{"id":660,"date":"2015-03-02T02:07:48","date_gmt":"2015-03-02T07:07:48","guid":{"rendered":"http:\/\/www.mynutriguide.com\/?p=660"},"modified":"2020-07-11T10:39:32","modified_gmt":"2020-07-11T14:39:32","slug":"chronic-maladaptive-anxiety-2","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/chronic-maladaptive-anxiety-2\/","title":{"rendered":"Anxiety, Chronic"},"content":{"rendered":"<h2><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/Anxiety1.gif\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-5336\" style=\"margin-left: 5px;margin-right: 5px\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/Anxiety1.gif\" alt=\"Anxiety\" width=\"279\" height=\"193\" \/><\/a>What Is Anxiety?<\/h2>\n<p style=\"text-align: justify\"><span class=\"dropcap\">A<\/span>nxiety or worry is a distressing emotional state of mind or mood that is characterized by a vague uneasiness, unpleasant feelings of apprehension or anticipation of danger and by interference with normal functioning, ranging from mild qualms and easy startling to occasional panic.<\/p>\n<p style=\"text-align: justify\"><strong>Q<\/strong>: What causes anxiety?<\/p>\n<p style=\"text-align: justify\"><strong>A<\/strong>: Anxiety can be a normal response to stress such as making an important decision, illness, divorce, problems at work or preparing for an exam.<\/p>\n<p style=\"text-align: justify\">In a dangerous situation, profound physiological changes rapidly\u00a0prepare us for a &#8220;fight or flight&#8221; response by release of adrenalin hormone.\u00a0Adrenalin speeds up metabolism to make available quick energy, tightens muscles in readiness, and speeds up the heartbeat and breathing so that more oxygen is made available to the brain and muscles.<\/p>\n<p style=\"text-align: justify\">Anxiety becomes a maladaptive disorder when it is excessive, unrealistic, or not provoked and impairs the ability to lead a normal life.<\/p>\n<p style=\"text-align: justify\">Anxiety that is part of a person&#8217;s personality is called &#8220;trait anxiety.&#8221;\u00a0Anxiety that comes and goes is &#8220;state anxiety,&#8221; as in state of mind, and is usually due to unresolved stress or an underlying health problem.<\/p>\n<h2>What Is Chronic Anxiety in Celiac Disease?<\/h2>\n<p><!--more--><\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\"><strong>Relationship between anxiety and celiac disease:\u00a0<\/strong>Chronic anxiety that is &#8220;state anxiety&#8221; is a common psychological feature of untreated celiac disease and can be a presenting symptom at diagnosis of celiac disease.<\/li>\n<li style=\"text-align: justify\"><strong>Relationship between anxiety and malabsorption:\u00a0<\/strong>Anxiety that develops in celiac disease is maladaptive.\u00a0It is not the type that exists as a personality trait or unresolved stress or as the result of an underlying disease process, such as thyroid or adrenal gland problems.\u00a0Rather, it results from deficiency of amino acids and vitamins needed to make the brain chemicals (neurotransmitters) that control mood and could be linked to immunological disregulation in celiac disease patients.<a href=\"#footnote_1_660\" id=\"identifier_1_660\" class=\"footnote-link footnote-identifier-link\" title=\"Potocki P, Hozyasz K. Psychiatric symptoms and celiac disease. Psychiatria Polska. Jul-Aug 2002; 36(4):567-78.\">1<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between anxiety and tryptophan\/ niacin:\u00a0<\/strong>The malnutritional impact causing anxiety is shown by lack of the amino acid tryptophan and the B3 vitamin niacin. Tryptophan deficiency results in insufficient production of the brain chemical serotonin.\u00a0Serotonin calms the mind while awake and at night, converts to melatonin, which is needed for sleep.\u00a0Niacin helps balance brain chemicals like serotonin and counters the effects of stress.<\/li>\n<\/ul>\n<p style=\"text-align: justify;padding-left: 30px\">If both niacin and tryptophan are low, the case becomes robbing one anti-anxiety nutrient to make another. The need for niacin is critical to all cells of the body. While our bodies can use tryptophan to make niacin, this is a low conversion process that requires adequate levels of co-factors iron, vitamin B2 (riboflavin), and vitamin B6 (pyridoxine).\u00a0Therefore, if tryptophan is also deficient and\/or the co-factors are deficient, then this avenue is closed to niacin production.<\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\"><strong>Relationship between anxiety and vitamin B deficiencies:\u00a0<\/strong>Most vitamin B deficiencies result in anxiety.<a href=\"#footnote_2_660\" id=\"identifier_2_660\" class=\"footnote-link footnote-identifier-link\" title=\"Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with celiac disease living on a gluten-free diet.&nbsp;Aliment Pharmacol Ther.&nbsp;2009 Apr 15; 29(8):811-6. doi: 10.1111\/j.1365-2036.2009.03945.x. Epub 2008 Jan 20.\">2<\/a>\u00a0On the other hand, anxiety itself causes depletion of vitamins and minerals through excess sweating, urination, and in some persons, loose bowels, which then furthers anxiety.<\/li>\n<li style=\"text-align: justify\"><strong>Relationship between\u00a0anxiety and sleep:\u00a0<\/strong> Both state and trait anxiety in celiac disease result in poor sleep.<a href=\"#footnote_3_660\" id=\"identifier_3_660\" class=\"footnote-link footnote-identifier-link\" title=\"Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. Aliment Pharmacol Ther. 2010 Oct;32(8):1031-6. doi: 10.1111\/j.1365-2036.2010.04432.x. Epub 2010 Aug 16.