I recently wrote a post on Facebook about an essay I was writing on the role of gluten and casein (a milk protein) in mental illness. It got such an overwhelming response and I had so many people request copies of that essay that I thought it would be a good idea to write a blog post about it based on the research I found while writing that assignment.
I am going to focus mainly on gluten for this post although casein is often linked to the same disorders and will get a mention too.
Gluten is a protein composite found in grains such as wheat, rye, barley and spelt. It actually consists of 2 different proteins – glutelin and gliadin and is the substance that gives dough its elastic texture. That is why baking with gluten free flours is so tricky!
Problems with gluten are usually associated with Coeliac disease which is an autoimmune condition where the immune system reacts abnormally to gluten causing damage to the small bowel. This damage interferes with nutrient absorption and leads to various gastrointestinal and other disorders. There are many psychiatric disorders associated with Coeliac disease including depression, anxiety, schizophrenia, ADHD, autism and eating disorders. More about these later in this post.
Gluten sensitivity is an issue that has only been recognised quite recently. Individuals who are sensitive to gluten do not show the same gastrointestinal symptoms as people with coeliac disease and in fact, may not have any gastrointestinal problems at all. Neurological and psychiatric issues may be the prime presentations for people with gluten sensitivity and because this issues is largely unknown or unrecognised by the general medical profession, it can easily go untreated.
Dr Natasha Campell-McBride, author of GAPS (Gut and Psychology Syndrome) describes how researchers have found both gluten and casein peptides (a product of protein digestion) in the urine of individuals with schizophrenia, autism, ADHD and depression. She explains how these disorders originate in the gut (due to poor gut health and intestinal permeability) and that the gluten and casein proteins do not get digested properly and turn into substances with similar chemical properties to opiates such as morphine and heroin. These opiate-like substances from grains and milk are thought to cross the blood-brain barrier and block certain areas of the brain, just as heroin and morphine do. This theory also explains why people with sensitivity to these substances crave them and are often very fussy eaters, mainly eating foods containing grains or dairy – parents of children with autism will know what I am talking about!
Interestingly, there is a much higher prevalence of coeliac disease in people with schizophrenia even though these two disorders have approximately the same prevalence in the general populations and these incidences are far greater than would be expected by chance alone. The link between these disorders was recognised as far back as the 1950s and led to an hypothesis by Dohan in 1966 that in individuals carrying the genotype for schizophrenia, the actual occurrence of the disorder may be related to the consumption of cereals such as wheat and rye. That is, having a genetic predisposition to schizophrenia does not necessarily mean that one will go on to develop this disorder but that certain things can trigger its development. Dohan’s research suggests that this may be consumption of cereals. Other theories have linked the development of schizophrenia to stress, drug use, trauma and other factors. Cascella et al (2011) found that people with schizophrenia have a increased level of particular antibodies to gluten and concluded that these individuals have a specific immune response to this substance. Antibodies to gliadin and casein have also been found in bipolar disorder and autism. In 1984, further research by Dohan found that in countries where wheat, rye, barley and oats were not part of the diet (New Guinea and other South Pacific Islands), there were fewer and less severe cases of schizophrenia than in countries with where the diets were rich in gluten containing grains. Even more interesting was the finding that when the diets of those countries became more westernised, the incidence of schizophrenia increased – scary huh?
Similar findings have been shown in autism where families who move from countries where the diets are low in grains and milk to countries where the consumption of grains and milk are high, have an increased rate of autistic syndromes.
There have been many studies that have looked at the effects of gluten and casein free diets in schizophrenia, autism, anxiety disorders, depression and ADHD. Most of the latter disorders have been studied in the context of coeliac disease however several studies show a significant improvement in symptoms after following a gluten free diet. There are also many case studies documenting outstanding results and remission of symptoms after following a gluten and casein free diet in individuals with schizophrenia and autism.
There are several theories as to why gluten or casein cause or trigger these mental health issues in susceptible people. These theories include food allergies, immune responses, interference in brain processes, exorphins being absorbed into the blood stream from the gut and then passing through the blood-brain barrier to affect the central nervous system (note the link to poor gut health here), links to serotonergic functioning, and autoimmune responses.
So, what is the take home message in all of this research? The role of diet in the development of mental health disorders is overlooked in the general medical models and as doctors (and psychologists!) receive no training in nutrition they will rarely consider an issue such as food allergies or gluten sensitivity when looking to treat a patient. In fact, as doctors are trained to see symptoms and prescribe something to ‘fix’ them, they rarely look for the underlying cause or assume that these disorders are all genetic or biological in nature. Medications prescribed often lead to worse gut health (and overall health) and many contain dairy or gluten, leading to worsening of symptoms and often more medications. For many people medication is absolutely necessary though so please don’t think that I am anti all medication.
My theory is that there is not one explanation for every disorder. I spend much of my time working with individuals who have experienced significant trauma and adverse life experiences which I believe lead to a significant proportion of mental health issues. However, I am also a firm believer in the role of diet and particularly in the role of gut health in the development and maintenance of mental health problems. Gluten is a known problem for gut health and clearly has links with many mental health problems. I would strongly encourage anyone suffering from any of the issues mentioned in this blog post (or any mental health issue) to consider removing gluten from their diet. For many this may lead to an improvement in symptoms or a calming of the nervous system enough to be able to engage in therapy and develop useful coping strategies. For others removing gluten might not go far enough and they might need to consider cutting out dairy and other grains or starches. There has been a lot of successes reported from a paleo approach to eating and I am a huge fan of the GAPS diet for gut healing. Switching to wholefoods rather than processed food can only have a positive effect on anyone’s health. For people where medication is necessary, a change in diet can still make a difference.
