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Celiac.com 07/25/2024 - Patients with celiac disease must follow a strict gluten-free diet to manage their condition. However, this dietary restriction can introduce psychological challenges, including eating disorders and body image issues. This study aims to assess the prevalence of these psychological problems and their association with adherence to a gluten-free diet in individuals with celiac disease. Study Design and Population This cross-sectional study involved 217 patients with celiac disease aged between 18 and 55 years. Participants were randomly selected from the East-Azerbaijan celiac disease registry. The study excluded pregnant or lactating women and those with untreated comorbidities like diabetes and thyroid disorders. Participants were assessed using the 26-item Eating Attitude Test (EAT-26) for eating disorders, the Stunkard Figure Rating Scale (FRS) for body image issues, and the Celiac Dietary Adherence Test (CDAT) for adherence to a gluten-free diet. Prevalence of Eating Disorders and Body Image Issues The study found that 43.5% of participants had eating disorders, while 65.9% experienced body dissatisfaction, and 41.1% had body image distortion. These figures highlight a significant psychological burden among celiac disease patients, suggesting that managing celiac disease involves more than just dietary adherence. Association Between Gluten-Free Diet and Psychological Issues The analysis revealed a significant negative association between adherence to a gluten-free diet and the presence of eating disorders. Patients who strictly followed the diet were less likely to have eating disorders. However, the study did not find a significant relationship between diet adherence and body image dissatisfaction or distortion. This suggests that while a gluten-free diet may help reduce eating disorders, it does not necessarily improve body image issues in celiac disease patients. Psychological Barriers to Diet Adherence The study underscores the importance of considering psychological barriers when advising celiac disease patients on diet adherence. Patients with eating disorders might struggle more with maintaining a strict gluten-free diet, which can, in turn, exacerbate their psychological issues. This creates a cycle where psychological distress and dietary non-compliance feed into each other. Implications for Treatment Given the high prevalence of eating disorders and body image issues among celiac disease patients, healthcare providers should incorporate psychological support into their treatment plans. Nutritionists and dietitians should be aware of these potential barriers and work closely with patients to address their psychological needs. This could involve referrals to mental health professionals or incorporating strategies to improve body image and eating behaviors into dietary counseling. Conclusion This study highlights the significant psychological challenges faced by celiac disease patients, particularly concerning eating disorders and body image dissatisfaction. While adherence to a gluten-free diet can help mitigate eating disorders, it does not necessarily address body image issues. Therefore, a comprehensive approach that includes psychological support is crucial for effectively managing celiac disease. For patients, understanding these potential challenges can encourage them to seek holistic care that addresses both their physical and psychological needs, ultimately improving their quality of life. Read more at: biomedcentral.com

Celiac.com 02/08/2024 - Living with celiac disease often means navigating a complex landscape of symptoms, dietary restrictions, and the quest for an optimal quality of life. Understanding Patterns Behind Persistent Celiac Symptoms Celiac disease is not a one-size-fits-all condition. A subgroup of adults experiences persistent symptoms, both gastrointestinal and extraintestinal, the origins of which are often elusive. A team of researchers recently conducted an observational study to uncover patterns within this diverse symptom landscape and explore their connections to gluten-free diet adherence, mental health, and quality of life. The research team included Cara Dochat, Niloofar Afari, Rose-Marie Satherley, Shayna Coburn & Julia F. McBeth. They are variously affiliated with San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA; the VA San Diego Healthcare System, San Diego, CA, USA; the University of California San Diego, La Jolla, CA, USA; the Department of Psychological Interventions, University of Surrey, Guildford, UK; the Children’s National Health System, Washington, DC, USA; the George Washington University School of Medicine & Health Sciences, Washington, DC, USA; and the Celiac Disease Foundation, Woodland Hills, CA, USA. The Study in Focus Their study included 523 U.S. adults with self-reported, biopsy-confirmed celiac disease. Participants voluntarily completed a set of questionnaires addressing various aspects of their condition: Celiac Symptoms Index (CSI): Capturing