The Silent Toll: How Celiac Disease Drives Psychiatric and Neurological Disorders

Christine Bowen, ND, FABNG

Abstract

Celiac disease (CD) is increasingly recognized as a systemic autoimmune condition whose psychiatric and neurological manifestations often precede or overshadow gastrointestinal symptoms. Evidence demonstrates strong associations between CD and a spectrum of disorders, including anxiety (62.7%), depression (34.9%), ADHD (20.7%), bipolar disorder, schizophrenia, peripheral neuropathy (up to 39%), gluten ataxia, migraines, and cognitive impairment. These conditions are driven by overlapping mechanisms such as chronic inflammation, nutrient deficiencies, autoimmune cross-reactivity, gut-brain axis disruption, and cerebral hypoperfusion. Despite these well-documented patterns, CD remains underdiagnosed in patients presenting with psychiatric or neurological complaints. This article reviews the scope of neuropsychiatric and neurological manifestations of CD, highlights key mechanistic pathways, and emphasizes the quality-of-life impact of delayed recognition. It further outlines integrative strategies for screening, diagnosis, and management—including strict gluten-free diet adherence, targeted nutritional support, mental health care, neurological monitoring, and microbiome restoration. Expanding clinical frameworks to include CD in the evaluation of unexplained neuropsychiatric symptoms offers an opportunity to improve outcomes through earlier diagnosis and whole-person care.

---

Introduction

As a clinician specializing in complex digestive health cases, I have consistently observed patterns linking gastrointestinal dysfunction—particularly Celiac disease (CD)—with neuropsychiatric symptoms. My personal experience with panic disorder, which resolved only after restoring gut balance, led me to question whether similar patterns were at play in my patients. In clinical practice, I have encountered numerous cases of disordered eating, treatment-resistant depression, anxiety, and cognitive complaints that ultimately traced back to undiagnosed CD. These clinical observations prompted a deeper investigation into the literature, which reveals a substantial and growing body of evidence supporting the connection between gluten-related autoimmunity and psychiatric and neurological dysfunction (Vaziri et al., 2024; Briani et al., 2023; Lebwohl et al., 2024).^1,3,5

Emerging research suggests that neuropsychiatric presentations of CD may now surpass the prevalence of classic gastrointestinal symptoms in many clinical contexts (Lebwohl et al., 2024).³ These manifestations—including anxiety, depression, ADHD, ataxia, migraines, and peripheral neuropathy—often present in isolation or long before digestive complaints emerge (Briani et al., 2023).¹ Despite these patterns, CD remains significantly underdiagnosed in individuals whose primary complaints are psychiatric or neurologic in nature (Vaziri et al., 2024).⁵

This article highlights the scope and mechanisms of Celiac-related neuropsychiatric manifestations, including immune-mediated pathways, nutrient deficiencies, gut-brain axis disruptions, and inflammatory drivers. It further outlines practical, integrative approaches to screening, diagnosis, and whole-person management, with the goal of improving outcomes for patients whose symptoms may be rooted in unrecognized gluten-related autoimmunity.

Psychiatric Manifestations of Celiac Disease

Individuals with CD are at significantly elevated risk for psychiatric conditions. Studies show that anxiety affects 62.7% of CD patients and depression impacts 34.9%, with both conditions often emerging due to a combination of immune dysregulation, chronic inflammation, and psychosocial stressors related to dietary restriction.⁵ Anxiety frequently arises from the unpredictability of symptoms, fear of gluten exposure, and social limitations. Depression, on the other hand, is closely linked to micronutrient deficiencies and the inflammatory effects of ongoing autoimmunity.

A 2024 meta-analysis also found that higher levels of anti-tTG IgG antibodies correlate with a 5% increased likelihood of mood disorders⁵, emphasizing the immunological basis of psychiatric involvement.

