Other special diets in addition to gluten-free diet are common among youth with celiac disease, but are not associated with overall well-being or treatment success

Abstract

Background: Various special diets have become increasingly common. However, their prevalence and significance in patients with celiac disease (CeD) who already adhere to a gluten-free diet (GFD) are unclear. Aim: We studied the abovementioned aspects in youth with CeD and controls. Methods: 210 patients and 212 controls, all adolescents and young adults with comparable age 16–30 years, completed an anonymous survey. Variables were compared between CeD patients with and without additional dietary restriction. Results: Overall, 53% of CeD patients and 81% of controls were students and 41% vs. 18% working. One-third of patients and controls reported adhering to special diets, particularly a vegetarian/vegan diet (9%/14%), an allergy diet (8%/7%), and a diet for irritable bowel syndrome (7%/8%). Patients with and without an additional diet besides a GFD were comparable in terms of sex, current age, age at diagnosis, body mass index, student/employment status, physical activity, and consumption of alcohol and tobacco. However, those following only a GFD reported fewer gastrointestinal symptoms at diagnosis (58% vs. 75%, p = 0.021) and fewer challenges with school and workplace meals (27% vs. 39%, p = 0.020) than those with another restrictive diet. Altogether 11% reported difficulties combining GFD and other diet, but there were no differences in adherence (91% vs. 93%, p = 0.705), persistent symptoms, health concerns, or well-being. Conclusion: One-third of CeD patients followed additional special diets, similar to the controls. While additional restrictions may not necessarily compromise well-being or treatment success, including GFD adherence and symptom resolution, they posed challenges that underline the need to consider them in CeD management.