Teaching Celiacs that they CAN Manage the Gluten-Free Diet is the Key to their Recovery

Patients with a gluten-associated disorder who perceived themselves to be competent in complying with a gluten-free diet attained better adherence, which resulted in reduced disease activity and improved mental health outcomes.

Kate Burba, healio.com/news/gastroenterology ¹

“The gluten-free diet is the mainstay of treatment for gluten-associated disorders. The success of this relies on patient adherence, and non-adherence has been associated with several factors and can be problematic,” Anna H. Lee, MD, a third-year medical resident at the University of California Los Angeles, told attendees at the ACG Annual Scientific Meeting.

“Given that it has been associated with worse outcomes such as greater disease activity and worse quality of life, in our study we looked at a conceptual model of human motivation called the ‘self-determination theory.’ ”

“Self-determination theory suggests that all humans have three basic psychological —autonomy, competence, and relatedness—that underlie growth and development. ²

Autonomy refers to feeling one has choice and is willingly endorsing one’s behavior.

Competence refers to the experience of mastery and being effective in one’s activity.

Relatedness refers to the need to feel connected and a sense of belongingness with others.

In a prospective, longitudinal study, Lee and colleagues used the “self-determination theory” to explore mental health status and factors associated with adhering to a gluten-free diet among 449 patients (mean age 48 years, 87.9% women) with self-reported gluten-associated disorders from the UCLA Celiac Collective. Lee noted 123 patients completed follow-up surveys.

Patients completed surveys at baseline (2016-2020) and follow-up (2022) which detailed demographics and medical history as well as psychosocial domains and mental health. Specific questionnaires included the

Celiac Dietary Adherence Test
Celiac Symptom Index
PRO Measurement Information System’s depression, anxiety, sleep disturbance, fatigue, pain and social satisfaction
Celiac Disease Quality of Life
Treatment Self-Regulation Questionnaire for motivation
Perceived Competence Scale and
Health Care Climate Questionnaire for relationship with health care provider.

According to analysis, lower scores for disease activity, anxiety, depression, fatigue and pain as well as higher competence, autonomous motivation and social satisfaction were associated with higher diet adherence and follow-up.

Patients whose adherence declined over time (n = 44) had increased disease activity, depression and fatigue.

“We believe that these results are significantly meaningful and can be used to guide high quality patient care to outcomes associated disorders,” Lee concluded.

“It’s important to note that patients’ perception of autonomous support from their provider was associated with a difference in adherence, which really highlights the importance of supporting our patients with informative discussions.

[We should be] acknowledging their goals and beliefs and encouraging them to ask those questions about their treatment options so that we can facilitate their motivation and their adoption of self-management, which ultimately helps support disease management goals.”