In the past decade, awareness of the potential harmful effects of gluten has risen exponentially within the medical community and general public. An increasing number of healthcare practitioners are recognizing that celiac disease is just one extreme manifestation of gluten sensitivity and that many other patients may unknowingly be suffering from non-celiac gluten sensitivity (NCGS). While non-celiac gluten sensitivity is most often associated with digestive system symptoms, it turns out that this disorder may have equally detrimental effects on the brain. Read on to learn about the relationship between non-celiac gluten sensitivity and the brain and how treatment of this condition may successfully reverse mental health disorders and neurodegenerative disease.
- What Is Non-Celiac Gluten Sensitivity?
- Non-Celiac Gluten Sensitivity Affects the Gut–Brain Axis
- Repairing the Gut–Brain Axis
- The Hazards of Gluten Sensitivity – Can Grains Affect the Brain?
- Gluten, Depression, and Anxiety: The Gut-Brain Link
- Gluten and Depression
- Gluten and Schizophrenia
- How Gluten Affects the Brain
- The Gut-Brain Connection
- Is gluten messing with your mind? Find out now.
- How to test yourself for gluten sensitivity
- The Difference Between Sensitivity And Disease
- A Paradigm Shift In Science
- Step 1: Prepare
- Step 2: Exclude
- Step 3: Track
- Step 4: Challenge
- Step 5: Observe
- From Meat To Wheat, From Grain To Brain
- Why You Should Run Your Own Test This Week
- Why You Need Gluten-Free
- We Know Why Gluten is Bad
- It’s All About Inflammation
- The Immune System Attacks
- Gluten is a Drug
- GMO Primes the Pump
- Testing Confirms It: For You, Me and Us
- Stop. Eating. Gluten. Now.
- Gluten Updates
- Celiac Disease and Anxiety
- What is Anxiety?
- What is the Connection between Celiac Disease and Anxiety?
- Where Can I Learn More?
What Is Non-Celiac Gluten Sensitivity?
Non-celiac gluten sensitivity (NCGS) is a chronic gastrointestinal disorder distinct from celiac disease, in which individuals experience a wide array of symptoms upon eating gluten. (1, 2) While celiac disease was long considered to be the only legitimate manifestation of gluten sensitivity, research indicates that the spectrum of gluten sensitivity is much broader than originally suspected. (3, 4, 5, 6) The term NCGS is used to designate other forms of gluten sensitivity along this spectrum. As in celiac disease, NCGS stimulates the immune system; however, NCGS has been found to stimulate innate immune activity, whereas celiac disease activates both the innate and adaptive immune systems. (7) In addition, NCGS increases CD-associated antibodies but does not cause atrophy of the intestinal villi. (8) Symptoms of NCGS improve or disappear when gluten is removed from the diet and recur if gluten is reintroduced. The diagnostic criteria for NCGS are as follows:
- Ingestion of gluten elicits rapid occurrence of intestinal and extraintestinal symptoms
- Symptoms disappear when gluten is removed from the diet and recur if gluten is reintroduced
- Wheat allergy has been ruled out
- Specific markers of celiac disease have been ruled out
- Intestinal mucosa is normal (no villous atrophy)
- Antigliadin antibodies (primarily IgG) may be positive (50 percent of NCGS patients are positive)
- HLA-DQ2 and/or HLA-DQ8 may be positive (40 percent of NCGS patients are positive)
Research estimates that approximately 18 million Americans have gluten sensitivity, a figure that is six times greater than the number of Americans who have celiac disease. (9) Despite the wealth of scientific evidence on this topic, and the astonishing numbers of people who may be affected by NCGS, there is a general lack of physician awareness of symptoms, related disorders, and testing for NCGS, and this condition remains largely undiagnosed and untreated.
While gluten sensitivity is perhaps the most frequently cited non-celiac, non-allergic reaction to wheat, it is also possible for people to demonstrate sensitivity to other peptides in wheat such as wheat lectin agglutinin (WGA), alpha-amylase trypsin inhibitors, and gluten exorphins, which are byproducts of gluten digestion that act as opioids. (10, 11, 12) Sensitivity to these peptides can cause symptoms similar to gluten sensitivity. The term used to describe this reactivity is non-celiac wheat sensitivity (NCWS).
Finally, although NCGS and NCWS are more common than is typically acknowledged, there is no evidence to support the claim that gluten causes neurological disease in people who aren’t gluten intolerant. Gluten does not affect all people in the same way. However, in those who are sensitive and susceptible, gluten can have significant effects on neurological health.
Non-Celiac Gluten Sensitivity Affects the Gut–Brain Axis
Symptoms of NCGS may be limited to GI distress, including diarrhea, constipation, and bloating; however, a growing body of research indicates that, in certain susceptible individuals, NCGS can have a significant impact on the brain. This is cause for concern, given the estimated number of people who may have undiagnosed NCGS and the dramatically rising numbers of people experiencing mental health disorders and neurodegenerative disease.
The link between gluten and mental health
NCGS appears to affect the brain by altering activity along the gut–brain axis, which is the bidirectional communication system between the enteric nervous system in the gut and the central nervous system in the brain and spinal cord. The gut–brain axis links gut function with emotional and cognitive centers in the brain. (13) Inputs that affect gut health, such as diet and the composition of the microbiome, ultimately affect brain function. Non-celiac gluten sensitivity incites inflammation in the gut and, through the gut–brain axis, can cause inflammation and dysfunction in the brain.
NCGS Can Trigger Neuroinflammation
In NCGS, gluten-triggered inflammation in the gut can instigate inflammation in the brain, referred to as neuroinflammation. Neuroinflammation has been found to play a central, triggering role in brain-related disease. In NCGS, there is a series of steps in the process that ultimately culminates in neuroinflammation and brain changes.
- Consumption of gluten triggers dysbiosis and gut inflammation and increases the permeability of the intestinal barrier.
- Increased intestinal permeability allows lipopolysaccharides (LPSs) produced by gut bacteria to leak out of the intestine and into the systemic circulation. Leaked LPSs trigger the immune system to release pro-inflammatory cytokines.
- LPSs and pro-inflammatory cytokines in the circulation cause toxins to accumulate in the blood stream, inciting systemic inflammation.
- When systemic inflammation reaches the brain, it creates neuroinflammation.
- Neuroinflammation leads to brain dysfunction, cognitive impairment, and an increased vulnerability to neurodegenerative disease.
Neuroinflammation has been associated with depression and anxiety, (14) bipolar disorder, (15, 16) schizophrenia, (17) ADHD, (18) and an increased vulnerability to neurodegenerative diseases (19). Therefore, NCGS may be an underlying cause of neuroinflammation, gradually altering the normal, healthy functioning of the brain and leading to manifestations of mental health problems and neurological disease. (20)
Gluten, Depression, and Anxiety
Non-celiac gluten sensitivity has been linked to both depression and anxiety. In NCGS, gluten may lead to depressive symptoms by inducing abnormalities in serotonin production and causing changes in the gut microbiota. (21 ,22, 23)
While there is limited research about the effects of a gluten-free diet on anxiety and depression in patients with NCGS, a longitudinal study of celiac disease patients found that a one-year-long trial of a gluten-free diet significantly improved anxiety symptoms. (24) In a small case study of patients diagnosed with celiac disease in adulthood who had previously been unsuccessful with antidepressant therapies, a gluten-free diet was found to quickly improve depressive symptoms. (25)
Gluten and Bipolar Disorder
Bipolar disorder, a mental health disorder characterized by periods of alternating elation and depression, as well as fluctuations in energy, is notorious for being resistant to conventional pharmaceutical treatment. Research has demonstrated that neuroinflammation is a common denominator in patients with bipolar disorder. (26) A growing body of evidence indicates that gluten sensitivity may be a key instigator of neuroinflammation in bipolar individuals. Several studies have found that individuals with bipolar disorder demonstrate significantly increased levels of IgG antibodies to gliadin in their blood, but not other markers of celiac disease, suggesting the presence of non-celiac gluten sensitivity. (27, 28)
In the medical community, the prevailing belief regarding schizophrenia is that it is a chronic, incurable disorder that can only be managed with a cocktail of pharmaceutical drugs. However, under-the-radar scientific evidence has been around for years indicating that gluten sensitivity may play a major role in the pathogenesis of schizophrenia. As early as the 1950s, researchers were examining the link between gluten sensitivity and schizophrenia; several studies found that schizophrenics experienced significant symptomatic improvement upon commencement of a gluten-free diet. (29, 30, 31, 32) More recently, a number of studies have demonstrated that individuals with recent-onset psychosis and multi-episode schizophrenia have increased IgG and IgA antibodies to gliadin, suggesting the presence of non-celiac gluten sensitivity. (33, 34) The mechanism by which gluten sensitivity induces symptoms of schizophrenia is through induction of inflammation in both the gut and brain, via the gut–brain axis.
