Depression, apathy, irritability and anxiety are among the possible psychological effects of untreated coeliac disease or non-coeliac gluten sensitivity.
Most people find that these symptoms dissipate when they switch to a gluten free diet, but this might not be the case for everybody. There is some evidence that gluten itself, as well as coeliac disease or gluten sensitivity, can be a cause of depression in some people.
Coeliac disease is an autoimmune disorder triggered by eating gluten, which is identified mistakenly by the coeliac patient’s immune system as a dangerous invader. The antibodies produced by the body to attack gluten cause damage to the lining of the small intestine, prompting a wide range of possible symptoms including abdominal pain, diarrhoea or constipation, chronic fatigue, joint pain, anaemia, and depression and anxiety.
Non-coeliac gluten sensitivity (NCGS), which is caused by a different immune system reaction to gluten and does not lead to intestinal damage, includes depression as one of its more common symptoms.
The treatment for both of these conditions is a gluten free diet, which, in most cases, will alleviate and eventually eliminate the symptoms.
Many studies have established a link between coeliac disease and symptoms of depression. In fact, several mental illnesses, including attention deficit-hyperactivity disorder, anxiety and schizophrenia have also been linked to coeliac disease.
Some researchers have suggested that higher-than-average incidences of depression and other mental health issues in coeliac patients may just be a result of having a chronic health problem. But there is also evidence to support the idea that depression could be trigged by coeliac disease. The damage to the intestinal mucosa impairs the absorption of nutrients.
When a person does not absorb enough iron, they may get anaemia, which is common among coeliac patients and often the reason they are diagnosed as gluten intolerant. Similarly, deficiencies in folate and vitamin B-6 occur among people with untreated coeliac disease, two nutrients that play a role in mood and neurotransmitter health. Studies have shown that supplementing vitamin B-6 can improve mood symptoms in coeliac patients.
In short, gluten may trigger depression in coeliac patients due to the malabsorption of certain key nutrients.
Can a gluten free diet cause depression and anxiety? There is no known direct connection between gluten free eating and depression. Most coeliac patients and people with NCGS will find their symptoms, including depression, lift as they stay gluten free. A study from 2011 by Penn State University researchers found that women who stuck to their gluten free diet more strictly had fewer depressive symptoms, although all coeliac women studied suffered from higher rates of depression than the population at large.
It is true that embarking on a strict gluten free diet can be daunting, especially when eating outside the home. Also, many people experience bouts of depression when they make a mistake and get ‘glutened’. In such cases, it is difficult to ascertain to what extent the depression is a direct symptom of the autoimmune reaction or despair or demoralisation caused by the unwanted situation.
Coeliac disease is severely underdiagnosed, with more people believed to have the condition without knowing it than those who have been diagnosed. This means that there is likely to be a proportion of undiagnosed coeliac patients amongst those who are suffering from depression. Depression seems to be an even more common symptom of non-coeliac gluten sensitivity, a condition which is even harder to diagnose as there is no blood test to detect antibodies, as is the case with coeliac disease.
The best treatment for coeliac disease and all of its associated symptoms, including depression and anxiety, is to adopt a gluten free diet. However, trying to figure out exactly what foods you can eat and maintaining a healthy, balanced diet can be stressful, especially at the beginning. It is important to seek qualified professional help from a doctor and a registered dietitian, if this is available to you.
Go easy on yourself. The transition to a gluten free diet can be hard to master, but you will learn and eventually it will become second nature. There is a lot of healthy, wholesome food that you can still enjoy. It is a good idea to seek out a support group so you can share your concerns and feel understood by others who are working through the same set of problems.
And, if you feel depressed, don’t soldier on alone. It is vital to talk about it, to your loved ones, and to a professional if the symptoms persist.
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