Gluten and Anxiety: What’s the Connection?

The Impact of Anxiety on Daily Life

Anxiety is often described as a feeling of immense uncertainty, often accompanied by the mounting fear of losing control. While commonly discussed in terms of generalized anxiety disorder, anxiety can be both a feeling and a trait. While the feeling of anxiety is a temporary response to certain situations, when it presents as a trait, termed generalized anxiety disorder, is the tendency towards this as a common response to most things.

The symptoms of anxiety include, but are not limited to, commonly experiencing nervousness or tenseness, having a sense of impending danger, panic or doom, commonly having an increased heart rate, rapid breathing, sweating, trembling, trouble sleeping, gastrointestinal (GI) problems, having difficult controlling worry and having the urge to avoid things that may trigger an anxiety response.

What Is Gluten?

Gluten is a protein found in wheat, rye, barley, and other grains. Gluten is added to food to improve protein content, texture, and flavor. It serves as a binding agent for processed foods. Our bodies have enzymes that help break down food. One of the enzymes is called protease, which breaks down proteins. However, it can not break down gluten completely. When undigested gluten reaches the small intestine, most people do not have any problems. Still, some people may have an autoimmune response or other unpleasant symptoms such as bloating, abdominal pain, changes in bowel movement, nausea or vomiting, brain fog or difficulty concentrating, fatigue, or rashes.

Does Cutting Gluten Out of Your Diet Help Mental Health?

The short answer is yes, but only if you already have a gluten sensitivity. If you are able to tolerate gluten, cutting it out does not seem to have any measurable impact on your mental health. However, there is plenty of research to support a diet filled with real, whole foods containing lots of fruits, vegetables, legumes, and healthy fats such as avocado or olive oil, all naturally containing little to no gluten, will have a measurably positive impact on mental health.

Gluten Intolerance & Anxiety

Gluten intolerance, also known as non-celiac gluten sensitivity (NCGS), could bring about issues like bloating, diarrhea, and stomach pain, which can be quite uncomfortable. People affected may also experience fatigue, headaches, and joint pain, adding to their discomfort. Individuals with anxiety may also experience physical symptoms similar to those of NCGS, though whether or not these exacerbate or cause one another is relative to the individual.

Gluten Sensitivity & Anxiety

Gluten sensitivity, or non-celiac gluten sensitivity (NCGS), can cause adverse reactions in individuals without celiac disease or wheat allergy.¹ There may be a link between gluten sensitivity and anxiety, with reported symptoms such as nervousness, restlessness, and irritability.² Diagnosing this condition is challenging due to the lack of specific biomarkers or reliable tests, requiring further research for better understanding and effective diagnostic methods.³

Celiac Disease & Anxiety

Celiac disease is an autoimmune disorder triggered by gluten that results in damaged intestinal lining and gastrointestinal discomfort. Common symptoms of celiac disease are digestive and abdominal ailments such as bloating, nausea, vomiting, and pain, in addition to inflammatory symptoms in other parts of the body such as osteoporosis, blisters and rashes, and joint and headaches. According to the research, “anxiety, depression, and fatigue are common complaints in patients with untreated celiac disease and contribute to lower quality of life”.⁴

Once diagnosed, the emotional and mental labor that a strict gluten-free diet requires has a psychological impact that is often underestimated and yet quite significant. Many individuals who must adhere to a gluten-free diet find that social outings and travel, though supposed to be stress-relieving and enjoyable parts of life, can become tainted with the need for hypervigilance around food and limited options for enjoyment.⁵

Celiac disease may also increase the risk of developing psychiatric disorders such as:

• Anxiety
• Depression
• Bipolar disorder
• Schizophrenia
• Eating disorders
• Social Anxiety

Does Gluten Cause Anxiety?

There is a growing body of research confirming the bidirectional relationship between the gut microbiome and central nervous system.⁶ When gluten consumption causes significant inflammation in the gut microbiome, this causes a dysregulated central nervous system, which can be experienced as anxiety. Though many individuals find relief after getting a celiac diagnosis as it provides clarity in what was previously experienced as a host of mystery symptoms,⁴ the management of the disease through strict dietary changes can be overwhelming, especially to those who consumed a great deal of gluten and would need to make more drastic changes.

