Exploring The Connection Between ADHD and Celiac

Jillian Enright

ADHD and Celiac Walk into a Bar…

ADHD Comorbidities Continued

As it turns out, ADHD and Celiac actually met in the bar. They seemed to have quite a bit in common and got on well, so they decided to go back to ADHD’s place (ADHD is known for being impulsive, after all).

What is Celiac Disease?

Simply put, Celiac disease (CD) is an immune reaction to eating gluten, a protein found in wheat, barley and rye.

Figuring out that I had Celiac Disease was challenging because a decade ago it wasn’t believed to be as common as it is now. In the early 2000s the prevalence rate was thought to be only 0.9%. It is now understood that Celiac Disease affects roughly 2% of the population.

The most common symptoms of Celiac Disease are:

  • bloating
  • chronic diarrhea
  • constipation
  • gas
  • lactose intolerance due to damage to the small intestine
  • loose, greasy, bulky, and bad-smelling stools
  • nausea or vomiting
  • pain in the abdomen

Sounds just lovely, doesn’t it? The only one of these I experienced was lactose intolerance, which my doctors assumed was a separate condition.

Another very common symptom I experienced is Iron Deficiency Anemia. Undiagnosed and untreated Celiac Disease (CD) results in damage to the intestines, leading to malabsorption of nutrients, which can lead to nutrient deficiencies.

Neurological & Psychological Symptoms of CD

What has come to light in more recent years is that untreated CD has a high comorbidity with psychological and psychiatric disorders, the most common among them being anxiety and depression, and I have been diagnosed with generalized anxiety.

There is also evidence of the following “extraintestinal” (meaning, not GI-related) manifestations of CD:

  • Ataxia and dizziness
  • Joint pain
  • Brain fog
  • Seizures
  • Fatigue
  • Skin conditions such as dermatitis herpetiformis (DH) and eczema
  • Obstetrical complications such as infertility and miscarriage

Well, golly gee, I experienced every single one of those symptoms! Every single one.

Ironically, it wasn’t until my sister-in-law, a doctor who lives over 2,000 kilometres away in another province, suggested I get tested for CD that it even entered the conversation.

The good news is that the treatment is simply a strict gluten-free diet.

Now, more than ten years later, I’m wondering how yet another diagnosis was overlooked for so long.

ADHD and CD

I recently came across a 2010 study that found a link between ADHD and Celiac Disease. I was diagnosed with Celiac Disease in 2009 and with ADHD 10 years later, in 2019.

Being the psych-nerd that I am, I proceeded to do a deep dive into the literature to find more established links between the two conditions.

Although it’s now known that CD affects approximately 2% of the general population, a 2019 study claimed the prevalence of CD in people diagnosed with ADHD is 6%.

This conclusion, however, is based on inadequate information. The findings in this study were based on checklists, questionnaires, and blood tests from only 99 children. As far as medical studies go, that is an extremely small sample size.

There are earlier studies that have found no conclusive evidence for a relationship between ADHD and CD, and a 2020 study concluded that there is not enough data to support screening children with ADHD for CD unless there are additional indications.

So, where is the connection?

Given what we’ve learned over the past few decades, it’s not surprising there’s a link between nutrition and neurochemicals.

Celiac disease causes malabsorption, which can lead to malnutrition. Malnutrition depletes our brain’s ability to produce and process necessary neurochemicals for healthy brain development and function.

Malnutrition can impact our body’s ability to produce and process certain neurotransmitters, such as dopamine and serotonin, which are implicated in mood, attention, and behaviour.

Wait a minute, that sounds familiar.

Before you get too excited…

Hold up. I know we ADHDers like to move quickly, but I think you’ll remember this phrase from pretty much any University 101 course:

Correlation does not equal causation!

Essentially, this means that just because two things are related does not mean one causes the other. The research establishes that untreated CD can worsen ADHD symptoms because of its impact on neurochemicals, but that does not prove that CD causes ADHD.

On a personal note, I have been 100% faithfully gluten-free since my diagnosis in June of 2009, more than 12 years ago. In 2019, I was 10 years gluten-free, yet I was still diagnosed with ADHD.