\">3<\/a><\/li>\n<li style=\"text-align: justify\"><strong>Relationship between anxiety and response to gluten after diagnosis.\u00a0<\/strong>Fully gluten free diet adherent patients are more likely to have symptomatic responses to dietary gluten (SRDG) less than 1hr than patients who are partial\/none adherent as are those patients at risk of both anxiety and depression. That is, anxiety and depression enhance the speed of symptom onset, and inadvertent exposure to dietary gluten in the fully gluten free diet adherent group is more likely to result in a severe SRDG in comparison to symptoms arising prior to consistent gluten free diet adherence.<a href=\"#footnote_4_660\" id=\"identifier_4_660\" class=\"footnote-link footnote-identifier-link\" title=\"Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease. J Gastrointestin Liver Dis. 2013 Dec;22(4):391-6.\">4<\/a><\/li>\n<\/ul>\n<h2>How Prevalent is Anxiety In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p style=\"text-align: justify\">Anxiety is common in untreated celiac disease and can be the only manifestation.<a href=\"#footnote_1_660\" id=\"identifier_5_660\" class=\"footnote-link footnote-identifier-link\" title=\"Potocki P, Hozyasz K. Psychiatric symptoms and celiac disease. Psychiatria Polska. Jul-Aug 2002; 36(4):567-78.\">1<\/a>,<a href=\"#footnote_5_660\" id=\"identifier_6_660\" class=\"footnote-link footnote-identifier-link\" title=\"Collin P, Kaukinen K, Mattila AK, Joukamaa M. Psychoneurotic symptoms and alexithymia in coeliac disease. Scand J Gastroenterol. 2008;43(11):1329-33. doi: 10.1080\/00365520802240248.\">5<\/a><\/p>\n<p style=\"text-align: justify\">In research, celiac disease patients showed high levels of state anxiety in a significantly higher percentage compared to controls (71.4% vs, 23.7%).<a href=\"#footnote_6_660\" id=\"identifier_7_660\" class=\"footnote-link footnote-identifier-link\" title=\"Addolorato G, Capristo E, Ghittoni G, et al. Anxiety, but not depression, decreases in celiac patients after one year gluten-free diet: a longitudinal study. Scandinavian Journal of Gastroenterology. May 2001; 36(5):502-6.\">6<\/a><\/p>\n<p style=\"text-align: justify\">In a postal survey of 224 biopsy-proven patients with celiac disease, prevalence of \u00a0anxiety numbered 30 (13%) while anxiety and depression numbered 72 (32%).<a href=\"#footnote_4_660\" id=\"identifier_8_660\" class=\"footnote-link footnote-identifier-link\" title=\"Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease. J Gastrointestin Liver Dis. 2013 Dec;22(4):391-6.\">4<\/a><\/p>\n<h2>What Are The Symptoms of Anxiety?<\/h2>\n<p style=\"text-align: justify\">Symptoms of anxiety include:<\/p>\n<ul class=\"cp_bullet red\">\n<li>Restlessness.<\/li>\n<li>Irritability.<\/li>\n<li>Trouble focusing attention.<\/li>\n<li>Cold and\/or sweaty palms and feet.<\/li>\n<li>Dry mouth.<\/li>\n<li>Trembling.<\/li>\n<li>Muscle tension.<\/li>\n<li>Headaches.<\/li>\n<li>Fatigue.<\/li>\n<li>Poor sleep (insomnia).<\/li>\n<li>Low blood sugar.<\/li>\n<li>A faster heart rate than normal.<\/li>\n<li>Skipped heartbeats.<\/li>\n<li>Chest pains.<\/li>\n<li>Elevated blood pressure.<\/li>\n<li>Rapid breathing.<\/li>\n<li>Dizziness.<\/li>\n<li>Frequent need to urinate.<\/li>\n<li>Problems swallowing.<\/li>\n<\/ul>\n<h2>How Does\u00a0Anxiety Develop In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p>Anxiety results from an unclear etiology involving these mechanisms:<\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify\"><strong>Inflammation of brain tissue and\/or cerebral blood vessels<\/strong> caused by gluten exposure.<\/li>\n<li style=\"text-align: justify\"><strong>Biochemical alterations in the brain<\/strong> caused by malabsorption of multiple nutrients in celiac disease including calcium, magnesium, iron, potassium, B vitamins, and tryptophan which cause cognitive, sleep and emotional problems.<\/li>\n<li style=\"text-align: justify\"><strong>The effects of low blood sugar<\/strong>\u00a0(hypoglycemia) on metabolism, the nervous system, and the cardiovascular system.<\/li>\n<li style=\"text-align: justify\"><strong>Alteration in\u00a0cerebral blood flow<\/strong>\u00a0(brain blood flow abnormalities) which diminishes the necessary delivery of oxygen and blood sugar to brain tissue. Cerebral single photon emission CT scan showed 73% of untreated celiac disease patients with anxiety had at least one hypoperfused (abnormally low blood flow to) brain region compared with only 7% of patients on a gluten free diet and none of controls.<a href=\"#footnote_7_660\" id=\"identifier_9_660\" class=\"footnote-link footnote-identifier-link\" title=\"Addolorato G, Guida D, Di Rossi G, et.al. Regional cerebral hypoperfusion in patients with celiac disease.&nbsp;American Journal of Medicine. Mr 12004; 116(5):312-7.\">7<\/a><\/li>\n<\/ul>\n<h2>Does Anxiety Respond To Gluten-Free Diet?<\/h2>\n<p style=\"text-align: justify\">Yes. In celiac disease-related anxiety withdrawal of gluten usually results in disappearance of symptoms.<a href=\"#footnote_1_660\" id=\"identifier_10_660\" class=\"footnote-link footnote-identifier-link\" title=\"Potocki P, Hozyasz K. Psychiatric symptoms and celiac disease. Psychiatria Polska. Jul-Aug 2002; 36(4):567-78.\">1<\/a>\u00a0Deficiencies may need to be corrected.<\/p>\n<p style=\"text-align: justify\">B vitamin supplements should be considered in people advised to follow a gluten-free diet.