From Gluten-Intolerance To Disordered Eating: Celiac Sufferers At Risk

Does gluten intolerance lead to depression and disordered eating? That’s what researchers from Penn State are saying, after finding that women with celiac disease were at a higher risk for both depression and eating issues—regardless of whether they were on a gluten-free diet.

Celiac disease—a condition in which eating gluten triggers damage to the small intestine lining that prevents the body from properly absorbing nutrients—has previously been linked to depression. And it’s not just because the intestinal damage causes awful symptoms, like cramping, gas, vomiting and diarrhea; or because avoiding all wheat, barley and rye—all of which contain gluten—really sucks. No, the small intestine’s failure to absorb essential nutrients—like zinc, tryptophan and B vitamins—can actually trigger depression by halting production of neurochemicals like serotonin (food and mood are so linked!). A 1998 study found about one-third of those with celiac disease were also clinically depressed.

But if we accept all of that, than eating a gluten-free diet should eventually end a celiac patient’s depressive symptoms. Which—according to this new Penn State study—isn’t the case. The researchers looked at 177 women with celiac disease, most of whom did adhere to a gluten-free diet. Avoiding gluten was “related to increased vitality, lower stress, decreased depressive symptoms and greater overall emotional health,” said study co-author Josh 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.”

Now perhaps the increased depression rates can still be attributed to nutrient deficiencies—even after going on a gluten-free diet, it can take someone with celiac disease as long as two or three years to fully catch up, and the study doesn’t say how long participants had been eating gluten-free.

But how to explain the body-image and disordered eating issues? The researchers aren’t sure. Does the obsessive focus that avoiding all gluten requires trigger an unhealthy relationship to food? Are eating issues triggered by depression? Or can the higher depression rates—even in those on a gluten-free diet—be explained as a consequence of disordered eating?

“What we don’t know is what leads to what and under what circumstances,” Smyth said in a Penn State press release. “It’s likely that the disease, stress, weight, shape and eating issues, and depression are interconnected. But we don’t know if women with both higher stress and 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.”

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    • Darren

      It took a long time for me to accept my gluten intolerance, but now I eat a much more healthy diet than before! As for ‘body image’ issues, this is particularly odd as cutting all pizza, pasta and so on out of my diet has definitely helped reduce the amount of fat my body is storing. No complaints from me!

    • Suzanne

      Stress can also a trigger for developing celiac disease. Did the study take into account whether the women were depressed or had eating disorders BEFORE being diagnosed with celiac? Depression and eating disorders place a tremendous amount of stress on the body, so it stands to reason that those could be possible causes to develop celiac, as opposed to symptoms of the disease.

      • Elizabeth Nolan Brown

        That’s a really good point.

    • shauna

      I wonder what questions were used for determining the issues these women had/didn’t have. I know the celiacs’ answered were compared to members of the non-celiac population, but I wonder exactly how psychologists measured a participants needs vs. their thought processes.

      For example, answers about how frequently you think about what you’re eating, how frequently you weigh yourself, how frequently you think about the nutrition in your food – these are not uncommon questions that are used to determine if someone has eating disorders. Too much focus is supposed to indicate disordered eating.

      If the answer is coming from a healthy adult who is not trying to lose or gain weight, knows how to cook, and has common foods they prepare regularly, then too much focus on eating might indicate a disorder, sure.

      If the answer is coming from a vitamin deficient woman who is underweight or overweight (as so many celiacs are), who has been told by their doctor that they need to change their weight, who has to learn about new foods and completely new ways to cook them and try to make sure they have the vitamins they are low in? Then the exact same answers about how much focus food has in their lives is not indicative of a disorder, it’s indicative of a being behind the learning curve and trying to maintain health.

      I think it has to be difficult to adjust the results to account for this type of thing. For example, were participants asked how long they’d been gluten free, because the longer they’ve been on the diet, the more familiar they should be with the cooking and ingredients. Were they asked if they have any health issues with their weight, if they require any weight changes?

      It’ll be interesting to see how it turns out when more details are available.

    • darma

      After reading an entry on Nora Gedgaudas’ site Primal Mind/Primal Body ( I think, may be the other way around), I have been reading about pyroluria, which is caused by deficiencies in zinc and Vitamin B6 – and absorption of both of these, as mentioned above, can be hampered by gluten intolerance.. People with pyroluria can suffer from depression and feel ‘different’ than the general population. Maybe a clue here?

    • Rebecca

      Just a few thoughts.
      I’ve struggled with an eating disorder for several years. As far back as I can remember I’ve been battling constant stomach-aches, indigestion, symptoms of IBS, etc. In my teenage years a plethora of other issues surfaced…anxiety, ADD, depression, etc.

      A few years ago a doctor suggested I may have a gluten intolerance but at the time I didn’t really fully consider it. Now that I’ve been in treatment for about 9 months, my therapist and I started discussing the possibility of a gluten intolerance after I had explained to her how terribly I’ve always felt after eating, and how I feel that the upset stomachs, etc. contribute to a poor body image. I don’t know yet whether or not I have a gluten intolerance, I am just starting a gluten-free diet to see if it makes a difference. However, I suspect that if a gluten intolerance feels anything like what I’ve always gone through with my digestive issues and such, there is probably definitely a correlation between it and eating disorders. I can say from my own experience and through having learned about my own personal body image and what I feel causes it to suffer, a lot of it is simply physical feelings.

      Just some thoughts.