Dec 28 2011 --- Women with celiac disease -- an autoimmune disorder associated with a negative reaction to eating gluten -- are more likely than the general population to report symptoms of depression and disordered eating, even when they adhere to a gluten-free diet, according to researchers at Penn State, Syracuse University and Drexel University.

People with celiac disease often suffer from abdominal pain, constipation, decreased appetite, diarrhea, nausea and vomiting. The disease affects somewhere between one in 105 to one in 1,750 people in the United States and is typically controlled by avoiding gluten-containing foods 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, professor of biobehavioral health and medicine, 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 used a web-mediated survey to assess a range of physical, behavioral and emotional experiences in 177 American women over the age of 18 who reported a physician-provided diagnosis of celiac disease. The survey questions explored respondents' levels of adherence to a gluten-free diet and assessed various symptoms of celiac disease, how physical symptoms interfere with functioning, the respondents' experience and management of stressful situations, symptoms of clinical depression, and frequency of thoughts and behaviors associated with eating and body image.

The results are posted online and will appear in a future issue of Chronic Illness.

"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."

Smyth noted that he and his colleagues did not survey people without celiac disease; rather, they compared their results to those previously determined for the non-celiac population.

It is understandable to find that women with celiac disease tend to suffer from disordered eating, given that the focus of celiac-disease management is to pay careful attention to what and how one eats, said Smyth.

"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. In the future, we plan to investigate the temporal sequence of these symptoms."

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."