How to Manage Anxiety With a Gluten-Free Diet

Although the research does not support a gluten-free diet alleviating anxiety in individuals who can tolerate gluten, it is important to note that a gluten-free diet rich in fruits, vegetables, legumes, lean and non-processed meats, and fish, nuts, and seeds is an optimal diet for mental health and wellness regardless of how you tolerate gluten. It is also important to note that many foods that have been shown to be detrimental to physical and mental health, such as beer, breads, breaded foods, cakes, cookies, pizza, and cereals, all contain gluten.

Those who have a gluten intolerance and choose to adopt a gluten-free diet may find it daunting when first starting out. The key is to be familiar with all that you can eat and focus on ways to build your meals around that. When it comes to eating at restaurants or while traveling, don’t be afraid to ask about gluten, as sometimes it may be hidden in thickeners or other ingredients you may not associate with gluten. As with any diet change, be sure to take stock in how you feel after you eat each meal and adjust accordingly. Just because something is gluten-free doesn’t mean it will sit right with you, so taking stock of your physical and mental wellness post-meals will be a great way to find the specific foods that are right for you.

Additional Coping Strategies for Anxiety

In addition to, or in lieu of a gluten-free diet, many find much more success with both dietary and lifestyle changes coupled with increasing the usage of coping skills and strategies to manage their anxiety. As with all coping strategies, it is important to incorporate them into your daily life and practice them at times you are regulated already, so that when you use them in times of distress, they are familiar, and you already know which ones work best for you.

Some other coping methods for relieving anxiety include:

• Box breathing: A common breathing technique that can be visualized as a square, box breathing entails inhaling for 4 counts, holding that inhale for 4 counts and then exhaling for 4 counts.
• Guided imagery: The practice of using guided imagery meditation for anxiety entails using an audio or visual prompt to focus the mind on imagery that is soothing and can bring the mind out of an anxious loop and into something that is more relaxing.
• Progressive muscle relaxation: A practice of alternating tightening and releasing isolated muscle groups, beginning at one end of the body and working your way to the other. Progressive muscle relaxation allows for a somatic release of stored tension. This cannot only provide relief to physical pains but also ease hyperarousal and tension in order to help relax the body and prepare for a state of rest.
• Intentional movement: While the term exercise might seem daunting to some, incorporating time each day to move intentionally, whether that is to stretch, dance, walk, or do a more structured or intense exercise, can make a monumental difference in the body’s ability to metabolize anxiety.
• Yoga: Trauma-informed yoga can help to practice grounding in the present moment and being aware of the body and mind in a way allows for a gradual approach. Yoga Nidra or NSDR is also a popular modality in supporting sleep and stress-relief.
• Challenging irrational thoughts: Take a thought you continue to have that makes you anxious and think of reasons why this may or may not be true. Breaking it down in this fashion not only desensitizes you to its intensity but also allows you to create space from the thought to think critically about it.
• Aromatherapy: Using your sense of smell is an underrated but potentially effective intervention for soothing anxiety. Using preferred, comforting smells can settle the nervous system and provide some relief and a sense of security. Though candles and essential oils are the most common ways to incorporate aromatherapy into your coping toolkit, some find fresh flowers or plants, using aromatic spices in cooking or being in nature all ways to use the sense of smell to ground the body and mind.
• Strong mint or sour candy: This edible intervention is intended to create an intense sensory experience that can displace the anxious energy elsewhere and help the mind and body reset.
• Cold exposure: Taking a cold shower or soaking in a bathtub of cold water for a minimum of three minutes, or dunking your head into a bowl of ice water for a few seconds at a time are all ways to experience cold exposure. This intervention supports healing from anxiety by lowering your heart rate and activating your parasympathetic nervous system which helps the body enter a state of calm.
• Journaling: A widely researched strategy to cope with anxiety, journaling for anxiety can be done in a variety of ways, from brain dumping, which entails free writing whatever comes to mind for a certain amount of time, to more structured approaches, this is a great way to organize your thoughts and process what you are feeling and experiencing. Some find it beneficial to look back on previous journal entries and others find it more therapeutic to destroy the writing after it is done.
• 4321 Grounding: This is a mental strategy that involves grounding yourself in the present moment by noticing four things you can see, three things you can hear, two things you can feel and one thing you can smell.
• Body Scan: Another mental strategy that involves taking stock of the sensations you are feeling and becoming more present in your body. This involves bringing your attention from the top of your head and tracing it all the way down your body to the tips of your toes. Notice any sensations and release any tension, such as a tight jaw or shoulders, a lower back ache, or the sensation of your seat pressed against the backs of your legs.

