Should a gluten-free diet be recommended to people with depression, anxiety, and other mental health problems?

Gluten-free diets are becoming increasingly popular as gluten is believed to be associated with the exacerbation of a range of physical and mental symptoms. Coeliac disease is an autoimmune condition where people cannot tolerate gluten. It is often associated with significant gastrointestinal symptoms including stomach pain, diarrhoea, and nausea. Tiredness, mood changes, and skin conditions are also common. Research confirms that people with coeliac disease have an increased risk of mental health problems [1].

However, another condition referred to as non-coeliac-gluten sensitivity is increasingly proposed as a potential cause of depression, anxiety and other mental health conditions [2]. People with this condition do not have coeliac disease but are still believed to be adversely affected by gluten. The authenticity of this condition continues to be debated by researchers and health professionals and further research is required to help us understand the real impact gluten has on mental health.

However, if one supports the premise that non-coeliac gluten intolerance is real, and can affect mental health, the solution is a simple one; one-hundred per cent adherence to a gluten-free diet!

This is a solution regularly promoted by many health professionals. Simply remove gluten from your diet and then physical and mental improvements will occur. Although it can take several months for improvements to occur, patients are encouraged to adhere to the diet.

Unfortunately, sticking to a gluten-free diet is not that simple. Gluten-containing foods are everywhere, and it takes quite a bit of effort to learn how to cook and shop for ‘healthy’ gluten-free foods. Most convenience foods contain gluten, and this is precisely the foods people often revert to when they are feeling anxious or down. While not necessarily good for you, eating these convenience foods can lift one’s mood temporarily (but not usually for long). Going out to restaurants will be difficult and there is the constant questioning by others about why you are going gluten-free. Added to this is the often contradictory advice that may be received by other health professionals. Many medical and mental health practitioners may also outrightly deny the dangers of gluten.

All of these factors have to be overcome to enable one to stick to a gluten-free lifestyle. Sticking to a gluten-free diet is very complicated for someone with depression and anxiety who may suffer from fatigue, poor sleep, low self-esteem, and a sensitivity to rejection or failure. Plus, in the short-term, they may actually not feel any better, but rather feel worse because of the cravings and stress associated with going gluten-free.

While I believe removing gluten may be helpful for many people, my concern is that it is a very difficult treatment to stick to for most people.

So, should we recommend gluten-free diets to people with depression and other mental health disorders? I believe this depends on a person’s motivation, willingness to learn to cook gluten-free foods, and the number of social, financial, and environmental barriers inherent in someone’s life. We especially need to consider the potential negative psychological effects promoting a gluten-free diet can have on someone. The reality is that most people will find it very difficult to stick to this diet. The end result could be another example of failure to someone who is already sensitive to negatives and sees him- or herself as flawed. So it is quite possible that despite all our best intentions, recommending gluten-free could actually make someone worse!

We need to remember that adhering to a gluten-free diet is even difficult for someone with coeliac disease. This is despite them experiencing quite clear and rapid adverse effects from gluten. In fact, some studies have shown that less than 50% of people with coeliac disease strictly adhere to a gluten-free diet [3].

This means that recommending a gluten-free diet should be done with caution, especially with someone who lacks motivation or expresses concerns about his/her ability to adhere to a gluten-free diet. Rather, improving one’s diet by increasing the consumption of healthy foods (e.g., fruit and vegetables), and decreasing the consumption processed and sugar-laden foods should be the primary recommendation. If gluten is, in fact, affecting brain and mental function, strategies to minimise the adverse effects of gluten should be considered. This includes reducing the immune/ inflammatory reaction to gluten, improving digestive health, and compensating for any nutritional deficiencies. This may be far more feasible for many people rather than consuming a gluten-free diet. I understand that while removing gluten may be the ideal option, it is simply not feasible for many people, particularly in the long term.

Below are some options to consider to reduce the potentially damaging effects of gluten:

• Improve bacterial diversity in the gut by consuming fruit, vegetables, and whole-grains
• Increase foods high in fibre
• Take prebiotics foods (e.g., chicory, Jerusalem artichokes, garlic, onions) and prebiotic supplements such as inulin and lactulose, fructooligosaccharides
• Take probiotics
• Take digestive enzymes
• Take gut-healing herbs, spices and nutrients such as glutamine, aloe vera, quercetin, curcumin, zinc, and fish oils
• Identify and treat nutrient deficiencies
• Take ‘breaks’ from gluten
• Minimise your intake of medications that can affect gut health e.g., antibiotics, proton-pump inhibitors, antacids, and anti-inflammatory drugs
• Reduce stress and learn helpful ways to relax
• Engage in regular exercise
• Sleep well

If you are experiencing mental health problems and believe that your diet may be affecting you, speak to a competent natural health practitioner.

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References

1. Zingone F, et al. Psychological morbidity of celiac disease: A review of the literature. United European Gastroenterol J. 2015 Apr;3(2):136-45
2. Losurdo G, et al. Extra-intestinal manifestations of non-celiac gluten sensitivity: An expanding paradigm. World J Gastroenterol. 2018 Apr 14;24(14):1521-1530.
3. Muhammad H, et al. Identifying and improving adherence to the gluten-free diet in people with coeliac disease. Proc Nutr Soc. 2019 Aug;78(3):418-425.