Staying Healthy

Is gluten making you depressed?

Is there a link between mental health issues and nutrition?

DepressionIt seems that there is, at least in some cases, and links have been made between gluten – which is of course my main interest here – and:

  • ‘brain fog’
  • anxiety
  • depression
  • dementia
  • autism
  • and schizophrenia

Many people have reported ‘brain fog’ and anxiety as symptomatic of gluten poisoning, and depression is a classic symptom of coeliac disease. The Mayo Clinic believes that coeliacs are at increased risk of dementia, and Michael Gardner, Professor Emeritus at Bradford University is researching the theory that diet is involved with autism and schizophrenia.

Today, though, I want to look at depression, and will come back to schizophrenia and autism another time.

We know that depression is present in a higher percentage of people with coeliac disease than in the normal population, based on Italian studies in 2003 (and others).

You might ask: which came first? Are people depressed as a result of their diagnosis, or is the disease the cause of the depression?

The answer seems to be both.

Eating gluten can cause depression

Eating gluten if you are a coeliac (diagnosed or not) seems to have an impact not only on your physical health, but also on your mental health. There may be two reasons for this:

  • malabsorption

    coeliacs eating gluten fail to absorb tryptophan, which leads to a decrease in production of serotonin (the ‘feel-good’ brain chemical), and increasing the risk of mood disorder. Coeliacs eating gluten are also likely to be short on other vitamins as a result of their malnutrition, such as vitamin B6, vitamin C, folic acid and zinc, all of which are needed to help make serotonin from tryptophan.

  • the immune response

    cytokines are produced that may change the body’s ability to regulate mood

    Cytokines, signaling molecules of the immune system, have been implicated as a contributing factor for mood disorders such as depression (from Biopsychiatry 2003).

    Maes and Smith (Perspectives in Depression 1999) have proposed excessive cytokine secretion due to chronic immune system activation as a fundamental pathology underlying depressive symptoms. Cytokines as such cannot cross the blood-brain barrier, but growing evidence suggests that specific cytokines may signal the brain to produce neurochemical, neuroendocrine, neuroimmune, and behavioral changes.(Kronfol and Remick, Am J Psychiatry 2000). Cytokine activation is known to enhance the hypothalamus-pituitary-adrenal axis hyperactivity associated with major depression. (Maes and Smith Psychomeuroendocrinology 1995). … Any such mechanism could be operative in untreated CD and could cause disturbances in brain serotonin function, predisposing the patient to mood and behavioral disorders. (from Psychosomatics 2002)

Being diagnosed can cause depression

And of course having a lifelong condition that requires a lifestyle change is highly likely to trigger depression – whether the condition is coeliac disease or some other significant disorder.

The Royal College of Psychiatrists has a section on physical illness and depression, as a subset of its depression pages.

So what can we do?

The easy answer is, of course, to avoid gluten, though as we all know, this isn’t that easy.

Once you’ve eliminated gluten from your diet, then your nutrition should improve. Eating a healthy diet – not junk food that happens to be gluten free – will help. Gluten free sources of the elements mentioned above include:

  • meat, fish, beans and lentils for tryptophan
  • avocados, bananas, raisins, currants and sultanas, sunflower seeds and soya for vitamin B6
  • a wide range of fruit and vegetables for vitamin C
  • leafy green vegetables, avocados, oranges, almonds and walnuts for folic acid
  • and zinc can be found in peanuts, cheese, figs, nuts and seeds, and small amounts in green and yellow fruit and vegetables

Eat all of that lot, and you ought to be producing some serotonin, and feeling a lot better. Plus, of course, removing gluten from your diet will also remove the immune reaction.

But what about depression caused by the discovery of the condition, rather than the condition itself?

If you think (or those around you think) that you may be depressed, you should seek treatment. This isn’t something you can just ‘snap out of’. Do go and see your doctor.

Also, researchers have found that psychological support can help coeliacs with anxiety and depression stick to the gluten free diet – so if you are struggling with the diet, ask for professional help. There are also supportive amateur communities around who can offer advice – try the gluten free messageboard – but this isn’t a substitute for treatment.

Further reading:

Food and Behaviour Research and Food and Mood have interesting and valuable information about the relationship between nutrition and health.

If you need more information about dealing with mental health issues, visit the NHS section on mental health at National Library for Health and the Royal College of Psychiatrists section on mental health information.

Kathy at Gluten Free Kathy is researching the psychology of celiac disease, and is compiling a list of useful links.

Drinks you can and can't enjoy if you’re gluten free

Recently diagnosed, and wondering what you can or can’t drink?

