Those with celiac disease, an autoimmune reaction to eating gluten, often suffer from abdominal pain, constipation, decreased appetite, diarrhea, nausea and vomiting. The disease is typically controlled by avoiding foods with gluten, such as wheat, barley and rye.
“It is easy to see how people who are not managing their disease well can frequently feel unwell and, therefore, be more stressed and have higher rates of depression,” said Josh Smyth, Ph.D., professor of biobehavioral health and medicine at Penn State.
“But researchers had not carefully looked at whether people who are effectively managing celiac disease exhibit a greater risk for such difficulties.”
Smyth and his colleagues, including researchers from Syracuse University and Drexel University, surveyed 177 American women who reported a physician-provided diagnosis of celiac disease.
The web-based survey explored levels of adherence to a gluten-free diet and assessed various symptoms of the disease, how physical symptoms interfere with daily functioning, the management of stressful situations, symptoms of clinical depression, and frequency of thoughts and behaviors associated with eating and body image.
“We found that most participants frequently adhered to a gluten-free diet, and this greater compliance with diet was related to increased vitality, lower stress, decreased depressive symptoms and greater overall emotional health,” said Smyth.
“However, even those people who were managing their illness very well reported higher rates of stress, depression and a range of issues clustered around body image, weight and shape, when compared to the general population.”
It is understandable that women with celiac disease tend to suffer from eating disorders, as managing the disease requires them to pay careful attention to what and how they eat, he noted.
“What we don’t know is what leads to what and under what circumstances,” he said.
“It’s likely that the disease, stress, weight, shape and eating issues and depression are interconnected. But we don’t know if women who are higher stressed and have celiac disease are more likely to develop symptoms of disordered eating and then become depressed, or if women with celiac disease are depressed and then become stressed, which leads to disordered eating.”
The team’s results may have implications for people with food allergies and Crohn’s disease, a form of inflammatory bowel disease, as well as celiac disease, according to Smyth.
“Going out to eat with friends or to a holiday potluck is a much different experience for these people because they have to be vigilant and monitor their diets,” he said. “They may feel that they are a burden on a host or hostess. In many cases the only treatment option they are given is to manage their diets. I think we need to educate patients at diagnosis or post-diagnosis about some of the other associated difficulties they might experience and provide strategies for how to better manage those things. I am a proponent of elaborating our treatment models to not just address diseases, but also to address the psychological, social and behavioral aspects of disease as well, as they can influence disease outcomes and the well being of patients.”
The results of the study are posted online and will appear in a future issue of Chronic Illness.
Source: Penn State