Claire Houston, MS, LCMHC

Celiac Disease, on the Couch

by Claire Houston, MS, LCMHC on June 30th, 2010


Kathleen (not her real name) came to counseling because of anxiety. After an intake, we identified several areas in her life that sounded like they were contributing to her difficulties. We started working with Cognitive Behavioral Therapy, a system that looks at the thought sequence you use, and where a distorted belief can be corrected and thereby relieve suffering.

After teaching her a series of formulas, she was able to apply the principles herself when not in the office with me. This is a very effective psychotherapy intervention, that is so useful that many insurance companies paying for counseling expect to see it as part of a treatment plan. But, it did not seem to offer Kathleen the relief I was expecting. So, we continued looking elsewhere in her life for the source and solution of her anxiety. If it wasn’t her thinking causing it, perhaps it was situational.

We identified that her work setting wasn’t a good match for her. After having her take the Myers-Briggs Type Indicator, a measure of personality preferences, which looks at how someone’s energy moves, how they take in information, how they make decisions, and how much structure they like in their outside world, we confirmed her natural tendencies. Looking through this lens, we could see that a certain work flow, and pressures, just weren’t going to work well with her personality type. Through a lot of focused work, she figured out what would be a better work environment for her, found a job that fit her better, and made the move.

After a short time of relief, the anxiety returned. More exploration followed. More areas in her life seemed to point to sources of her distress. But, I had a growing suspicion forming in my mind. She decided she wanted to try medication, and her insurance company wanted her to too. I arranged for a medication evaluation with a psychiatrist, but I also arranged to confer with a clinical nutritionist. As Kathleen was meeting with the doctor, I was floating some of my thoughts with this trusted nutritionist colleague of mine.

I wondered aloud with her. What sort of nutritional deficiencies might contribute to anxiety? How would those nutritional deficiencies happen? How could we test her for them? The nutritionist was accustomed to hearing lists of digestive symptoms associated with a celiac disease discussion, but not mental/emotional symptoms.

I had a read a series of articles in a variety of publications about celiac disease. Being a mental health counselor, I always gravitate to all possible explanations for mental health symptoms and disorders. I had been noticing for quite a while references to celiac disease including symptoms like depression, anxiety, inability to focus, schizophrenia, attention deficit problems. One article led me to a book called Gut and Psychology Syndrome (GAPS), by Dr. Natasha Campbell-McBride.

GAPS, an acronym Campbell-McBride coined, is a book dedicated to how the digestive track impacts mental and emotional functioning. I found trying to skim through the book pointless, as it was one of those books where you had to start from page one, and move sequentially through the chapters to have a productive read. So, one afternoon, I forced myself to sit down and read the book, cover to cover. I learned much more about digestion, and how it works, than I ever wanted to know. But by the end, I felt certain that not only were some solutions for Kathleen contained in the book, but for other clients of mine as well.

When Kathleen didn’t get the comprehensive relief from the medication she was hoping for, I approached the discussion of celiac disease. It didn’t ring true to her, as she said she had no trouble after eating wheat. Not being a nutritionist, or doctor, I told her I couldn’t fairly represent how it all worked, but that this disease was often not like having a peanut allergy. A peanut allergy is more straightforward. Eat a peanut, throat closes, someone knows clearly they have a problem with peanuts.  But, I explained, for many, a delayed, adult-onset case of celiac disease will present itself in a much less cause and immediate effect way.

Kathleen was willing to trust me on this one, and went for an evaluation with the nutritionist. Her blood panel came back negative for celiac disease. She wanted to stop there, but the nutritionist told her that all that a negative blood test meant was that the immune reaction could be being contained in the digestive track. The nutritionist told her that it was good news, because once it hits the blood, “you’re really in trouble,” with things like osteoporosis, and other big problems.