<a href=\"#footnote_8_660\" id=\"identifier_11_660\" class=\"footnote-link footnote-identifier-link\" title=\"Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther. 2009 Apr 15; 29(8):811-6. doi: 10.1111\/j.1365-2036.2009.03945.x. Epub 2008 Jan 20.\">8<\/a><\/p>\n<h2>6 Steps To Improve Anxiety In Celiac Disease and\/or Gluten Sensitivity:<\/h2>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>1<\/strong><\/span><\/span><strong><span style=\"color: #800000\">Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<b>Treatment<\/b>. This condition responds to the complete elimination of gluten, which is the required treatment that improves both anxiety and gut health.<\/p>\n<ul class=\"cp_bullet green\">\n<li>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.<\/li>\n<li>A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.<\/li>\n<li>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.<\/li>\n<\/ul>\n<p><strong>Correct Your Individual Nutritional Needs.<\/strong><\/p>\n<ul class=\"cp_bullet green\">\n<li>Eat foods that can replenish missing nutrients. Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<li>Take nutritional supplements as needed.\u00a0Find them under\u00a0NUTRIENT DEFICIENCIES.<\/li>\n<\/ul>\n<p><strong>Recovery<\/strong>. You should begin to feel better within a week and notice more energy as inflammation subsides and the \u00a0absorbing cells that make up the surface lining of your small intestine are better able to function.<\/p>\n<ul class=\"cp_bullet green\">\n<li style=\"text-align: justify\">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.<\/li>\n<li style=\"text-align: justify\">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.<a href=\"#footnote_9_660\" id=\"identifier_12_660\" class=\"footnote-link footnote-identifier-link\" title=\"Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.&nbsp;Clinical Science. Apr 2001;100(4):379-86.\">9<\/a><\/li>\n<li style=\"text-align: justify\">The intestinal lining may take up to a year to heal.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000\"><span class=\"dropcap\"><strong>2<\/strong><\/span><\/span><strong><span style=\"color: #800000\">\u00a0Reduce Inflammation. Foods to Eat and Foods Not to Eat:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">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).<\/p>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Major Inflammatory Food Types That Reduce Healing<\/strong>:<\/p>\n<ul class=\"cp_bullet red\" style=\"text-align: justify\">\n<li><strong>Damaging Foods<\/strong>. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.<a href=\"#footnote_10_660\" id=\"identifier_13_660\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">10<\/a><\/li>\n<li><strong>Allergenic Foods<\/strong>. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.<\/li>\n<li><strong>Shelf Stable Processed Foods.\u00a0<\/strong>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.<a href=\"#footnote_10_660\" id=\"identifier_14_660\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">10<\/a>\u00a0Many cause cancer such as polysorbate 60, potassium bromate, and sodium nitrate.<\/li>\n<li><strong>Fats.<\/strong>\u00a0Limit 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.<a href=\"#footnote_10_660\" id=\"identifier_15_660\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">10<\/a>.<\/li>\n<li><strong>Excessive Refined White Flours\u00a0<\/strong>(bran layer removed)<strong>.\u00a0<\/strong>Includes\u00a0products made from them such as cookies, bread, cakes, pies.\u00a0Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream.\u00a0Also disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_10_660\" id=\"identifier_16_660\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">10<\/a><\/li>\n<li><strong>Refined Sugars.\u00a0<\/strong>\u00a0Includes white sugar, corn fructose and high fructose corn syrup.<\/li>\n<li><strong>Artificial sweeteners.<\/strong> Includes Aspartame, Sucralose, and Saccharin which are also linked to cancer and autoimmune disease.<\/li>\n<li><strong>Certain Spices<\/strong>. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_10_660\" id=\"identifier_17_660\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">10<\/a><\/li>\n<li><strong>Alcohol and Caffeine<\/strong>. Disrupt intestinal permeability causing leaky gut.<a href=\"#footnote_10_660\" id=\"identifier_18_660\" class=\"footnote-link footnote-identifier-link\" title=\"Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.&nbsp;Journal of Gastroenterology and Hepatology. 2003;18:479-91.\">10<\/a>\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Here Are Important Anti-Inflammatory Food Types to Promote Health<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li><strong>Fruits<\/strong>.\u00a0Contain ample amounts of vitamins, minerals and phytochemicals which are\u00a0naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.<\/li>\n<li><strong>Non-Starchy Vegetables.<\/strong>\u00a0Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.<\/li>\n<li><strong>High Quality Complex Carbohydrates<\/strong>. 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.<\/li>\n<li><strong>Antioxidants<\/strong>. Protect the body from inflammatory oxidant molecules that continually occur and\u00a0help 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\u00a0nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.<\/li>\n<li><strong>Omega-3 Fatty Acids<\/strong>. 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.