My CD is very well controlled by diet, I no longer have any of the symptoms I mentioned earlier, and yet I still have ADHD. My neurochemistry may be impacted by my diet and nutrition, but my neurobiology will always be complex and divergent, and I am very much okay with that.

In fact, I’ve come to be proud of my neurodivergent self. Our differently wired brains can make my life harder at times, but they come with their own set of unique gifts too, and the world needs us.

© Jillian Enright, ADHD 2e MB

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References

Akmatov, M. K., Ermakova, T., & Bätzing, J. (2021). Psychiatric and Nonpsychiatric Comorbidities Among Children With ADHD: An Exploratory Analysis of Nationwide Claims Data in Germany. Journal of Attention Disorders, 25(6), 874–884. https://doi.org/10.1177/1087054719865779

Coburn, S. S., Puppa, E. L., & Blanchard, S. (2019). Psychological Comorbidities in Childhood Celiac Disease: A Systematic Review. Journal of Pediatric Gastroenterology and Nutrition, 69(2), e25-e33. https://doi.org/10.1097/MPG.0000000000002407

Ertürk, E., Wouters, S., Imeraj, L., & Lampo, A. (2020). Association of ADHD and Celiac Disease: What Is the Evidence? A Systematic Review of the Literature. Journal of Attention Disorders, 24(10), 1371–1376. https://doi.org/10.1177/1087054715611493

Fedorak, R. N., Switzer, C. M., & Bridges, R. J. (2012). Canadian Digestive Health Foundation Public Impact Series 4: celiac disease in Canada. Incidence, prevalence, and direct and indirect economic impact. Canadian journal of gastroenterology = Journal canadien de gastroenterologie, 26(6), 350–352. https://doi.org/10.1155/2012/384787

Gibson, G. E., & Blass, J.P. (1999). Nutrition and Functional Neurochemistry. In: Siegel GJ, Agranoff BW, Albers RW, et al. (Eds.). Basic Neurochemistry: Molecular, Cellular and Medical Aspects. (6th edition). Lippincott-Raven. https://www.ncbi.nlm.nih.gov/books/NBK28242

Hoffenberg, E. J., MacKenzie, T., Barriga, K. J., Eisenbarth, G. S., Bao, F., Haas, J. E., Erlich, H., Bugawan Tl, T. l., Sokol, R. J., Taki, I., Norris, J. M., & Rewers, M. (2003). A prospective study of the incidence of childhood celiac disease. The Journal of pediatrics, 143(3), 308–314. https://doi.org/10.1067/s0022-3476(03)00282-8

Honar, N., Barkhordarian, M., Ghanizadeh, A., Radanfar, R. (2019). Association of Celiac Disease with Attention Deficit Hyperactivity Disorder. Journal of Comprehensive Pediatrics; 11(1):e97114. https://dx.doi.org/10.5812/compreped.97114

Kumperscak, H. G., Rebec, Z. K., Sobocan, S., Fras, V. T., & Dolinsek, J. (2020). Prevalence of Celiac Disease Is Not Increased in ADHD Sample. Journal of Attention Disorders, 24(7), 1085–1089. https://doi.org/10.1177/1087054716666953

Niederhofer H. (2011). Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. The primary care companion for CNS disorders, 13(3), PCC.10br01104. https://doi.org/10.4088/PCC.10br01104

Talarico, V., Giancotti, L., Mazza, G. A., Miniero, R., & Bertini, M. (2021). Iron Deficiency Anemia in Celiac Disease. Nutrients, 13(5), 1695. MDPI AG. http://dx.doi.org/10.3390/nu13051695

Therrien, A., Kelly, C. P., & Silvester, J. A. (2020). Celiac Disease: Extraintestinal Manifestations and Associated Conditions. Journal of clinical gastroenterology, 54(1), 8–21. https://doi.org/10.1097/MCG.0000000000001267

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Neurodivergent. 20+ years social work and psychology experience. I write about mental health, neurodiversity, advocacy, education, and parenting. Founder of ADHD 2e MB. CYW, BA Psychology.

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