QUESTION: Why do we create a conversation with our patients about the possibility that they are sensitive to gluten? What does eating gluten have to do with stress?

ANSWER: After I’d been doing ear acupuncture for stress for about 10 years and noted that our results were not quite as good as the results of treating people with substance addiction with the same acupuncture points, I began to look for things we could include to improve our results.

At exactly this time I joined a new clinic where patients came who had been through the mainstream system and either their symptoms had defied diagnosis or who had not found a treatment which worked. At this clinic, extensive laboratory testing was done and people began to show results which suggested they might be caught up in an inflammatory process which implicated the gluten portion of wheat. My own family were among those diagnosed with gluten sensitivity, (but not with Celiac Disease) and there were so many of them that I began to see a picture of who might and might not be candidates for it.

At the time, a test came online from a laboratory in Dallas Texas called Enterolab, (available without a doctor’s referral) that diagnoses gluten sensitivity from a stool specimen. But Enterolab testing hasn’t yet met all of the world standards, meaning that there are still both false positive and false negative results. But the most important thing we learned, after seeing gluten sensitivity diagnosed this way, was that people who really were gluten sensitive are highly prone to developing inflammatory diseases which are both debilitating and can be deadly. A high portion of these patients whose testing proved positive also had long-standing difficulties adapting to stress.

We found out that this had to do with the fact that if you were sensitive to gluten, that it was very likely that you would not be able to absorb all of the amino acids necessary to create optimal levels of circulating neurotransmitters. In such a case no treatment, medication or talk therapy was going to work unless the neurotransmitter levels were returned to normal. Since removing gluten from one's diet tended to do that, the patients who did so were becoming candidates for restoring their ability to deal with stress. But as it turned out, the habits they had acquired when they had low levels of neurotransmitters persisted unless something dramatic could be done to start them over. Smith's ear acupuncture fit the bill. Simply put, if you are gluten sensitive, nothing will work while you consume gluten. And if and when one stops eating gluten, one feels better but doesn’t perform better yet.

Since ear acupuncture was known to work with people who had removed gluten from their diet, the doctors at work in the clinic sent their patients who had been tested and removed from gluten for
treatment and our treatment worked with most of these people. So far so good. But with this information, I began to notice in other patients who simply appeared, complaining that nothing they had done proved to be a bit of help, that many of these people were undiagnosed gluten sensitives, and so I found a questionnaire which helped me identify which ones are and which ones aren't. Want to see what we tell patients about discovering if one is gluten sensitive? CLICK HERE.

I can tell, from how the patient fills in this questionnaire, with reasonable accuracy if a patient is gluten sensitive. I've watched the numbers (people scoring over five items are somewhat likely, and if over 8 are very likely) - and I find that one out of every two patients who appears with chronic stress, turn out to be people who are gluten sensitive and who need to remove gluten from their diet if they are to succeed. I’m not always right, but I can't diagnose them for sure by even Enterolab testing, so the worldwide standard has been to have people go off gluten entirely for a month, see if their symptoms subside, then have a gluten challenge meal after a month, and if their symptoms return, this becomes a positive test - meaning that they should avoid gluten for the rest of their lives.

The long and short of it is that our doing this has picked up on a number of people who wouldn't have gotten any results if we hadn't suggested they check out gluten. To me, it's not a big sacrifice, and it could be the difference between success and failure for a person to take a month and try going off gluten. I have written an article in the medical literature (seen below) which makes this point. I further summarize my advice suggesting to some people, identified in part by the questionnaire above, that they test for gluten sensitivity below...

The Relationship Between Gluten Sensitivity and Depleted Neurotransmitter Levels

prepared by Brian C. Bailey M.D. for health care providers

In my current patient brochure, for South-East Ottawa Community Heath Centre (which you can access by clicking the icon), prepared in part to clarify my focus on gluten sensitivity as a major contributor to chronic maladaptation to stress, I make this statement: “ more than half of our chronically stressed clients we see have seriously depleted levels of neurotransmitters, caused by gluten sensitivity and benefit from going gluten free.” The thrust of this statement in a brochure meant for patients is to give patients an inkling why they might have done all they could to relieve stress yet remained stuck, only to find it’s what they eat. I elaborate here on this new but increasingly-well-known conclusion to health care providers. 

To start with, let me state that I’m a clinician, not an academic researcher, and so I’m more interested in what happens to how people feel, how people function and whether people prosper with treatment or not. In that respect, I’m closer to paying attention to the questions other clinicians pay attention to, and further away from academic research. So my conclusions came, in part, from my actual experience, and were later backed up by the research I’ll present below. My discovery that 50% of chronically-stressed patients are implicated is based on a chart-by-chart review of 300 consecutive patients presenting for treatment.

When gluten sensitivity reared its head in 2004 I was working in an Ottawa clinic with its own testing laboratory that saw patients whose medical problems had defied diagnosis and therefore treatment. Patients who came there were prepared to pay for more extensive testing ($600) which wasn’t covered by provincial health care plans. After all, they were unsolved cases who were languishing despite mainstream diagnosis and treatment. That year a new lab called Enterolab in Dallas Texas opened its doors, and for $500, patients who’d been unable to be diagnosed before were being diagnosed as gluten sensitive. In the following 10 years, however, gastroenterologists world-wide accepted as definitive going off gluten for 1-3 months and if symptoms lessened, trying a gluten challenge meal. A positive test is when symptoms return in large measure. Depression and anxiety were among the major symptoms, and those who were Enterolab positive were readily seen to be the very people who.d been put on antidepressants without success.

In the early days of getting people to self-test by going gluten free, patients still on antidepressants began to feel the toxic side effects of antidepressant overdose after coming off gluten. The obvious conclusion reared its head among my colleagues - the antidepressants didn’t work because they had lacked neurotransmitters, and once they corrected this, the antidepressants had a substrate to work on again. So, they began to measure levels of neurotransmitters in platelets, and found that almost 100% of gluten sensitives had below normal levels of dopamine, serotonin and noradrenaline - often markedly lowered. It made sense. While this reversed after a year off gluten (again based in testing), at $275 it was an expensive test, and since they’d found it abnormal so often they stopped doing it. But their theory was proven. I wasn’t involved in this testing, but I did get to treat the patients. Off gluten, they did get better.   

The very same conclusion can now be found in a plethora of medical literature articles, but I will restrict myself to quoting the one of recent date which is authored in part by the acknowledged world authority on gluten sensitivity, Dr. Alessio Fasano Director, Center for Celiac Research, Massachusetts General Hospital for Children. Neurologic and Psychiatric Manifestations of Celiac Disease and Gluten Sensitivity Psychiatric Quarterly March 2012; 83(1):91-102 which states, among other conclusions:

“Gluten intolerance may also have some relationship to serotonergic functioning. One study found that a majority of adolescents with CD displayed depressive and behavioral symptoms before the diagnosis of CD and had low free tryptophan levels. In that study, a gluten free diet was found to improve depressive symptoms and behavioral problems and increase free L-tryptophan levels to a level approaching significance [80]. After 1 year on a gluten free diet, patients with CD experienced a significant increase in major serotonin and dopamine metabolite concentrations [81]. Thus, this theory is incomplete but suggests that L-tryptophan and serotonin may be involved in the pathophysiologic link between gluten mediated immune responses and psychiatric comorbidities.”


I have published the article below in the fall of 2014 issue of the GP Psychotherapist, the Journal of the Ontario General Practice Psychotherapy Association on determining how to detect hidden gluten sensitivity: