Restricting foods beyond gluten in adults with celiac disease is associated with poorer quality of life (QoL) and increased rates of depression. This underscores the psychological impact of excessively restrictive diets.
Anne R. Lee, RDN, LD, and her team from the Celiac Disease Center at Columbia University highlighted the risk of eating disorder development in individuals with celiac disease and other gastrointestinal conditions. They noted that restrictive diet therapies often lead to subtle but maladaptive eating behaviors, such as fasting, excessive exercise, hyper-vigilance, and an intense focus on meals and food preparation. These behaviors can interfere with daily life, resulting in avoidance of social gatherings, dining out, and travel, potentially leading to social isolation.
This cross-sectional study explored the impact of food avoidance behaviors in adults with biopsy-confirmed celiac disease who follow a gluten-free diet. The analysis involved 50 participants who completed surveys evaluating various factors, including demographics such as age, gender, race, ethnicity, education, marital status, income, weight, height, and years since diagnosis. Quality of life (QoL), food avoidance patterns, and eating behaviors were also assessed. Disease symptoms were measured using the Celiac Disease Symptom Diary (CDSD), while adherence to the gluten-free diet was evaluated through the Celiac Dietary Adherence Test (CDAT). Mental health assessments included depression, measured by the Center for Epidemiology Studies Depressive Scale (CESD), and anxiety, evaluated with the State-Trait Anxiety Inventory (STAI).
Researchers evaluated food avoidance beyond the gluten-free diet by asking participants if they refrained from specific foods, the source of the advice to avoid those foods, and whether they had a formal allergy diagnosis for them.
The cohort demonstrated generally good quality of life (QoL) related to celiac disease, with an average score of 62.7. The mean state anxiety score was 37.4, which falls within the normal range, while the mean trait anxiety score reached 39.8, slightly exceeding the clinical threshold for anxiety. Additionally, one in four participants was identified as experiencing either state anxiety or anxious traits.
Clinical depression was prevalent in 77% of participants who avoided foods beyond gluten, as indicated by scores exceeding the CESD threshold of 15.
In contrast, individuals adhering strictly to a gluten-free diet without additional restrictions reported better quality of life and lower levels of depression. These findings suggest that self-imposed dietary limitations beyond gluten may amplify emotional and psychological difficulties in those with celiac disease.
“While adherence to a gluten-free diet is essential for managing celiac disease, it should be promoted with sensitivity to the individual’s emotional well-being,” the investigators emphasized. They noted that concerns about comorbidities, healing, persistent symptoms, or accidental gluten exposure might heighten anxiety around dining out, scrutinizing ingredients, or cross-contamination risks. This heightened focus can foster hyper vigilance, which has been linked to overly restrictive behaviors, potentially resulting in further dietary limitations and challenges.