<\/li>\n<li><strong>Probiotics.\u00a0<\/strong>Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.<\/li>\n<li><strong>Prebiotics\/ High Fiber Foods<\/strong>. \u00a0Food with fiber keeps our population of colonic microbes healthy.<\/li>\n<li><strong>Protective Herbs and Spices<\/strong>. \u00a0See below #6 below for examples.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\" style=\"text-align: justify\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">3<\/span>\u00a0Information Sheet You Can Take to Your Doctor or Other Health Professional:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify\">Click here.<\/p>\n<ul class=\"cp_check green\">\n<li><span style=\"color: #800000\"><strong><em><span class=\"dropcap\">4<\/span>\u00a0Manage Your Medications\u00a0Safely<\/em>:<\/strong><\/span><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: justify\">Certain prescription drugs used for anxiety can cause nutritional deficiencies. Ask your doctor or pharmacist about this possible adverse effect especially if you are prescribed these drugs (do not stop without supervision):<\/p>\n<ul class=\"cp_bullet blue\">\n<li>Benzodiazepines deplete melatonin, a brain chemical needed for sleep. These include:\n<ul>\n<li>Valium\u00ae (diazepam), Tranxene\u00ae (clorazepate dipotassium),\u00a0Ativan\u00ae (lorazepam), Klonopin\u00ae, Xanax\u00ae (alprazolam).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Caution<em>: <\/em><\/strong><em>If you are taking anti-anxiety drugs, discuss taking herbals such as Kava-Kava and St John&#8217;s Wort with a\u00a0licensed health care professional before trying them (at the same time) because they can have an additive effect. \u00a0<\/em><\/p>\n<p style=\"text-align: justify\"><em>For example, Kava-Kava is very effective for anxiety. However, it modifies the same receptors that\u00a0benzodiazepines bind.\u00a0<\/em><br \/>\n<em>Combined administration of St. John\u2019s wort with alprazolam decreases the blood levels of alprazolam and should be avoided unless otherwise directed by a licensed health care professional.<\/em><a href=\"#footnote_11_660\" id=\"identifier_19_660\" class=\"footnote-link footnote-identifier-link\" title=\"http:\/\/www.pharmacistelink.com\/naturalmedicine\/pdfs\/P4880x1204DrugChart.pdf\">11<\/a>\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000\"><strong><span class=\"dropcap\">5<\/span>Nutritional Supplements To Help Correct Deficiencies:<\/strong><\/span><\/em><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<ul class=\"cp_bullet orange\">\n<li style=\"text-align: justify\">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.<\/li>\n<li style=\"text-align: justify\">100% of the B vitamins, or as prescribed by a doctor. About\u00a0B Vitamin Complex supplements: \u00a0some labeling can be confusing, for example, &#8220;B 100&#8221; does not mean 100%. If the ingredient list shows\u00a0\u00a0an excessive amount like\u00a03000% or more, look for another brand because this excessive amount will cause the loss of mineral in the urine.<\/li>\n<li style=\"text-align: justify\">100% of any of these that are deficient: \u00a0Calcium as Calcium Citrate, Iron as Ferrous Fumarate (bloodwork first), Chelated Magnesium, Potassium (bloodwork first).<\/li>\n<\/ul>\n<p><strong>Storage Note<\/strong>:\u00a0<em>Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet &#8211; not in the bathroom or on the kitchen table<\/em>.\n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\">\n<li><span style=\"color: #800000\"><em><strong><span class=\"dropcap\">6<\/span>Manage Natural Remedies:\u00a0<\/strong><\/em><\/span><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Hydration is very important in managing anxiety<\/strong>:<\/p>\n<p style=\"text-align: justify\">Research in young men showed that even mild dehydration induces adverse changes in vigilance and increased tension\/anxiety and fatigue.<a href=\"#footnote_12_660\" id=\"identifier_20_660\" class=\"footnote-link footnote-identifier-link\" title=\"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.\">12<\/a><\/p>\n<p style=\"text-align: justify\">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.<a href=\"#footnote_13_660\" id=\"identifier_21_660\" class=\"footnote-link footnote-identifier-link\" title=\"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.\">13<\/a><\/p>\n<ul class=\"cp_bullet green\">\n<li style=\"text-align: justify\">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.<\/li>\n<li style=\"text-align: justify\">If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C that improves anxiety.<\/li>\n<li style=\"text-align: justify\">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.<\/li>\n<li style=\"text-align: justify\">What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<p style=\"text-align: justify\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Carminatives.\u00a0<\/strong>The following anti-inflammatory\u00a0plant sources called carminatives help heal the digestive tract. They 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.<\/p>\n<p style=\"text-align: justify\"><strong>Carminative Food Remedies<\/strong>:<\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Raspberry.<\/li>\n<li>Carrot is also a cleansing digestive tonic.<\/li>\n<li>Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.<\/li>\n<li>Redbeets also stimulate and improve digestion and are easily digested.<\/li>\n<li>Cabbage also stimulates and improves digestion and is also a liver decongestant.