Wednesday, 14 May 2014

Is Gluten Making You Depressed?


I recently consulted with a 24 year-old patient diagnosed with ADHD, anxiety, and depression. He was prescribed a different medication for each diagnosis: Adderall for ADHD, Valium for anxiety, and Zoloft for depression.
He was on three medications, one for each diagnosis, yet he continued to struggle with attention problems, anxiety, and depression! Moreover, he wanted additional medication to help him sleep.
Before prescribing medication for any patient, I recommend a comprehensive panel of blood work to rule out hormone or nutritional deficiencies.
In the case of my 24 year-old patient, I discovered that he was anemic with very low iron and zinc levels and a significant B12 deficiency. For a physically healthy, meat eating young man these were unusual lab results.
Why hadn't his other doctors caught these results? His previous psychiatrists never ordered any blood work and his last visit to his PCP was for the flu and blood work was not done.
Based on his nutritional deficiencies I ordered additional tests. Further testing revealed that he was positive for antibodies to gliadin, a protein found in wheat often used as a marker for the presence of celiac disease. A biopsy confirmed that he had celiac disease.
Celiac disease, commonly thought of as only a GI disorder, can cause profound psychological symptoms. One of which is depression.
In celiac disease the body's immune system mistakenly attacks a protein called gluten, which is found in wheat, rye, and barley. In its attack on gluten, the immune system damages the small intestine, producing intestinal symptoms such as abdominal cramps and swelling, pain, gas, vomiting, diarrhea, and constipation. Once damaged the small intestine may not absorb essential vitamins, minerals, and proteins as well as it should.
The health consequences of celiac disease, however, extend beyond gastrointestinal issues and may affect every organ system, including the brain.
Other consequences of celiac disease include:
  • Anemia
  • Anorexia
  • Arthritis
  • Behavioral changes
  • Depression
  • Fatigue
  • Infertility
  • Joint pain and inflammation
  • Migraine headaches
  • Missed menstrual periods
  • Numbness and tingling of the hands and feet
  • Osteoporosis
  • Seizures and other neurological problems
  • Skin lesions
  • Tooth decay and discoloration
  • Weakness
  • Weight loss
Researchers have long observed an overlap between celiac disease and depression. Reports of depression among celiac disease patients have appeared as early as the 1980s. In 1982 Swedish researchers reported that "depressive psychopathology is a feature of adult celiac disease and may be a consequence of malabsorption." A 1998 study confirmed that about one-third of those with celiac disease also suffer from depression. Adolescents with celiac disease also face higher than normal rates of depression. Adolescents with celiac disease have a 31% risk of depression, while only 7% of healthy adolescents face this risk.   
How does depression relate to the damage done to the small intestine in celiac disease? The intestinal damage wrought by celiac disease prevents absorption of essential nutrients that keep the brain healthy, especially zinc, tryptophan, and the B vitamins. These nutrients are necessary for the production of essential chemicals in the brain such as serotonin, a deficiency of which has been linked to depression.
In particular, low zinc levels have been linked to depression. In addition to keeping the immune system strong and the memory sharp, zinc plays an important role in the production and use of neurotransmitters-brain chemicals that help modulate mood. This is why low levels of zinc have been linked to major depression, and why supplemental zinc enhances the effects of antidepressant medications in many people. A 2009 study found that zinc supplementation significantly reduced depression scores in people who had not been helped by antidepressants in the past.
Sadly, in cases of depression related celiac disease these nutritional deficiencies are often ignored by physicians who are more comfortable in treating the symptoms of depression with medication.
Why does this happen?
Physicians may think that the nutritional deficiencies are unrelated to depression. Celiac disease is often undiagnosed or misdiagnosed as disorders with similar gastrointestinal symptoms such as anorexia nervosa, chronic fatigue syndrome, IBS (irritable bowel syndrome), or Crohn's disease. Physicians, as with many people, tend to separate the gastrointestinal issues of celiac disease from the psychological problems and treat them separately.
If celiac disease is suspected, a blood test is administered to look for the antibodies to gluten-anti-gliadin, anti-endomysial, and anti-tissue transglutaminase. High antibody levels indicate the presence of celiac disease. However, the only way to make a definitive diagnosis is to perform an endoscopy of the intestinal lining.
Once diagnosed, how do you treat celiac disease? The tragic news is that no treatment will cure celiac disease. But the disease can be managed with a gluten-free diet. By avoiding foods containing gluten, the symptoms of celiac disease, including the psychological symptoms, will resolve and the body can heal some if not all of the intestinal damage. Most people who begin a gluten-free diet feel better almost immediately, although the psychological symptoms may require months of nutritional support before seeing any improvement.
After making a definitive diagnosis for my 24 year-old patient, he was started on a gluten-free diet. After nearly two years, he's no longer on any psychiatric medications and no longer has three psychiatric diagnoses. His symptoms of anxiety and depression slowly subsided with a gluten-free diet.
Undiagnosed celiac disease can exacerbate symptoms of depression or may even be the underlying cause.
Patients with depression should be tested for nutritional deficiencies. Who knows, celiac disease may be the correct diagnosis and not depression.

Tuesday, 13 May 2014

Connecting Emotional Physical and Mental Health in Traditional Chinese Medicine

What Are The Seven Emotions?

Suwen (The Book of Plain Questions)
says "The five yin-organs of the human body produce five kinds of essential qi, which bring forth joy, anger, grief, worry, and fear." TCM also believes that certain organs are related to emotional activities, i.e. the heart is related to joy, the
liver to anger, the spleen to pensiveness, the lungs to anxiety and the kidneys to fear.

