Celiac Disease, Gluten-Free Diet, and Glutenated Depression


Overview

Depression can be defined as a deep, chronic feeling of sadness. According to the National Institute of Mental Health, it almost always requires treatment to improve. Many treatments exist, including natural remedies that can help a person avoid the need for antidepressant medications. A gluten-free diet is offered for consideration by some experts as an alternative treatment for depression, but conflicting research exists as to whether this is effective. More than that, the overwhelming data has been recently received that gluten-free diet may cause or aggravate the depressive disease. It is important to talk with your primary doctor or therapist before beginning alternative treatment like that.

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Celiac Disease

While some chose to maintain the gluten-free diet, other do not have much choice. Celiac disease is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.

There are many symptoms of celiac disease, such as bloating or gas, diarrhea, headaches, an inability to gain weight and fatigue. The National Foundation for Celiac Awareness also lists other nonphysical symptoms, such as depression and irritability. As of today, following a gluten-free diet during lifetime is the only treatment for celiac disease.

It’s very hard for some celiacs (people with celiac disease) to accept the fact that they need to adhere to gluten-free diet for their life. Many of them lack mental strength to accept this reality. Also, such dietary plans create many deficiencies in the body.

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Glutenated Depression Causes

Research has shown that people with celiac disease do develop depression; however, the connection is not fully understood. The higher sensitivity to the depressive episodes can be explained by several reasons:
  1. Some people may not be aware they are not aware that they are suffering from celiac disease, so they inadvertently consume an inacceptable for them dose of gluten from their daily intake. Simple things like breads, pizzas and other wheat products contain huge quantity of gluten. This in turn affects their villi (lining of your small intestine) and their capacity to absorb essential nutrients is substantially reduced. The malnutrition may cause severe health and mental consequences. Sometimes, depression related to the celiac disease is referred in the literature as ‘glutenated depression’.
  2. While being diagnosed with celiac disease, patients have to accept a bitter reality that they have to consume gluten-free diet for lifetime. They are told to change drastically their eating habits and lifestyle, with complete exclusion of wheat. So they will be banned from eating all sorts of breads, pizzas, they cannot drink beer and they will be cutting most of the deserts from their diet. It’s not easy to accept these realities. Their mind and body will resist. It becomes very hard for them to say “no” to all ‘glutenated’ foods every now and then, even if they are told by their doctor that these things can harm them. They may get severe cravings for the gluten containing treats, but they have to keep their mouth shut, which is not always easy. Gluten is very nasty nutrient. It will immediately show up. Starting from diarrhea and stomach upsets, it will make the person sick mentally and physically. So it will lead to glutenated depression.
  3. Even if a person follows a strict gluten-free diet, he/she may not be aware of the deficiencies, which such diet creates in the body. So he/she strictly adheres to gluten-free diet, but may not take in essential vitamins and nutrients, which would have been otherwise, part of his/her normal diet. So it will affect his body (mainly brains) and within a short period of time he will start feeling empty and depressed. This may be considered as the third potential cause of glutenated depression.

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Research Studies

According to various studies, there is a some link between depressive disorder and adherence to the gluten-free diet, required for celiac disease patients.
  • One study conducted by Addolorato et al., reported that depression was present in a higher percentage of celiac patients. They found that one year of gluten-free diet failed significantly to affect depressive symptoms. The presence of depression after introduction of the gluten-free diet could be related to the reduction in quality of life in celiac patients. The non-regression of depression after introducing the diet could suggest that these patients need psychological support.
  • Another study found that celiac disease increased a patient's risk of subsequent depression. Moreover, patients with celiac disease were 1.8 times as likely to develop subsequent depression as those without the gastrointestinal disorder. Also, prior depression increased the risk of celiac disease at odds ratios of 2.3. The investigators suggested, in the Journal of Affective Disorders, that this increased risk might be due to increased screening for the condition among patients with mood disorder compared to healthy individuals.

Consideration

While it is absolutely clear that celiac disease is a strong risk factor for the depression development, the leading factor for the depression might not be a gluten-free diet itself, but other two factors of consideration, reviewed earlier.

The authors of the study published in the journal BMC Psychiatry observe:
“Celiac disease in adolescents has been associated with an increased prevalence of depressive and disruptive behavioral disorders, particularly in the phase before diet treatment.”

There are also ‘non-celiac’ aspects of gluten sensitivity. Gluten related inflammation in the brain can manifest as a host of cognitive, emotional and neurodegenerative disorders in the absence of intestinal manifestations. This is often referred to as “silent celiac disease”:
“Celiac disease is an under-diagnosed autoimmune type of gastrointestinal disorder resulting from gluten ingestion in genetically susceptible individuals. Non-specific symptoms such as fatigue and dyspepsia are common, but the disease may also be clinically silent.”

They further note that:
”Depressive symptoms and disorders are common among adult patients with celiac disease, and depressive and disruptive behavioral disorders are highly common also among adolescents, particularly in the phase before diet treatment. Recently 73% of patients with untreated celiac disease – but only 7% of patients adhering to a gluten-free diet – were reported to have cerebral blood flow abnormalities similar to those among patients with depressive disorders.”

Their data revealed abnormalities in tryptophan assimilation (tryptophan is the amino acid precursor to serotonin) and prolactin levels in adolescents with celiac disease and depression prior to treatment. They revealed that
 “A significant decrease in psychiatric symptoms was found at 3 months on a gluten-free diet compared to patients’ baseline condition, coinciding with significantly decreased celiac disease activity…”

This data shows that the diet by itself plays a small role in the depression development in celiacs, so for those who are diagnosed with celiac disease, there is no second thought that they have to adhere to the required gluten-free diet.

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But what about others, who want to try gluten-free diet “by choice”? Based on the unclear and sometimes conflicting data available as of today, I would be careful with such experiments, and I would not make such diet related life changes without approval of your primary doctor or therapist.





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