Treatment for Anxiety

While coping strategies and adopting a gluten-free diet could help some people, some may still require traditional treatment methods in addition to diet and lifestyle changes. Fortunately, there are so many ways to access healing and it is important to try different strategies, techniques and treatments to find ones that are affirming and effective for your individual needs and preferences.

Anxiety Therapy

There are many options for anxiety therapy available, such as individual or group therapy and support groups, in-person or virtual. It is important to research and try out different therapists, styles, and formats to find the best fit for you. For many, especially in the beginning of your therapy journey, people usually do one group or individual session per week. Some may find it helpful to do a combination of the two, though one should suffice.

Common types of anxiety therapy include:

• Acceptance and Commitment Therapy (ACT):  ACT is an action-oriented approach that focuses on moving from avoidance and denial of their emotions to accepting them as a part of their human experience and committing to behavioral changes despite what is happening in their life.
• Art and music therapy: Two of the most widely used forms of expressive therapies are art and music therapy, which utilizes art and music to process emotions and promote healing and well-being.
• Cognitive behavioral therapy (CBT): CBT for anxiety is grounded in the fact that thoughts, feelings and behaviors are inextricably linked and targets changing one of the three to influence the other two. It seeks to identify and interrupt unhelpful and transform thought patterns that lead to mental health symptoms.
• Dialectical behavioral therapy (DBT): DBT for anxiety is a skills-based approach that focuses on educating the client on tools and skills regarding emotion regulation, interpersonal effectiveness, distress tolerance and mindfulness. It empowers clients to use these techniques to manage everyday stressors.
• Exposure therapy: An effective and common treatment modality for anxiety is exposure therapy, which involves placing the client in contact with their trigger in real time, whether in reality or by simulation, and coaching the client to cope with their distress and become more comfortable with the experience.
• Eye Movement Desensitization and Reprocessing (EMDR): EMDR for anxiety is a modality where a clinician utilizes directed eye movements to reprocess trauma by stimulating the brain’s neural networks.
• Interpersonal therapy (IPT): IPT is a treatment modality that targets relational distress as a source for everyday triggers and symptoms. It seeks to resolve interpersonal traumas to promote healing and balance so that one can access social support in a healthy way.
• Psychodynamic therapy: A widely known modality that has been practiced for many decades is psychodynamic therapy. When engaging in psychodynamic therapy, a therapist supports the uncovering and processing of the unconscious and the underlying emotions that lead to our conscious beliefs and experiences.
• Neurofeedback: This is a type of biofeedback that monitors and adjusts abnormal brain waves through a machine that is delivered through a computer-based program. Neurofeedback is one of the leading non-pharmaceutical interventions aside from talk therapy for anxiety and other disorders.

Anxiety Medications

For some, medication may need to be explored as a part of their anxiety treatment plan. This could expedite results or bring a person to a place of stability where talk therapy can be more effective. For some anxiety disorders, medication may be a shorter-term solution and can sometimes be weaned out as the client progresses through their treatment plan. Medication management would be through a licensed prescriber who may also be able to carry out the talk therapy, such as a psychiatrist, or with a team approach of a prescriber collaborating with a clinician.

Common medications prescribed for anxiety include:

• Antidepressants: Common brands of SSRIs, SNRIs, and tricyclic antidepressants include Lexapro, Zoloft, and Cymbalta. These medications work to increase serotonin and norepinephrine in the brain which support mood, sleep and overall feelings of well-being.
• Beta blockers: Beta blockers are a blood pressure medication that can be used to treat anxiety with its ability to cause the heart to beat more slowly, and with less force. It blocks the hormone epinephrine, commonly known as adrenaline, which supports the stabilization of a hyperactive nervous system.
• Benzodiazepines: These medications act on GABA-A receptors to make the nerves in the brain less sensitive, which has a calming effect. Some well-known benzodiazepines are Xanax, Klonopin and Valium.
• Monoamine oxidase inhibitors (MAOIs): These medications were the first developed to treat anxiety. However, they have largely been replaced by antidepressants due to the amount of side effects these medications typically cause.

When to Seek Professional Help for Anxiety

If you are learning to manage both a gluten intolerance and anxiety, and you find your anxiety interferes with your ability to manage your gluten consumption, or your excessive worry about gluten management contributes to increasing anxiety, support from a therapist or other professional is key. Support is more accessible than ever due to a wide range of different online therapy options and an online therapist directory. If you are unsure if you have a gluten intolerance, working with your primary care provider to get the necessary tests is important to understand if gluten elimination is something you would benefit from.