Apathy

What Is Apathy?

[dropcap]A[/dropcap]pathy is an abnormal emotional state that is characterized by indifference to things which others find interesting, moving or exciting, and diminished motivation to perform regular daily activities.

The neural mechanisms of apathy are postulated to involve the brainstem and forebrain circuits that regulate goal-directed behavior.¹

What Is Apathy In Celiac Disease and/or Gluten Sensitivity?

Apathy as an atypical psychological symptom in celiac disease that manifests long before the onset of other symptoms of Celiac Disease.²

Apathy develops from multiple nutritional deficiencies that impair normal brain function. These include fatty acids, minerals, amino acids, and vitamins. For example, apathy is a symptom of anemia.³ Here is a rundown of common relationships:

• Iron deficiency anemia impairs the ability of blood to oxygenate the body. Impaired oxygen to the brain results in impaired cognition (lowered intellect), while impaired oxygen to muscles causes weakness and fatigue. So the apathy in anemia is related to not having the mental ability to care about or the physical ability to perform normal activities.
• Copper deficiency is a cause of iron deficiency anemia because copper is essential for the formation of hemoglobin and red blood cell production and stimulates the absorption of iron through the copper transport protein ceruloplasmin. Importantly, copper serves as a co-factor for the brain chemical norepinephrine.
• Thiamine (vitamin B1) plays a role in the formation of the brain chemical acetylcholine and transmission of nerve impulses. Deficiency results in apathy. In four double-blind studies an improvement in thiamine (vitamin B1) status was associated with improved mood.³
• Glucose deficiency impairs neurologic function because brain tissue is particularly dependent on glucose for energy. Impaired energy to the brain results in difficulty concentrating, diminished memory, and poor judgment while impaired energy to muscles results in weakness and fatigue. So apathy results from not having mental ability to care about or the physical ability to perform normal activities.
• Zinc is a component of insulin which is required for energy production to supply the brain, resulting in impaired mental function. Zinc deficiency causes apathy, lowered learning ability, lethargy, and mental retardation in children.⁴
• Magnesium is required for glucose metabolism and energy production for the brain and for nerve transmission. Magnesium deficiency results in apathy.⁵
• Omega Fatty Acids are involved in brain biochemistry, physiology and functioning.⁶ Deficiency impairs brain function, causing apathy. DHA (Docosahexaenoic Acid), an omega-3 fatty acid is a key component of neuronal membranes together with arachidonic acid (AA), a major omega-6 fatty acid, making up 15-20% of the brain’s dry mass. In healthy human volunteers, positron emission tomography (PET) has shown that the normal human brain consumes 17.8 and 4.6 mg/day, respectively, of DHA and AA.⁷ 
• EPA (eicosapentaenoic acid) is an essential omega-3 fatty acid that is crucial for fetal brain and retina development and the child’s subsequent neurodevelopment. In all ages, it is essential for normal brain function, helping nerve cells in the brain to communicate.⁸. 
• Tryptophan is an amino acid required for the production of the brain chemical serotonin which regulates mood. 
• Niacin (vitamin B3), vitamin B12, and folic acid are each essential for normal brain and nervous system function. 

How Prevalent Is Apathy In Celiac Disease and/or Gluten Sensitivity?

Apathy is common in patients with untreated celiac disease and appears before classic symptoms such as anemia.⁹

What Are The Symptoms Of Apathy?

• Lethargy.
• Lack of normal concern.
• Failure to get things done.

How Does Apathy In Celiac Disease and/or Gluten Sensitivity Develop?

• Apathy in celiac disease results from biochemical alterations in the brain due to multiple nutritional deficiencies including omega-3 and omega-6 fatty acids, vitamin B1 (thiamin), vitamin B3 (niacin), vitamin B9 (folic acid), vitamin B12, vitamin C, tryptophan, iron, phosphorus, magnesium, zinc, and copper.

Does Apathy Respond To Gluten-Free Diet?

Yes. Apathy in celiac disease responds to gluten free diet containing adequate nutrition with supplementation of deficient nutrients as needed.

6 Steps To Improve Apathy Related To Celiac Disease:

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both apathy and gut health.

• Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
• A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
• Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

• Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
• Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.¹⁰
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

[box type=”shadow” ]Here Are Major Inflammatory Food Types That Reduce Healing:

• Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.¹¹
• Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
• Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.¹¹
• Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.¹¹.
• Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.¹¹
• Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
• Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.¹¹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.¹¹[/box]

[box type=”shadow” ]Here Are Important Anti-Inflammatory Food Types to Promote Health:

• Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
• Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
• High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
• Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
• Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
• Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
• Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
• Protective Herbs and Spices.  See below #6 below for examples.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

 

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain prescription drugs cause deficiencies of nutrients resulting in apathy that include: omega-3 and omega-6 fatty acids, vitamin B1 (thiamin), vitamin B3 (niacin), vitamin B9 (folic acid), vitamin B12, vitamin C, tryptophan, iron, phosphorus, magnesium, zinc, and copper.

Ask your doctor or pharmacist about this possible adverse effect. Do not stop without supervision – this is mandatory):

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Copper, Zinc, Vitamin B12.
• Foscanet depletes Magnesium. 

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

• Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Vitamin B3, Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Zinc.
• Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete Vitamin B6, Vitamin B12, Vitamin C, Folic Acid, Magnesium, Zinc.

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete zinc.
• Loop Diuretics (Lasix®, Bume®x, Edecrin®) depletes Vitamin B1, Zinc.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Folic Acid, Zinc.

DIABETIC DRUGS 

• Metformin® depletes Folic acid, Vitamin B12.

CARDIOVASCULAR DRUGS

• ACE Inhibitors (Capoten®, Vasotec®, Monopril® and others) deplete Zinc. A
• Antihypertensives (Catapres®, Aldomet) deplete Vitamin B1, Zinc.

ANTI-INFLAMMATORIES – Disrupt Intestinal permeability.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Magnesium, Zinc, Vitamin B6, Vitamin B12, Folic Acid.
• NSAIDS (Motrin®, Aleve®, Advil®, Anaprox®, Dolobid®, Feldene®, Naprosyn® and others) deplete Folic acid.
• Aspirin and Salicylates deplete Folic acid, Iron.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Folic Acid, Vitamin B12, Vitamin B1, Copper, Zinc.

MAJOR TRANQUILIZERS  

• Thorazine®, Mellaril®, Prolixin®, Serentil® and others deplete Vitamin B12.

ANTIBIOTICS  disrupt Intestinal permeability.

• Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete B Vitamins.
• Tetracyclines deplete  Iron, Zinc, Magnesium.
• Cipro depletes Zinc.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Folic Acid, Iron, Vitamin B12, Zinc, Magnesium.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Folic Acid, Iron, Vitamin B12.
• Prevacid®, Prilosec® depleteVitamin B12.
• Alka Seltzer®, Baking Soda deplete Folic Acid, Magnesium.

ANTI-DEPRESSANTS

• Adapin®, Aventyl®, Elavil®, Pamelor®, and others deplete these nutrients: Vitamin B12.

Caution:If you are taking anti-depression drugs, discuss taking herbals such St. John’s wort with a licensed health care professional before trying them (at the same time) because they can have an additive effect.¹²[/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

• Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
• 100% of the B vitamins, or as prescribed by a doctor. About B Vitamin Complex supplements:  some labeling can be confusing, for example, “B 100” does not mean 100%. If the ingredient list shows  an excessive amount like 3000% or more, look for another brand because this excessive amount will cause the loss of mineral in the urine.
• 100% of any of these that are deficient: Iron as Ferrous Fumarate (bloodwork first), Chelated Magnesium,  zinc, and copper (bloodwork first).
• EPA in fish oil preparations.

Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table. Fish oil goes in the refrigerator[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]Hydration is very important in managing apathy:

Research in young men showed that mild dehydration induces adverse changes in vigilance, which is the opposite of apathy, and working memory, and increased tension/anxiety and fatigue.¹³

Research investigating how mental performance is affected by slowly progressive moderate dehydration induced by water deprivation shows that subjective ratings by subjects of mental performance changed significantly toward increased tiredness and reduced alertness, and higher levels of perceived effort and concentration necessary for test accomplishment during dehydration.¹⁴

• Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
• If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
• Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
• What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.[/box]

[box type=”shadow” ]Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort which are often part of chronic anxiety.

Carminative Food Remedies:

• Raspberry.
• Carrot is also a cleansing digestive tonic.
• Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
• Redbeets also stimulate and improve digestion and are easily digested.
• Cabbage also stimulates and improves digestion and is also a liver decongestant.
• Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
• Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

• Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
• Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
• Parsley also relieves indigestion.
• Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
• Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

• Cloves are also antispasmodic.
• Nutmeg is also useful for indigestion.
• Ginger.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise stimulates the brain to produce anti-depressive chemicals and get rid of stress hormones.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. [/box]

What Do Medical Research Studies Tell About Apathy In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

[The following study underscores the great need for researching the effects of malnutrition as a cause of apathy. Please note: any of the deficiencies that cause apathy also cause dementia and their correction can reverse dementia without the need for drugs. Deficiencies in common are: copper, omega3 and omega-6 fatty acids, iron, thiamin, niacin, vitamin B12, and folic acid.]

