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Celiac Disease, Gluten-Free Diet, and Glutenated Depression




Overview





Depression can be defined as a deep, chronic feeling of sadness. According to the National Institute of Mental Health, it almost always requires treatment to improve. Many treatments exist, including natural remedies that can help a person avoid the need for antidepressant medications. A gluten-free diet is offered for consideration by some experts as an alternative treatment for depression, but conflicting research exists as to whether this is effective. More than that, the overwhelming data has been recently received that gluten-free diet may cause or aggravate the depressive disease. It is important to talk with your primary doctor or therapist before beginning alternative treatment like that.






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Celiac Disease





While some chose to maintain the gluten-free diet, other do not have much choice. Celiac disease is an inherited, autoimmune disease in which the lining of the small intestine is damaged from eating gluten and other proteins found in wheat, barley, rye, and possibly oats.





There are many symptoms of celiac disease, such as bloating or gas, diarrhea, headaches, an inability to gain weight and fatigue. The National Foundation for Celiac Awareness also lists other nonphysical symptoms, such as depression and irritability. As of today, following a gluten-free diet during lifetime is the only treatment for celiac disease.





It’s very hard for some celiacs (people with celiac disease) to accept the fact that they need to adhere to gluten-free diet for their life. Many of them lack mental strength to accept this reality. Also, such dietary plans create many deficiencies in the body.






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Glutenated Depression Causes





Research has shown that people with celiac disease do develop depression; however, the connection is not fully understood. The higher sensitivity to the depressive episodes can be explained by several reasons:


  1. Some people may not be aware they are not aware that they are suffering from celiac disease, so they inadvertently consume an inacceptable for them dose of gluten from their daily intake. Simple things like breads, pizzas and other wheat products contain huge quantity of gluten. This in turn affects their villi (lining of your small intestine) and their capacity to absorb essential nutrients is substantially reduced. The malnutrition may cause severe health and mental consequences. Sometimes, depression related to the celiac disease is referred in the literature as ‘glutenated depression’.

  2. While being diagnosed with celiac disease, patients have to accept a bitter reality that they have to consume gluten-free diet for lifetime. They are told to change drastically their eating habits and lifestyle, with complete exclusion of wheat. So they will be banned from eating all sorts of breads, pizzas, they cannot drink beer and they will be cutting most of the deserts from their diet. It’s not easy to accept these realities. Their mind and body will resist. It becomes very hard for them to say “no” to all ‘glutenated’ foods every now and then, even if they are told by their doctor that these things can harm them. They may get severe cravings for the gluten containing treats, but they have to keep their mouth shut, which is not always easy. Gluten is very nasty nutrient. It will immediately show up. Starting from diarrhea and stomach upsets, it will make the person sick mentally and physically. So it will lead to glutenated depression.

  3. Even if a person follows a strict gluten-free diet, he/she may not be aware of the deficiencies, which such diet creates in the body. So he/she strictly adheres to gluten-free diet, but may not take in essential vitamins and nutrients, which would have been otherwise, part of his/her normal diet. So it will affect his body (mainly brains) and within a short period of time he will start feeling empty and depressed. This may be considered as the third potential cause of glutenated depression.







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Research Studies



According to various studies, there is a some link between depressive disorder and adherence to the gluten-free diet, required for celiac disease patients.


  • One study conducted by Addolorato et al., reported that depression was present in a higher percentage of celiac patients. They found that one year of gluten-free diet failed significantly to affect depressive symptoms. The presence of depression after introduction of the gluten-free diet could be related to the reduction in quality of life in celiac patients. The non-regression of depression after introducing the diet could suggest that these patients need psychological support.



  • Another study found that celiac disease increased a patient's risk of subsequent depression. Moreover, patients with celiac disease were 1.8 times as likely to develop subsequent depression as those without the gastrointestinal disorder. Also, prior depression increased the risk of celiac disease at odds ratios of 2.3. The investigators suggested, in the Journal of Affective Disorders, that this increased risk might be due to increased screening for the condition among patients with mood disorder compared to healthy individuals.