CD is also strongly associated with more severe psychiatric conditions. Affected individuals have a 17-fold increased prevalence of bipolar disorder.⁵ Schizophrenia was one of the earliest documented neurological complications of CD, with historical reports noting symptom improvement following a gluten-free diet (Briani et al., 2023).¹ Elevated anti-gliadin IgG antibodies are frequently observed in patients with both schizophrenia and bipolar disorder, suggesting immune activation by gluten as a contributing factor.

Neurodevelopmental conditions such as ADHD and ASD are also more prevalent among those with CD. ADHD is reported in 20.7% of CD patients, while ASD is comorbid in 2.62–4.4% of cases (Vaziri et al., 2024).⁵ Contributing mechanisms include neuroinflammation, oxidative stress, and altered gut microbiota. Notably, maternal CD has been shown to increase the risk of ASD in offspring³, reinforcing the need for early diagnosis and nutritional intervention.

Disordered eating and food neophobia may also be tied to CD. While a 2024 study found no statistically significant increase in eating disorders among CD patients, prior meta-analyses suggest a higher prevalence.⁵ Fear of contamination can drive rigid, hypervigilant food behaviors that mimic classic eating disorders but are rooted in autoimmune pathology and dietary necessity.

Neurological Manifestations of Celiac Disease

CD is associated with a range of neurological complications, often described collectively as NeuroCD.¹ These can occur independently of gastrointestinal symptoms and may be the first—or only—manifestation of disease.

Gluten Ataxia is characterized by cerebellar damage driven by gluten-induced immune responses. Patients may exhibit gait disturbances, dysarthria, and impaired coordination. Gluten ataxia affects 6% of all CD patients and up to 40% of those with neurological symptoms.¹ Early adherence to a gluten-free diet (GFD) has been shown to reverse or halt progression in many cases.

Peripheral Neuropathy is present in up to 39% of individuals with CD and typically manifests as numbness, tingling, or burning in the extremities.¹ Neuropathy is believed to result from gluten-related antibodies targeting neural structures, contributing to cumulative nerve damage.

Cognitive Impairment and Brain Fog are commonly reported and include memory lapses, reduced processing speed, and attention deficits. Studies show that these symptoms may stem from systemic inflammation, cytokine dysregulation, and blood-brain barrier dysfunction, and often improve within 6–12 months of strict GFD adherence.³

White Matter Disease, visible on MRI as hyperintensities, has been documented in both symptomatic and asymptomatic CD patients. These structural changes may explain neurological symptoms in individuals who otherwise lack clear GI involvement.¹

Epilepsy and Headaches, including migraines, occur more frequently in CD. Children appear to be particularly vulnerable to seizure disorders associated with gluten exposure. A strict GFD has been shown to reduce headache and seizure frequency in some patients.^1,3

Pathophysiological Mechanisms

The link between CD and neuropsychiatric illness involves several overlapping mechanisms:

• Nutritional Deficiencies: Malabsorption of key nutrients—iron, folate, vitamin D, and B-vitamins—impairs neurotransmitter synthesis, energy metabolism, and myelination, which can significantly impact mood and cognitive function.³
  
• Chronic Inflammation: Systemic immune activation increases pro-inflammatory cytokines (e.g., IL-6, TNF-alpha), which have direct effects on the brain and nervous system, contributing to symptoms like fatigue, depression, and neuropathy.⁵
  
• Gut-Brain Axis Dysfunction: Alterations in the gut microbiota and intestinal permeability lead to abnormal signaling between the GI and central nervous systems, with downstream effects on behavior, emotion, and cognition.³
  
• Autoimmune Cross-Reactivity: Antibodies to gliadin and tissue transglutaminase may cross-react with brain tissue, contributing to cerebellar and peripheral nerve damage.¹
  
• Cerebral Hypoperfusion: Reduced cerebral blood flow has been observed in untreated CD patients, impacting cognitive performance and emotional regulation.¹

Quality of Life (QoL) Concerns

Undiagnosed or untreated CD can dramatically reduce quality of life. Patients often report social isolation, anxiety, and fear surrounding food, travel, or social gatherings due to the unpredictability of their symptoms and the challenges of gluten avoidance. QoL metrics remain low in CD patients even after diagnosis unless comprehensive support is provided.³

Routine screening for psychiatric symptoms and providing integrative mental health care are essential to reducing symptom burden and improving daily functioning.

