Where does the universe end? Does time really exist? What causes mental health disorders? All mega mysteries, but we’ll be investigating number three. That brings us to celiac disease and mental health: the truth hurts.
A simple blood test is available to test for CD. However, the only way to confirm a diagnosis is to have an intestinal biopsy.
The number goes down to 1% in the United States, but consider this. It’s believed that 83% of those who actually have celiac disease don’t know it. And that’s attributed to not being diagnosed, as well as being misdiagnosed.
Celiac disease can generate all sorts of serious medical conditions, including emotional and mental disorders. That means we need to talk about it. We’ll take care of business in two parts. Here, we’ll learn about celiac disease, and we’ll come back and review the mental health connection in part two.
Let’s roll…
What is celiac disease?
Celiac disease (CD) is a serious autoimmune disease that occurs in genetically predisposed people. For them, the ingestion of gluten, a protein found in wheat, rye, barley, and triticale (a hybrid of wheat and rye), generates an immune response that attacks the small fingerlike projections that line the small intestine, known as villi.
That’s a major problem because when villi are damaged, proper absorption of nutrients can’t take place. CD can develop at any age after an individual begins to consume gluten. FYI, “celiac” means anything having to do with the abdomen or abdominal cavity.
Classical, non-classical, silent celiac disease
CD can be categorized as classical, non-classical, and silent…
Classical
In classical CD, patients have signs and symptoms of malabsorption, including diarrhea, steatorrhea, and weight loss or growth failure in children.
Non-classical
In non-classical CD, patients may have mild gastrointestinal symptoms without clear signs of malabsorption or they may have seemingly unrelated symptoms. Patients may also suffer from abdominal distention and pain, iron-deficiency anemia, chronic fatigue, chronic migraines, peripheral neuropathy, unexplained chronically elevated liver enzymes, reduced bone mass and bone fractures, vitamin deficiency (folic acid and B12), difficulty losing weight, late menarche/early menopause, unexplained infertility, dental enamel defects, depression and anxiety, dermatitis herpetiformis.
Silent
Silent CD is also known as asymptomatic CD. Patients don’t report symptoms, but they still experience damage to the villi in the small intestine. Studies show that even though patients thought they had no symptoms, after going on a strict gluten-free diet, they reported better gastrointestinal and overall health.
Heredity
People with a first-degree relative (parent, child, sibling) with CD have a 1 in 10 risk of developing the disease. First-degree relatives should always be screened, even if they have no symptoms. Second-degree relatives (grandchildren, grandparents, aunts, uncles, nieces, nephews) also have an increased risk of developing CD.
Testing and diagnosis confirmation
A simple blood test is available to test for CD. However, the only way to confirm a diagnosis is to have an intestinal biopsy. There’s so much more to learn about testing and confirmation. Be sure to hit those links.
What does celiac disease look like?
Healthy villi on the left, atrophied on the right
Painting a picture of CD is hard to do. After all, there are in excess of 200 known symptoms that can occur in the digestive system, as well as in other parts of the body.
And keep in mind, CD can strike adults and children, and the symptoms aren’t necessarily the same.
That presents serious challenges.
We’re certainly not going to hit them all, but let’s run with some symptoms that cover most of the bases…
Symptoms in children
- Abdominal bloating and pain
- Anxiety and depression
- Attention-deficit/hyperactivity disorder (ADHD)
- Chronic diarrhea
- Delayed puberty
- Fatigue
- Headaches
- Nausea and vomiting
- Short stature
- Weight loss
Symptoms in adults
- Abdominal pain
- Bloating and gas
- Cognitive impairment
- Diarrhea and constipation
- Depression and anxiety
- Fatigue
- Headaches or migraines
- Itchy, blistery skin rash (dermatitis herpetiformis)
- Missed periods
- Mouth ulcers and canker sores
- Nausea and vomiting
- Osteoporosis and osteomalacia
- Peripheral neuropathy
- Reduced functioning of the spleen
- Weight loss
That gives you an idea of what CD looks like. And it isn’t a pretty picture, is it.
How is celiac disease treated?
The only treatment for CD is to follow a strict gluten-free diet – for life. In the United States, for example, products can be labeled gluten-free if they contain less than 20 parts per million (ppm) of gluten. Well, that may handle the heart of the disease; however, what about associated conditions?
Vitamin, mineral, and other deficiencies
People with CD are typically deficient in fiber, iron, calcium, magnesium, zinc, folate, niacin, riboflavin, vitamin B12, and vitamin D, as well as calories and protein. Deficiencies in copper and vitamin B6 are also possible, but less common. Supplementation of B12 and folate may help individuals with CD recover from anxiety and depression caused by vitamin deficiencies. However, patients may continue to be vitamin B deficient because a gluten-free diet may not provide sufficient supplementation. That can be remedied with a daily gluten-free multivitamin. It should not exceed 100% of the daily value (DV) for vitamins and minerals. Calcium and vitamin D supplementation may also be prescribed by a physician if intake is not sufficient.
Bone health
An adult CD patient’s physician should order a bone density test at the time of diagnosis to screen for osteopenia/osteoporosis. A bone density test may also be ordered for children and adolescents who have experienced severe malabsorption, a prolonged delay in diagnosis, have bone disease symptoms, or are non-compliant with a gluten-free diet. If an individual is at high-risk for bone fracture, they’ll likely be prescribed dietary supplements and indicated medication.
Dermatitus herpetiformis
Medication such as dapsone or sulfapyridine is administered for a short period of time to control the rash. In most individuals, following a strict gluten-free diet greatly reduces symptoms of dermatitis herpetiformis. FYI, the chances of getting a medication that contains gluten are extremely small. But, it’s important to eliminate all risks by running ingredients by a physician or pharmacist.
That’s a wrap
I knew very little about celiac disease going in to this series. And I have to tell you I was taken aback by what I learned. Frankly, it shook me up.
I hope you found the information helpful.
Now it’s on to part two for details on those mental health connections.
The two wonderful info sources for this piece merit a visit. If you have celiac disease, want to learn more about it, or wish to donate, stop by: Celiac.com Celiac Disease Foundation Chipur mood and anxiety info and inspiration articles always make for a good read. Give one a go.
Bill White is not a physician and provides this information for educational purposes only. Always contact your physician with questions and for advice and recommendations.