Gluten and Autism
Autism may be part of the gluten-sensitivity spectrum. While research does not implicate gluten as the sole cause of autism, non-celiac gluten sensitivity appears to play a role in the gut–brain axis dysfunction characteristic of autism. (35) It is hypothesized that the opioid-like peptides formed from the incomplete breakdown of gluten leak out of the intestine, enter the systemic circulation, and cross the blood–brain barrier, detrimentally affecting neurotransmission and causing alterations in behavior. (36) Children with autism have been found to have significantly increased levels of IgG antibodies to gliadin, (37) and a gluten-free diet may produce a positive change in autistic behaviors. (38)
Gluten and ADHD
Non-celiac gluten sensitivity may also contribute to behavioral changes characteristic of attention-deficit/hyperactivity disorder. (39) A six-month gluten-free diet has been reported to improve symptoms in patients with ADHD. (40)
Gluten and Neurodegenerative Disease
Through its effects on the gut–brain axis, ingestion of gluten may also predispose NCGS individuals to cognitive decline and an increased vulnerability to neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease. (41) The systemic inflammation characteristic of non-celiac gluten sensitivity may promote the deposition of amyloid plaques and neurofibrillary tangles, phenomena characteristic of Alzheimer’s disease. (42) In addition, a recent study has concluded that intestinal dysfunction represents one of the earliest manifestations of Parkinson’s disease pathology; thus, the disease originates in the intestine and appears to spread to the brain via the gut–brain axis. (43)
Repairing the Gut–Brain Axis
To alter the progression of mental health disorders and neurodegenerative disease precipitated by non-celiac gluten sensitivity, the health of the gut–brain axis must be restored. This can be accomplished by eating a gluten-free diet, restoring the health of the microbiome, reducing systemic inflammation, and rehabilitating the gut–brain axis through vagus nerve stimulation.
Eliminate Gluten from the Diet
The fundamental basis of treatment for non-celiac gluten sensitivity is removal of gluten from the diet. Research indicates that when gluten is removed from the diets of individuals with NCGS, this can result in a complete resolution of symptoms. (44) A nutrient-dense diet that contains plentiful vegetables; some fruit; high-quality sources of animal protein; a healthy balance of fats, nuts, and seeds; and perhaps some gluten-free grains is a great framework for a balanced gluten-free diet.
Restore the Microbiome
Restoration of the microbiome is crucial in the treatment of NCGS, as long-term ingestion of gluten in individuals with NCGS can result in significant dysbiosis. Research indicates that probiotics such as Bifidobacteria and Lactobacilli, combined with prebiotics such as FOS and inulin, may help reduce neuroinflammation in NCGS by restoring a normal microbial balance. (45, 46)
Another aspect of NCGS that must be addressed is oxidative damage and antioxidant depletion. Eating an anti-inflammatory gluten-free diet is key for reducing gut and brain inflammation. However, repletion of antioxidants is also crucial. This can be done by consuming antioxidant-rich foods, which come with a “full package” of beneficial compounds that benefit our health, as well as by supplementing with certain targeted nutrients such as ubiquinone and acetyl-L-carnitine, which have been found to protect the brain against oxidative damage. (47)
Try Vagus Nerve Stimulation
The vagus nerve is a cranial nerve that links the brain to the intestine, as well as to several other key visceral organs, and is a critical component of the gut–brain axis. Two types of signals travel along the vagus nerve: afferent signals, which convey information from the gut to the brain, and efferent signals, which transport information from the brain to the gut. The vagus nerve mediates activity of the parasympathetic nervous system, the division of the nervous system responsible for “rest and digest” functions. Stimulation of the vagus nerve has been shown to reduce the body’s response to stress, decrease heart rate and blood pressure, stimulate digestion, reduce inflammation, and change the function of certain parts of the brain. (48)
Vagus nerve stimulation sends a mild pulse of electrical energy through the vagus nerve, thus activating the parasympathetic nervous system. In conventional vagus nerve stimulation, a device is surgically implanted under the skin and connected to the left branch of the vagus nerve using a wire. When activated, the device sends electrical signals along the vagus nerve. Fortunately, this invasive form of vagus nerve stimulation is no longer a necessity, as there are now a handful of noninvasive vagus nerve stimulation devices available. While not yet mainstream in the United States, these noninvasive devices have been approved in Europe for treating epilepsy, depression, and pain.
Vagus nerve stimulation may be useful for healing the gut–brain axis in non-celiac gluten sensitivity, due to its ability to downregulate stress and the inflammatory response and upregulate healing processes. Vagus nerve stimulation attenuates injury to the gut induced by lipopolysaccharides and repairs tight junctions between intestinal epithelial cells. (49) By reversing dysbiosis and sealing up the gut, systemic inflammation is reduced, and this in turn reduces neuroinflammation induced by gluten sensitivity. Vagus nerve stimulation has also been found to be effective in the treatment of depression and bipolar disorder, and emerging research suggests it may also benefit individuals with schizophrenia, autism, and Alzheimer’s disease (50, 51, 52, 53, 54); this evidence further confirms the potential of vagus nerve stimulation to repair both ends of the gut–brain axis—the intestine and the brain.
The Hazards of Gluten Sensitivity – Can Grains Affect the Brain?
Gluten Sensitivity is a term that is being heard more and more. However, what exactly does it mean? And what are the implications of being sensitive to gluten?
Celiac disease is the most commonly recognized condition associated with gluten. It is an autoimmune condition whereby gluten provokes an abnormal immune response, resulting in the body attacking and damaging the lining of the small intestine. This leads to the common digestive symptoms experienced. In addition to this, nutritional deficiencies, poor growth, weight loss and some neurological signs may also be seen.
Gluten Sensitivity Different to Celiac Disease
Gluten Sensitivity may involve different mechanisms to those involved in celiac disease and may often present with more psychological or neurological symptoms. In fact, gluten sensitivity has been shown to be a common factor, in both children and adults, with conditions such as ADHD1, ASD1, seizures2, depression3, anxiety disorders4 and schizophrenia5. Gluten ataxia, an issue involving problems with co-ordination, speech and balance, is a neurological condition involving a reaction to gluten and is becoming more recognized6.
Gluten sensitivity, sometimes referred to as Non-Celiac Gluten Sensitivity (NCGS), has been shown to be 6 times more prevalent than celiac disease 7. Some may ask why the incidence of gluten sensitivity seems to be on the rise? This apparent rise in cases may be down to several factors including an increased awareness of the impact of gluten, grains containing higher gluten content or an increase in the consumption of gluten-containing grains or products. Whatever the reason for the rise in cases, the evidence is mounting on the impact of gluten on the brain.
How Does Gluten Cause a Problem?
Gluten-containing grains such as wheat, rye, barley and spelt contain toxic protein fractions in the form of gliadins, glutenins and other prolamins. These toxic protein fractions have been shown to have wide-ranging effects on the body and may disrupt normal gut balance8 and involve the immune system in susceptible people9. Although it is commonly the protein fractions that cause a reaction in sensitive individuals, it is possible to react to other components within gluten.
During digestion of gluten compounds such as gluteomorphins, also called gliadorphins, are released. These have an opioid-like effect on the brain and have been linked to conditions such as ASD10.