The nutritionist wanted to order a test for Kathleen from EnteroLab.com. Kathleen and I looked at it together, as she was having difficulty deciding if she wanted to commit to the test. It was expensive, for her, and her insurance wouldn’t pay for it. They wanted to stop with the blood test. Why keep testing when the first test came back normal?

We read through the description of the test online at their website. The nutritionist wanted her to have the comprehensive gene and stool analysis test. We let some weeks pass by, and as my client continued to feel new anxieties emerge, she decided to go forward with the testing.

The nutritionist sent the results of the test, and arranged for a meeting with my client to go over what it meant. It turned out that she had a genetic predisposition for celiac disease, and an active immunological reaction going on in her GI track. Kathleen and I met for our weekly session, and she was still stunned by the results. How could this not have been identified earlier in her life? What about her kids? Did they have it too? What is involved with going gluten free?

With a new course set, we started down this new treatment plan road. First I found some simple books about celiac disease for her, with recipes included as part of the book. In our sessions, she processed how massive a change this would be in her life. “Do you know how much gluten is in prepared foods?” she burst out with at the start of one of her sessions. “I threw out nearly everything in my cupboards! This is outrageous!” Even though I heard indignation in her complaints, I also heard hope. For a psychotherapist, hope is the pivot point that often signals the beginning of success. I was eager to see where this would lead.

Her journey took work, but it was so worth it. As quickly as within 2 days of being on a gluten free (GF) diet, she began seeing changes in her symptoms. Conditions she just figured she’d have for a lifetime began to change. Joint pain began to ease. Sleeping became less problematic. Nasal blockage she was accustomed to began going away. Months later other symptoms changed too. Bloating she didn’t even know she had went away. Chronic skin conditions went away. And, yes, her mood began to change.

Some chronic jealousy she would feel regarding her husband just disappeared. Her whole perspective about herself, and her life became broader. Her baseline mood rose up, and she operated from a place of more buoyancy. I say this from my perspective, as I’m not sure that she would identify these issues. To her, it was all happening so naturally, that she could hardly keep up with all the shifts. But, as her therapist, I had witnessed some chronic, stubborn mental and emotional symptoms that were easing and changing finally.

For Kathleen, this process of identifying celiac disease was life changing. For more of my clients, it was also life changing. I put celiac disease on my filters, as diagnostic possibilities for new clients. Now, I spend time talking to colleagues, and forwarding articles about celiac disease and psychology, to spread the word about the interaction between the gut and the brain. I’ll admit, celiac disease education in the psychological community is slow going.

There appears to be quite a resistance in professionals to integrate interdisciplinary thinking. The psychological models we learned in graduate school originally, then reinforced by continuing education classes after graduate school, guarantee that a change in the culture will take time. But, I’m hopeful, and as I said, hope is the pivot point that signals the beginning of success.

----------------------------- Author Information: Claire Houston, MS, LCMHC Claire Houston, MS, LCMHC, is a licensed psychotherapist in NH and NY, with offices in Exeter, NH. She integrates holistic and spiritual philosophies into her empowering counseling approach. Visit her at www.wswcenter.com or call 603-772-0799.


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19 Responses to “Celiac Disease, on the Couch”

  1. Theresa says:

    I have been gluten free for 14 mos. and am much better in many areas of my life. Other family members have recently started the diet. Most impressive benefit has been with my 9yr. old grandson’s bipolar disorder. His psychiatrist is gluten free herself and was very supportive when my daughter suggested wanting to try the diet. I pray for the day when the medical profession will take a much longer, harder, look at not only celiac disease but non-celiac gluten intolerance and be the one’s to initiate the conversation and a trial period of the diet. I still wonder if his psychiatrist would have mentioned a gluten/casein free trial period and possible connection had my daughter not brought up the subject. It has been a little over a year since this article was written. Would love an update from the mental health professional that penned this article.

