Anxiety is a pretty common symptom both in celiac disease and in gluten sensitivity — plenty of newly diagnosed people (and more than a few who've been diagnosed for some time) report feelings of both anxiety and depression.
What's not clear is why this occurs.
It's possible that nutritional deficiencies and malnutrition might contribute to anxiety in people with diagnosed celiac disease (who have intestinal damage that prevents them from absorbing nutrients). But people with gluten sensitivity don't suffer from this same intestinal damage... and yet some experience similar or potentially even higher levels of anxiety.
What's causing this anxiety in people with celiac disease and gluten sensitivity? Researchers aren't certain. However, it could be a combination of factors, including an anxious reaction to the necessity of following the gluten-free diet, and possibly even a direct effect of gluten itself on the brain.
Anxiety Common In Celiac Disease Patients At First Diagnosis
Several studies have identified high levels of anxiety in people with celiac disease when they're first diagnosed.
According to one study, both state anxiety (a type of anxiety that's temporary and involves a heightened autonomic nervous system response) and trait anxiety (a measure of how prone you are to anxiety) were elevated in people who had just learned they had celiac disease.
That study, which looked at 35 celiacs and compared them to 59 control subjects, found high levels of state anxiety in 71% of the celiacs, but in only 24% of the control subjects. It also found that 26% of the newly diagnosed celiacs showed anxiety as a trait, compared to 15% of controls (that difference, however, did not reach statistical significance, meaning it could have been due to chance).
After a year of following the gluten-free diet, the celiacs' anxiety levels had dropped. However, 26% were still affected by state anxiety and 17% still showed anxiety as a trait. The study authors note that the drop in trait anxiety did not reach statistical significance, again indicating it could have been due to chance.
"These findings suggest that anxiety in celiac disease patients is present predominantly as a reactive form rather than as a personality trait, probably related to the presence of the main symptoms such as abdominal pain, diarrhea and weight loss, often reported by the patients as a reason for work and relationship invalidity and it may not be 'disease-specific' to sprue, but rather to features of chronic illness," the authors wrote.
Another study looked specifically at anxiety and depression levels in 441 adult celiacs who had been on a gluten-free diet for at least a year. It found a probable anxiety disorder in nearly 17% of study subjects, which is significantly higher than the 6% found in control subjects. Women had a higher risk of probable anxiety disorder than men.
Interestingly, living alone was associated with a reduced risk of having a probable anxiety disorder. The authors speculated that the problems of eating gluten-free in a shared kitchen and dealing with family members who aren't gluten-free might contribute to "financial and interpersonal problems," which in turn raise the risk for having an anxiety disorder.
There is some evidence that supplementing B vitamins might help improve anxiety in diagnosed celiacs. A study conducted in Sweden found improvement in well-being and in anxiety and depressive symptoms in celiac adults who took folic acid, vitamin B12 and vitamin B6 for six months.
Anxiety, Other Neurological Symptoms Occur Frequently in Gluten Sensitivity
Although researchers only are beginning to define non-celiac gluten sensitivity, there already are indications that it may have a significant neurological component.
University of Maryland Center for Celiac Research director Dr. Alessio Fasano says neurological symptoms such as brain fog occur in about one-third of people with diagnosed gluten sensitivity, a much higher percentage than is reported in celiac disease. Gluten-related depression and anxiety also occur at high rates, he says.
It's not clear why this is so — research into gluten sensitivity is just beginning, and many physicians don't even agree it exists yet. However, Dr. Rodney Ford, a New Zealand-based pediatrician and author of The Gluten Syndrome, postulates that gluten harms your nervous system directly, leading to the wide spectrum of symptoms experienced in both gluten sensitivity and celiac disease, including anxiety.
How To Handle Gluten-Induced Anxiety
The good news for people with celiac disease or gluten sensitivity is, symptoms of anxiety seem to decline when you go gluten-free. The bad news is, many people report experiencing resurgences of anxiety symptoms when they get glutened, although these symptoms generally seem to be short-lived.
Still, the medical studies do show that many people struggle with high levels of anxiety even when they're eating gluten-free, possibly because of the stresses involved in maintaining the diet, especially in a household shared with people who eat gluten.
If you're experiencing high levels of anxiety despite eating strictly gluten-free, you might want to consider talking to your physician about it — she might recommend you see a mental health professional for treatment that could include counseling and/or medication to ease your anxiety symptoms.
Addolorato G. et al. Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scandinavian Journal of Gastroenterology. 2001 May;36(5):502-6.
Ford R. The Gluten Syndrome. Medical Hypotheses. 2009 Sep;73(3):438-40. Epub 2009 Apr 29.
Hallert C. et al. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Alimentary Pharmacology and Therapeutics. 2009 Apr 15;29(8):811-6. Epub 2008 Jan 20.
Häuser W. et al. Anxiety and depression in adult patients with celiac disease on a gluten-free diet. World Journal of Gastroenterology. 2010 Jun 14;16(22):2780-7.