The immune reaction to gluten may be complex and may, or may not, involve specific antibodies.In celiac disease there may be several antibodies present including anti-endomysial antibodies (EMA), anti-tissue transglutaminase antibodies (tTG),) or IgE mediated antibodies. In gluten sensitivity, these antibodies may be absent and there is evidence to show an increase in anti-gliadin antibodies11. Antibodies to deamidated gliadin peptides can also be raised and testing for their presence may be particularly useful in young children12. It is thought that anti-gliadin antibodies could negatively affect a protein involved in neurotransmitter release, thereby directly interfering with neurotransmitters and potentially affecting psychological function13. Gliadin itself may activate the production of chemical messengers called cytokines, which are involved in the inflammatory response, setting the stage for an increased inflammatory response14. Links have been made to increased cytokine levels and the development of conditions like ADHD and ASD15.
One interesting finding by researchers is that the gut lining of those with gluten sensitivity may be distinctly different to those with celiac disease. There does not always seem to be flattening of the villi on the gut lining and it is possible to have normal intestinal permeability16 and a healthy gut lining17 in cases of gluten sensitivity. Having said that, there is a high incidence of leaky gut in association with ASD and ADHD18.
The microbiome is known to contribute to overall gut health and play a role in immune system functioning. Their link to good health is undisputed and a direct link between the gut and brain has been established. The microbiota can send signals to the brain via several mechanisms including activation of the vagal nerve and through hormones19. An imbalance in the microbiome has been linked to several psychological issues including depression and anxiety20.
Both gluten and gliadin have been shown to disrupt the microbiome in susceptible individuals21. There is evidence to show that the use of probiotics, to restore balance in cases of dysbiosis, in ADHD and ASD gives improvements in symptoms22.
Risk factors – Why are Some People More Susceptible?
Genetics – The link between celiac disease and inherited DNA variations is well known and almost all celiacs have HLA-DQ2 and HLA-DQ8 haplotypes (A haplotype is a group of genes inherited together from a single parent). The incidence of these haplotypes in association with gluten sensitivity does exist but varies from 50%23-25 to 90%26
Microbiome transfer – Children are born with a sterile gut and are reliant upon maternal transfer of microbiota, through vaginal delivery and breast-feeding, to enable them to develop a healthy microbiome. Microbiota play a vital role in brain development and function and microbiome disruption at an early age may have long term consequences including increased susceptibility to gluten sensitivity.
Toxic load – The accumulation of toxins within the body has been linked to hypersensitivity and impaired tolerance of the immune system. One or more triggers, such as gluten, seem to provoke a reaction in those with a high toxic load27. Inherited toxic load whilst in the womb may also be a factor in children who have developed gluten sensitivity.
- Gluten sensitivity is complex and can present with different signs to celiac disease
- Gluten sensitivity has been shown to be a common factor in ADHD, ASD, depression, anxiety and ataxia
- Protein fractions in gluten may disrupt normal gut balance and involve the immune system
- Morphine like compounds released during digestion of gluten have opioid-like effects on the brain
- Gut lining health and microbiota balance may play a key role in sensitivity to gluten
- There is a genetic link to gluten sensitivity
- The high toxic load may impact on immune tolerance to gluten
Gluten poses risks for some children and adults and can have a large impact on brain functioning. It is clear that many people with gluten sensitivity get relief from many of their symptoms on a gluten-free diet. For some the benefits are within a few days or weeks, for others, it takes longer. It is also worth considering a probiotic supplement in order to restore any imbalances. If you are considering a gluten-free diet or a probiotic it is always best to work with a well-trained and experienced functional health practitioner.
Gluten can be a hazard and have a large impact on brain functioning. Avoiding gluten-containing foods can dramatically reduce both psychological and neurological symptoms.
Several years ago, parents of a lovely nine-year-old girl, Karen, brought her to see me because she had poor memory. They indicated that she had difficulty in thinking and focusing, and because of these issues she was falling further and further behind in her school work. Interestingly, they stated that at times she was fine, while clearly at other times her brain function seemed to be different. They indicated that she had difficulty keeping her thoughts together and that she became profoundly frustrated when this would occur.
Because of her significant issues with academic performance, her parents elected to home school her. Her academic testing revealed that she was functioning at or below a third grade level in a variety of areas, including math skills, reading fluency, story recall and overall academic skills. Fortunately, she had no significant medical problems in her past and her overall physical, as well as neurological examinations were entirely normal. Routine, typical blood studies were unrevealing, so I was left to reconsider her history to see if there were any clues as to what might be causing this child’s problems.
What caught my attention was the interesting fact that her problems were not constant, indicating that basically her brain was intact but something seemed to be detrimentally influencing her from time to time, causing her to have these significant issues with respect to how her brain functioned. In considering what factors change day to day in terms of someone’s exposure, certainly diet is at the top of the list.
Recognizing that gluten sensitivity (a protein found in wheat, barley and rye) is extremely common, I decided to perform a simple blood test to determine if this child was gluten sensitive. When the laboratory studies were completed, we were surprised to learn that she was profoundly sensitive to gluten. So at that point I instructed her parents to put her on a gluten-free diet. While they considered this diet to be challenging, eliminating all wheat, barley and rye from her diet, nevertheless they complied. Over the next two weeks, her parents observed a remarkable change in her cognitive function. Karen suddenly was able to focus much more readily on her school work and indicated to her parents that she suddenly noticed she was thinking much more clearly. Her parents maintained her on a gluten-free diet and over the next several months continued to notice further improvements in her school work. At the end of the school year, she was tested and her grade level equivalent for math calculation skills was 5.1, reading fluency 5.6 and story recall 8.4, which is to say, functioning at a level considered “normal” midway through the year for an eighth grader.
A brief note from her parents reported:
“Karen is completing third grade this year. Prior to removing gluten from her diet, academics, especially math, were difficult. As you can see, she is now soaring in math. Based upon this test, entering the fourth grade next year, she would be at the top of her class. The teacher indicated that if she skipped fourth grade and went to fifth grade, she would be in the middle of her class. What an accomplishment!”
Louis Pasteur stated, “Chance favors the prepared mind.” I am certainly grateful that chance favored us several years ago when Karen came to be evaluated. Because of this experience, I became deeply involved in research exploring the effects of gluten sensitivity on the brain. I learned that gluten sensitivity, known as celiac disease, is actually an extremely common human affliction. In fact, it has been described as “one of the most common human diseases.” Current studies indicate that about one percent of Americans are gluten sensitive. This is an astounding statistic when you consider that at the time of this writing, there are approximately 297,000,000 Americans. That means, about 3 million Americans are gluten sensitive. When you consider the population from birth to age five years is 23 million children, that means that approximately 230,000 of these children are gluten sensitive.
It seems astounding that a disease that is so common, is nevertheless, fairly obscure. Despite the fact that it was originally described in 1888, we still don’t hear much about it. Standard medical text books typically describe celiac disease (gluten sensitivity) as being primarily a gastrointestinal problem. I recall in medical school being taught that celiac disease was characterized by abdominal pain, abdominal distention with bloating and gas, decreased appetite, diarrhea, nausea, unexplained weight loss and growth delay in children. Newer research indicates that celiac disease can have a profound effect on the nervous system.
Dr. Maios Hadjivassiliou of the United Kingdom, a recognized world authority on gluten sensitivity, has reported in the journal, The Lancet, that “gluten sensitivity can be primarily and at times, exclusively a neurological disease.” That is, people can manifest gluten sensitivity by having issues with brain function without any gastrointestinal problems whatsoever. Dr. Hadjivassiliou indicates that the antibodies that a person has when they are gluten sensitive can be directly and uniquely toxic to the brain.
Since his original investigations in 1996, the recognition that gluten sensitivity can lead to disorders of brain function has led to a virtual explosion of scientific papers describing this relationship. Researchers in Israel have noted neurological problems in 51 percent of children with gluten sensitivity and further, describe a link between gluten sensitivity and attention deficit/hyperactivity disorder (ADHD). As authors in a recent issue of the journal, Pediatrics, stated in their research, “This study suggests that the variability of neurologic disorders that occur in celiac disease is broader than previously reported and includes softer and more common neurologic disorders including chronic headache, developmental delay, hypotonia and learning disorders or ADHD.”
