The experience of stress is a normal reaction to various challenging situations we find ourselves in. It is a physical and psychological process that allows us to meet the needs of a given problem and, in this sense, it can be helpful and adaptive. Experiencing stress that is too severe or prolonged is associated with a variety of psychological and biological changes (e.g. feeling depressed/anxious, hypertension, headaches, sleep difficulties).
On top of the usual sources of stress, those with coeliac disease are often faced with a variety of stress-inducing situations related to managing the gluten-free diet (e.g. difficulty finding gluten-free options when out of the house, dealing with the threat of cross-contamination).
Stress has been associated with ‘triggering’ coeliac disease in some people, that is, severe psychological distress can coincide with the first emergence of coeliac symptoms. Similarly, stress can also trigger a physiological response in the body that affects the composition of the gut microbiome –the 100 trillion microorganisms that inhabit the human gastrointestinal tract. These changes can result in a state of dysbiosis, or microbial imbalance. Research indicates that a state of dysbiosis can result in various gastrointestinal symptoms (e.g. bloating, diarrhea) and has been linked to a variety of psychological disorders.
On a psychological level, stress is also closely associated with other psychological symptoms (e.g. depression, anxiety) and may, if prolonged and/or severe enough, become a diagnosable psychological disorder (e.g. major depressive disorder). Stress is also associated with the use of maladaptive coping strategies, that is, the use of coping strategies that may provide some temporary relief but nonetheless do not address the core issue (e.g. the use of drugs or alcohol). Reliance on maladaptive coping strategies can exacerbate symptoms of psychological distress and is also associated with poorer illness management (e.g. not following the gluten-free diet properly, missed medication doses etc.).
Psychological distress is generally associated with poorer gluten-free diet adherence, however, there is some evidence to suggest that in some cases the opposite may be true. Recent research has found that individuals who were strictly adherent to the gluten-free diet, as evidenced by healing of the intestinal mucosa (i.e. the villi of the small bowel), were more likely to be anxious. Similarly, other findings suggest that those with excellent dietary adherence may experience reduced well-being compared to less adherent individuals, potentially due to being in a state of ‘hypervigilance’ regarding their diet (i.e. psychological burden of being on ‘high alert’ regarding food).
Although maintaining strict adherence is essential for both short- and long-term health, doing so should not feel mentally exhausting. If you are regularly finding yourself feeling stressed, anxious, or tired, it may be a sign that additional mental health support is needed. Having coeliac disease often means having to navigate an additional set of challenges on top of the usual hurdles of daily life. People deal with these challenges in a variety of ways and it is important to take the time to assess your coping strategies and how they contribute to your overall mental health.
If you are finding that the challenges of daily life feel overwhelming, or you are relying on maladaptive ways of coping (e.g. using drugs or alcohol, self-blame), consulting a mental health professional can benefit your well-being significantly through effective, evidence-based illness management strategies.
There are many strategies to reduce stress and you will develop your own unique combination of stress management techniques based on what works best for you.
The following ideas are a few good starting points:
- Talk to close friends or family members. Although they might not always understand exactly how you feel, discussing things with them can help you consolidate your thoughts and emotions, lend a fresh perspective, and make you feel less isolated.
- Exercising (e.g. team sport, going to the gym, taking a brisk walk around the block). The benefits of exercise for mental health cannot be understated. Exercise remains one of the single most effect means of reducing anxiety and depression, and acts as a protective factor against stress.
- Meditation or relaxation techniques (e.g. deep breathing).
- Do something you find personally meaningful and immersive (e.g. reading a new book from your favourite author, practicing an instrument).