  2. Mona says:

    Thank you for publishing a very important article. When I was suffering with depression, my therapist recommended anti-depressants. I am not a fan of those drugs, and decided to wait it out and see. During that period, I did some research and came across a great book by Dr. Mark Hyman called “The UltraMind Solution”. His book talks about the connection between brain and gut health and led me to investigate. Initially, I did the EnteroLab test which showed that I have the Celiac gene. The test also reported elevated antigliadin antibodies and an autoimmune reaction. I then visited Dr. Hyman’s Ultra Wellness Center and had further testing done. The intestinal permeability test showed “Leaky Gut” which is a big problem for celiacs and can cause a lot of systemic problems in the body. Before my diagnosis, I had suffered with terrible emotional mood swings, bouts of depression, extreme fatigue, lack of energy and severe anxiety. There were moments where I felt as though I was losing my mind. Since going Gluten-free and being treated with customized nutritional supplements to heal my gut, my symptoms have improved dramatically, and my leaky gut has healed. It is really amazing how a food reaction can cause so much disruption in the body and how many people are not getting diagnosed properly and wind up taking drugs that are not necessarily treating the underlying cause.

  3. LAM says:

    Hurray!!!! I am a clinical mental health counseling student who has gluten sensitivity and am thrilled to read this article.

    Do you know I have found only ONE journal article dealing with counseling for celiacs? In contrast, I have found SEVERAL journal articles about physicians mistakenly diagnosing celiac teen girls with anorexia. I have two friends who were misdiagnosed with anorexia before anyone ever figured out they had celiac — even though they and their parents strongly objected to the anorexia diagnoses. Thankfully both sets of parents ignored the doctors who said their daughters had anorexia and finally found doctors who said, “Hey, these symptoms match celiac, let’s test your daughter.” And voila! Once gluten was removed from their diets, each of the girls began to gain weight and their health improved. Ron Hoggan’s book (he wrote a comment above) also mentions this misdiagnosis phenomenon.

    Because I live with gluten problems, I plan to practice as you do re: getting nutritionists involved when signs point to other possible causes. Many times we don’t need a pill to fix us; we just need to eat what our bodies need. Thank you for being a pioneer!

  4. Sandy says:

    My husband was tested for Celiac disease after having been told he has Parkinson’s disease and no he does not have Parkinson’s disease. The test came back positive for Celiac disease 3 days ago and I have given away food and restocked with Gluten Free Flours, etc and I am happy to say that he seems so much happier, anxiety seems to have lifted, depression, moodiness. I feel so much better also. I only hope that with time the tremors will also disappear. Thanks for the article

    • John Libonati john.admin says:

      Hi Sandy,

      We received a letter from a woman whose husband has celiac disease. As an RN, she got a copy of Recognizing Celiac Disease to help with his treatment.

      Her friend’s son who was in his early 30s was diagnosed with early-onset Parkinson’s. After reading through the book, she decided the family would try the gluten-free diet. Within two weeks, she said he went from needing assistance to eat to pouring tea from a teapot. She also said her stubborn rash that no doctor could figure out went away. (My guess is dermatitis herpetiformis. You can read her letter and many others here.

  5. Roberta says:

    The founder of our company has celiac disease and I look for articles that really add value to our GF customers. I loved this article and hope it is ok to share!

    Roberta

  6. Kerry says:

    Hi Claire,
    I’m Diana’s cousin and have been battling migraine headaches for years. I just recently saw someone here in Santa Fe who is suggesting that the problem might be celiac’s. I’m embarking on a gluten free diet next week, and it was really helpful to read your article. Shows that the scope of dietary intolerances is well beyond what we understand. Thanks!

  7. Judy says:

    Very informative and thought provoking. Personally, I know that when I cut back on wheat, I feel better and my mood improves. On another note, while observing the elderly, I have noticed a seeming connection between the inability to absorb nutrients through the gut and certain forms of dementia. Perhaps celiac disease precedes what is known as “wasting disease” and any associated dementia?

