By Christina Gentile, MS, Clinical Psychology doctoral student
Gastrointestinal problems have long been some of the most recognized symptoms of celiac disease. These include, but are not limited to diarrhea, constipation, abdominal pain, bloating and fatty stools. In recent years it has become well accepted that celiac disease presents in a myriad of ways that extend beyond the digestive system, including fatigue, joint pain and mouth sores.
No matter the sign or symptom, we know that in celiac disease the damage incurred to the small intestine may lead to nutritional deficiencies and further health complications due to prolonged malabsorption of essential nutrients. This further affects an individual’s well-being, as he or she becomes more at risk for medical problems including iron deficiency anemia, osteopenia or osteoporosis, and infertility. However, some individuals may not realize that celiac disease can also affect their mental health.
Celiac and Mental Health: Part 1
What is Mental Health?
People in good mental health can realize his or her own abilities, cope with and manage stress, develop and maintain interpersonal relationships, work productively, and make decisions. Mental health also includes how a person thinks, feels, and behaves.
Research suggests celiac disease can manifest itself through psychological problems, which influences mental health. That means celiac disease may affect a person’s thinking (cognition), emotions (affect), and behaviors. There is limited research concerning the relationship between mental health and the restrictiveness of the gluten-free diet, but research has shown a link between mental functioning and celiac disease.
Celiac and Thought Processes
When a person has a problem with cognitive functions, his or her thought processes are directly affected. Examples include attention and concentration difficulties, “brain fog” (mental confusion, difficulty thinking clearly), memory lapses, and forgetfulness.
Nutrient deficiencies related to celiac disease, both pre- and post-diagnosis, may have an impact on cognitive function, which impedes mental health. Newly diagnosed individuals often have nutritional deficiencies due to malabsorption, including low iron and vitamin D. Among those who are diagnosed and on a gluten-free diet, the gluten-free diet can lead to deficiencies in B-vitamins, iron, zinc, calcium, and vitamin D because many gluten-free products are not fortified like their gluten-containing counterparts. Proper supplementation may be required to achieve a healthy nutritional status.
Celiac and Emotions
Individuals with celiac disease also may experience problems related to their affect, or emotions. The most common “affective” disorders reported by patients with celiac disease include depressive and anxiety disorders. Common signs and symptoms of depression and anxiety include:
lack of energy
loss of appetite
In addition, feelings of anger, impatience, and moodiness may also occur in those experiencing an affective disorder. For a more detailed look at depression and anxiety in individuals with celiac disease, watch for Part 2 of this series in NFCA’s November 2011 newsletter.
Celiac and Behavioral Health
Sometimes, people with celiac disease report issues that influence their behaviors and social interactions. Common associated concerns include:
hyperactivity or hypoactivity
ataxia (poor coordination)
Some may report a diagnosis of ADHD or ADHD related symptoms that cause hyperactivity; others may report the opposite, in which they are lethargic and feel fatigued. Similarly, brain fog - as mentioned above in “Celiac and Thought Processes” – can understandably have an impact on behavior.
Individuals with ataxia may feel unsteady when walking and often have trouble controlling their body movements. This can be frustrating and embarrassing, which may prompt individuals to withdraw from social engagement.
Eating and weight issues can manifest in a variety of ways. For example, some diagnosed celiacs become overly cautious about contamination risks and do not take in a sufficient amount of food. Others replace gluten-containing foods with the same quantity of gluten-free alternatives, which tend to be higher in fat and calories. As a result, they gain weight – often to their surprise.
The affects of celiac disease on mental health may also influence social interactions. Have you ever avoided a social gathering or felt fearful about eating? If so, you’re not alone. The gluten-free diet can be isolating, especially for the newly diagnosed. It is important to work through these challenges to maintain a positive social and emotional well-being.
In a separate but related vein, research has shown an association between Asperger’s Syndrome, Autism, and gluten in children. In a study conducted in 2010, children on a gluten-free diet for 12 months showed improvements along different aspects of social measures (communication, social interaction, attentiveness, and activity levels). While these children were not diagnosed with celiac disease, these findings indicate that the mental health benefits of a gluten-free diet span beyond the celiac population.
Celiac and Coping Strategies
Initiating and adhering to a gluten-free diet is a life change that requires major emotional and physical adjustments. Getting diagnosed and learning the requirements of a gluten-free lifestyle can take a toll on mental health. What’s more, strict adherence to a gluten-free diet can cause frustration, stress and anger.
Individuals need to be able to cope and adapt to a new way of eating, and may have difficulty dealing with the dietary changes. Living with celiac disease may become troublesome, and may not always be easy. However, managing celiac does become easier overtime, especially with a better understanding of the gluten-free diet.
Research proves that diagnosed individuals benefit from psychological support to discuss their difficulties with the diet and to alleviate feelings of stress, depression and anxiety due to the diagnosis. Psychologists can also help you gain insight on how to increase your well-being.
In addition to professional help, support groups play an important role in promoting good mental health. Support group meetings give diagnosed celiacs and family members the opportunity to share their challenges and gain trusted advice. Most importantly, they foster a sense of community as opposed to isolation. Similarly, forums, blogs and social media outlets like Facebook and Twitter give individuals the ability to gain confidence and learn coping strategies from celiacs, dietitians and support groups across the globe.
Remember: Mental health is a combination of cognitive, emotional and behavioral well-being. Each factor affects the other, so work toward a positive, holistic balance that encompasses them all.