Gluten and Mental Health
Did you know that gluten can affect your mental health? While gluten intolerance is often associated with gastrointestinal symptoms, such as diarrhea, bloating, and constipation, many suffer from a bewildering array of non-GI related symptoms including fatigue, arthritis, neuropathy, and migraines. In sensitive individuals, gluten can even cause or exacerbate mental health conditions such as depression and anxiety.
Celiac Disease, Wheat Allergy, and Non-Celiac Gluten Sensitivity (NCGS)
A variety of conditions make individuals susceptible to the negative effects of gluten, a protein found in wheat, barley, and rye. Celiac disease is a genetic condition in which gluten provokes an immune response that damages the small intestine. About 1 in 100 people have the disease.
However, given the variety of symptoms that can occur, celiac disease is thought to be underdiagnosed. Some individuals with “silent celiac disease” may not experience any immediate symptoms at all, though they may still experience intestinal damage from gluten and its long-term negative effects. Celiac disease is typically diagnosed by endoscopy, which allows physicians to visually assess the damage in the small intestine. If you suspect you might have celiac disease, you may wish first to have a DNA test to see whether or not you have the gene for it before getting an endoscopy.
Individuals without celiac disease may still react to gluten on account of a wheat allergy or sensitivity. Wheat allergy can be diagnosed with a conventional allergy test. Additionally, roughly 1-3% of the population have non-celiac gluten sensitivity: while these individuals may not experience the intestinal damage that is characteristic of celiac disease, they may still experience symptoms similar to those of celiac disease. Currently, there is no test available for non-celiac gluten sensitivity. Patients suffering from this condition must simply try a strict gluten-free diet for one to three months and see if their symptoms improve.
The good news is that the treatment for celiac disease, wheat allergy, or non-celiac gluten sensitivity is dietary: individuals must avoid consuming gluten (or wheat specifically if allergic). Sensitive individuals must watch out for cross-contamination on any surfaces or with any utensils that might have come into contact with gluten. Those with celiac disease might react even to miniscule amounts of gluten.
Gluten’s Effect on Mental Health
Celiac disease can take a toll on one’s mental health. The sheer knowledge that one has an incurable disease can lead to depression or feelings of hopelessness. The accommodations needed to maintain a strict gluten-free diet can lead to social challenges and feelings of isolation. Normal social gatherings, like work lunches or potlucks, can be challenging. Those with celiac disease suffer higher rates of depression than the general population, possibly on account of these challenges.
However, the body’s reaction to gluten itself can also cause (or exacerbate) mental illness and mood disturbances in some individuals. While some may suffer from gastrointestinal symptoms, others might experience no gastrointestinal symptoms at all. In fact, some individuals may experience only psychological or neurological symptoms. Such symptoms can include peripheral neuropathy, seizures, headaches, cognitive impairment, and neuropsychiatric diseases.
There are several associations between gluten sensitivity and mental illness. In addition to higher rates of depression among those with celiac disease, patients with bipolar, major depressive disorder, and schizophrenia tend to have higher levels of gluten-related antibodies than the general population.
A gluten-free diet has been shown to improve mood disorders and psychological well-being in patients with CD, IBS, and NCGS. Research has shown that those suffering from non-celiac gluten sensitivity (NCGS) experienced increased depression within days of a gluten challenge. In fact, mood symptoms are often a central motivation for those adopting a gluten-free diet. If you’ve been suffering from depressive symptoms and other interventions haven’t worked, you might consider trialing a gluten-free diet.
While there’s no doubt that gluten can lead to mood disorders in susceptible individuals, it is possible that mood disorders could lead to greater levels of gluten sensitivity as well. Interestingly, antidepressants have been found to reduce pain in irritable bowel syndrome.
One reason for gluten’s impact on mental health is its effect on the blood brain barrier. When the blood brain barrier functions properly, it allows nutrients, oxygen, amino acids, some drugs, and glucose in, while keeping bacterial components out. However, gluten’s effect on the intestinal lining can lead to system-wide inflammation as well as intestinal inflammation, which increases the passage of partially digested food molecules and bacterial components into the bloodstream.
Inflammation limits the ability of the blood brain barrier to restrict passage of bacterial components into the brain. The passage of bacterial components into the brain might play a role in the neuropsychiatric and neurological symptoms commonly associated with celiac disease.
One way in which a gluten-free diet seems to improve depression is by lowering inflammation. Research shows that a gluten-free diet can both diminish symptoms of depression in susceptible individuals and reduce markers of inflammation in patients with IBS.
Conclusion
Does everyone need to go gluten-free? While it is probably wise for the general population to limit their consumption of gluten, since it is proinflammatory and low in nutrients, it is probably not necessary for otherwise healthy individuals to follow a strict gluten-free diet. The highest estimates indicate that less than 5% of the population suffer from any form of severe wheat or gluten sensitivity. The burden of following an extremely strict gluten-free diet presents social and psychological challenges.
A strict gluten-free diet can limit one’s ability to go to restaurants and enjoy social dining events. While it is crucial for those with sensitivities to avoid cross-contamination, it is probably sufficient for most people to simply limit the amount of gluten they regularly consume. Most healthy individuals can safely indulge from time-to-time and don’t need to worry about occasional cross-contamination.
However, a gluten-free diet might benefit those suffering from IBS or another gut-related disorder, particularly if they are also experiencing cognitive or neurological symptoms. Those suffering from mental illnesses, such as depression, anxiety, or bipolar disorder, might also benefit from trying a gluten-free diet, particularly if they receive adequate social and nutritional support along the way.
Mind Body Seven clinicians offer treatment in Brooklyn and via teletherapy for adolescents and adults. If have not worked with us and want to get started please contact us here, so we can set you up with the clinicians that best suit your individual needs. If you are an existing patient get in touch with us here to set up your next appointment.