There is no one size fits all approach – see what works for you as an individual. But, if things are not working for you at the moment then try some small changes and observe the effects. What have you got to lose?
For an amazingly delicious and easy to make gluten free bread click here.
Please feel free to share this post with anyone that might find it useful. Lets spread the word that there is a link between diet and mental health. I am unable to keep emailing out the essay but I have added the full reference list from the essay at the bottom of this post so you can read the research for yourself.
Addolorato, G., Capristo, E., Ghittoni, G., Valeri, C., Masciana, R., Ancona C. & Gasbarrini. G. (2001). Anxiety but not depression decreases in coeliac patients after one-year gluten-free diet: a longitudinal study. Scandinavian Journal of Gastroenterology, 36, 502 – 506.
Addolorato, G., Mirijello, A., D’Angelo, C., Leggio, L., Ferrulli, A., Vomghia, L., Cardone, S., Leso, V., Miceli, A. & Gasbarrini, G. (2008). Social phobia in coeliac disease. Scandinavian Journal of Gastroenterology, 43(4), 410 – 415.
Cade, R., Privteet, M., Fregly, M., Rowland, N., Sun, Z., Zele, V., Wagemaker, H. & Edelstein, C. (2000). Autism and Schizophrenia: Intestinal Disorders. Nutritional Neuroscience, 3, 57 – 72.
Campbell-McBride, N. (2010). GAPS: gut and psychology syndrome. Revised and expanded edition. Medinform Publishing, Cambridge, United Kingdom.
Cascella, N. G., Kryszak, D., Bhatti, B., Gregory, P., Kelly, D. L., McEvoy, J. P., Fasano, A. & Eaton, W. W. (2009). Prevalence of celiac disease and gluten sensitivity in the united states clinical antipsychotic trials of intervention effectiveness study population. Schizophrenia Bulletin doi:10.1093/schbul/sbp055
Coeliac Australia. http://www.coeliac.org.au/coeliac-disease/
Dickerson, F., Stallings, C., Origoni, A., Vaughan, C., Khushalani, S., Alaedini, A. &Yolken, R. (2011). Markers of gluten sensitivity and celiac disease in bipolar disorder. Bipolar Disorders, 13, 52–58.
Dohan, F. C. (1966). Cereals and schizophrenia. Data and hypothesis. Acta Psychiatrica Scandinavia, 42, 125 – 152.
Dohan, F. C., Martin, L., Grasberger, J. C., Boehme, D. & Cottrell, J. C. (1972). Antibodies to wheat gliadin in blood of psychiatric patients: possible role of emotional factors. Biological Psychiatry, 5, 127 – 137.
Dohan, F. C., Harper, E. H., Clark, M. H., Rodrigue, R. B. & Zigas, V. (1984). Is schizophrenia rare if grain is rare? Biological Psychiatry, 19, 383 – 399.
Elder, J. H., Shankar, M., Shuster, J., Theriaque, D., Burns, S. & Sherrill, L. (2006). The gluten-free, casein-free diet in autism: results of a preliminary double blind clinical trial. Journal of Autism and Developmental Disorders, 36(3), 413 – 420.
Jackson, J. R., Eaton. W. W., Cascella, N. G., Fasano, A. & Kelly, D. L. (2012). Neurologic and psychiatric manifestations of celiac disease and gluten sensitivity. Psychiatric Quarterly, 83(1), 91 – 102.
Kalaydijian, A. E., Eaton, N., Cascella, N. & Fasano, A. (2006). The gluten connection: the association between schizophrenia and celiac disease. Acta Psychiatrica Scandinavica,113, 82 – 90.
Neibuhr, D. W., Li, Y., Cowan, D. N., Weber, N. S., Fisher, J. A., Ford, G. M. & Yolken, R. (2011). Association between bovine casein antibody and new onset schizophrenia among US military personnel. Schizophrenia Research, 128, 51 – 55.
Neiderhofer, H. & Pittschieler, K. (2006). A preliminary investigation of ADHD symptoms in persons with celiac disease. Journal of Attentional Disorders, 10(2), 200 – 204.
Pynnonen, P. A., Isometsa, E. T., Verkasalo, M. A., Kahkonen, S. A., Sipila, I., Savilahti, E. & Aalberg, V. A. (2005). Gluten-free diet may alleviate depressive and behavioural symptoms in adolescents with coeliac disease: a prospective follow-up case-series study. BMC Psychiatry, 5, 14
Reichelt, K. L. & Knivsberg, A-M. (2003). Can the pathophysiology of autism be explained by the nature of the discovered urine peptides? Nutritional neuroscience, 6 (1), 19 – 28.
Severance, E. G., Dupont, D., Dickerson, F. B., Stalling, C. R., Origoni, A. E., Krivogrsky, B., Yang, S., Haasnoot, W. & Yolken, R. H. (2010). Immune activation by casein dietary antigens in bipolar disorder. Bipolar Disorders, 12, 834 – 842.
Whiteley, P., Haracopos, D., Knivsberg, A-M., Reichelt, K. L., Parlar, S., Jacobsen, J., Seim, A., Pedersen, L., Schondel, M. & Shattock, P. (2010). The scanbrit randomised, controlled, single-blind study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders. Nutritional Neuroscience, 13(2), 87 – 100.
If you have a story of how changing your diet has helped with your mental health I would love to hear it. Please share in the comments below or email it to me. I am always happy to share success stories as blog posts or facebook posts if you would like me to!