5 November 2019 - Psychology Today - An Autoimmune Reaction to Gluten May Cause Childhood Anxiety
Alison Escalante M.D.
The connection between inflammation and mental illness has recently become more clear. This has led researchers to wonder about the role of autoimmune disorders in anxiety and depression. But does autoimmunity cause problems in the absence of obvious inflammation? A new study in Pediatrics
looks at whether the antibodies that lead to celiac disease can be tied to emotional problems in children.
We already know that kids with diagnosed celiac disease may have several emotional and behavioral problems. But the role of the immune response without obvious clinical disease has remained obscure. To sort this out, researchers looked at 3,715 children with a median age of 6 years. They measured their tissue transglutaminase autoantibodies (TTG). These are antibodies the body turns against itself because of a reaction to the gluten protein.
When they looked at behavioral rating scales, the researchers found a connection. Kids who were positive for celiac autoimmunity, without actual symptoms of celiac disease, had a higher rate of anxiety problems. They were also more likely to have oppositional and defiant behaviors.
What is celiac disease?
Celiac disease, a chronic immune disease triggered by a response to the protein gluten, is estimated to affect 1% of the population. However, about 80% of those with celiac disease are not diagnosed. This is because the disease presentation is diverse. It can range from severe diarrhea and abdominal pain to growth failure and vague fatigue.
In a disease like celiac, one can have the gene for the condition but that gene can remain inactive throughout life. Or it can be triggered to create the autoimmune reaction. In those with the autoimmune reaction (a TTG >= 7), only some will show the kind of symptoms that lead to a diagnosis.
True celiac disease hurts. When you treat it with a gluten-free diet, people feel better physically. It makes sense that their emotional symptoms also get better.
What about the kids in the study? Could these kids be anxious or acting out because they were in pain? The study team said no. The gastrointestinal symptoms did not explain the behaviors. They also pointed out that body mass index was not linked to the mental health symptoms. Since the children had not been diagnosed with a disease, knowledge of "having a disease" didn't explain their anxiety either.
What's the pathway?
What then is the biological pathway that leads from asymptomatic immune markers to anxiety? The study authors do not yet know how precisely the CDA leads to anxiety or behavioral problems. Suggested pathways have included micronutrient deficiencies and disruption of the gut microbiome.
But one finding was clear: it was not the gene that caused the behavioral symptoms. Kids who had the gene for celiac, but no evidence of the autoimmune response, had no increase in mental health problems. So there is something important about the immune disruption.
What does this mean for testing anxious children?
Does this mean we should start screening anxious or defiant kids for celiac disease? There is not enough evidence to start testing across the board. Nevertheless, evidence for the biological roots of some behavioral problems is growing. A good medical exam with a pediatrician who knows your family's medical history makes sense. Pediatricians can add a great deal to the care of children's mental health.
Should anxious children go gluten-free?
It's popular for parents to tinker with their children's diets, and there is always a new fad. But restrictive diets in children come with their own problems, such as nutritional and growth difficulties. In fact, the gluten-free diet may be tied to its own health problems. At least in the case of celiac autoimmunity, there is a test we can run. Parents would be wise to consult with their doctor before making dietary changes.