The link between gluten sensitivity and problems with brain function, including learning disabilities, difficulty staying on task and even memory dysfunction, is actually not that difficult to understand. Gluten sensitivity is caused by elevated levels of antibodies against a component of gluten, gliadin. This antibody (anti-gliadin antibody) combines with gliadin when a person is exposed to any gluten containing food like wheat, barley or rye. Testing for the antibody can be performed in any doctor’s office. When the antibody combines with this protein, specific genes are turned on in a special type of immune cell in the body.
When these genes are turned on, inflammatory chemicals are created called cytokines, which are directly detrimental to brain function. In fact, elevated cytokines are seen in such devastating conditions as Alzheimer’s disease, Parkinson’s disease, multiple sclerosis and even autism. Basically, the brain does not like inflammation and responds quite negatively to the presence of cytokines. Another problem with anti-gliadin antibody is that it can directly combine with specific proteins found in the brain. Specific brain proteins can look like the gliadin protein found in gluten-containing foods and the anti-gliadin antibody just can’t tell the difference. This direct role of anti-gliadin antibody in combining with specific proteins in the brain, has been described for decades and again leads to the formation of cytokines, the chemical mediators of inflammation. This is an example of turning on genes that ultimately function in a negative way in relation to brain health and function.
Calling all HuffPost superfans! Sign up for membership to become a founding member and help shape HuffPost’s next chapter
Gluten, Depression, and Anxiety: The Gut-Brain Link
Even raisins and nectarines are labeled that way — as if they ever contained gluten in the first place. Is it a fad much like the “fat-free” hype of the ’80s?
But based on my own experience eliminating gluten from my diet, and the stories of people who struggle with chronic depression that I’ve read in the online forums I participate in, I believe the stuff can be toxic to your mood — especially if you have a sensitivity to it.
While only 1 percent of the U.S. population has celiac disease (when eating gluten triggers an autoimmune response that damages the intestines and keeps nutrients from being properly absorbed), many more may be living with non-celiac gluten sensitivity. For these folks, consuming even a small amount of gluten — a protein found in wheat, barley, and rye — causes digestive problems, drops in energy, and symptoms of depression and anxiety.
“ are the main allergens and foods that cause bad brain reactions,” writes Mark Hyman, MD, in his best-seller The Ultramind Solution. “Stopping these foods can be life-changing for the majority with brain and mood problems.”
Gluten and Depression
A small study published in Alimentary Pharmacology & Therapeutics in May 2014 demonstrated the psychological effects of gluten on people with self-reported non-celiac gluten sensitivity. In this study, 22 participants ate a gluten-free diet low in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) for a three-day baseline period, and then received one of three dietary challenges (supplemented with gluten, whey, or placebo) for three days, followed by a three-day minimum washout period before starting the next diet.
Researchers assessed the participants at the end of the study using a psychological tool called the Spielberger State-Trait Personality Inventory (STPI). People in the study who consumed gluten had higher overall STPI depression scores compared to those on the placebo diet.
The high correlation between celiac disease and depression is also telling in regards to gluten’s effects on mood. One study, published in 1998 in Psychiatric Quarterly, determined that about one-third of those with celiac disease also have depression.
Another study, published in April 2007 in the Journal of Affective Disorders, evaluated approximately 14,000 people with celiac disease and found that they had an 80 percent higher risk of depression. Swedish researchers reported in August 2011 in Digestive and Liver Disease that the risk of suicide was moderately higher in people with celiac disease.
Gluten and Schizophrenia
The first research into how gluten impacts the brain and could lead to psychiatric problems occurred more than 60 years ago with groups of schizophrenic patients.
In a study published in January 1966 in The American Journal of Clinical Nutrition, researchers calculated the numbers of women admitted to mental hospitals in Finland, Norway, Sweden, Canada, and the United States from 1936 to 1945, and the consumption of wheat and rye during the same period. They found a significant positive correlation between the increase in average annual admissions for schizophrenia in each country and the increase in consumption of wheat or wheat and rye. The reverse was also true: As gluten grain rations decreased, so did the rate of first-time admission to psychiatric institutions.
There is an increasing volume of research associating gluten consumption to schizophrenia, such as the study published in September 2013 in the The World Journal of Biological Psychiatry that found elevated levels of antibodies to the gluten protein gliadin in people with schizophrenia. Researchers compared the anti-gliadin antibodies of 950 adults with schizophrenia to those of 1,000 healthy controls. The odds of having anti-gliadin antibodies was 2.13 times higher in schizophrenics, indicating the possibility of an adverse reaction to wheat proteins among this population.
In a study published in January 2011 in Schizophrenia Bulletin, researchers discovered that people with schizophrenia have higher than expected antibodies related to celiac disease and gluten sensitivity.
How Gluten Affects the Brain
So what is the link between gluten and psychiatric disorders? How might wheat impair the brain? That’s what I find most fascinating.
In 1979, Christine Zioudrou, PhD, and her colleagues at the National Institute of Mental Health found that gluten contains polypeptides, or protein fragments, that are able to bind to morphine receptors in the brain — the same receptors that the polypeptides in opiate drugs bind to. They dubbed them “exorphins,” short for exogenous morphine-like compounds, distinguishing them from the endorphins (also morphine-like compounds) that we produce internally and occur, say, during a runner’s high. These receptor sites impact the degree of pleasure and reward we feel and, because of the withdrawal effect, alter brain chemistry. They can have a distinct effect on mood.
According to William Davis, MD, author of Wheat Belly, researchers speculate that exorphins might be the active factors in wheat that caused the deterioration of schizophrenic symptoms in a famous study led by F. Curtis Dohan, MD, during his time at the Veteran’s Administration Hospital in Coatesville, Pennsylvania. “Wheat, in fact, nearly stands alone as a food with potent central nervous system effects,” Dr. Davis writes. “Outside of intoxicants such as ethanol (like that in your favorite merlot or chardonnay), wheat is one of the few foods that can alter behavior, induce pleasurable effects, and generate a withdrawal syndrome upon its removal.”
The Gut-Brain Connection
In people with celiac disease, gluten causes intestinal dysbiosis, a condition in which the gut bacteria are out of balance. As I’ve written about before, gut bacteria can certainly impact mood — so much that our gut is sometimes dubbed our second brain. In some people, gluten could also erode the gut lining when certain foods enter our bloodstream: Our immune system, responding to an attack by a foreign object, sends an SOS message through our nervous system, which can generate symptoms of anxiety and depression.
Basically, gluten triggers inflammation, and the response to that inflammation can affect different organs and tissues, all of which impact mood. A damaged intestinal wall also means that we are not properly absorbing essential nutrients, especially those critical to mood, like zinc, the B vitamins, and vitamin D.
Finally, if our intestines are unhealthy, that means we’re not manufacturing as much serotonin, since 80 to 90 percent of serotonin is produced in our gut nerve cells. Gluten could also limit the production of tryptophan, an amino acid that is the precursor of serotonin.
I eliminated gluten from my diet two-and-a-half years ago and noticed a substantial improvement in my mood — but it didn’t happen instantly. It took as long as nine months to reap all the benefits. Now that I’m gluten-free, I’ve become much more sensitive to it and can feel its effects almost immediately: anxiety, brain fog, and death thoughts.
Fad or no fad, I’m a believer in gluten-free!
Join Project Hope & Beyond, the new depression community.
PHOTO CREDIT: Helmut Seisenberger/Getty Images
Is gluten messing with your mind? Find out now.
How to test yourself for gluten sensitivity
Maria Cross MScFollow Jun 27, 2018 · 9 min read Source
Sometimes you crave the very foods that are making you ill. These foods can mess with your mind, as well as your body. Of all potential food felons, there’s nothing quite like gluten. This protein can trigger a broad range of symptoms and conditions, from gastrointestinal pain to schizophrenia. Most commonly, it can cause depression, headache, anxiety, insomnia, fatigue and a “foggy” brain.
As a nutrition consultant throughout the 1990s and 2000s, I regularly saw many of these symptoms in my clients. And I lost count of the times that they disappeared after gluten was removed from the diet. It normally took less than a week to conclude that gluten sensitivity was the problem.
