The Connections Between Wheat, Celiac Disease and Mental Health

The research on the relationship between the gut and the brain continues to find startling connections and correlations. One condition not often considered as having a relationship with mental health is celiac disease. Normally, celiac disease is considered a cause of intestinal problems due to an inflammatory reaction to eating gluten, a protein found in wheat.

Typical symptoms include abdominal pain, diarrhea and weight loss. Yet the spectrum of celiac disease and the symptoms it can produce is much broader, including anxiety, depression and even psychosis. Understanding the complex interplay between gluten, celiac disease and mental health can sometimes be the key to improving or resolving a patient’s mental and emotional symptoms.

Based on the latest research, numerous mental health conditions have been shown to occur with increased frequency in patients with celiac disease. Higher rates of anxiety disorders, depression, bipolar disorder, eating disorders and attention-deficit/hyperactivity disorder are found in children who have the condition (Lebwohl 2021). And individuals with celiac disease have twice the risk for schizophrenia (Wijarnpreecha 2018).

Celiac Disease

Celiac disease is caused by an immune disorder that induces an inflammatory reaction to gluten found in wheat and related grains. The inflammatory reaction causes damage to the small intestine that can be visualized upon biopsy. Extraintestinal manifestations of celiac disease are common and can include most organ systems of the body, including the brain.

Even with increasing rates of diagnosis, estimates suggest that up to 80% of celiac patients have not been properly identified. Considering that around 1% of the population has celiac disease there are a lot of undiagnosed cases (Rubio-Tapia 2012). Further complicating diagnosis is the fact that a large percentage of patients do not have classic symptoms. In one case-review study of patients with confirmed celiac disease, only 35% of patients had gastrointestinal symptoms (Ehsani-Ardakani 2013).

Once diagnosed, standard treatment is the elimination of gluten from the diet. For celiac patients with mental health conditions, gluten elimination can improve symptoms, likely from reduced inflammation. While more research is needed, better adherence to gluten-free diets has been shown to correlate with improved symptoms of depression (Sainsbury 2018). Case reports have documented remission of schizophrenia on a gluten-free diet (Jackson 2012). And a review of the research also suggests that gluten-free diets can be helpful for treating schizophrenia, although in most of the studies, the patients’ celiac status was unknown (Levinta 2018).

Non-Celiac Gluten Sensitivity

It is also worth being aware that a significant subset of patients that react to wheat do not have classic celiac disease or wheat allergy. Non-celiac gluten sensitivity (NCGS) has only recently been identified as a clinical diagnosis. There aren’t currently any biomarkers to identify patients with the condition. Diagnosis is based solely on improvements from a gluten-elimination diet followed by a gluten challenge.

Estimates for the incidence of NCGS in the general population range from 0.6% to 13%. Digestive symptoms often mirror the symptoms of irritable bowel syndrome, but mental-emotional symptoms are also prevalent, with anxiety being reported most commonly (Roszkowska 2019). Depression and brain fog may also be symptoms of NCSG, although better studies are needed to fully confirm the relationship with depression.

Conclusion

Celiac disease and NCGS can cause or contribute to mental-emotional symptoms. While testing for celiac disease can be helpful, a subset of patients that do not have celiac disease likely still react to wheat or gluten. When other options have been eliminated, NCGS should still be considered as a potential diagnosis. For a subset of patients with mental illness, gluten elimination may help to provide a reduction or elimination of symptoms.

References

Ehsani-Ardakani MJ, Rostami Nejad M, Villanacci V, et al. Gastrointestinal and non-gastrointestinal presentation in patients with celiac disease. Arch Iran Med. 2013;16(2):78-82.

Jackson J, Eaton W, Cascella N, et al. A gluten-free diet in people with schizophrenia and anti-tissue transglutaminase or anti-gliadin antibodies. Schizophr Res. 2012;140(1-3):262-263. doi:10.1016/j.schres.2012.06.011

Lebwohl B, Haggård L, Emilsson L, et al. Psychiatric Disorders in Patients With a Diagnosis of Celiac Disease During Childhood From 1973 to 2016. Clin Gastroenterol Hepatol. 2021;19(10):2093-2101.e13. doi:10.1016/j.cgh.2020.08.018

Levinta A, Mukovozov I, Tsoutsoulas C. Use of a Gluten-Free Diet in Schizophrenia: A Systematic Review. Adv Nutr. 2018;9(6):824-832. doi:10.1093/advances/nmy056

Roszkowska A, Pawlicka M, Mroczek A, Bałabuszek K, Nieradko-Iwanicka B. Non-Celiac Gluten Sensitivity: A Review. Medicina (Kaunas). 2019;55(6):222. Published 2019 May 28. doi:10.3390/medicina55060222

Rubio-Tapia A, Ludvigsson JF, Brantner TL, Murray JA, Everhart JE. The prevalence of celiac disease in the United States. Am J Gastroenterol. 2012;107(10):1538-1545. doi:10.1038/ajg.2012.219

Sainsbury K, Marques MM. The relationship between gluten free diet adherence and depressive symptoms in adults with coeliac disease: A systematic review with meta-analysis. Appetite. 2018;120:578-588. doi:10.1016/j.appet.2017.10.017

Wijarnpreecha K, Jaruvongvanich V, Cheungpasitporn W, Ungprasert P. Association between celiac disease and schizophrenia: a meta-analysis. Eur J Gastroenterol Hepatol. 2018;30(4):442-446. doi:10.1097/MEG.0000000000001048