<\/li>\n<li>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.<\/li>\n<li>Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Herb Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\" style=\"text-align: justify\">\n<li>Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. \u00a0Drink as tea or use in cooking.<\/li>\n<li>Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.<\/li>\n<li>Parsley also relieves indigestion.<\/li>\n<li><strong>Rosemary <\/strong>as a tea and in cooking acts as a nervous system tonic for stress and fatigue thanks to carnosic acid, which\u00a0enhances blood circulation in the brain, improves thinking, and <strong>specifically blocks free-radical damage to brain tissue<\/strong>.\u00a0Rosemary\u00a0also stimulates bile and helps relieve headaches and indigestion.<\/li>\n<li>Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.<\/li>\n<\/ul>\n<p style=\"text-align: justify\"><strong>Carminative Spice Remedies:<\/strong><\/p>\n<ul class=\"cp_bullet green\">\n<li style=\"text-align: justify\">Cloves are also antispasmodic.<\/li>\n<li>Nutmeg is also useful for indigestion.<\/li>\n<li>Ginger.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t<strong>Exercise Helps<\/strong>:<\/p>\n<p>Exercise stimulates the brain to produce anti-anxiety chemicals and get rid of stress hormones.<\/p>\n<ul class=\"cp_bullet green\">\n<li>Walking is aerobic exercise that reconditions the whole body to improve stamina.\u00a0Read more about<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">\u00a0Exercise and Fitness<\/a>.<\/li>\n<li>Weight training builds muscle.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<li>Stretching improves flexibilty.\u00a0Read more about\u00a0<a href=\"https:\/\/glutenfreeworks.com\/health\/2014\/07\/08\/fitness-guide\/\">Exercise and Fitness<\/a>.<\/li>\n<\/ul>\n<p>Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal. \n\t\t\t<\/div><\/div>\n<h2>What Do Medical Research Studies Tell About Anxiety\u00a0in Celiac Disease?<\/h2>\n<h4><span style=\"color: #000000\"><strong>RESEARCH STUDY SUMMARIES<\/strong><\/span><\/h4>\n<p style=\"text-align: justify\"><strong>&#8220;Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease.&#8221;<\/strong> This study investigating the type, timing and severity of symptomatic responses (SRDG) to dietary gluten with reference to a range of\u00a0disease-related factors found that patients with consistent gluten free diet adherence experience a SRDG faster and more severe in comparison to prior gluten exposure possibly demonstrating an adept immunological response. Anxiety and depression also enhance the speed of symptom onset and co-existing visceral hypersensitivity is a risk factor for severe reactions to dietary gluten.<\/p>\n<p style=\"text-align: justify\">Method of study: Postal survey of 224 biopsy-proven patients including gluten-free diet adherence, symptom checklist, ROME II criteria and The Hospital Anxiety &amp; Depression Scale. Case-note review was also conducted.<\/p>\n<p style=\"text-align: justify\">26% of respondents were male. Full gluten free diet adherence numbered 159 (70%). Irritable bowel syndrome (IBS) numbered 50 (22%). Anxiety numbered 30 (13%); Depression numbered 33 (14%); Anxiety &amp; Depression numbered 72 (32%).\u00a0Pruritus, fatigue and bloating were a more common SRDG in the partial\/none gluten free diet adherent group. Co-existing IBS was associated with a greater prevalence of nausea and fatigue in response to gluten.<\/p>\n<p style=\"text-align: justify\">Fully gluten free diet adherent patients are more likely to have SRDG less than 1hr than partial\/none adherent as are a third of patients with co-existing IBS and those patients at risk of both anxiety and depression. Inadvertent exposure to dietary gluten in the fully gluten free diet adherent group is more likely to result in a severe SRDG in comparison to symptoms arising prior to consistent gluten free diet adherence.<a href=\"#footnote_4_660\" id=\"identifier_22_660\" class=\"footnote-link footnote-identifier-link\" title=\"Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease. J Gastrointestin Liver Dis. 2013 Dec;22(4):391-6.\">4<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cAnxiety and depression in adult patients with celiac disease on a gluten-free diet.\u201d<\/strong> The aim of this large German study comparing anxiety and depression levels in adult patients with celiac disease on a gluten-free diet with controls found that living alone was associated with a reduced risk of an anxiety disorder which highlights the difficulty of maintaining a Gluten Free Diet when living with people eating gluten.\u00a0Study results of the questionnaire showed that Gluten Free Diet may reduce psychological symptoms due to malabsorption of tryptophan, but may also increase psychological distress associated with the financial and social restrictions of Gluten Free Diet and disease-related worries.\u00a0A higher psychosocial burden on female Celiac Diseases because of buying and preparing food for the family can be presumed.<a href=\"#footnote_14_660\" id=\"identifier_23_660\" class=\"footnote-link footnote-identifier-link\" title=\"H&auml;user 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. 2010 Jun 14; 16(22):2780-7.\">14<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cThe quality of sleep in patients with celiac disease.\u201d<\/strong> The aim of this study was to evaluate the quality of sleep in coeliac disease.