physical symptoms and subjective health. Celiac Dietary Adherence Test: Assessing adherence to a gluten-free diet. PROMIS-29, SF-36, and Celiac Disease Quality of Life Survey: Exploring psychiatric symptoms and quality of life. Latent profile analysis identified four distinct symptom profiles: Little to No Symptoms (37%): Individuals in this profile reported excellent subjective health and minimal symptoms. Infrequent Symptoms (33%): Experience relatively moderate symptoms with a focus on extraintestinal symptoms. Occasional Symptoms (24%): Moderate symptoms, particularly gastrointestinal, physical pain, and fair to poor subjective health. Frequent to Constant Symptoms (6%): Enduring significant symptoms and fair to poor subjective health. Beyond Symptoms: The Mental Health and Quality of Life Equation Interestingly, profiles did not significantly differ in terms of clinical characteristics, gluten-free diet adherence, or overall quality of life. However, distinctions emerged in mental health dimensions. Profiles 2 and 3 reported moderate symptomology, with Profile 2 leaning toward more extraintestinal symptoms and Profile 3 showing a dominance of gastrointestinal symptoms, physical pain, and lower subjective health. Profile 3, despite its moderate symptom burden, surprisingly reported the lowest psychiatric symptoms and the highest quality of life on standardized measures. Implications and Future Directions The study’s findings underscore the complexity of celiac disease, emphasizing that a one-size-fits-all approach may not be effective. Notably, even lower symptom burden did not always correlate with better mental health and quality of life, suggesting a need for nuanced behavioral interventions. The lack of profile differences in gluten-free diet adherence implies the necessity for additional dietary or medical assessments and interventions. As we navigate the intricate terrain of celiac disease, personalized and comprehensive care emerges as a key consideration, addressing not only symptoms but also the broader aspects of mental health and overall well-being. Read more in BMC Gastroenterology volume 24, Article number: 9 (2024)

Celiac.com 03/15/2023 - A recent study by Indiana University School of Medicine's Jonathan Montrose, DO, found that only one out of 36 patients with both celiac disease and inflammatory bowel disease (IBD) adhered to a gluten-free diet long-term. That's less than 3% of those patients following a gluten-free diet. According to Montrose, the lack of formal education on gluten-free diets is a factor, as only six of the 36 patients had received dietary education from a celiac dietitian. The majority of patients in the study were white women, and 50% of patients required escalation of IBD medication despite adhering to a gluten-free diet. "Overall, our study showed that there was suboptimal adherence to gluten-free diets." Montrose and his colleagues suggested that the establishment of celiac disease centers at tertiary hospitals could be one way to address the lack of formal gluten-free diet education. Montrose and colleagues suggest establishing celiac disease centers at tertiary hospitals to provide adequate clinical guidance. Perseus Patel, MD, of the University of California San Francisco, agreed that getting adults to stick to a gluten-free diet is challenging and that more education is needed in this area. He noted that "If you go out to eat, you often don't have many choices, so it is not always the easiest thing to do." The fact that only 3% of patients in the study followed a gluten-free diet long-term is concerning because it suggests that many patients with celiac disease and IBD may not be getting the optimal treatment they need. Furthermore, the study found that 50% of patients required escalation of IBD medication despite adhering to a gluten-free diet, indicating that there may be other factors contributing to the management of these conditions. The recommendation to establish celiac disease centers at tertiary hospitals is a practical solution that could improve patient outcomes by providing adequate clinical guidance and support. In conclusion, this study highlights the challenges of managing celiac disease and IBD, particularly in terms of adherence to a gluten-free diet. Healthcare professionals need to be more proactive in educating patients about the importance of a gluten-free diet. There's also a need for more resources and support for patients with these conditions. The establishment of celiac disease centers could be an effective way to address this issue and improve patient outcomes. Read more at: Metpagetoday.com