You know you can’t eat gluten … but what is in your mug? There are many drinks that you can enjoy, whether hot, cold, alcoholic or not.

black coffee

  • water – whether tap, mineral or flavoured should be fine. There’s no gluten in pure water, and we should all be drinking more of this
  • pure fruit juice – no gluten in this – just flavour and vitamins (and, sadly, calories from the sugars). Be careful about smoothies – these are usually just fruit juice and yoghurt, but do sometimes have other ingredients, so just check
  • milk is gluten free. If you’re lactose intolerant, or avoiding dairy for other reasons, try soya milk or rice milk. You may be able to handle goat’s milk
  • probiotic drinks are a new trend. Check them, but they should be fine if you can handle dairy products
  • plain tea is gluten free, as should be any milk or sugar that you add, but be wary of drinks from vending machines, as there may be cross-contact (see Make Mine Gluten Free for a discussion of the difference between cross-contact and cross-contamination)
  • herbal or fruit teas and infusions should all be gluten free
  • plain coffee is gluten free (and so are milk and and sugar) but be careful of flavourings and other additions (e.g. some chocolate toppings to go on cappuccinos, lattes, etc). Again, be careful about using vending machines
  • coffee substitutes, such as chicory blends or decaffeinated drinks may contain gluten. I had an email from the SoyCoffee; people to promote their gluten free coffee substitute – but I haven’t tried it.
  • pure instant chicory is gluten free
  • chocolate drinks: pure cocoa powder is gluten free, but check drinking chocolate because this can contain wheat
  • savoury drinks, such as Bovril and Marmite should be checked (particularly if you are not in the UK, as I understand that non-UK Marmite may not be gluten free)
  • most fizzy drinks are gluten free, but be alert to ‘cloud’ – this can be wheat-based
  • most fruit squashes are gluten free, but don’t drink the ‘fruit and barley’ squashes. It’s obvious, but you’d be surprised how easy it is to miss this!
  • avoid malted drinks (because of the malt). The only example I can think of is Ovaltine, but no doubt there are others out there. Malt extract and malt flavouring are made from barley, and widely used in breakfast cereals, pre-prepared meals, sweets and snacks. Small amounts of malt extract can be tolerated by many coeliacs, but not everyone, so check, and be careful. Even if you can handle a bowl of Rice Krispies, you may tip yourself over the ‘safe’ limit if you eat malt repeatedly throughout the day
  • cider, sherry, port and liqueurs are gluten free – and so, presumably is perry. Some fortified wines and sherry may contain caramel colour, which may be derived from wheat starch, but doesn’t contain detectable gluten, and is considered to be gluten free
  • wine should be gluten free, whether still, fizzy, sweet or dry, but we have had reports that some Australian wines are treated with hydrolysed wheat gluten as part of the fining process. Again, the level of gluten is not detectable in the final product, and it is considered to be gluten free
  • spirits are gluten free as long as no gluten product is added after distillation. Yes, including malt whiskies, because of the distillation process. But be careful of cocktails, which may have a gluten-containing product in them …
  • most beer, lager, stout and ale contain gluten, so avoid these. There are a growing range of gluten free beers of all varieties available.

I hope that helps. I’m just going to put the kettle on …

Don’t let celiac disease break your bones

Did you know that people with coeliac disease have an increased need for calcium even when they are on a gluten free diet?

Milk - lots of calciumI didn’t. I thought that simply cutting out the gluten and eating a generally healthy diet would be enough. But according to a dietician I met last week at the local Coeliac Society meeting, coeliacs (and people with dermatitis herpetiformis) have an increased risk of osteoporosis even if keeping strictly to a gluten free diet, and that they therefore need more calcium.

As the mother of a pre-teen coeliac daughter, this is a bit of a worry. Luckily I’ve always given the children lots of dairy products. But what if you’re not keen on dairy products, or are lactose intolerant?

Recommended daily dose of calcium

The standard recommended dose for adults here in the UK is 700mg per day (Food Standards Agency).

However, the UK Coeliac Society is recommending that coeliac adults should take 1500mg per day, and they provide a guide to daily calcium requirements. The guidelines are different in different countries, so you decide what is appropriate for you (ask a dietician if you are in any doubt – I am not qualified to make recommendations).

Age Daily amount
mg
(CUK)
Daily amount
mg
(US)
1-3 years 350 400-800
4-6 years 450 800
7-10 years 550 800
11-18 years 900 800-1200
Adults 700 800-1200
Adults with coeliac disease 1500
Pregnant women - 1200
Breastfeeding women 1250 1250
Post-menopausal women 1000 1500

I can’t find specifics for children with coeliac disease, but I imagine it is safe to assume that it is higher than the standard recommendation for children, but lower than the adult recommendation.