Consideration





While it is absolutely clear that celiac disease is a strong risk factor for the depression development, the leading factor for the depression might not be a gluten-free diet itself, but other two factors of consideration, reviewed earlier.





The authors of the study published in the journal BMC Psychiatry observe:


“Celiac disease in adolescents has been associated with an increased prevalence of depressive and disruptive behavioral disorders, particularly in the phase before diet treatment.”





There are also ‘non-celiac’ aspects of gluten sensitivity. Gluten related inflammation in the brain can manifest as a host of cognitive, emotional and neurodegenerative disorders in the absence of intestinal manifestations. This is often referred to as “silent celiac disease”:


“Celiac disease is an under-diagnosed autoimmune type of gastrointestinal disorder resulting from gluten ingestion in genetically susceptible individuals. Non-specific symptoms such as fatigue and dyspepsia are common, but the disease may also be clinically silent.”





They further note that:


”Depressive symptoms and disorders are common among adult patients with celiac disease, and depressive and disruptive behavioral disorders are highly common also among adolescents, particularly in the phase before diet treatment. Recently 73% of patients with untreated celiac disease – but only 7% of patients adhering to a gluten-free diet – were reported to have cerebral blood flow abnormalities similar to those among patients with depressive disorders.”





Their data revealed abnormalities in tryptophan assimilation (tryptophan is the amino acid precursor to serotonin) and prolactin levels in adolescents with celiac disease and depression prior to treatment. They revealed that


 “A significant decrease in psychiatric symptoms was found at 3 months on a gluten-free diet compared to patients’ baseline condition, coinciding with significantly decreased celiac disease activity…”





This data shows that the diet by itself plays a small role in the depression development in celiacs, so for those who are diagnosed with celiac disease, there is no second thought that they have to adhere to the required gluten-free diet.






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But what about others, who want to try gluten-free diet “by choice”? Based on the unclear and sometimes conflicting data available as of today, I would be careful with such experiments, and I would not make such diet related life changes without approval of your primary doctor or therapist.





















What Judaism Tells you Аbout Clinical Depression?




“We Americans are insane. Eleven p.m. every night, we snuggle up, ready for bed, and what’s the last thing we do? We switch on the evening news. Thirty minutes of murder, brutality, corruption, catastrophe, moral lunacy, sports and weather. Good night. And then in the morning we are awakened by a clock radio set to some news station. And we begin the day with…murder, brutality, corruption, catastrophe, moral lunacy, sports and weather. And you want to know why you’re depressed?”





Rabbi Ed Feinstein








Depression in Torah





While the Torah does not address depression directly, it does refer to the state of being man or woman should exist in. A person should not be so troubled and despondent that they are incapable of feeling their connection to the divine. By extension, medicine that aids the body and the mind to find succor and to function is important, but not if the medicine so obliterates the pain and connection to reality that they cannot experience the wonder of the divine. In other words, some sadness is natural, but when depression is a medical condition and creates an inability to function, seeking medical help is advised.





Judaism doesn’t work like a drug that blots out pain. Judaism acknowledges the reality of sorrow in this world. The Bible itself offers poignant examples of depressed individuals. Saul, the first king of Israel, suffers excruciating fits of melancholy. He loves his protégé, David, but is also desperately jealous of him, and he fears the people around him are plotting against him. Periodically he sinks into black despair and fits of rage.





King Saul got some relief from melancholy when David played his harp. This story is interpreted as evidence that external measure – including therapy, medication, physical exercise, making art or listening to music – can help to alleviate the pain of depression.






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Elijah, the lonely prophet of the book of First Kings, is rejected by his society and feels that his work has been a failure. At the lowest point of his life he flees into the wilderness, sits down under a tree and prays for his own death. “Enough!” he cries. “Please, G-d, take my life, for I am no better than my fathers” [1 Ki.19:4].