Holistic Management Approaches

Effectively managing the neuropsychiatric and neurological impacts of CD requires an integrative and multidisciplinary approach:

• Strict Gluten-Free Diet (GFD): Adherence to a 100% gluten-free diet is the cornerstone of treatment. Even trace exposure can trigger immune and neurological symptoms. In refractory cases, additional dietary approaches such as Low FODMAP may improve symptoms and quality of life.³
  
• Nutritional Supplementation: Regular monitoring and repletion of iron, vitamin D, folate, and other B-vitamins are critical to support brain and nerve function.
  
• Psychological Support: Cognitive Behavioral Therapy (CBT) and other mental health services can help patients process the emotional and practical challenges of chronic dietary restriction.
  
• Neurological and Psychiatric Screening: Routine assessment for neuropathy, mood disorders, ADHD symptoms, and cognitive decline should be standard care in CD management.
  
• Microbiome Restoration: Targeted probiotic and prebiotic interventions may help reestablish gut-brain homeostasis, potentially improving mood and cognition.³
  
• Patient Education and Advocacy: Empowering patients with knowledge about cross-contamination, hidden gluten sources, and mental health risks associated with CD can lead to better long-term outcomes.

Celiac disease is a systemic autoimmune condition whose psychiatric and neurological effects often precede—or eclipse—its digestive symptoms. For integrative and naturopathic clinicians, the growing body of evidence offers both an imperative and an opportunity: to expand our screening practices, update our clinical frameworks, and address root causes that may otherwise go unrecognized.

In light of data showing that CD is associated with anxiety (62.7%), depression (34.9%), ADHD (20.7%), peripheral neuropathy (up to 39%), and a 17-fold increase in bipolar disorder^1,5, clinicians should include Celiac serologies in the workup of persistent or unexplained neuropsychiatric symptoms. Likewise, mental health screening tools such as the PHQ-9 and GAD-7 should be routinely used in patients with known CD to monitor impact and guide intervention.

Recognizing the full spectrum of CD demands more than blood tests, intestinal biopsies, and gluten elimination. It requires an integrative, whole-person approach that supports neurological health, psychological resilience, nutritional balance, and everyday functionality. By adopting broader diagnostic frameworks and personalized management strategies, we can reduce diagnostic delays, enhance quality of life, and more fully realize the promise of root-cause, patient-centered care.

References

1. Briani, C., et al. (2023). Neurological complications of celiac disease and gluten sensitivity. Frontiers in Neurology, 14, 9779232. https://pmc.ncbi.nlm.nih.gov/articles/PMC9779232/
2. Johnston, S. (2024). The Australian researchers in the race to find coeliac treatment. The Australian. https://www.theaustralian.com.au/health/the-australian-researchers-in-the-race-to-find-coeliac-treatment/news-story/4e5f3a54d706e80e184fce3d2ec3a988
3. Lebwohl, B., et al. (2024). Celiac disease and mental health: The role of nutrition and inflammation. Nutrients, 16(5), 142. https://pmc.ncbi.nlm.nih.gov/articles/PMC11370848/
4. University of Chicago Medical Center. (2024, May 16). Gluten peptides damage intestinal barrier in celiac disease [Press release]. ScienceDaily. https://www.sciencedaily.com/releases/2024/05/240516122605.htm
5. Vaziri, S., et al. (2024). Psychiatric symptoms in celiac disease: A systematic review. Psychiatric Research & Clinical Practice. https://www.psychiatryonline.org/doi/10.1176/appi.prcp.20230076
6. ZED Therapeutics. (2024, June 24). Transglutaminase 2 inhibitor (ZED1227) shows promise in celiac disease clinical trial [Press release]. ScienceDaily. https://www.sciencedaily.com/releases/2024/06/240624125521.htm