Celiac.com 07/22/2020 - Currently, the only effective treatment for celiac disease is a permanent gluten-free diet. Many commercial gluten-free foods are low in fiber, and high in fat, salt, sugar. Many health professionals question the nutritional adequacy of a gluten-free diet. To date, there has been no large case-control study regarding the nutritional adequacy of the gluten-free diet on children with celiac disease. To try to better understand the nutritional value of a gluten-free diet, a team of researcher set out to assess nutritional status, dietary intake, and adherence to a gluten-free diet in children with celiac disease. The research team included Elena Lionetti, Niki Antonucci, Michele Marinelli, Beatrice Bartolomei, Elisa Franceschini, Simona Gatti, Giulia Naspi Catassi, Anil K. Verma, Chiara Monachesi, and Carlo Catassi. They are variously affiliated with the Department of Pediatrics at Marche Polytechnic University in Ancona, Italy; and the Division of Pediatric Gastroenterology and Nutrition and Center for Celiac Research at Mass General Hospital for Children in Boston, MA, USA. The study included children diagnosed with celiac disease following a gluten-free diet for two or more years. The team matched control subjects for age and gender against healthy, non-celiac children, and enrolled 120 children with celiac disease, and 100 healthy non-celiac children. For each subject, the team recorded physical measurements and energy usage. Dietary assessment was performed by a 3-day food diary. The team used the KIDMED index to assess adherence to the Mediterranean diet. They found no differences between celiac children and control subjects in either physical measurements or energy expenditure. Overall, kids with celiac disease ate much more fat and much less fiber than the control group. Children with celiac disease showed a median KIDMED index of 6.5, while healthy non-celiac control kids showed a median of 6.8. The results of this study show that, compared with healthy control subjects, kids with celiac disease are eating a diet that is nutritionally less balanced, higher in fat, and lower in fiber. Because of this, children with celiac disease may benefit from dietary counseling to help steer them toward a more nutritious gluten-free diet. However, it's fair to say that both groups in this study were far from a Mediterranean diet, and both could stand to see some improvement. That said, kids with celiac disease have even further to go to achieve a more nutritious diet. Here are some tips on how to get more nutrition in your gluten-free diet. How to Get Better Nutrition on a Gluten-Free Diet Eat more natural, whole foods The list of natural, whole gluten-free foods is too long to delineate here, but it includes all fresh fruits and vegetables, along with numerous nutritious foods like peas, beans and oats. Eat more high fiber foods There are plenty of high fiber foods that are naturally gluten free, including beans, peas, and more. Here's list a of thirty great gluten-free high fiber foods. Read product labels Many commercial gluten-free foods are low in fiber, and high in fat, sugar and salt. Read more at Nutrients. 2020 Jan; 12(1): 143

Celiac.com 08/08/2019 - A strict gluten-free diet is the only currently accepted treatment for celiac disease. Current treatment guidelines for celiac disease recommend regular dietary interviews and blood tests to gauge dietary adherence. However, those guidelines might not be doing the job. A team of researchers recently set out to see if fecal gluten immunogenic peptides might help support the diagnosis, and determine the adherence to the gluten-free diet in celiac children. The research team included Isabel Comino, Verónica Segura, Luis Ortigosa, Beatríz Espín, Gemma Castillejo, José Antonio Garrote, Carlos Sierra, Antonio Millán, Carmen Ribes-Koninckx, Enriqueta Román, Alfonso Rodriguez-Herrera, Jacobo Díaz, Jocelyn Anne Silvester, Ángel Cebolla, and Carolina Sousa. They are variously affiliated with research institutions in Spain, Canada and the USA. The team's multi-center prospective longitudinal study included 64 children with celiac disease. For each child, the team assessed fecal gluten peptides, and tissue transglutaminase and deamidated gliadin peptide antibodies at diagnosis, and 6, 12 and 24 months afterward. The researchers used gluten peptide levels to estimate patient gluten consumption. A total of 97% of children showed detectable gluten peptides upon diagnosis. For patients on a gluten-free diet, the rate of gluten peptides rose from 13% at 6 months to 25% at 24 months. Average estimated gluten exposure fell from 5543 mg/d at diagnosis to 144 mg/d at 6 months, then rose to about 600 mg/d after two years. In contrast, antibodies to deamidated gliadin peptide normalized and only 20% of patients showed elevated tissue transglutaminase antibody after 24 months. Patients with detectable gluten peptides had longer periods of tissue elevated transglutaminase antibody. Overall, absolute levels of tissue transglutaminase antibody showed low sensitivity for identifying patients with detectable gluten peptides. Evaluation by a dietitian only moderately improved gluten peptide detection. At some point, testing for fecal gluten peptides could help to guide celiac treatment prior to diagnosis and to test adherence to a gluten-free diet. Further studies are needed to determine if spotting gluten exposure early can reduce the need for expensive/invasive investigations for non-responsive celiac disease. Read more in Alimentary Pharmacology & Therapeutics