\u00a0Study subjects were: 1) patients at diagnosis of celiac disease; 2) patients with celiac diseases on a gluten-free diet at follow-up, and 3) healthy volunteers. Results found significant differences between celiacs and volunteers. PSQI score was inversely associated with the quality of the physical and mental component scores. The sleep quality scores were related to depression, fatigue, <strong>state anxiety and trait anxiety<\/strong>.<a href=\"#footnote_15_660\" id=\"identifier_24_660\" class=\"footnote-link footnote-identifier-link\" title=\"Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. Aliment Pharmacol Ther. 2010 Oct;32(8):1031-6. doi: 10.1111\/j.1365-2036.2010.04432.x.\">15<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cGluten encephalopathy with psychiatric onset: case report.\u201d<\/strong> A 38-year-old man was admitted as an inpatient for worsening anxiety symptoms and behavioural alterations. After the addition of second generation antipsychotic to the therapeutic regimen, the patient presented neuromotor impairment with high fever, sopor, leukocytosis, raised rhabdomyolysis-related indicators. Neuroleptic malignant syndrome was strongly suspected. After worsening of his neuropsychiatric conditions, with the onset of a frontal cognitive deficit, bradykinesia and difficulty walking, dysphagia, anorexia and hypoferraemic (low iron) anaemia, SPET revealed a reduction of cerebral perfusion and ENeG results were compatible with a mainly motor polyneuropathy. Extensive laboratory investigations gave positive results for anti-gliadin antibodies, and an appropriate diet led to a progressive remission of the encephalopathy.<a href=\"#footnote_16_660\" id=\"identifier_25_660\" class=\"footnote-link footnote-identifier-link\" title=\"Nicola Poloni,&nbsp;Simone Vender, Emilio Bolla, Paola Bortolaso, Chiara Costantini, and Camilla Callegari Gluten encephalopathy with psychiatric onset: case report. Clin Pract Epidemiol Ment Health. 2009; 5: 16.\">16<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cClinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet.\u201d<\/strong> The aim of this study was to assess the biochemical and clinical effects of B vitamin supplementation in adults with longstanding celiac disease. In a double blind placebo controlled multicenter trial, 65 coeliac patients (61% women) aged 45-64 years on a strict gluten-free diet for several years were randomized to a daily dose of 0.8 mg folic acid, 0.5 mg vitamin B12 and 3 mg pyridoxine or placebo for 6 months. The outcome measures were psychological general well-being and the plasma total homocysteine level which is a marker of B vitamin status.<\/p>\n<p style=\"text-align: justify\">Results found normalized homocysteine, which dropped a median of 34%, accompanied by significant improvement in well-being, notably a<strong>nxiety and depressed mood<\/strong> for patients with poor well-being. Conclusion: B vitamins should be considered in people advised to follow a gluten-free diet.<a href=\"#footnote_17_660\" id=\"identifier_26_660\" class=\"footnote-link footnote-identifier-link\" title=\"Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther. 2009 Apr 15; 29(8):811-6. doi: 10.1111\/j.1365-2036.2009.03945.x.\">17<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cPsychoneurotic symptoms and alexithymia in celiac disease.\u201d<\/strong> The aim of this study was to evaluate whether patients with coeliac disease suffer from psychoneurotic symptoms by means of applying the Crown-Crisp Experiential Index (CCEI) and its six subscales to measure neurotic psychopathology, and whether a gluten-free diet has an impact on the symptoms. Study found that somatic anxiety was higher in coeliac disease patients before the introduction of the gluten-free diet than after adhering to the diet.<a href=\"#footnote_18_660\" id=\"identifier_27_660\" class=\"footnote-link footnote-identifier-link\" title=\"Collin P, Kaukinen K, Mattila AK, Joukamaa M. Psychoneurotic symptoms and alexithymia in coeliac disease. Scand J Gastroenterol. 2008;43(11):1329-33. doi: 10.1080\/00365520802240248.\">18<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cRegional cerebral hypoperfusion in patients with celiac disease.\u201d<\/strong> The aim of this study was to evaluate cerebral perfusion (blood flow) in untreated celiac disease patients with no neurologic or psychiatric disorder other than anxiety or depression.\u00a0Study demonstrated evidence of significant regional cerebral blood flow alteration. Cerebral single photon emission CT examination showed 73% of untreated celiac disease patients had at least one hypoperfused (abnormally low blood flow to) brain region compared with only 7% of patients on a gluten free diet and none of controls.<a href=\"#footnote_19_660\" id=\"identifier_28_660\" class=\"footnote-link footnote-identifier-link\" title=\"Addolorato G, Guida D, Di Rossi G, et.al. Regional cerebral hypoperfusion in patients with celiac disease. American Journal of Medicine. Mr 1 2004; 116(5):312-7.\">19<\/a><\/p>\n<p style=\"text-align: justify\"><strong>\u201cAnxiety but not depression decreases in celiac patients after one year gluten-free diet: a longitudinal study.