Here’s how you can test yourself for gluten sensitivity in just seven days. But first, some context.
The Difference Between Sensitivity And Disease
Gluten is the name of a group of proteins found within certain grains, namely wheat, rye and barley. Gluten sensitivity is not the same as celiac disease, or wheat allergy, which until recently were the only gluten-related conditions recognised by the medical community.
Perhaps that’s why so many people choose to look elsewhere for help. Simon, a 29 year-old managing director, came to see me with various health problems, the main ones being lack of energy, depression, poor concentration and anxiety. He also had a history of gastroenteritis, and regularly experienced bloating and indigestion.
This looked to me like a classic case of gluten sensitivity, especially when I saw his food questionnaire. In response to the question “What food or drinks would you find hard to give up?” he wrote: “pasta and sandwiches”.
The good thing about paying for advice is that you are more likely to take it. I had no trouble persuading Simon to do the exclusion/challenge test, described below. I saw Simon three weeks later, and sure enough he had tested positive for gluten sensitivity.
He was astonished by the changes he saw in himself, within just a few days. His anxiety and depression had vanished, and his concentration and energy levels were “much better.” He said he felt really good off gluten, but “groggy” when he ate it again as part of the challenge.
Simon already knew he didn’t have celiac disease or a wheat allergy, because he’d tested negative to both conditions. Celiac disease is a debilitating autoimmune disease caused by damage to the small intestine by gluten. It results in malabsorption and symptoms that can affect the whole body. Wheat allergy is an allergic reaction to wheat gluten, and can take many forms, from swelling of the mouth to hives, headaches and diarrhea.
Until very recently, gluten intolerance (or sensitivity) was considered the preserve of the “worried well”, an attention-seeking trend outside the peripheral vision of medics. After all, bread is a staple food, and wheat is a natural plant food that grows in fields, not factories.
The only diagnosis you were ever going to get was a self-diagnosis; the only treatment available was the one you self-administered, as best you could. But now the concept of gluten sensitivity is gaining traction within the scientific community, with the emergence of irrefutable evidence. It has even been given a medical term: non-celiac gluten sensitivity (NCGS).
A Paradigm Shift In Science
The “classical” presentation of NCGS is, indeed, a combination of gastro-intestinal symptoms including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations including disorders of the neuropsychiatric area such as “foggy mind”, depression, headache, fatigue, and leg or arm numbness.” — Gluten Psychosis: Confirmation of a New Clinical Entity
In 2018, researchers published a disturbing case history in the journal Nutrients. They told the story of a 14-year-old girl who in 2012 developed psychosis, after recovering from a fever. Her symptoms included headache, irritability, crying episodes, apathy and trouble concentrating. Her teachers confirmed that her school performance had deteriorated.
The child was referred to a local neuropsychiatric outpatient clinic, and treated with the psychoactive drug benzodiazepine. It had no effect, and her mental health deteriorated with the onset of complex hallucinations. At the same time, she developed gut problems: bloating and severe constipation.
After months of tests, misdiagnoses, scans, a lumbar puncture and several hospitalizations for psychotic episodes, her symptoms not only remained a mystery, they got worse. By September 2013, she was experiencing severe abdominal pain together with depression, “distorted” and paranoid thinking, and suicidal thoughts.
Two months later, a nutritionist was consulted — not for the child’s psychiatric symptoms, but for her gastrointestinal problems. A gluten-free diet was prescribed, and within a week both intestinal and psychiatric symptoms “dramatically improved”.
An exclusion/challenge test confirmed that she was gluten intolerant. This test is considered the “gold standard” method of determining food sensitivities, as blood tests are notoriously unreliable. Her mother reported that, after remaining on a gluten-free diet, her daughter had returned to being a “normal girl”.
The gold standard test is straightforward and reliable. If you have a combination of gastrointestinal and neuropsychological symptoms, it is well worth a punt. You won’t be missing out on anything: gluten grains have low nutritional value, and offer nothing that can’t be obtained from better sources.
There are a number of variations on the exclusion/challenge theme, but I’ve always found this particular system to work well. Others recommend an exclusion period of 2–4 weeks, but from experience I know that after a week, people are prone to slipping up and accidentally ingesting something containing gluten. Plus, I’ve always found a week to be perfectly adequate in terms of results.
Here’s how you can run your own gold standard test, in five steps.
Step 1: Prepare
You are preparing to exclude gluten from your diet for a period of 7 days. Have a kitchen clear out. This test only works if you scrupulously avoid any and every food that contains gluten. If it slips into your diet, you’ll have to start again.
Here is where you’ll find gluten:
- Wheat, and wheat species: spelt, kamut and durum flour.
- Wheat derivitives: semolina, couscous, bulgar
- Rye and rye products
- Rye and barley products
- Products made from wheat, including bread, cakes, biscuits, savory snacks, croissants.
Bear in mind that processed foods — anything in a can, plastic box, jar or tube may contain gluten. Check labels — or better still, cook all your meals from scratch and avoid processed foods. It’s only a week!
As a rule, I am not a big fan of cereal grains in any form. They have low nutritional value and can play havoc with blood sugar. But I understand that for many people, giving up all starchy foods, all at once, is way too ambitious. In any case, for the time being you just want to know if gluten is your nemesis.
So feel free to include, in your diet:
- Buckwheat (despite its name)
*Oats are not gluten grains, but can become contaminated if grown near wheat or other gluten crops. Therefore seek out oat products that state on the packaging that they are gluten-free.
Step 2: Exclude
Avoid all gluten foods strictly for seven days. Don’t forget, you can still eat plenty of protein foods — meat, eggs, fish, dairy, nuts and beans, as well as fruits and vegetables.
Step 3: Track
I’ve always found it helps to keep a symptom diary. Write a list of all your common symptoms, and cross them off as they vanish over the course of the week. You may start noticing changes straight away.
Step 4: Challenge
On day 8, you get to eat a portion of your favorite gluten fix. You might choose a sandwich, or a small bowl of pasta. Whatever you miss most. It could be your last! But only have one dish.
Tip: it’s a good idea to do this challenge on a day when you are at home. If you do have gluten sensitivity, you might experience all your old symptoms at once, so be prepared and only have one portion.
Step 5: Observe
Watch what happens. If you are gluten sensitive, your symptoms will return and you will know about it. Obviously, if you get a reaction, you should continue to exclude gluten from your diet.
As you might guess, this test is useful for identifying any food intolerance, aside from gluten, so you can repeat it with any food that falls under suspicion. These foods may include eggs, chicken, dairy, nuts, and soya beans.
If you do find you’re gluten sensitive, at least now you know. But why?
From Meat To Wheat, From Grain To Brain
Wheat, rye, barley…. These are all natural grains, not fake industrial foods. So how can they wreak such havoc on mind and body?
The answer is that all cereal grains are relatively new components of the human diet. Until around 10,000 years ago, there was no agriculture, and therefore no cultivation of grains. In Britain, we were hunter-gatherers until about 7,000–8,000 years ago. Cereals grew wild, and any consumption was opportunistic rather than habitual. Farming eventually spread across the globe and cereals became the main staple food.
After three million years of evolution based on a diet of meat, fish, nuts, fruits and vegetables, with the odd variation, the human genome has simply not had time to adapt to this whole new menu. Wheat has been bred well beyond its wild origins to maximize the gluten content. Gluten makes bread more doughy and elastic, so high-gluten wheat offers significant benefits to food manufacturers, even if it comes at a cost for the rest of us.
The effect of gluten is so powerful that the term gluten-psychosis has been coined, as described in the paper Gluten Psychosis: Confirmation of a New Clinical Entity. One theory is that NCGS is caused by intestinal permeability, or “leaky gut” which allows gluten proteins to leak into the blood, then cross the blood-brain barrier and enter the brain.
This is a highly plausible theory — I wrote about leaky gut in a previous article, and about how damage to the gut lining can allow all manner of food particles and undesirable elements to cross into the blood. Once there, they can travel to every part of the body. We know that about a third of patients with celiac disease suffer from depression and other psychiatric syndromes. Depression is not the only possible outcome.