Celiac.com 08/20/2018 - Following a gluten-free diet is critical for people with celiac disease. However, the factors that influence gluten-free diet success for people with celiac disease are not well understood on a population-wide scale. A team of researchers recently set out to assess the factors that influence gluten‐free diet adherence in patients with celiac disease. The research team included E. P. Halmos, M. Deng, S. R. Knowles, K. Sainsbury, B. Mullan, and J. A. Tye‐Din. The team asked celiac patients to complete an online survey that included the validated Celiac Dietary Adherence Test, along with questions on demographics, details of diagnosis and management and assessment of diet knowledge, quality of life and psychological distress. The team then reviewed the survey data for predictors of adherence and quality of life. There were a total of 7,393 survey responses, with 5,310 people completing the Celiac Dietary Adherence Test, and 3,230 of whom were following a gluten‐free diet. Multivariate regression showed that predictors of gluten-free dietary adherence included older age, being male, symptoms severity after gluten consumption, above average gluten-free food knowledge, and lower risk of psychological distress. People with celiac disease who followed a gluten-free diet also reported better quality of life. Respondents who reported having poor food knowledge were more likely to wrongly identify gluten‐free foods, though they could still recognize gluten‐containing foods. This indicates that poor overall food knowledge may lead people with celiac disease to over‐restrict their diet. Poor understanding of gluten‐free diet and stressful psychological well-being were the main modifiable risk factors for failure to follow a gluten‐free diet in patients with celiac disease. From these responses, the team concluded that access to a dietitian and mental health care professional, in cases of psychological stress, is likely necessary to improve gluten-free dietary observation, and thus to improve overall patient health and well-being. Read more at: Alimentary Pharmacology & Therapeuticsdoi.org/10.1111/apt.14791 The researchers in this study are variously affiliated with the Department of Gastroenterology, The Royal Melbourne Hospital in Parkville, Victoria, Australia, the Department of Gastroenterology, Central Clinical School, Monash University in Melbourne, Victoria, Australia, the Cartovera Pty. Ltd. in Adelaide, SA, Australia, the Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology in Hawthorn, Victoria, Australia, the Department of Mental Health, St Vincent's Hospital in Fitzroy, Victoria, Australia, the Department of Psychiatry, University of Melbourne in Parkville, Victoria, Australia, Institute of Health and Society, Faculty of Medical Sciences, Newcastle University in Newcastle Upon Tyne, UK, the Health Psychology & Behavioural Medicine Research Group, School of Psychology, Curtin University in Bentley, WA, Australia, the Immunology Division, The Walter and Eliza Hall Institute of Medical Research in Parkville, Victoria, Australia, and the Department of Medical Biology, University of Melbourne in Parkville, Victoria, Australia.

Celiac.com 03/03/2017 - Previous studies have shown us that men are generally less troubled living with celiac disease than are women, but most studies of men with celiac disease have been mostly quantitative, and have a bio-medical emphasis. A team of researchers recently set out to explore the social experience of young men with screening-detected celiac disease and to highlight daily life situations five years after diagnosis. The research team included Ethel Kautto, Cecilia Olsson, Anneli Ivarsson, Phil Lyon, Agneta Hörnell, and Lena Alex. They are variously affiliated with the Department of Food and Nutrition and Umeå Center for Gender Studies, Umeå University, Sweden, the Department of Food and Nutrition, Umeå University, Sweden, the Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Sweden, the School of Arts, Social Sciences and Management at Queen Margaret University, UK, and the Department of Nursing at Umeå University in Sweden. Using a large Swedish school-based celiac screening-study, the team arranged to interview seven young men, all of whom were diagnosed with celiac disease at 13 years-old. The semi-structured interviews were analyzed from a gender perspective which resulted in three themes. Those themes were of young adult men being subjected to changes, striving for normality and emphasizing commitment. Many of young men reported dissociating themselves from being seen as a person with a life-long chronic disease. The analysis also showed that the young men’s daily experiences of living with celiac disease largely depended on their use of characteristics known to be associated with masculinity: such as being self-assured, demanding, and behaving authoritatively. In food situations, where the young men had the ability to make use of such characteristics in their informal group, they experienced fewer negative aspects of the disease. If the young men did not hold a strong position in their informal group, their situation was insecure and vulnerable and this could lead to avoidance of contacts and social meal situations. So, basically, being relaxed and socially confident about eating gluten-free helps to ensure success with the diet. Source: International Journal of Celiac Disease Vol. 4, No. 4, 2016, pp 138-145. doi: 10.12691/ijcd-4-4-7