There are apparently some further, specific, recommendations in the US which you might find helpful:

Age Daily amount
mg
(US)
Men 25-65 1000
Men over 65 1500
Women 25-50 1000
Women over 50 on HRT 1000
Women over 50 not on HRT 1500
Women over 65 1500
Pregnant and nursing women 1200-1500


Calcium is found in a variety of foods

The richest sources of calcium are dairy products, but also in fish, dried fruit, leafy green vegetables such as spinach, oranges, nuts and tofu.

Food Amount
of calcium (mg)
1 glass (200ml or 1/3 UK pint) milk
(full-fat, semi-skimmed or skimmed)
250
40g or 1 1/2oz cheddar cheese 250
1 serving carton fruit yoghurt 150
Sardines (2, or 1/2 a small tin) 250
Salmon including bones (3.5 oz of 100g) 100
Portion fortified gluten free breakfast cereal 150
2 slices of calcium enriched gluten free bread 200
1 calcium enriched gluten free roll 250
1 dried fig or 7 dried apricots 50
Portion boiled spinach (3.5 oz or 100g) 150
Shelled almonds (3.5 oz or 100g) 250
1 medium orange 50
Portion of tofu (3.5 oz or 100g) 500
Portion of baked beans (1/4 large can, or 100g) 50
Fortified mineral water (200ml) 50

Being strict about the gluten free diet will increase your absorption of nutrients such as calcium, but do make sure that you are eating enough in the first place. Simply work out how much you should be taking using the tables in the first section, then work out what you need to eat in an average day, using the list above, to get to your recommended total.

Not enough?

Most people don’t manage to eat enough calcium. You can take a supplement, but it is recommended that you don’t take more than 1500mg by supplement – and don’t take more than 500mg at a time, as you won’t absorb it all in one go. You might get better results if you take at least part of the supplement at night, and with a glass of milk or apple juice, which can improve the uptake of calcium.


What else can I do?

To be sure that your bones are as strong as possible, you can also do the following:

  • get some vitamin D. You can get most of this from sunlight, but if you have dark skin or don’t see the sun much, you can get it in your diet from margarine, oily fish and some dairy products. (I sense another post coming on soon …)
  • get some exercise. Yes, I know you’ve heard this before, but it will help strengthen your bones. Make sure it is weight-bearing exercise such as walking or dancing. Anything where you are bouncing up and down on your feet – swimming won’t help in this case.
  • keep the amount you drink to below the recommended amount
  • reduce the amount of coffee you drink
  • … and don’t smoke.

I hope that’s helpful – more thoughts on vitamins soon.

(So, if one child drinks two glasses of milk and eats one portion of cheese, and one of ice-cream, and has milk on their cereal, and …

Don’t eat Spelt – whatever the Independent says

The Independent, my favourite newspaper, has – sadly – let me down today.

Every Saturday, it provides a 50 Best feature, which is always interesting – how many of the 50 Best Beaches have I visited? Would I wear any of the 50 Best Women’s Coats, and so on. This week it is 50 Best Food Luxuries, and at no.13, it recommends spelt flour, saying “It’s perfect for the gluten-intolerant”.

No! No!

I quote from the Coeliac UK site:

Spelt is an ancient strain of wheat and research indicates that it is toxic to people with coeliac disease. Spelt is not suitable for a gluten-free diet.

And here I thought you could believe everything you read in the newspaper … Do you think they’d be interested in 50 Best Ways to Live Gluten Free? I’d love to have a go at that!

Skin care for Rosacea

This is slightly off-topic, but I’d like to recommend the Sher System for facial skin care if you suffer from rosacea or acne (middle-aged or the usual!). I’ve been using it for a few years now, and I really do think it helps.

The first few days are tricky, and your skin may feel very dry and tight as it gets used to the new regime, but after that it is great. The system is basically a two stage cleanse, a facial oil (multi-action serum) and then a moisturiser. They have a wonderful concealer/healer cream which hides the blemishes while healing them, and they also offer makeup and suncream as well as a few other products. I like the fact that the system is based on water, and I love the facial oil.

It is expensive, I think, but is well worth it, and the bottles do seem to last a long time.

Bizarrely, the short video link on their site seems to be about the ACCA accounting courses, rather than about the skincare product, and the explanatory video I was sent when I started using the skincare system was of poor quality – but don’t be put off. I expect they have a brand new explanatory video/dvd now, and the instructions are straightforward.

Stick with it past the first few days, and you should see an improvement. I know I did …