The following information is based partially on the Beyond Celiac webinar, “It’s Not Just In Your Head: The Psychological Impacts of Celiac Disease,” featuring Marie-Nathalie Beaudoin, PhD, training director at Bay Area Family Therapy & Training Associates. Note: This webinar was held when Beyond Celiac was still known as the National Foundation for Celiac Awareness.

Download the webinar slides here.

How can a problem in the gut impact psychological functioning? What is the gut-brain connection and which areas of psychological functioning are most affected by celiac disease?

Understanding the Link between Celiac Disease and Psychological Disorders

There is a big link between celiac disease and psychological function. Anxiety, depression and fatigue are common issues reported in celiac disease patients prior to diagnosis. Side effects of celiac disease can affect the brain in various ways, lowering quality of life for those suffering from untreated celiac disease or even after diagnosis.

These negative mental impacts happen for a variety of reasons, including:

• Malnutrition and vitamin deficiency
  
  • Damaged gut is unable to assimilate certain nutrients essential to proper functioning of a number of organs
  • Damaged villi cannot properly process and assimilate a number of nutrients, particularly: Vitamin B, such as B6, B12, & Folate, Iron, Vitamin D, K, and Calcium
  • The body becomes 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.
  • Some toxins affect opioid receptors of the brain.
• Immune response
  
  • Inflammation is the body’s natural response to assault.
  • Production of antibodies against own tissue.
  • Swelling, i.e. abdominal, joint pain, headaches, hypoperfusion in brain.
  • Production of stress hormones.
  • Byproducts of digestion end up in the bloodstream and affect different parts of the body such as joints.
• Secodonary disease, i.e. thyroid malfunctioning
  
  • After many years of this regimen, organs can become chronically affected and develop primary diseases.
  • Common example is thyroid disease: Studies show that in people who have celiac AND depression, up to 80% of them have a comorbid thyroid disease.

Psychological Issues Associated with Celiac Disease

Research shows that celiac can manifest itself through psychological problems impacting:

• Cognitions (thinking)
  
  • Brain fog
  • Memory lapse
  • Headaches in up to 50% of people with celiac disease
  • Attention difficulty
• Affect (emotions)
  
  • Depression
    • Moodiness, discouragement, overwhelmed, non-restful sleep
  • Anxiety
    • Phobias, separation anxiety, obsessive compulsive, social phobia, panic attacks
  • Irritability
    • Impatience and grumpiness in adults; Anger outbursts in children
• Behaviors
  
  • Hyperactive: ADD, ADHD
  • Hypoactive: Lethargy, fatigue
  • Ataxia: Clumsiness, poor coordination, imbalance
  • Eating and weight issues: Under and over
• Social Interactions
  
  • Avoidance of social situations
  • Withdrawn
  • Uncomfortable
  • Fear of people
  • Asperger’s Syndrome and autism in children (celiac disease may present as autism in children)

Post Celiac Disease Diagnosis

Your brain may need help recovering after diagnosis and starting the gluten-free diet. Some tips for aiding in recovery include:

• Exercise daily about 30 minutes
• Be vigilant with regards to contamination
• Consult with a knowledgeable dietitian or specialized doctor
• Supplements often recommended such as Vitamin B and digestive enzymes
• Other organs may be damaged and require care such as the thyroid

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

Possible explanations for continued psychological issues after going gluten-free:

• 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

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 after starting the gluten-free diet, feeling isolated socially or having anxiety or frustration over complying with the gluten-free diet.

Some people reconnect with well-being through mindfulness exercises where they learn to “inhabit” moments of well-being. Meditation has been found to increase cortical thickness. Studies show that connecting with others also enhances people’s ability to handle the gluten-free diet. Some forms of counseling or brief therapy can provide personalized education and support with regards to integrating the gluten-free diet in the particularities of your life.