“An overlap between the irritable bowel syndrome (IBS) and NCGS has been detected, requiring even more stringent diagnostic criteria. Several studies suggested a relationship between NCGS and neuropsychiatric disorders, particularly autism and schizophrenia.” — Gluten Psychosis: Confirmation of a New Clinical Entity
Who knows how many people are affected by NCGS without knowing it. It is estimated that the prevalence of NCGS among people with irritable bowel syndrome is about 28%. Women seem to be affected more than men.
Why You Should Run Your Own Test This Week
The researchers who described the case history of the 14-year-old child concluded their paper by saying:
“Until a few years ago, the spectrum of gluten-related disorders included only CD (celiac disease) and wheat allergy, therefore our patient would be turned back home as a “psychotic patient” and receive lifelong treatment with anti-psychotic drugs.” — Gluten Psychosis: Confirmation of a New Clinical Entity
It really is quite unnerving, and desperately sad, to think of all the gluten-sensitive people for whom anti-psychotic drugs have indeed been their only, lasting treatment. Even today, there must be countless people needlessly being turned back home, facing a lifelong future of anti-psychotics.
Don’t be one of them.
Why You Need Gluten-Free
After you read this, you’ll want to know more including the how’s and why’s of a gluten-free lifestyle. Don’t miss the world’s first Gluten Free Summit, a FREE, ONLINE event taking place from November 11-17, 2013, that gathers 29 of the world’s experts and opinion leaders to discuss the topics of gluten-related disorders, nutrition and healthy living. If you don’t have time to listen, then you can download the transcripts! Sign up here.
“You should consider eliminating all gluten and dairy from your diet for three months.”
Those words hung in the air like an alien spacecraft hovering between us.
When I had the good sense to consult a naturopath after my diagnosis with postpartum thyroiditis, this was the backbone of her recommendation to me. To me, as a psychiatric fellow, 9 years into my medical training, gluten had no relevance to the non-celiac population.
Celiac disease was a rare and unfortunate affliction that made living a “normal” life impossible because of the strict prohibition on, what seemed to me at the time, all food. Raised on classic Italian pastas, lasagnas, and paninis, and a NYC pizza and bagel-ophile, I honestly couldn’t conceive of what I would eat. Fast-forward five years, several hundred medical journal articles, conferences, seminars, and a personal health revolution later, and I am now convinced of the imperative for all people to eliminate this inflammatory food from their lives. I plan to detail – be forewarned: science to follow – the information that made me change my tune on this seemingly innocuous, but quite ubiquitous “food.” Here’s the goods in 1500 words:
We Know Why Gluten is Bad
Sometimes, as I read a medical paper, I get this euphoric rush that makes time seem to slow down (nerd alert). I grip the pages a bit tighter and I savor what is to come because I know that I am experiencing paradigm-shifting information, first hand. When I read this paper by Alessio Fasano in 2011, I knew the processed food industry was going to have to think fast to get out from under this knowledge. In a feat of scientific brilliance, he connected the dots for us and explained the following:
- The gut does more than absorb food – it is the barrier determinant of self and non-self that educates the immune system. Here is where our bodies learn about what to attack, and where they can be miseducated about attacking themselves (autoimmunity).
- The trafficking of macromolecules across the gut barrier requires a facilitator – a doorman who lets them through. This agent is called zonulin and opens the spaces or tight junctions between gut cells.
- Zonulin is triggered by gliadin which is the protein found in the grains wheat, rye, and barley. This triggering occurs in 80% of the population based on hereditary haplotypes.
- There is reason to suspect that prolamine grains including the above and corn, sorghum, and oats (called this because of their high proline and glutamine content) may all play a role in triggering these dynamic gut changes. Cross-reactivity and stimulation of alpha gliadin by foods like dairy, oats, corn, millet, and even instant coffee was examined in this study suggesting that those with limited clinical improvement on a gluten free diet (but with positive antibodies) should also consider broader eliminations.
- Immune activation is mediated by changes in gut permeability and blood brain permeability. Essentially, once local inflammation is kicked off and the door to the blood stream is opened, the immune system responds. This permeability also allows for the passage of toxins from bacteria called lipopolysaccharide that may play a significant role in depression.
The nature of this immune response is becoming better elucidated. Here are some important conceptual players:
This is an immunologic concept that appears to lie at the root of a lot of what ails us in this world full of foreign particles. The immune system reacts to unknown/novel compounds through the innate system, which is mediated by white blood cells including macrophages and dendritic cells, complement cascades, natural killer cells, and cytokines. This arm of the immune system instructs the “learned” or adaptive system, which employs B cells and T cells to build antibodies that continues to re-recognize the offending agent.
The Immune System Attacks
Once gliadin peptides in gluten have breached the gut mucosa, they can stimulate production of an array of antibodies and other tissue impairing agents:
- Alpha/beta, gamma, and omega gliadin antibodies
- Endomesial tissue antibodies
- Tissue transglutaminase: Tissue transglutaminase is an enzyme that plays an important role in presenting gliadin to B and T cells to be marked for antibody production. This enzyme is tagged as part of the complex with gluten and becomes a target of the immune system. Importantly, transglutaminase 6 is active in the central nervous system and appears to mediate the neurologic effects of gluten intolerance including depression, seizures, headaches, multiple sclerosis/demyelination, anxiety, ADHD, ataxia, neuropathy as discussed here and here. Importantly, transglutaminase deposits accumulate in blood vessels including the blood brain barrier.
- Synapsin, GAD (glutamic acid decarboxylase), and gangliosidee: 51% of the Celiac population develops neurologic or psychiatric dysfunction, and significant percentages of neurologic diseases such as ataxia, seizures, and neuropathy are found to be driven by and resolved by gluten exposure. One study found that 27% of schizophrenics had gliadin antibodies. Once again, molecular mimicry is at the foundation of gliadin-reactive antibodies that target cellular components of the nervous system influencing neurochemical transmission. Neurological manifestations most often present in the absence of any report of gastrointestinal symptoms.
- Thyroid autoantibodies: Autoimmune thyroid disease occurs in unexpected frequency in Celiac patients leading researchers to identify shared pathology to these two conditions. Molecular mimicry and amino acid motif overlap in gliadin and the thyroid enzyme peroxidase and protein thyroglobulin may trigger cross-reactivity in the setting of intestinal permeability and immune response to gluten. Tissue transglutaminase antibodies also bind thyroid tissue causing gland destruction and recruitment of the immune system for repair. The inflammatory cytokine IL-15 is a shared mechanism for immune reactivity in Celiac disease and Hashimoto’s thyroiditis and is thought to drive inflammation that is furthered by poor selenium absorption when the gut lining is compromised. Selenium is not only integral for thyroid hormone function, but is also an antioxidant that does damage control in the setting of oxidative stress.
Gluten is a Drug
Independent of the brain effects already discussed, gliadin peptides may travel through the blood stream can stimulate opiate receptors in the brain resulting in their being termed gliadorphins. The effects of this stimulation may have wide-ranging psychiatric manifestations, not the least of which is the addictive potential of these foods. Those eating high gluten diets can expect to undergo 1-3 weeks of withdrawal symptoms upon cessation. This type of a relationship with a food raises flags for this psychiatrist!
You may have sprinkled wheat germ on your cereal for a little health boost or even been recommended sprouted grain bread as a wellness intervention sanctioned by gurus everywhere. These foods contain the highest and best-studied levels of lectin, an anti-nutrient and partner in crime to gliadin peptides in wheat, barley, and rye, but present in many foods and most in grains, legumes, and dairy (and notably genetically modified foods designed to increase lectin content for pest control). They are the plant world’s natural defense, the thorn on the rose meant to inspire regret in those who deign to feast on them. Lectins promote intestinal inflammation and permeability, and then cause wide-spread and varied organ damage by binding with sugars in body tissues. Lectins can be minimized but not eliminated by processing/preparation of grains and beans, and is one of the reasons white rice is recommended over brown.