    • John Libonati john.admin says:

      Absolutely, Judy. Celiac disease is a wasting disease in that it causes malabsorption of nutrients. The result is a malnourished individual and the “wasting” that you describe. This doesn’t necessarily mean the person looks skinny. Sometimes, edema (fluid retention) can be so great that the person looks heavy, when actually they have little muscle and are very sick.

  8. Diana says:

    This is a very enlightening article about the connection between the physical and the emotional bodies. I found myself contemplating how much gluten I ingest and how it might be affecting me in similar ways to Claire’s client. Thank you, Claire, for this well-written exploration!!

  9. Ann Bliss says:

    great article Claire. I’m with you that one can’t make an assumption that mental health problems are solely psychological. All too often I have managed to help a client alter a diet or get a nutritional eval which leads to more relief than anyone could have imagined.
    Thanks for the info about celiac disease.

  10. Robbie Kaye says:

    Thank you Claire! This is SO crucial to know about. I really believe that what we eat has so much to do with our psychology and wellness. Thank you for your work and commitment to getting the word out. Great article!!

  11. Debra Stapleton says:

    Wonderful article! Thank you so much. There is a great deal of ‘food for thought’ for me!

  12. Di says:

    Fascinating! Very well written. Thank you for your insight.

  13. SHALANI MCCRAY says:

    This is a very valuable article. As a Natural Medicine practitioner specialising in Naturopathic Nutrition I adhere to and prescribe the Weston Price philosophy utilised in the treatment of and prevention of GAPS. I am buoyed to find a health professional willing to look outside their own box to realise what an impact our diet can have on so many areas of our wellbeing.
    The population experiencing similar issues to Kathleen with wheat and/or gluten intolerance being the culprit seems to be increasing at an alarming rate. As was pointed out, a negative blood result does not dismiss an intolerance being the issue. As was also pointed out most packaged food is going to be unsuitable which is why we need to prioritise preparing our food at home from scratch as generations before us did. The fact that the gut is now accepted as the second brain and that two thirds of our immune cells are found there can only be impetus to make the necessary changes to our diet. As was alluded to in this article the symptoms can be vague and varied and develop incrementally that many people have become accustomed to feeling below par and accept it as normal. As more people realise the importance of gut health on our overall wellbeing we are set to witness very positive impacts on many areas of our day to day living.

  14. Riva Danzig says:

    This was a really good read! As someone with chronic anxiety and insomnia, I will definitely get even more serious about going gluten-free! Thanks!

    • John Libonati john.admin says:

      Just be sure to ask your doctor to test you for celiac disease before you adopt the gluten-free diet. Otherwise, test results will be affected and may come back false negative. It’s important to know if you have celiac disease, so your doctor can test you for nutrient deficiencies.

  15. Hi Ms. Houston,
    Thanks for this most interesting article, and for your open mind. I’m thrilled to see this beginning of a new trend in psychotherapy. I’ll be teaching a continuing education class on gluten and cognitive function at Royal Roads University, beginning in October, and I’d like to include your article in the readings. May I have your permission to do so?

    Thanks in advance,
    Ron
    Ron Hoggan, Ed. D.
    co-author: Dangerous Grains ISBN: 978158333-129-3 http://www.dangerousgrains.com
    author: The Iron Edge: a complete guide for meeting your iron needs ISBN: 978-0-9736284-4-9 http://tiny.cc/ironedge
    author: Smarten Up! ISBN: 978-0-9736284-3-2 http://www.smartenup.info
    editor: Journal of Gluten Sensitivity http://www.celiac.com
    co-author: Cereal Killers http://tiny.cc/s7neg

  16. Alta says:

    An informative post, to say the least! While I have digestive issues related to gluten, I did find that when removing it from my diet, I was better able to handle my emotions and had a better sense of well-being. It’s so important to look at all of the causes of a particular symptom, and sometimes, that means thinking WAY outside the box.

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