The emotions are considered the major internal causes of disease in TCM. Emotional activity is seen as a normal, internal, physiological response to stimuli from the external environment. Within normal limits, emotions cause no disease or weakness in the body. However, when emotions become so powerful that they become uncontrollable and overwhelm or possess a person, then they can cause serious injury to the internal organs and open the door to disease. It is not the intensity as much as the prolonged duration or an extreme emotion, which causes damage. While Western physicians tend to stress the psychological aspects of psychosomatic ailments, the pathological damage to the internal organs is very real indeed and is of primary concern of the TCM practitioner.
Excess emotional activity causes severe yin-yang energy imbalances, wild aberrations in the flow of blood, qi (vital energy) blockages in the meridians and impairment of vital organ functions. Once physical damage has begun, it is insufficient to eliminate the offending emotion to affect a cure; the prolonged emotional stress will require physical action as well. The emotions represent different human reactions to certain stimuli and do not cause disease under normal conditions.
The Pathogenic Features of the Seven Emotions:

Directly impairing organ qi (vital energy)
Affecting the functions of organ qi (vital energy)
Deteriorating effects of emotional instability

The seven emotions in TCM are:

Joy * Anger * Anxiety * Pensiveness * Grief * Fear * Fright


In TCM joy refers to a state of agitation or overexcitement.

"When one is excessively joyful, the spirit scatters and can no longer be stored," states the Lingshu (The Vital Axis). However, in TCM, joy refers to a states of agitation or overexcitement, rather than the more passive notion of deep contentment. The organ most affected is the heart. Over-stimulation can lead to problems of heart fire connected with such symptoms as feelings of agitation, insomnia and palpitations.

Anger Anger could lead to high blood pressure.

Anger, as described by TCM, covers the full range of associated emotions including resentment, irritability, and frustration. An excess of rich blood makes one prone to anger. Anger will thus affect the liver, resulting in stagnation of liver qi (vital energy). This can lead to liver energy rising to the head, resulting in headaches, dizziness, and other symptoms. In the long run it can result in high blood pressure and can cause problems with the stomach and the spleen. It is commonly observed that ruddy, "full-blooded" people with flushed faces are more prone than others to sudden fits of rage at the slightest provocation.

Anxiety can block the qi and manifest in rapid, shallow breathing.

"When one feels anxiety, the qi (vital energy) is blocked and does not move." Anxiety injures the lungs, which control qi (vital energy) through breathing. Common symptoms of extreme anxiety are retention of breath, shallow, and irregular breathing. The shortage of breath experienced during periods of anxiety is common to everyone. Anxiety also injures the lungs' coupled organ, the large intestine. For example, over-anxious people are prone to ulcerative colitis.

Too much intellectual stimulation can cause pensiveness.

In TCM, pensiveness or concentration is considered to be the result of thinking too much or excessive mental and intellectual stimulation. Any activity that involves a lot of mental effort will run the risk of causing disharmony. The organ most directly at risk is the spleen. This can lead to a deficiency of spleen qi (vital energy), in turn causing worry and resulting in fatigue, lethargy, and inability to concentrate.

  Grief that remains unresolved can create disharmony in the lungs.

The lungs are more directly involved with this emotion. A normal and healthy expression of grief can be expressed as sobbing that originates in the depths of the lungs - deep breathes and the expulsion of air with the sob. However, grief that remains unresolved and becomes chronic can create disharmony in the lungs, weakening the lung qi (vital energy). This in turn can interfere with the lung's function of circulating qi (vital energy) around the body.

Fear that cannot be directly addressed is likely to lead to disharmony in the kidneys.

Fear is a normal and adaptive human emotion. But when it becomes chronic and when the perceived cause of the fear cannot be directly addressed, then this is likely to lead to disharmony. The organs most at risk are the kidneys. In cases of extreme fright, the kidney's ability to hold qi (vital energy) may be impaired leading to involuntary urination. This can be a particular problem with children.

Fright can affect the kidneys if left unchecked.

Fright is another emotion not specifically related to only one organ. It is distinguished from fear by its sudden, unexpected nature. Fright primarily affects the heart, especially in the initial stages, but if it persists for some time, it becomes conscious fear and moves to the kidneys.

May Newsletter.

Dear Friends,

Last month we have had a chocolate overdose, which fuelled a very productive gathering. Kindly Steve Woodhams has contributed collecting the minutes (do send us an email if you wish to have a copy).
Our May meeting is now fast approaching. Please join us next Monday the 19th of May, 6.30-8.30pm at LARC 62, Fieldgate Street E1 In our agenda some forthcoming events to discuss, including a possible event dedicated to R D Laing and a special Open Mic. Remember the Summer Shuffle festival last year? Chances are we will be back with an Outsiders Open Mic next July. Details to be confirmed, but do get in touch if willing to perform.
The Survivors History Group is also meeting this month, on Wed the 28th May at Together, 12 Old
Street, London, EC1V 9BE

The Gandhi Foundation is having their AGM and an Illustrated Talk on Saturday 24th May 2014, 2-4pm at Kingsley Hall, Powis Road, Bromley-By-Bow, London E3 3HJ RSVP: (for catering purposes)

Please spread the word - we are asking people in the UK and overseas to collect and send us their used postage stamps. We can recycle them and raise funds for BCSW. You can send any amount of stamps, at any time, to BCSW Stamp Appeal, PO BOX 654, Bristol BS99 1XH. Please remember to put the correct postage on your packages. Thanks very much!