Do your ADHD symptoms get worse if you eat gluten? It might be to do with Coeliac disease

If you feel unfocused and foggy-brained with bloating and gut discomfort after eating wheat or gluten, there may be a connection with ADHD.

It is now known that a higher-than-average number of people with ADHD also have an autoimmune condition called Coeliac disease, which is a gut malabsorption problem linked to the consumption of wheat and gluten. It doesn’t necessarily mean that one causes the other, but they are often found to coexist alongside each other and may be linked.

Coeliac disease is often in the picture when a person has the inattentive or combined subtype of ADHD, where the person is more likely to be a distracted daydreamer with poor executive function rather than hyperactive. This lack of focus may be because Coeliac disease directly influences our ability to absorb certain nutrients efficiently and, ultimately, affects brain function.

So, if this sounds like you, it is critical to ask your GP for a Coeliac blood test called Tissue Transglutaminase. The NatureDoc clinical team can screen further for more in-depth autoimmune reactions to wheat, gluten and grains as well as test for nutrient deficiencies and imbalances in the gut.

This blog explores why ADHD and Coeliac disease often coexist, why it is important to heal the gut and which nutrient deficiencies you might need to bolster. When your body and brain are better nourished, you should then start to feel more focused, less distracted, and on a more even keel.

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What are the symptoms of Coeliac disease?

If you have Coeliac disease, you will most likely experience abdominal pains and bloating as well as frequent vomiting and diarrhoea, but this is not always the case.

With Coeliac disease, you are likely to be very slim (but again not always), pale, tired and irritable due to the malabsorption of nutrients including iron, vitamin B12, folate, vitamin D, zinc and magnesium.

You might have thinning tooth enamel and experience regular mouth ulcers. You may be at higher risk for osteopenia and osteoporosis which lead to bone thinning and higher risk of bone fracture.

You may experience numbness and tingling in your hands and feet called peripheral neuropathy.

Occasionally a chronic skin condition develops called Dermatitis herpetiformis which is Coeliac disease of the skin. It is a pustule type rash with intense itching and burning sensations which usually affect the knees, elbows, scalp, the back of the neck and the buttocks.

Teenagers may have delayed puberty. Women with untreated Coeliac disease often experience unexplained subfertility and repeated miscarriages.

Both children and adults with Coeliac disease may also display neurological changes called gluten ataxia which affects co-ordination such as balance and walking and gait instability, as well as slurred speech or jumpy vision.

What is Coeliac disease?

Coeliac disease is an autoimmune response to eating gluten (which is in wheat, spelt, kamut, rye, barley and most oats), where the gluten destroys the function of the villi in the small intestine. These villi are tiny finger like projections that help with the absorption of a wide range of both macro and micronutrients including proteins, fats and carbohydrates as well as vitamins and minerals.

Classic untreated Coeliac disease gives the mucous lining of the intestines a flat surface with no villi, which is known as total villous atrophy, and this can pose a high risk for a wide range of nutrient deficiencies. However, in most cases there is not such an extreme effect, and if it is diagnosed early there is only a reduction in the normal function of the villi. This simply means that the ability to absorb nutrients reduces but it is easier to get this function back over a few months. The degree of malabsorption varies from person to person.

Because of the malabsorption, people with Coeliac disease often have bulky, ochre and pale-coloured fatty stools known as steatorrhea. The high proportion of fat in the large yellow stools is the residue of the carbohydrate, fats and proteins that have not been able to be absorbed by the small intestine. The stool will also contain the vitamins and minerals that the villi will have failed to absorb. When the stool starts to turn mid-brown and more of an even ‘sausage’ shape, this is a sign that the gut is starting to heal, and the malabsorption is lessening.

After removing the gluten entirely for several months, in most cases the villi can start functioning normally again, and a healthy gluten-free diet slowly reverses any nutrient shortfalls. These nutrient levels revert to normal in blood tests and people start to feel more themselves again.

However, refractory Coeliac disease can mean that a gluten-free diet alone is not enough and sometimes other types of starch (disaccharides like potato, rice and corn), or dairy products, also need to be removed from the diet. Extra help may also be needed to help with digestion and absorption as well as additional vitamin and mineral supplements. This is where the help from one of the NatureDoc clinical team can guide you.

Are there shared genetic risks?

Coeliac disease affects around 1 per cent of the population (and around 2 per cent of Italians) and is a strongly inherited genetic condition, in which around 99.6 per cent of people with Coeliac disease carry one or both HLADQ2 or HLADQ8 genetic SNP alleles. Only a very small number of people living with Coeliac disease acquire it for other reasons. These genetic SNPs also pose a higher risk for developing other autoimmune conditions such as Type 1 Diabetes and Hashimoto’s Thyroiditis. So, even if you are not aware of other family members with Coeliac disease, you may see a pattern of other autoimmune conditions amongst family members.

The rate of psychiatric illness and neurological differences in people with untreated Coeliac disease is as high as 21 per cent and therefore it is important to be tested for it if you or your child have a decline in your mental health, or if your ADHD traits have become amplified or are not managed well on medication alone. Again, consider the Coeliac disease link if you have had a decline in academic performance or overall cognitive acuity.

