Psychological Impacts of Celiac Disease

• 7/27/2021: Beyond Celiac Partners with University of Sheffield to Research Neuropathology of Celiac Disease and Gluten-Related Disorders – Researchers continue to investigate the sometimes debilitating neuropsychological impairment in those with celiac disease and NCGS.
• 6/11/2021: Brain fog survey reveals details about the symptom – Brain fog is a symptom that gets a lot of attention in the celiac disease and non-celiac gluten sensitivity communities, but not as much attention from researchers.
• 6/2/2021: The burden of celiac disease includes ongoing symptoms, missed workdays and disordered eating – Young adults with celiac disease may have more anxiety, disordered eating attitudes and beliefs, and a lower quality of life, a study suggests.
• 3/22/2021 – Neurological and psychological symptoms of celiac disease exposed by Go Beyond Celiac – data from the Go Beyond Celiac Gluten Exposure Survey highlights a number of neurological and psychological symptoms that celiac disease patients report experiencing after exposure to gluten
• 6/11/2020: Children with celiac disease at greater risk of mental health disorders – About one-third of children with celiac disease have mental health disorders, primarily anxiety disorder and attention-deficit/hyperactivity disorder (ADHD), according to a new study.
• 3/25/2020: Brain images show celiac disease-related damage – Brain injury, cognitive deficiency and mental health issues tied to gluten exposure, study finds.

The gut and brain are intimately connected. Just thinking about food can cause the stomach to release fluids and prepare to eat. Some people make decisions based on a “gut feeling,” or experience “butterflies in their stomach” when they are excited or nervous. Others may experience diarrhea whenever they are particularly anxious (called “anxiety poops” or “stress poops” colloquially). These are all examples of how things that happen in the gut can affect the mind and vice versa. So it makes sense that when the gut is suffering because of celiac disease, the mind might suffer, too.   

The exact reasons why those with celiac disease can experience negative psychological symptoms are varied, but include:

• Malnutrition and vitamin deficiencies
  
  • Damaged villi, the distinguishing effect of celiac disease, make it difficult for the gut to assimilate nutrients essential for proper functioning of a number of organs.
  • Notable nutritional deficiencies common in those with celiac disease include vitamin B (B6, B12, and Folate), iron, vitamin D, vitamin K, and calcium. 
  • The malnourished body may be unable to produce enough tryptophan and other monoamine precursors needed for the production of key neurotransmitters in the brain, such as serotonin, dopamine and norepinephrine.
  • This biochemical imbalance in the brain is associated with emotional problems.
• Toxins
  
  • Celiac disease is also associated with “leaky gut” syndrome.
  • Poorly digested food overtax filtering organs such as the liver, leading to buildup.
  • Some toxins affect opioid receptors of the brain.
• Immune response
  
  • Inflammation is the body’s natural response to assault.
  • In the case of autoimmune illnesses, such as celiac disease, the body produces antibodies against the body’s own tissue.
  • This manifests with symptoms like swelling, abdominal, joint pain, headaches, and hypoperfusion (low blood flow) in the brain.
  • The immune response may also cause the production of stress hormones.
  • Byproducts of digestion end up in the bloodstream and affect different parts of the body.
• Secondary diseases
  
  • After many years of this autoimmune reactions, organs can become chronically affected and develop primary diseases.
  • A common example is thyroid disease: studies show that in people who have celiac disease and depression, up to 80% of them have a comorbid thyroid disease.
• Social Isolation
  • Some people dread social events or frequently decline to go at all because of their symptoms, such as fatigue, migraines, joint pain, itchy rashes, or a constant need to go to the bathroom. This can create feelings of social isolation, depression, and anxiety.

Some studies reveal complete remission of depression, anxiety and irritability with gluten-free diet, especially with younger populations. Other studies, especially on depression, are associated with mixed results.

Here are a few things you can do after your diagnosis to help your brain recover:

• Stay gluten-free. No cheat days!
• Consider taking supplements until your gut heals.
• Exercise for about 30 minutes every day.
• Other organs may be damaged and require care, so talk to a doctor about getting additional tests to evaluate organ health and nutritional deficiencies.
• Try to become aware of your thinking habits and reframe overly negative or catastrophizing thoughts.

Let’s dive into that last bullet point. Did you know that the way we think creates neural connections in our brains? Humans develop habitual ways of thinking about situations and interpreting the world—they get used to using certain neural pathways. If you’re continually grumpy or sad for years, it becomes easier to feel grumpy or sad rather than happy. It make take effort to seek out and enjoy happiness.

After many years of living in a bubble of discomfort, many forget to really live moments of well-being, satisfaction or joy. An official diagnosis can bring relief to many; however, others can feel emotionally secluded, socially isolated, or anxious and frustrated because of the gluten-free diet.

Some people reconnect with well-being through mindfulness exercises where they learn to “inhabit” happy and peaceful. Soaking up the good vibes, if you will. Meditation has also been found to increase cortical thickness.

Finally, studies show that connecting with others also enhances people’s ability to handle the gluten-free diet. Support groups and online forums can allow you to meet others who have experienced or are experiencing the same things, and counseling or therapy can provide personalized education around coping mechanisms for feelings of isolation and anxiety.

Some possible reasons for continued celiac disease-related mental health problems after starting the gluten-free diet:

• Non-adherence to the gluten-free diet
• Unidentified food intolerances
• Thyroid problems
• Nutritional deficiencies
• Lengthy recovery period
• Difficulties accepting dietary change and its social implications
• Habitual ways of experiencing life
• Pre-existing conditions

It’s important to note that while many people see most of their ailments clear up after starting the gluten-free diet, there are also those that simply have a pre-existing psychological condition, not caused by or related to celiac disease. The gluten-free diet will not affect pre-existing conditions.

Treatments for pre-existing conditions include lifestyle changes and medications. If you take medication regularly, review the ingredients to ensure it is gluten-free. You should avoid medications with wheat starch when possible.