair, caused by brain shrinkage [14,18], cognitive impairment [19,20], or even body weight [21,22].

On the other hand, the incidence of gluten intolerance and celiac disease has grown drastically in recent years, which can be explained by an increased use of genetically engineered foods. These genetic processes have modified food´s composition and the way body metabolizes these new processed foods [17,23]. Gluten intolerance (not synonym of celiac disease) has shown to have an influence on autism development and low brain performance, producing physiological changes in the brain [24,25].

Neurodegenerative Diseases and Diet

Neurodegenerative diseases are illnesses that affect the brain, specifically neurons. The most common symptoms caused by these diseases include malfunctions in balance, respiration, movement, reflexes, motor skills, or even in heart beat activity [26-28]. There are various risk factors that influence the incidence of NDD, these can be genetic, for example, the ApoE e4 protein on Alzheimer, or can be non-genetic factors. Nutrition is the non-genetic factor that has shown the greatest influence on NDD incidence and development [17]. The common factor in most NDD is a state of chronic inflammation, which is greatly influenced by nutrition.

The brain can suffer from inflammation, although it cannot be felt like in other tissues because the brain has no pain receptors, so its inflammation will be impossible to be detected without specific exams. Chronic brain inflammation will trigger accelerated cell death, interfering with proper chemical neuronal functions, causing cognitive impairment [29,30] and, in certain cases, it has been related to an increased risk of suffering from NDD [17,31,32]. Inflammatory processes are localized responses, which will remain activated during oxidative stress, creating a destruction and death cycle impossible to break without antioxidant defenses (Figure 1). This process starts as a body defensive mechanism, but in chronic conditions, it leads to cell impairment and death [17,31-34], the turning point in which changes from a protective mechanism into a chronic inflammation is still unknown.

Citation: Caamao D, de la Garza A, Beltrán-Ayala P and Chisaguano AM. Nutrition and Neurodegenerative Diseases: The Role of Carbohydrates and Gluten. Int J Nutr Sci. 2016; 1(2): 1007.