New research also indicates that there may be a correlation between ADHD and the presence of other autoimmune diseases among blood relatives, attributed to shared genetic risk factors. The risk of developing ADHD is increased you have a history of autoimmune disease or if your mother has a history of it. If autoimmunity is prevalent in the wider family, it may be prudent to explore whether autoimmunity is part of the picture via blood tests.

It is important to stress that not everyone with Coeliac disease has ADHD and not everyone with ADHD has Coeliac disease, but a person with one is more likely to live with the other in tandem.

Links with gut permeability and the blood-brain barrier

Research has found that ADHD traits can be exaggerated in people with Coeliac disease, and this may be because the ingestion and consequent breakdown of gluten into tiny proteins (called immunogenic peptides) could mean these peptides “leak” through the tight junctions of the intestinal wall in between the villi into the bloodstream. This leaky gut is due to increased intestinal permeability from the Coeliac disease.

The gluten peptides travel through the bloodstream and may pass into the brain through the blood–brain barrier, potentially causing low-grade neural inflammation. As a result of this inflammation, there can be functional deficits in the frontal cortex or prefrontal cortex in people with Coeliac disease which can lead to poorer executive function such as planning and organisation.

Nutrient deficiencies and neurotransmitter regulation

Another significant aspect of the ADHD-Coeliac connection lies in the malabsorption of essential nutrients, due to damage to the intestinal villi that line the small intestine.

These villi play a vital role in nutrient absorption. When they become damaged, as is the case in Coeliac disease, malabsorption occurs, leading to deficiencies in key nutrients such as vitamin B12, folate, vitamin D, iron, magnesium, and zinc.

These nutrients are all crucial for brain health and function. They support the central nervous system and play a significant role in regulating neurotransmitter production and reuptake. They help to make, synthesise and recirculate dopamine, norepinephrine, serotonin, acetylcholine and GABA which are all critical chemical messengers in the brain that help with focus, impulsivity and executive function.

When a person is first diagnosed with Coeliac disease, their bloodwork may also show marked deficiencies in these key nutrients, and I usually recommend they focus on eating foods rich in these vitamins and minerals and top up with supplements until optimal levels are reached in the blood.

Many people with Coeliac disease need ongoing support with additional vitamin and mineral supplements, partly because most gluten-free convenience foods such as bread, pasta, biscuits and cakes do not contain enough or any of these key nutrients.

Another reason for a need for ongoing supplement support is that some people find that their villous atrophy means that they continue to struggle to absorb nutrients over the longer term. This is where daily supplements plus a gut healing protocol for gut permeability can be helpful which can be managed and overseen by one of the NatureDoc clinical team.

Which nutrients do I need to prioritise?

Here are the key nutrients to prioritise when you are first diagnosed with Coeliac disease, especially if ADHD is also in the picture:

Vitamin B12 is essential for the production of myelin, the protective sheath around nerves. A deficiency in B12 can lead to nerve damage and contribute to the symptoms observed in ADHD. Foods containing vitamin B12 include meat, fish, eggs and dairy products.
Folate comes hand in hand with vitamin B12 and helps to support the neurological system. Foods abundant in folate include green salad leaves, green vegetables, eggs and pulses such as lentils, beans and chickpeas.
Vitamin D has a vital role in brain health, and its deficiency has been linked to cognitive impairment and neurological challenges, including ADHD symptoms. Most vitamin D comes from the sunshine, and you can get some in oily fish and eggs.
Iron is the most abundant mineral in the central nervous system and is crucial for synthesis of dopamine, norepinephrine and serotonin, the neurotransmitters involved in ADHD. Iron-rich foods are red and brown meats, pulses, green vegetables, eggs, prunes and apricots.
Zinc is the second most abundant mineral in the central nervous system and is essential for the regulation of neurotransmitters, including dopamine, which is implicated in ADHD. It can help with learning and memory as well as self-regulation and emotional regulation. Zinc is plentiful in seafood and fish as well as meat, dairy and pumpkin seeds.
Magnesium deficiencies have been associated with the magnification of ADHD symptoms, and it plays a role in neurotransmitter function and brain health to help dampen down hyperactivity or feelings of overwhelm. It is very calming and helps with sleep. Find magnesium in cocoa/cacao, dark green vegetables, nuts and seeds.

Round up

The link between ADHD and Coeliac disease opens a new avenue for understanding and managing both conditions. Recognising the shared pathways of gut permeability, blood-brain barrier integrity, and nutrient absorption can help develop more comprehensive treatment strategies. Through addressing nutrient deficiencies and supporting gut health, we may be able to alleviate some of the more marked and challenging symptoms associated with ADHD, especially in individuals with Coeliac disease.

If you or your child have ADHD or are on the ADHD pathway then do consider testing for Coeliac disease, which could be exacerbating or mimicking the symptoms. Once the Coeliac disease is treated through a strict gluten-free diet, healing the gut and addressing nutrients shortfalls, then you or your child should feel more switched on, organised and able to manage your lives day to day.

The NatureDoc clinical team are able to run tests for autoimmunity and gluten sensitivity markers as well as gut permeability, so be in touch if you need to explore this more deeply.

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