“Pharmacologic treatment of apathy in dementia.” Apathy in patients with dementia is common, underrecognized, and undertreated. This study sought to improve understanding of the pharmacologic treatment of apathy in dementia by performing a systematic literature review of studies that used apathy outcome scales to document results of pharmacologic treatments for apathy. There is limited evidence of efficiency of pharmacotherapy (drugs) for treatment of apathy in dementia. The best results were found for acetylcholinesterase inhibitors. There was some evidence of efficacy for memantine, but less evidence of efficacy for stimulants, calcium antagonists, and antipsychotics. There was no evidence to support the use of antidepressants or anticonvulsants. The research quality of studies was modest.¹⁵

“Clinical features of children with screening-identified evidence of celiac disease.” This case-control study investigated Denver area healthy infants and young children at risk for celiac disease to evaluate growth and clinical features of children who later test positive for an autoantibody associated with celiac disease. Researchers found that screening-identified TG antibody-positive children demonstrate mild alterations in growth and nutrition and report more symptoms than control subjects.

A group of children with HLA genetic susceptibility for celiac disease were followed prospectively since birth for the development of immunoglobulin A antitissue transglutaminase autoantibodies (TG). Clinical evaluation, questionnaire, blood draw, and small bowel biopsy were performed. Growth and nutrition and frequency of positive responses were measured.

Compared with 100 age- and gender-matched TG-negative controls, 18 TG-positive children 5 to 6 years of age, had a greater number of symptoms and lower z scores for weight-for-height and for body mass index. Responses that were independently associated with TG-positive status were irritability/lethargy, abdominal distention/gas, and difficulty with weight gain.¹⁶

Sources:

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3. Benton D, Donohoe RT. The effects of nutrients on mood. blic Health Nutr. 1999 Sep;2(3A):403-9. [↩] [↩]
4. Pfeiffer CC, Braverman ER. Zinc, the brain and behavior. Biol Psychiatry. 1982 Apr;17(4):513-32. [↩]
5. Rasmussen HH, Mortensen PB, Jensen IW. Depression and magnesium deficiency. Int J Psychiatry Med. 1989;19(1):57-63. [↩]
6. Bourre JM. Dietary omega-3 Fatty acids and psychiatry: mood, behaviour, stress, depression, dementia and aging. J Nutr Health Aging. 2005;9(1):31-8. [↩]
7. Rapoport SI. Brain arachidonic and docosahexaenoic acid cascades are selectively altered by drugs, diet and disease. Prostaglandins Leukot Essent Fatty Acids. 2008 Sep-Nov;79(3-5):153-6. Epub 2008 Oct 29. [↩]
8. Coletta JM, Bell SJ, and Roman AS. Omega-3 Fatty Acids and Pregnancy. Rev Obstet Gynecol. 2010 Fall; 3(4): 163–171 [↩]
9. Bosseckert H. Clinical aspects and differential diagnosis of malabsorption. Deutsche Zeitschrift fur Verdauungs-und Stoffwechselkrankheiten 1983; 43(1):27-32. [↩]
10. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
11. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
12. http://www.pharmacistelink.com/naturalmedicine/pdfs/P4880x1204DrugChart.pdf [↩]
13. Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto LM, Marzano S, Lopez RM, Jimenez L, Le Bellego L, Chevillotte E, Lieberman HR. Mild dehydration impairs cognitive performance and mood of men. Br J Nutr. 2011 Nov;106(10):1535-43. doi: 10.1017/S0007114511002005. [↩]
14. Szinnai G, Schachinger H, Arnaud MJ, Linder L, Keller U. Effect of water deprivation on cognitive-motor performance in healthy men and women. Am J Physiol Regul Integr Comp Physiol. 2005 Jul;289(1):R275-80. [↩]
15. Berman K, Brodaty H, Withall A, Seeher K. Pharmacologic treatment of apathy in dementia. Am J Geriatr Psychiatry. 2012 Feb;20(2):104-22. doi: 10.1097/JGP.0b013e31822001a6. [↩]
16. Hoffenberg EJ, Emery LM, Barriga KJ, Bao F, Taylor J, Eisenbarth GS, Haas JE, Sokol RJ, Taki I, Norris JM, Rewers M. Clinical features of children with screening-identified evidence of celiac disease. Pediatrics. 2004 May;113(5):1254-9. [↩]