Celiac disease affects 1% of people in the UK and the US as well. People who are afflicted with this disease have to abstain from eating gluten. While fatigue and chronic diarrhea is well recognized in this group of people, the psychological consequences of celiac disease are not often highlighted. Recent studies show that the psychological complications of celiac disease can be quite troubling.

From an every-day perspective, people who cannot eat gluten have to be extra careful when they eat out. This can lead to a range of feelings from frustration to feeling excluded. When they are at dinner parties, they may be embarrassed because of having to decline certain foods and overall, the dietary restrictions may impose social restrictions as well. How do these social restrictions manifest and what can people do about this?

One of the commonest complications is anxiety (often accompanied by depression.)1 While the anxiety about state of health and diarrhea may be alleviated on a gluten-free diet 2, adult patients with celiac disease still have residual anxiety compared to the general population and this effect may be particularly prominent in female patients with the disease.3 Thus, the anxiety about diarrhea and overall well-being may be replaced by the anxiety of social exclusion and restriction. In fact, the diet does little to change the overall psychological state of people who have celiac disease 4

The problem with many anti-anxiety agents is that they also affect the gut causing nausea and diarrhea as well. This can be very unsettling to people who already have a gut-related problem. In these cases, adding on or using self-help to reduce anxiety may be helpful. Below are some brain-based interventions for people who suffer from celiac disease to reduce their anxiety:

1. Reduce fear conditioning: When you have a disease like celiac disease that causes anxiety, the anxiety circuits in your brain may start to habitually fire. Thus, after your gluten-free-diet is introduced, you may still be anxious. The anxious neurons in your brain fire out of habit. In these cases, you have to actively remind yourself that fatigue and diarrhea, for example, will not be a problem any more. Also, when you eat gluten-free food, rather than simply being relieved and unperturbed, relish the thought of how you have a newfound freedom to live with a better state of well-being. If you are invited to someone's dinner party and are afraid that you might embarrass the host, call them up and let them know how excited you are to see them. Then, tell them that you would like to bring a little something before the party that they might serve you instead of what might be served because of your intolerance to gluten. In all likelihood, once they understand what you can eat, they will accommodate you.

2. Refocus your attention: When your brain travels to the anxious zone on autopilot, realize that you have more control over this than you might think. To start out, once on a new diet, consider keeping a gratitude and optimism diary for a few months at least. This will help to train your brain to pay attention to positive things as well as the anxiety of exclusion.

3. Reduce your feeling of exclusion: In addition to the party suggestion yourself, throw gluten-free arties without calling them that. Look up recipes at sites like Family Circle or Allrecipes. You can tell a few friends who have celiac disease about this. This will help a lot.

Thus, celiac disease can result in ongoing anxiety if you do not nip it in the bud as soon as possible. These are three simple but useful interventions you can use to help live a more psychologically comfortable life.

References
1. Black JL, Orfila C. Impact of coeliac disease on dietary habits and quality of life. J Hum Nutr Diet. May 25 2011.
2. Ukkola A, Maki M, Kurppa K, et al. Diet improves perception of health and well-being in symptomatic, but not asymptomatic, patients with celiac disease. Clin Gastroenterol Hepatol. Feb 2010;9(2):118-123.
3. Hauser W, Janke KH, Klump B, Gregor M, Hinz A. Anxiety and depression in adult patients with celiac disease on a gluten-free diet. World J Gastroenterol. Jun 14 2010;16(22):2780-2787.
4. Collin P, Kaukinen K, Mattila AK, Joukamaa M. Psychoneurotic symptoms and alexithymia in coeliac disease. Scand J Gastroenterol. 2008;43(11):1329-1333.

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