\u201d<\/strong> The aim of this study was to evaluate the real nature of anxiety in newly diagnosed celiac disease patients (classic type) by means of the State and Trait Anxiety Inventory test demonstrated that anxiety is present in a predominantly reactive form rather than as a personality trait. This study found that after one year on gluten free diet, a significant decrease in the percentage of state anxiety was found while there were no significant changes in the percentage of trait anxiety.<a href=\"#footnote_20_660\" id=\"identifier_29_660\" class=\"footnote-link footnote-identifier-link\" title=\"Addolorato G, Capristo E, Ghittoni G, et.al. Anxiety but not depression decreases in celiac patients after one year gluten-free diet: a longitudinal study. Scandinavian Journal of Gastroenterology. May 2001; 36(5):502-6.\">20<\/a><\/p>\n<h4 style=\"text-align: justify\"><span style=\"color: #000000\"><strong>CASE REPORT SUMMARIES<\/strong><\/span><\/h4>\n<p style=\"text-align: justify\"><strong>&#8220;Neuropsychiatric symptoms and celiac disease.&#8221;<\/strong> This case report describes the diagnosis of celiac disease in a patient suffering from chronic, treatment-resistant symptoms of depression and anxiety. The diagnosis of celiac disease and introduction of an elimination diet caused a significant improvement in mental state and everyday functioning in the presenting patient.<\/p>\n<p style=\"text-align: justify\">The reporting physicians state, &#8220;The presence of persistent anxiety and depressive symptoms, with a poor reaction to pharmacological treatment, indicates a need to identify somatic reasons for the underlying condition. It is important to remember that celiac disease can occur at any age, not only in childhood. The presence of this somatic cause of persistent depressive and anxiety symptoms should be considered in the diagnostic process in adults.<a href=\"#footnote_21_660\" id=\"identifier_30_660\" class=\"footnote-link footnote-identifier-link\" title=\"Urban-Kowalczyk M, OEmigielski J, Gmitrowicz A. Neuropsychiatric symptoms and celiac disease. Neuropsychiatr Dis Treat. 2014 Oct 14;10:1961-4. doi: 10.2147\/NDT.S69039. eCollection 2014.\">21<\/a><\/p>\n<ol class=\"footnotes\"><li id=\"footnote_1_660\" class=\"footnote\">Potocki P, Hozyasz K. Psychiatric symptoms and celiac disease. <em>Psychiatria Polska<\/em>. Jul-Aug 2002; 36(4):567-78.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_660\" class=\"footnote\">Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with celiac disease living on a gluten-free diet.\u00a0Aliment Pharmacol Ther.\u00a02009 Apr 15; 29(8):811-6. doi: 10.1111\/j.1365-2036.2009.03945.x. Epub 2008 Jan 20.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_660\" class=\"footnote\">Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. <em>Aliment Pharmacol Ther.<\/em> 2010 Oct;32(8):1031-6. doi: 10.1111\/j.1365-2036.2010.04432.x. Epub 2010 Aug 16.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_660\" class=\"footnote\">Barratt SM, Leeds JS, Sanders DS. Factors influencing the type, timing and severity of symptomatic responses to dietary gluten in patients with biopsy-proven coeliac disease.<em> J Gastrointestin Liver Dis<\/em>. 2013 Dec;22(4):391-6.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_22_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_660\" class=\"footnote\">Collin P, Kaukinen K, Mattila AK, Joukamaa M. Psychoneurotic symptoms and alexithymia in coeliac disease. <em>Scand J Gastroenterol.<\/em> 2008;43(11):1329-33. doi: 10.1080\/00365520802240248.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_660\" class=\"footnote\">Addolorato G, Capristo E, Ghittoni G, et al. Anxiety, but not depression, decreases in celiac patients after one year gluten-free diet: a longitudinal study. <em>Scandinavian Journal of Gastroenterology<\/em>. May 2001; 36(5):502-6.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_660\" class=\"footnote\">Addolorato G, Guida D, Di Rossi G, et.al. Regional cerebral hypoperfusion in patients with celiac disease.\u00a0<em>American Journal of Medicine<\/em>. Mr 12004; 116(5):312-7.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_660\" class=\"footnote\">Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. <em>Aliment Pharmacol Ther<\/em>. 2009 Apr 15; 29(8):811-6. doi: 10.1111\/j.1365-2036.2009.03945.x. Epub 2008 Jan 20.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_11_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_660\" class=\"footnote\">Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease.\u00a0<em>Clinical Science<\/em>. Apr 2001;100(4):379-86.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_12_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_660\" class=\"footnote\">Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease.\u00a0<em>Journal of Gastroenterology and Hepatology<\/em>. 2003;18:479-91.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_13_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_14_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_15_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_16_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_17_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_18_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_11_660\" class=\"footnote\">http:\/\/www.pharmacistelink.com\/naturalmedicine\/pdfs\/P4880x1204DrugChart.pdf<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_19_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_12_660\" class=\"footnote\">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. <em>Br J Nutr. <\/em>2011 Nov;106(10):1535-43. doi: 10.1017\/S0007114511002005.