Jonah, another misunderstood prophet, is frustrated with God and humanity alike; he, too, begs G-d to take his life and put him out of his misery. And the Book of Psalms, the most personal book in the Bible, expresses the full range of human despair at the sorrows of this world.





Historical Perspectives





Jews come from a tradition that doesn’t encourage escapism. It forces them to acknowledge the pain, injustice and strife all around, and simultaneously cultivates an intense yearning for justice, goodness and peace. Since the World around is far from being perfect, this combination inevitably produces dissatisfaction with the world. Dissatisfaction is a necessary religious trait for Jews. It’s the engine that motivates them to want to change the world and make it better.





However, while dissatisfaction with the world is essential to a Jewish life, sadness and depression are not. In fact, our tradition sees sadness as the enemy of the good life, the very antithesis of the life Judaism tries to bring about. The Torah itself commands happiness; it is a religious obligation for Jews, as stated in the book of Deuteronomy: “You shall rejoice in all the good that G-d has given you” [Dt.26:11].





In 12th century Spain, Yehudah Halevi taught: “It is not in accordance with the spirit of the Torah to worry and feel anguish throughout one’s life; one who does so transgresses God’s commandment to be content with what you have been given…” In the 19th century, Rabbi Samson Raphael Hirsch wrote that “Judaism never considered pain, sorrow, self-affliction or sadness to be valid goals. The opposite is true – one should pursue happiness, bliss, cheer, joy and delight.” And Rabbi Nachman of Bratzlav who, you’ll recall, struggled all his life with depression, is famous among Hasidim for his great teaching: “Mitzvah gedolah lihiyot b’simcha tamid – it is a great mitzvah to be ever joyful, and to overcome feelings of sorrow and melancholy” [Likkutei Etzot, Joy 30].





Jewish tradition endorses modern therapeutic techniques such as cognitive behavioral therapy, which is based on the idea that overcoming negative patterns of thought can alter the way we feel and act. Jewish ethical writing, starting in the middle ages, argues that we need not be victims of our emotions, but can discipline ourselves to acquire positive attitudes and feelings. In fact, the Baal Shem Tov, the founder of Hasidism, pointed out that if we rearrange the letters of the Hebrew word for “thought” – machshavah – we get the word “b’simcha – with joy,” teaching us that we can often combat depression by changing the way we think.






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Depression Types





A certain amount of depression in life is natural when depression refers to the sadness and anxiety associated with living. Mourning, for example, is a time when the heart and the mind can be depressed. In Judaism, rituals for observing death and mourning such as sitting shiva for the departed help assuage grief. Judaism's extended community also creates a very real support system that is vital for overcoming the psychological wear and tear of loneliness, depression and anxiety.





Depression Sources





A common source of unhappiness is unachieved goals. This can lead to low self esteem which may doom one to more failures, further erosion of self esteem, causing a downward spiral into the abyss of sorrow. One can prevent this vicious cycle by setting realistic goals from the outset. If sadness has already settled in, one can stop the snowball effect by setting short-term, easy goals that bolster ones confidence and in turn empower one to achieve longer-term, more significant goals. This will initiate an upward spiral to level ground.





Another source of sorrow is feeling that we don’t have everything we want. On this our Sages taught, "Who is truly wealthy? One, who is content with his portion." A poor man once complained to the Maggid of Mezritch about his poverty. The Maggid sent him to Rebbe Zusha of Anipoli for advice. Rebbe Zusha, who himself suffered dire poverty and poor health, questioned in all sincerity, "I don’t know why the Maggid sent you to me, I’ve got everything I need".





Also, we often get depressed about bad things that happen. Contemplating the good in the bad helps mitigate ones melancholy. King David’s son Avshalom rebelled against him, forcing him to flee: "David ascended the Mount of Olives, weeping as he went" (II Samuel 15:30). Nevertheless, David concluded that it’s better the rebel be his son because another man would have killed him. In the end, not only did he not despair, he began to sing: "A psalm of David when he fled from Avshalom his son" (Psalms 3:1).





