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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 05/13/2024 - A recent study from Ontario, Canada sheds light on a concerning association between immune-mediated gastrointestinal (GI) conditions such as celiac disease and inflammatory bowel disease (IBD) and the increased risk of developing eating disorders. While previous research hinted at this connection, this comprehensive study provides deeper insights into the matter. The study was conducted by Subramanian, Lakshmimathy MD; Coo, Helen MSc; Jane, Alanna MD; Flemming, Jennifer A. MD, MAS; Acker, Amy MD; Hoggan, Benjamin MSc; Griffiths, Rebecca BSc; Sehgal, Anupam MBBS, DNB; Mulder, and Daniel MD, PhD. They are variously affiliate with the Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada; the Gastrointestinal Diseases Research Unit, Faculty of Health Sciences, Queen’s University, Ontario, Canada; and the Institute of Clinical Evaluative Sciences (ICES), Ontario, Canada. Their study is a retrospective matched cohort analysis, which involved individuals under the age of 50 diagnosed with immune-mediated GI diseases between 2002 and 2020. Researchers meticulously matched cases with controls based on birth year, sex, and region of residence. Among the 83,920 cases examined, those with pre-existing eating disorders were excluded. Twofold Increased Risk Over the follow-up period until January 31, 2022, the study identified 161 cases of eating disorders among individuals with immune-mediated GI diseases, compared to 160 among controls. The incidence rate ratio for eating disorders in this population was 1.99, indicating a nearly twofold increased risk. Interestingly, the risk was particularly pronounced among pediatric cases, with children under 18 years old showing a significantly higher hazard ratio compared to adults. For instance, pediatric incident cases of ulcerative colitis exhibited the largest hazard ratio of 4.11. Celiac Disease and IBD Patients Should be Monitored for Eating Disorders These findings underscore the importance of early screening and detection, especially among pediatric patients with immune-mediated GI diseases. Healthcare professionals should be vigilant in monitoring patients with celiac disease and IBD for signs of eating disorders, as timely intervention can significantly impact outcomes. Further research is warranted to explore the underlying mechanisms driving this association and develop targeted interventions to mitigate the risk. Read more in Clinical and Translational Gastroenterology

Celiac.com 09/26/2022 - Celiac disease is on the rise, and so are the gastrointestinal and other symptoms that go with it. A number of researchers have documented connections between various psychiatric disorders and celiac disease. However, the relationship between celiac disease, and such psychiatric disorders is not well studied or documented. A team of researchers recently set out to provide a greater understanding of the existing evidence and theories surrounding psychiatric manifestations of celiac disease. The research team included Emma Clappison, Marios Hadjivassiliou, and Panagiotis Zis. They are variously affiliated with the Medical School of the University of Sheffield, Sheffield, and the Academic Department of Neurosciences, Sheffield Teaching Hospitals NHS Foundation Trust and University of Sheffield, Sheffield. Their systematic review and meta-analysis appears in a special issue on gluten-related disorders, titled, Time to Move from Gut to Brain. The team conducted a search of online medical literature search using PubMed, pulling data on rates of celiac disease and psychiatric disorders from eligible articles. They then conducted a meta analysis of odds ratios. For their review, the team found a total of 37 articles that met their eligibility parameters. Compared with healthy controls, the team found people with celiac disease to have a significantly higher risk for autistic spectrum disorder, attention deficit hyperactivity disorder, depression, anxiety, and eating disorders. They found no significant differences for bipolar disorder or schizophrenia. The study revealed that celiac disease is associated with a higher risk of depression, anxiety, eating disorders, along with ASD and ADHD. The team is calling for more research into the specific biological reasons underpinning this connection, along with the potential benefits of a gluten free diet in improving these conditions. Read more in Nutrients 2020, 12(1), 142