Celiac.com 06/15/2011 - A duodenal biopsy during endoscopy is the gold standard for diagnosing celiac disease. Because the histopathological features suggesting celiac disease , specifically villous atrophy, can vary in severity throughout the length of the small intestines, the American Gastroenterological Association Institute recommended in 2006 that at least 4 specimens be taken for examination. Yet the degree of adherence to this recommendation has not been assessed, and neither has its impact on diagnoses. A recent study by Benjamin Lebwohl at the Columbia University Celiac Disease Center concludes that most physicians are not following the guidelines, but they should be; doing so doubles the diagnosis of celiac disease. Dr. Lebwohl and colleagues collated the specimens sent to Caris Life Sciences, a specialized GI pathology laboratory that receives samples from endoscopy centers in forty-three states plus the District of Columbia and Puerto Rico. They looked at 132, 352 patients who had endoscopies for various indications between January 1, 2006 and December 31, 2009. From these endoscopies, only 35% followed the recommendation of submitting at least four specimens. There was a slight increase once the guidelines were proposed, in 2006; but by the end of 2009 adherence to the guidelines was still a low 37%. Interestingly, the number of specimens submitted could be directly correlated with the probability of a positive diagnosis of celiac disease. Adherence varied by indication, with the highest rates (43.9%) among patients undergoing endoscopies for diarrhea and the lowest rates (30.0%) among those having endoscopies because of heartburn. Among patients having endoscopies for malabsorption or suspected celiac disease adherence was only 38.5%. Adherence to the guidelines also decreased with the age of the patient. The researchers did not have access to socioeconomic or racial data regarding the patients, so could not determine if that factored into adhering to the guidelines. The proportion of patients diagnosed with celiac doubled when at least four biopsy specimens were submitted. This increase varied by indication; it was most apparent in those undergoing endoscopy because of malabsorption and suspected celiac disease, but was present for the other indications as well. This study validates those recommendations; hopefully the slight increase in adherence since they have been proposed will continue to grow. Source: Lebwohl B, Kapel RC, Neugut AI, Green PHR, and Genta RM. Adherence to biopsy guidelines increases celiac disease diagnosis. Gastrointest Endosc. 2011 May 19.

Celiac.com 05/08/2013 - A team of researchers recently set out to test determine if an interactive online intervention might help to improve gluten free diet adherence in adults with celiac disease. The research team included Kirby Sainsbury BA/BEd, DCP (candidate), Barbara Mullan PhD and Louise Sharpe PhD. They are affiliated with the School of Psychology, and the Clinical Psychology Unit at the University of Sydney in Sydney, New South Wales, Australia For their controlled trial, the researchers recruited 189 adults with biopsy-confirmed celiac disease. They randomly assigned 101 adults to receive the intervention, and 88 adults to a wait-list control condition. They retrieved post-intervention data for 70 intervention subjects and 64 wait-list participants, along with three month follow-up data for 46 of 50 who completed the intervention period. The team first measured overall gluten-free diet adherence, then measured gluten-free diet knowledge, quality of life and psychological symptoms. The researchers based their results on intention-to-treat analysis, which bases their calculations on initial treatment assignment and not on the treatment eventually received. ITT analysis helps avoid various misleading factors that can color intervention research, such as non-random attrition of participants from the study or crossover. Overall, the intervention group showed strong improvement in gluten-free diet adherence, and gluten-free diet knowledge following the treatment period compared to the wait-list control group. However, changes in knowledge had no effect on adherence. These improvements continued through the 3-month’ follow-up period. The results show that the online intervention program helped improve adherence to a gluten-free diet for people with celiac disease. Such a program can be developed into a valuable resource for celiacs who are struggling with gluten-free diet adherence. Source: Am J Gastroenterol advance online publication 5 March 2013;