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_20_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_13_660\" class=\"footnote\">Szinnai G, Schachinger H, Arnaud MJ, Linder L, Keller U. Effect of water deprivation on cognitive-motor performance in healthy men and women. <em>Am J Physiol Regul Integr Comp Physiol<\/em>. 2005 Jul;289(1):R275-80.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_21_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_14_660\" class=\"footnote\">H\u00e4user W, Janke KH, Klump B, Gregor M, Hinz A. Anxiety and depression in adult patients with celiac disease on a gluten-free diet. <em>World J Gastroenterol<\/em>. 2010 Jun 14; 16(22):2780-7.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_23_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_15_660\" class=\"footnote\">Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C. The quality of sleep in patients with coeliac disease. <em>Aliment Pharmacol Ther<\/em>. 2010 Oct;32(8):1031-6. doi: 10.1111\/j.1365-2036.2010.04432.x.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_24_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_16_660\" class=\"footnote\">Nicola Poloni,\u00a0Simone Vender, Emilio Bolla, Paola Bortolaso, Chiara Costantini, and Camilla Callegari Gluten encephalopathy with psychiatric onset: case report. <em>Clin Pract Epidemiol Ment Health<\/em>. 2009; 5: 16.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_25_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_17_660\" class=\"footnote\">Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. <em>Aliment Pharmacol Ther.<\/em> 2009 Apr 15; 29(8):811-6. doi: 10.1111\/j.1365-2036.2009.03945.x.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_26_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_18_660\" class=\"footnote\">Collin P, Kaukinen K, Mattila AK, Joukamaa M. Psychoneurotic symptoms and alexithymia in coeliac disease. <em>Scand J Gastroenterol<\/em>. 2008;43(11):1329-33. doi: 10.1080\/00365520802240248.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_27_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_19_660\" class=\"footnote\">Addolorato G, Guida D, Di Rossi G, et.al. Regional cerebral hypoperfusion in patients with celiac disease. <em>American Journal of Medicine<\/em>. Mr 1 2004; 116(5):312-7.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_28_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_20_660\" class=\"footnote\">Addolorato G, Capristo E, Ghittoni G, et.al. Anxiety but not depression decreases in celiac patients after one year gluten-free diet: a longitudinal study. <em>Scandinavian Journal of Gastroenterology<\/em>. May 2001; 36(5):502-6.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_29_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_21_660\" class=\"footnote\">Urban-Kowalczyk M, OEmigielski J, Gmitrowicz A. Neuropsychiatric symptoms and celiac disease. <em>Neuropsychiatr Dis Treat.<\/em> 2014 Oct 14;10:1961-4. doi: 10.2147\/NDT.S69039. eCollection 2014.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_30_660\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>What Is Anxiety? Anxiety or worry is a distressing emotional state of mind or mood that is characterized by a vague uneasiness, unpleasant feelings of apprehension or anticipation of danger and by interference with normal functioning, ranging from mild qualms and easy startling to occasional panic. Q: What causes anxiety? A: Anxiety can be a &#8230;<\/p>\n","protected":false},"author":29,"featured_media":5336,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[4,779,139,144,102,108,117,1682,200,115,49,199,127],"tags":[101,1924,1926,1901,890,1649,468,1350,1561,327,1251,1562,1098,776,1567,582,1164,382,1906,384,1912,1961,1566,1911,1564,1563,457,1565,1560,1887,1960,599,981,180],"class_list":["post-660","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions-2","category-associated-disorder","category-b-vitamins","category-brain","category-calcium","category-iron","category-magnesium","category-malabsorption-disorders","category-mind","category-potassium","category-nervous-2","category-tryptophan","category-thiamin","tag-associated-disorders","tag-b-vitamins","tag-brain","tag-calcium","tag-chronic-maladaptive-anxiety","tag-dehydration","tag-dizziness","tag-dry-mouth","tag-fast-heart-rate","tag-fatigue","tag-fear","tag-frequent-need-to-urinate","tag-headaches","tag-health-conditions","tag-impaired-blood-flow-to-brain","tag-inability-to-concentrate","tag-increased-blood-pressure","tag-insomnia","tag-iron","tag-irritability","tag-magnesium","tag-mind","tag-niacin-vitamin-b3-deficiency","tag-potassium","tag-problem-swallowing","tag-rapid-breathing","tag-restlessness","tag-skipped-heartbeats","tag-sweaty-palmsfeet","tag-nervous-2","tag-tryptophan","tag-tryptophan-deficiency","tag-vitamin-b1-thiamin","tag-water"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/660","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/29"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=660"}],"version-history":[{"count":41,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/660\/revisions"}],"predecessor-version":[{"id":17872,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/660\/revisions\/17872"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/5336"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=660"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=660"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=660"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}