Finally, one must realize that everything is from G-d for the ultimate good. An observer unfamiliar with surgery would consider it a most terrible act. The surgeon however understands it’s for the patients good, sometimes saving his life. Ultimately there can always be a sudden turn-around. Abraham and Sara suffered being barren for a long time until unexpectedly they were blessed with a child who fathered the entire Jewish nation.






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Judaism and Anti-depressants





Some medications that treat depression can influence a person's ability to experience emotions naturally. According to more conservative traditional views, if a person subsists on medication that inhibits their connection to G-d, then he or she should discontinue. Someone who was taking anti-depressants asked since while depressed he used to pray with tears but now the medication makes it harder for him to feel the same connection to G-d, perhaps he should stop taking the medicine. Rabbeinu Yonah (Spain, 1200-1263) addressed this issue some 800 years ago: "Although there is a beneficial aspect to sadness it prevents people from becoming overly joyous over the pleasures of this world nevertheless one should not pursue the state of sadness, since it is a physical disease. When a person is despondent, he is not able to serve his Creator properly." While it is admirable that this person initially used his depression to feel close to G-d, clearly G-d prefers that he face the new challenge of finding spirituality as a healthy person. The medicines the rabbi likely referred to involved hallucinogens, opiates and other medicines designed to disconnect mind and body and not pharmaceutical medications to treat clinical depression.





The modern position on the anti-depressants use is clear: If your doctor is reliable and he/she has prescribed anti-depressants, you should certainly take them. Modern Judaism accepts the point of view that depression is like any other illness and needs to be treated with the correct medication. A person suffering clinical depression needs competent treatment. It is wrong to tell him “Just pull yourself together,” just as it would be cruel to tell a drowning person “Just pull yourself together.” This is adding insult to injury.








Sources and Additional Information:












Thinking Styles Feeding your Depression

Every person is unique, even biological twins are different in their biological development and cognitive expression styles. However, all depressed people have much in common in a way of thinking. Yes, they all think in remarkably similar ways. Understanding what these thinking styles are and why they form a pattern, will offer the best weapon to fight depression in its sources.


Depression, to be ongoing, has to be maintained. Otherwise, depression will simply evaporate over time. This maintenance is performed by thinking styles that encourage any introspection to be emotionally arousing.


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What's The Difference Between Depression and Prolonged Sadness?


We all suffer, when unfortunate and stressful life events struck suddenly, or penetrate slowly in our lives, causing mental exhaustion and despair: a loved one dies, or perhaps due to outside circumstances beyond our control, we have to move from a house we've lived in and loved for many years. Our energy level may well sink and perhaps we become more insular.


Someone who is grieving can suffer exactly the same chemical imbalance which is so often cited as the cause of depression. However, there are key differences between grieving (sadness), and depression. The person who is not suffering from depression, but is simply sad, is able to see beyond the sadness. They know it'll lift.


The poor old depressive, on the other hand, feels that life will always be the way it is now. There is no future for him or her and quite probably no past either, at least not one, they are able to remember. There's only the crippling misery of 'the now.' The old saying that time heals everything is true for the person who's sad because of an unpleasant event, but it certainly doesn't work for the depressive.


Depressive Thinking Leads to Depression, Leads to Depressive Thinking, leads to…


 As you explore the thinking styles, associated with depression, you'll see how each one of them helps to maintain depression. It alters our perception of reality. It's these thinking styles that make an end to depression a hopeless dream. We're imprisoned by our thoughts.


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It's these thinking styles that make it so hard to see an end to the depression, as they limit our possibilities of thought. Once these patterns take hold, the emotional arousal they cause begins to affect us physically. It is not your fault if you are depressed, but there are concrete, effective things you can do about it.