GMO Primes the Pump
One of the primary reasons that I, and many educated others, believe that genetically modified foods are the death by one thousand cuts of modern man is because of their impact on the gut. Bt-toxin and glyphosate are two poisons heavily employed in the production of genetically modified crops. Bt-toxin is used in corn as a “natural” pesticide the American public has been assured does not affect the human body. Its perforating effects on insect digestive tracts does not appear to be limited to these pests, as this toxin has been found in fetal circulation (implying that it obviously violated the gut barrier of pregnant women consuming these products).
Herbicides such as the heavily employed RoundUp, have now been revealed to have active bacteria-killing and inflammatory effects in our guts, changing our microbiome with every dose we consume.
Vegetable oils, soy, corn, and animals consuming corn are a ubiquitous part of the modern diet that likely perpetuates gut dysfunction that then facilitates the immune-based effects of gluten exposure.
Testing Confirms It: For You, Me and Us
The limitations of currently available conventional testing are very real as most physicians who do a “Celiac panel” are only testing for alpha gliadin, tissue transglutaminase 2, and endomesial antibody. As discussed above, in a grain consisting of 6 sets of chromosomes, capable of producing greater than 20,000 proteins, this testing may just be too small a window into a very complex space.
Some degree of gluten reactivity is thought to occur in up to 80% of the population and is driven by shared and distinct immune response mechanisms. Response to gluten free diets in placebo-controlled trials and inflammation in the guts of non-Celiac patients, even without gliadin antibodies (such as in this study of exposed non-Celiac patients) argues for the universal effects of this food, and the individuality of our immune responses accounting the variations in severity and presentation. This paper is an incredible review and is named on my desktop, “The Mother of all Gluten Papers,” if you’d like to delve into the topic and references.
Celiac incidence has increased more than fourfold in the past 50 years which may be attributable to the increased gluten content of wheat secondary to hybridization techniques, increased consumption, combined exposure to a number of environmental toxins, and associated microbiome changes.
As Sayer Ji of GreenMedInfo.com discusses here, it is possible that Celiac Disease is an adaptive, symptom-producing response to an environmental toxin we, as a species are not meant to consume. The rest of us are having vague, cumulative malaise and immune-mediated effects that we have more difficulty associating to the source – consuming grains. I’m here to help expedite your healing.
Stop. Eating. Gluten. Now.
There are many wonderful and freely available guides to converting to a gluten free life, but the basic principle is to eliminate rye, barley, wheat, and unspecified oats. The difficulty is in identifying the hidden sources of gluten in sauces, condiments, soups, and flavorings. Essentially, going gluten-free should mean eliminating processed food from your life, which is why I have a low threshold to also recommend elimination of co-reactive foods like dairy (casein), corn, soy, and in some cases legumes (including peanuts), and gluten free grains like rice and millet. After gut healing, quinoa, amaranth, and buckwheat may be less stimulatory as they are technically dicots and may not overlap as much with monocot grains. For emergencies, the enzyme DPPIV is available over the counter and may help aid in the digestion of gluten grains with “accidental” exposure.
Environmental Working Group has a great guide to pesticide free shopping. See the Non GMO Shopping guide, available online and as an app, to help avoid genetically modified foods.
Armed with this information, I’m hoping that those suffering from neurologic, psychiatric, gastrointestinal, or otherwise undiagnosable health concerns might consider this palliative intervention. It may be the last prescription you’ll ever need.
This post first appeared on The Healthy Home Economist.
Symptoms of gluten sensitivity are not always limited to physical manifestations- as research has suggested, various levels of gluten sensitivity can be attributed to psychiatric and neurological conditions, both due to the immune responses triggered by gluten, and due to the stress that is often experienced alongside attempting to maintain gluten-free diets.
Gluten anxiety is something that is prolific in the gluten-free community, due to the numerous and subtle obstacles to gluten-free diet maintenance. Through GluteGuard testimonials and discussions with our community members, it has been revealed that gluten-sensitive individuals find that obstacles to gluten-free diet compliance include:
- Improperly labelled foods
- Misconceptions of or lack of knowledge about gluten-free needs in the food and catering industry
- Language barriers when travelling
- Embarrassment, social or career pressures
Individuals with severe levels of gluten sensitivity often report symptoms of anxiety and depression both before and after beginning a gluten-free diet. This can be due to the symptoms attributed to an undiagnosed or undiscovered gluten-related condition, and, with the introduction of a gluten-free diet, diet compliance-related stress and anxiety. As it was demonstrated in a 2016 study, 91% of gluten-sensitive individuals experience gluten exposure at least once per month, with over half being unaware that they had consumed gluten until they experienced symptoms. The vigilance required to sidestep risks such as cross-contamination can take a psychological and emotional toll on a gluten-sensitive individual’s wellbeing- it is unsurprising that many people avoid eating out or travelling!
GluteGuard may be a helpful tool for assisting those with diagnosed gluten-sensitivity, helping to minimise the chances of experiencing the symptoms associated with accidental gluten-ingestion. GluteGuard is intended to assist with the maintenance of the gluten-free diet, and is not a replacement for one. With a reduced risk of symptoms, there may come reduced feelings of anxiety, and an improvement to emotional wellbeing.
Comments such as below- as disclosed by GluteGuard user, Kim- demonstrate the positive influence that GluteGuard can have, not only for gluten-free diet compliance but for greater personal wellbeing!
“My 24 year old son has gluten intolerances and would not eat out at cafes or restaurants for fear of gluten cross-contamination. I purchased some GluteGuard in the hope that we could change this behaviour and its been a lifesaver. He still adheres to a strict GF diet, but can now eat a GF meal out and take the GluteGuard in case of contamination. It really has given him more options socially. Thank you very much” – Kim, AUS.
Contributor: Georgie, Glutagen.
Recent studies have documented a link between celiac disease and several mental health conditions, including anxiety and depression. Anxiety and depression can even be the primary symptoms that lead to a diagnosis of celiac disease.
“In the clinic, we tend to see that patients have a variety of symptoms and a common occurrence is anxiety and depression together,” says Danielle Arigo, PhD, assistant professor of psychology at Rowan University in New Jersey.
What gets tricky is that some symptoms of anxiety and depressive disorders can be the same, Arigo says. These symptoms—especially fatigue, sleep disorders and headache—can also overlap with symptoms associated with celiac disease.
Whether anxiety is more common in people with celiac disease than in the general population has been the subject of several recent studies. Many of these studies have reached differing conclusions, in part due to different comparison populations, says Benjamin Lebwohl, MD, a celiac expert at the Celiac Disease Center at Columbia University in New York.
For example, compared to the general population of healthy adults, people with celiac disease are more likely to report symptoms of anxiety and depression. But compared to people with other chronic conditions apart from celiac disease, there might not be a difference.
Lebwohl says it doesn’t matter, as it is important either way. “Enough people with celiac disease are living with anxiety,” he says.
Stressors in Celiac Disease
Experts have a number of theories—none of them mutually exclusive—for the co-occurrence of anxiety and celiac disease.
Nutrient deficiencies as well as imbalances in the gut biome or the gut-brain connection could play a role.
Other contributors include feeling sick or fatigued in the months and years before a celiac diagnosis, says Shayna Coburn, PhD, assistant professor of pediatrics and psychiatry & behavioral sciences at Children’s National Health System Celiac Disease Program in Washington, D.C. “The stress of not feeling well and not knowing why, or dealing with embarrassing and unpredictable gastrointestinal symptoms can be a significant source of stress and anxiety,” she says.
On top of that, managing a chronic disease and a new diet introduces yet another set of potential stressors.
“Gluten is everywhere, and the risk of cross contamination is a constant presence,” Lebwohl says. “Particularly among those predisposed to anxiety, this can become a focal point of one’s anxiety.”
In fact, the fear of cross contact can be so strong it can prevent one from dining out, resulting in a gradual closing off of one’s social life. Others might develop a fear of close relationships, concerned that friends will not understand or will be easily frustrated. Some people may even avoid intimacy, including kissing, because of potential exposure to gluten. Children (or their parents) may be fearful of the school environment because of gluten-filled lunch boxes, snack tables and classroom celebrations. Some people, particularly those whose celiac disease wasn’t confirmed by biopsy, may cut out multiple foods in hopes of avoiding symptoms, bordering on disordered eating, Lebwohl says.