Celiac.com 11/15/2021 - For people with celiac disease, managing a strict gluten-free diet can be challenging, even in the best of circumstances. The process can be confusing, frustrating, embarrassing and depressing. For many, especially young people, trying to navigate and manage a gluten-free diet can lead to impaired psychosocial well-being, a diminished quality of life and disordered eating. We know, for example, that children and adolescents with celiac disease, and non-celiac gluten sensitivity, face extra challenges with academic or emotional well-being, and may be at higher risk for disordered eating. Adolescents can also suffer stress when trying to manage a gluten-free diet. A team of researchers recently set out to understand adolescents’ approaches to managing a gluten-free diet and the association with quality of life. Here's what they found. Using the Celiac Dietary Adherence Test and quality of life survey, researchers tested and surveyed a group of thirty adolescents with celiac disease, who ranged from 13–17 years old, and had been following a gluten-free diet for at least 1 year. To explore the teens' approaches to gluten-free diet management, the researchers used a semi-structured interview that focused on developing key themes using an iterative process, and classified their management strategies and quality of life using psychosocial rubric. They then compared Celiac Dietary Adherence Test ratings across groups. Using a four point scale, the team classified the gluten-free diet strategies that drive adaptive eating behaviors. They characterized behaviors by: greater flexibility (as opposed to rigidity); trust (as opposed to avoidance); confidence (as opposed to controlling behavior) and awareness (as opposed to preoccupation). More than half of those surveyed reported using maladaptive approaches to manage their gluten-free diet. Patients using maladaptive approaches to manage their gluten-free diets were more likely to be older, with lower celiac-specific Pediatric Quality of Life scores. Scoring differences between the groups ranged from 15.0 points for Isolation to 23.4 points for Limitations. Adolescents with celiac disease, who manage a gluten-free diet using maladaptive eating behaviors that are similar to feeding and eating disorders, report lower quality of life. Teens with lower QOL scores in areas like school or emotional function might require interventions, including a Section 504 plan or meeting with a psychologist or social worker. To reduce this risk, the team recommends that adolescents with celiac disease receive regular follow-up visits with gastroenterologists and dietitians, along with psychosocial support, as needed. Parents of adolescents with celiac disease should also talk with, and listen to their celiac teens about the dietary pressures and difficulties facing them on a daily basis. Making sure that adolescents with celiac disease learn to use healthy strategies to properly manage their gluten-free diet will help to ensure that future generations of celiac sufferers have a smoother path and a better quality of life. Remember, when our teens thrive, we all win! Read more in the Journal of Human Nutrition and Dietetics The research team included J. W. Cadenhead, R. L. Wolf, B. Lebwohl, A. R. Lee, P. Zybert, N. R. Reilly, J. Schebendach, R. Satherley, and P. H. R. Green. They are variously affiliated with the Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University in New York, NY; the Department of Medicine, Celiac Disease Center, Columbia University Medical Center, Harkness Pavilion, New York, NY, USA; the Department of Psychiatry, Columbia University Medical Center, New York, NY, USA; and the Faculty of Life Sciences and Medicine, School of Population Health & Environmental Sciences, King's College London in London, UK.

Celiac.com 05/16/2017 - A number of studies have indicated that kids with celiac disease face an increased risk for mood disorders, anxiety and behavioral disorders, ADHD, ASD, and intellectual disability. A new study by a team of researchers in Sweden puts it more precisely. They put the increased risk for psychiatric disorders in children with celiac disease at 1.4-fold over kids without celiac disease. The research team assessed the risk of any type of childhood psychiatric disorders, including psychosis, mood, anxiety, and eating disorders, psychoactive substance misuse, behavioral disorder, ADHD, ASD, and intellectual disability, in children aged 18 and younger, along with their siblings. The researchers included Agnieszka Butwicka, MD, PhD, of the department of medical epidemiology and biostatistics, Karolinska Institute, Stockholm, Sweden, and colleagues. For each of the 10,903 children with celiac disease, the research team randomly selected 100 non-celiacs from the general population. These control subjects were then matched by gender and year and country of birth. For each of the 12,710 siblings of celiac disease subjects, the research team randomly assigned 100 healthy control siblings from the general population. These were also matched by gender, year and country of birth of both siblings. Both sets of siblings were required to be free of celiac disease to age 19. The researchers reviewed histological data on patients who showed villous atrophy in small intestine biopsy specimens between 1969 and 2008, and equated villous atrophy with celiac disease. In the main cohort study, the researchers estimated the risk for any psychiatric disease, as well as specific psychiatric disorders (ie, mood, anxiety, eating, and behavioral disorders, as well as neuropsychiatric disorders such as attention deficit hyperactivity disorder (ADHD), autistic spectrum disorders (ASD), and intellectual disability) in children with celiac disease, compared with general population controls. They used sibling analyses to assess whether underlying familiar factors could account for the associations. As a comparing factor, they compared the risk for psychiatric disorders in the siblings against the risk in siblings of the general population. The team conducted both univariate and multivariate analyses, adjusting for maternal/paternal age at the child's birth, maternal/paternal country of birth, level of education of highest-educated parent, and the child's gestational age, birthweight, Apgar score, and history of psychiatric disorders prior to recruitment. During follow-up, 7.7% of children were diagnosed with a psychiatric disorder. A positive association was found in the first univariate analysis between celiac disease and any psychiatric disorder, which remained even after the researchers adjusted for maternal/paternal age at childbirth and country of birth, parental education level, and child's gestational age, birthweight, Apgar score, and previous history of psychiatric disorders. The overall prevalence of psychiatric disease in the entire sample celiac disease patients was about 7%. That number remained steady in the 10 years after biopsy. However, once the researchers analyzed the findings by cohort, they found that rates of psychiatric disorders had actually increased 8-fold over that 10-year period. The siblings of celiac disease patients showed no increased risk for any psychiatric disorder. The study showed that psychiatric disorders "may precede a diagnosis of celiac disease in children." The research team called this finding "important." They write that their study also offers "insight into psychiatric comorbidities in childhood celiac disease over time." The study showed that children with celiac disease definitely faced an elevated risk for specific psychiatric disorders, including mood disorders, anxiety disorders, eating disorders, behavioral disorders, ADHD, ASD, and intellectual disability. Although the study showed that patients with celiac disease are more likely to have prior psychiatric disorders, the team notes that they have yet to determine "the mechanisms underlying the association between celiac disease and psychiatric orders." The fact that the siblings of celiac disease patients showed no increased risk of psychiatric disorders indicates that these may be an "effect of celiac disease per se rather than common genetic or within-family environmental factors," the researchers add. The researchers conclude that their study "underscores the importance of both mental health surveillance in children with celiac disease and a medical workup in children with psychiatric symptoms." This study offers yet another piece in the complex puzzle that is celiac disease. It emphasizes the need for doctors and parents to remain on the lookout for potential psychiatric issues when dealing with children who have celiac disease. Source: Psychiatry Advisor

Celiac.com 08/25/2020 - A number of studies describe psychological disorders, in addition to other extra intestinal manifestations of celiac disease, such as fatigue, neurological conditions including headache and neuropathy. However, there hasn't been study with robust enough data to provide accurate risk estimates. In an effort to obtain accurate risk estimates, Jonas F. Ludvigsson, MD, PhD, of the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden, and colleagues analyzed data from the Swedish nationwide ESPRESSO cohort to explore associations between childhood celiac disease and psychiatric disorders. They matched nearly 20,000 children with biopsy verified celiac with up to five of 100,000 reference children, and gathered data on psychiatric disorders from the patient register. During a follow-up period of just over 12 years, nearly 17% of 3,174 children with celiac disease were diagnosed with a psychiatric disorder, compared with about 14% of the 13,286 control subjects. People with childhood celiac disease had a nearly 20% increase in risk for any psychiatric disorder, an increase seen in every childhood age group. Specifically, celiac patients faced elevated risks for mood disorders, anxiety disorders, eating disorders, attention deficit hyperactivity disorder, autism spectrum disorder, and increased use of psychiatric drugs. The risk was highest in the first year after celiac diagnosis, but continued into adulthood. The results of this study underline the importance of mental health monitoring in people diagnosed with celiac disease as children. Because of the elevated risk of psychiatric disorder, the team advises that people diagnosed with celiac disease in childhood receive both physical and mental monitoring into adulthood. Stay tuned for more on this and related stories. Read more at Healio.com.