Thinking Styles List


The following styles in thinking can be subtle yet very powerful in causing us to experience needless emotional distress. Interestingly, the more distressed we become, the more our thinking can become narrowed and focused, making it difficult to think in balanced ways. Many times, simply identifying which Thinking Style/s we are using can be very liberating, allowing us to break free from narrowed, unhealthy thinking patterns.


All-Or-Nothing: Events are only good or only bad. They are black or white with no gray areas between the extremes. If something falls short of perfection, then it is seen as a complete failure. "My work today was a total waste of time."


Overgeneralization: You draw general conclusions based on one event or a single piece of evidence. If something bad happens one time, you see it as an unending cycle of defeat. "People are always mean to me."


Mind Reading: Even though they have not told you so, you believe you know what people think and feel about you, as well as why they behave the way they do towards you. "He thinks I'm stupid."


Catastrophizing: You expect things to turn out badly. "If I ask my boss for a raise he will yell at me."


Chain Reaction: You continue down the chain, link by link, with how one bad thing will lead to another bad thing, ending in a larger bad outcome with regard to an overall goal. "If I fail this test I won't pass this class, then I will fail out of school, then I won't graduate, then I won't get a good job, then I will be unhappy in a dead-end job forever."


What If's: You ask questions about bad or fearful things that could possibly happen in the future, while being unsatisfied with any answers. "What if something happens to her?"


Personalization: You think that things people say or do are in reaction to you, or you believe you are responsible for things people do or say. "He looked at his watch because I'm boring."


Shoulds/Musts: You have strict rules about how you and others should/must feel and behave. You feel angry if others break these rules and guilty if you break them. "I shouldn't take any time off. I must work hard all the time."


Filtering: You magnify or dwell on the negative details of a situation while ignoring all the positive ones. "Look at all the things I have done badly."


Jumping to Conclusions: You make illogical leaps in believing that A causes B without enough evidence or information to support your conclusions. "My boyfriend was late in picking me up. He doesn't really want to go out with me tonight."


Comparisons: You compare yourself to other people, trying to figure out who is better, smarter, more attractive, etc. "She is so talented. I'll never amount to anything."


Discounting Positives: You automatically discount or reject positive actions or events as if they don't matter. If you did something well, you tell yourself that it doesn't count, it wasn't good enough, or anyone could have done it as well or better. You don't allow yourself to enjoy even small accomplishments. "If I had spent more time preparing for my presentation it could have been better."


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Maximization/Minimization: You maximize your problems or blow the effects of them out of proportion to the situation. Or, you minimize the value of your positive qualities. "This is the worst thing that could happen. I can’t manage it."


Blaming: You blame yourself for things that are not in your control. Or, you hold others responsible for your misfortunes. "It's my fault that my husband drinks. If I were a better wife he wouldn't do that."


Emotional Reasoning: You automatically believe that what you feel is true for you. If you feel strange, boring, stupid, etc. then you believe you are these things. "I feel embarrassed. I am so awkward and foolish."


Being Right: You are always trying to prove that your opinions and behaviors are the right ones. You cannot accept that you might be wrong or inaccurate, and you will go to great lengths to prove that you are right or others are wrong. "You don't know what you're talking about. We have to do it my way or it won't work."


Reward Fallacy: You expect to receive rewards or payoffs as a result of your own deeds or sacrifices, as if someone is keeping score. You feel angry or resentful if your actions do not reap rewards. "I spent all that time fixing a nice dinner and no one appreciated it."


Change Fallacy: You believe that if you pressure people enough they will change to suit you. You also believe they must change since you let your happiness depend on them. "If she told me she loved me more often, then I could feel happy."


Fairness Fallacy: You believe you know what is fair, but since others don't agree with you, you feel resentful or angry. "I deserve a day off from work since I worked hard over the weekend, but my boss won't allow it."


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Sources and Additional Information:








 
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