Gluten ataxia is thought to be an autoimmune disease provoked by exposure to gluten, a protein found in wheat and some other grains. Symptoms usually begin in middle adulthood (though the range of age of onset is broad), start subtly, and progress slowly. The symptoms are chronic and usually include unsteadiness and imbalance; some patients also experience dysarthria (difficulty pronouncing words). The treatment for gluten ataxia is to start and maintain a strict gluten-free diet. It can be difficult to start and maintain a gluten-free diet because it is not always clear which foods contain gluten, and also because an improper gluten-free diet may increase the risk of developing a nutritional deficiency, so most patients will get advice about this from a medical dietician or nutritionist.