Where does the universe end? Does time really exist? What causes mental health disorders? All baffling mysteries, but we’re going to investigate number three. That brings us to celiac disease and mental health: the truth hurts.

It’s estimated that 1.4% of the world’s population suffer from celiac disease.

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 up our sleeves…

What is celiac disease?

Celiac disease (CD) is a serious autoimmune disease that occurs in genetically predisposed people where the ingestion of gluten, a protein found in wheat, rye, barley, and triticale (a hybrid of wheat and rye) leads to damage in the small intestine.

When people with CD eat gluten, their body mounts an immune response that attacks the villi, small fingerlike projections that line the small intestine.

That’s a major problem because when villi are damaged, proper absorption of nutrients can’t occur.

CD can develop at any age after an individual starts consuming gluten.

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 (pale, foul-smelling, fatty stools), 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 CD diagnosis is to have an intestinal biopsy.

There’s so much more to learn about testing and confirmation. Be sure to dig in.

What does celiac disease look like?

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 other parts of the body.

We can’t hit them all, but let’s take a look at some of symptoms of CD…

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
• 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?

Vitamins and other dietary supplements

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 the gluten-free diet may not provide sufficient supplementation.

This can be remedied with a daily, gluten-free multivitamin. The multivitamin 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’s physician should order a bone density test at the time of CD diagnosis to test 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 the 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 hereafter dermatitis herpetiformis.

By the way, the chances of getting a medication that contains gluten is extremely small. But as a health protector, it’s important to eliminate all risks by evaluating the ingredients in medications.

Come on back

I knew very little about celiac disease going in to this series. And I have to tell you I was stunned by what I learned. Frankly, it shook me up. Hmm.

Okay, I’ll have part two up shortly. Stay tuned so you don’t miss 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 on by: Celiac.com  Celiac Disease Foundation

And Chipur mood and anxiety info and inspiration articles always make for a good read.

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.