But perhaps the most universal experience for those with anxiety and celiac disease is a worsening of their anxiety after inadvertent exposure to gluten—aka, a glutening.
Anxiety After Getting Glutened
Erin’s anxiety is at its worst when she knows—or suspects—that she’s been accidentally glutened. It happened last summer while she was on vacation in Mexico with her boyfriend. For several days, she’d successfully navigated the buffet, sticking to the plain chicken, white rice and steamed veggies. But on the third day, something was different about the veggies. “I took a bite and could tell they weren’t just steamed in butter, as before.” There was the unmistakable flavor of malt vinegar—not safe on a gluten-free diet.
Despite trying to keep calm with deep breathing techniques, Erin’s thoughts were racing. Before long, she was in the throes of a panic attack. She was so overcome by fear she couldn’t speak to her worried boyfriend.
“I was totally paralyzed and ended up throwing up,” she says. “I don’t know if the panic attack caused me to be sick or if the gluten upset my stomach. In a twisted way, I was relieved to have it out of my system, even though I know that’s not healthy or even a reliable way to get ‘rid’ of accidental gluten.”
The episode set her back—she found herself not wanting to go out and declining social invitations—but with the help of her therapist, dietitian and prescription anxiety medication (taken as needed for stressful situations), she has been able to resume an active social life. “Most of the time I’m able to relax and enjoy myself and be present with my friends,” she says.
But for Marta,* a teacher from New York diagnosed with celiac disease four years ago, a bad glutening led to a major setback.
Following a mix-up at a restaurant—a gluten-containing dish was mixed with a regular dish—Marta refused to step inside a restaurant for over a year. Finding safe foods became a preoccupation, and, eventually, she limited herself to just five ‘safe’ foods.
Recent research has shed light on the burden of gluten-related anxiety. A 2018 study showed people with celiac disease who report the strictest dietary vigilance also report lower quality of life. Of the 50 adults and 30 teens in the study, 19 met study criteria for “extremely vigilant,” meaning they dined exclusively at celiac-friendly restaurants, asked thorough questions of staff when dining out, avoided all potential sources of cross contact at home, and carefully studied food, medication and supplement labels. Compared to their less vigilant counterparts, the adults who were extremely vigilant reported significantly lower quality of life, due to more limitations and worsened mood.
“We need to acknowledge that even though a gluten-free diet is essential for celiac disease, it comes at a cost, and for some that cost includes a decreased quality of life,” Lebwohl says.
Separate research, also published in 2018, linked anxiety with intestinal health in celiac disease. In this study, researchers in Sweden looked at anxiety and depression in people with celiac disease who were undergoing a second biopsy to check for healing of the intestine. Researchers found that those who healed were more likely to subsequently develop anxiety and depression. And in the reverse, people with anxiety and depression were more likely to heal.
Researchers have two explanations: First, those with the strictest dietary adherence might be at increased risk of anxiety because of all the precautions they feel they must take. Second, individuals with anxiety and depression may be more careful with the gluten-free diet and, therefore, more prone to heal.
One final study from 2018 suggests there may be important links between mental health, dietary adherence and celiac symptoms. This study showed that people without depression recognize a clearer link between poor dietary adherence and physical symptoms of celiac disease compared to people with depressive symptoms.
“It appears depression might cloud the relationship between avoiding gluten and physical symptoms,” explains Lebwohl, who was part of the research team on each of these three studies.
Further research is needed but results could one day suggest screening for depression in people experiencing recurrent celiac symptoms.
Help Is Available
If someone is struggling, they might start by looking for support from a close family member, friend, counselor or support group, Coburn says. The most important thing is to talk to someone who hears and understands your struggles, even if they can’t fix the problem, she adds.
“Celiac support groups can be wonderful to connect with people going through similar challenges,” she says, with the caveat that online communities can sometimes exacerbate anxiety. “Sometimes people end up feeding off one another’s worries.”
If anxiety is preventing you from having the life you want, seek professional treatment, Arigo says.
Treatments vary, but experts often recommend cognitive behavioral therapy (CBT). In CBT, people learn new and more effective ways to think and act.
“If someone is fearful of attention in a restaurant, we’ll rehearse a likely conversation you’d have in the restaurant in the privacy of the office,” Coburn says. “Eventually we’ll go in-person to a casual restaurant and ask one question but not order any food.” At the same time, relaxation strategies like deep breathing and visualization will be used to help manage anxiety.
“Over time, we build confidence and skills to self-advocate and navigate the restaurant experience,” she says. “The focus is teaching the body to calm down and to let go of tension while finding ways to think and act differently in those situations that scare a person the most.”
Medications can be used in conjunction with CBT. So can newer therapies, such as eye movement desensitization and reprocessing (EMDR)—a form of psychotherapy to help heal the symptoms of emotional distress.
“Don’t underestimate the importance of sleep, exercise and diet,” Burkhart emphasizes. “If you’re not sleeping well for any reason, anxiety will be worsened. Exercise can help with both anxiety and depression. When it comes to diet, many people find sugar and caffeine exacerbate anxiety.”
Lebwohl stresses the importance of working with an expert dietitian right away. “We know anxiety and depression can interfere with quality of life, as well as the process of adhering to a healthy diet that is free of gluten but not overly restrictive,” he says. “An expert dietitian can help patients achieve that balance of maintaining a safe gluten-free lifestyle that maximizes quality of life.”
Erin admits that for her, the dial is constantly moving—sometimes she’s more vigilant, other times less so. But when things feel too out of kilter, she leans on her dietitian, therapist and good friends. “I’ve learned I need to periodically check in with myself and ask—how am I coping?”
Getting Help for Celiac-Related Anxiety
Consult a mental health professional—psychotherapist, psychologist, licensed clinical social worker, counselor or psychiatrist—who is familiar with chronic illness, celiac disease or gastrointestinal health. Gastrointestinal centers are starting to embed therapists on site so you can talk to them at your doctor’s appointment, says Danielle Arigo, PhD. “This integrative model is the future of care.” Therapists can also be found in the searchable database on psychologytoday.com.
Consult a dietitian who is knowledgeable about gluten issues and celiac disease. To find an expert dietitian, visit Gluten Free Dietitian. In addition, visit the Academy of Nutrition and Dietetics’ database; select “gluten intolerance” in the search menu.
Contributor Christine Boyd, former health editor of Gluten Free & More, is a health policy analyst in Baltimore, Maryland.
Celiac Disease and Anxiety
What is Anxiety?
Anxiety is the body’s way of helping us cope and react to stress. Positive stress, called eustress, is a form of anxiety that affects mostly everyone. People typically experience this type of anxiety in situations such as a first date, an interview for a dream job or a really important test at school. When anxiety becomes excessive and irrational and affects your daily life and relationships, it is considered a disorder. This type of negative stress, called distress, can cause people to become consumed with fearfulness, worry and uncertainty. Anxiety disorders affect nearly 40 million American adults aged 18 and older. Anxiety disorders may occur simultaneously with depression, which can cause both symptoms to worsen if the conditions are not treated properly.
What is the Connection between Celiac Disease and Anxiety?
People with celiac disease face a number of stressors both before and after diagnosis.
Before a Celiac Disease Diagnosis:
- Researchers are currently unsure if anxiety symptoms that begin before diagnosis are related to the presence of celiac disease
- Some evidence suggests that people who experience anxiety before diagnosis will feel better and less anxious after adopting the gluten-free diet
- Some symptoms of anxiety overlap with symptoms of celiac disease, such as nausea, dizziness, numbness or tingling in the hands and feet, and not being able to be calm or still
After a Celiac Disease Diagnosis:
- Many individuals with celiac disease often find diagnosis to be a relief, however others develop more symptoms of anxiety as changing the diet can be a stressful experience
- Anxiety may be common in females with celiac disease
- Anxiety is often related to the challenges of disease management
- The constant attention to avoiding cross-contact can lead to fears related to eating or dining out
Where Can I Learn More?
- National Institute of Mental Health
Do you or a family member suffer from anxiety? You may have celiac disease. Find out now. Take our Celiac Disease Symptoms Checklist.