GATES BRAIN HEALTH NEWSLETTER
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Does Gluten Cause Depression?
The infamous gluten. Some are tired of hearing about this ‘dirty’ protein that is in wheat, barley, oats, and rye. One might ask, why is gluten ‘dirty’? And hasn’t wheat been around for thousands of years?
Metaphorically, gluten is ‘dirty’ as it appears to be causing a problem in a rising number of Americans. Around the year 2000, one in a thousand individuals had an autoimmune attack against this wheat protein, referred to as Celiac Disease or Celiac Sprue (sprue refers to diarrhea). However, now twenty years later, one in a hundred individuals are diagnosed with Celiac Disease.
No one knows exactly why gluten is such a menace all of a sudden but didn’t cause a problem in the recent past. There are multiple different theories that could explain this phenomenon. Theories include the hybridization of wheat, so that gluten has become a tougher molecule to break down in the gastrointestinal tract. Another theory is that mass use of antibiotics and the fact that as a society, we are too clean and lack diversity in our microbiome. A third popular theory is that pesticides sprayed on corn and soy crops may be responsible for the human digestive tract becoming resistant to this particular wheat protein.
Additionally, over the last twenty years science has verified that gluten has a role in the disease process for some but not all cases of Autism, Hashimoto’s thyroiditis, Bipolar Disorder, Peripheral Neuropathy, Ataxia, and Schizophrenia to name a few. Ironically, most of these conditions are not stomach, intestine, or colon conditions. They are “EXTRAINTESTINAL”, meaning they are outside the gastrointestinal tract. Other names for this association between gluten and far reaching areas of the body include Gluten Related Disorders and Non-Celiac Gluten Sensitivity.
Since the discovery of Non-Celiac Gluten Sensitivity, researchers have found a link between it with Depression. Professor Peter Gibson, an Australian Researcher, was one of the first in the world to acknowledge a relationship between gluten and health problems outside of Celiac Disease. Again, Celiac disease is a well defined autoimmune condition, meaning you either have it or you don’t. Doctor’s know if someone has Celiac disease based on the following:
-Positive blood work for Tissue Transglutaminase Antibodies, and or antiendomysial antibodies.
-Endoscopic biopsy (camera down the throat into the small intestines) demonstrating villous atrophy (finger like structures in the small intestines become short and diminutive in appearance) and intraepithelial lymphocytosis (lots of immune cells in the small intestines seen on the microscope slide)
-Gliadin antibodies are likely present.
If an individual has a very high reading for TTG antibodies, that by itself is enough evidence for some doctors without the endoscopy to diagnose Celiac disease.
Now that the criteria is well understood, Gluten Related Disorders and Non Celiac Gluten Sensitivity (NCGS) can be better embraced.
NCGS patients sometimes have antibodies to gliadin (a piece of the gluten molecule) and sometimes they do not. Some estimates say that about 50% of patients have antibodies to gliadin. But, gliadin antibodies are positive in a number of conditions ranging from Celiac, to autoimmune hepatitis, IBS, connective tissue diseases, and healthy individuals (2-8%). Therefore, gliadin antibodies are not regarded as a stand alone lab test for NCGS.
The preferred method for documenting NCGS, is for patients to go on a gluten free diet for at least 4 weeks and then reintroduce gluten into the diet and monitor their symptoms. Professor Peter Gibson observed this relationship with patients and promoted the validity of NCGS.
With a seminal article published in 2013, he and his team found that Irritable Bowel Syndrome patients did not have a reaction to gluten, published in the Journal of Gastroenterology. He had approximately 37 patients consume a low FODMAP diet (that is a whole other issue, these are foods high in carbohydrates which promote bloating and gas in the gut such as garlic and onions), followed by a 1 week course of eating high gluten, low gluten and high dairy, or just dairy proteins. Each of these three diets were followed by a 2 week washout period before moving onto the next diet. The summary was that all the patients felt better on a low FODMAP diet and most of them felt worse eating gluten and dairy, but that gluten by itself was not a problem.
His findings hit the mainstream media and news articles and stories were abound saying that gluten was not really a problem as noted by a world renowned researcher on gluten. What did not hit the media was Dr. Gibson’s 2014 study.
Published in Alimentary Pharmacology and Therapeutics for those interested, Dr. Gibson took 22 patients with NCGS and did a similar study as mentioned above. The differences were that the patients ate the foods for 3 days rather than a week, and the washout period was 3 days rather than 2 weeks. Interestingly, Dr. Gibson showed that gluten exposure resulted in feelings of depression without causing gastrointestinal symptoms. Quite interesting. He controlled for a number of variables and concluded that for those sensitive to gluten, the reaction was causing an issue with the brain and depression more than that gluten was causing a reaction in the intestines.
Estimates vary between 5-18 percent of the US population having NCGS. The purpose of this series on depression is to bring light to Treatment Resistant Depression and to uncover the underlying causes of this significant mental health concern.
To recap, Treatment Resistant Depression is where an individual does not respond or stops responding to antidepressant medications. Estimates vary, but some are as high as stating 50% of depressed patients have Treatment Resistant Depression. For this reason, it is important to evaluate other potential seemingly far removed causes such as gluten, Hashimoto’s thyroiditis, obesity, and changes in the gut microbiome. In the coming weeks, we will be discussing more about genetics and stress hormones.
If you have questions about you or a loved one, let us know if you would like further testing or guidance regarding gluten.
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This week’s recipe is brought to you by Unbound Wellness.