A large national study has found that adults with celiac disease are more than six times as likely to develop an eating disorder compared with adults without the condition. The findings, presented at Digestive Disease Week 2026, highlight a growing concern that the strict food rules required to manage celiac disease can sometimes overlap with anxiety, food avoidance, and clinically diagnosed eating disorders.

Why Does Celiac Disease Increase Eating Disorder Risk?

Celiac disease is an autoimmune condition in which eating gluten triggers an immune reaction that damages the small intestine. The only accepted treatment is a strict lifelong gluten-free diet. For many people, that diet is medically necessary and life-changing. It can reduce symptoms, allow the intestine to heal, and lower the risk of long-term complications. However, the same strict attention to food labels, ingredients, restaurant preparation, and cross-contact can also create emotional and psychological strain.

For someone with celiac disease, food is not just food. Every meal can require checking labels, asking questions, reading menus, contacting manufacturers, avoiding shared fryers, and worrying about cross-contact. This level of vigilance is necessary for staying gluten-free, but it can also become exhausting. Some people may begin by carefully avoiding gluten, but over time their list of avoided foods may grow beyond what is medically necessary. Others may become afraid to eat outside the home, skip meals when safe food is not available, or feel intense guilt after possible gluten exposure.

What Did the Research Actually Show?

Researchers examined health records from a large national research network and compared adults with celiac disease to adults without celiac disease. The study included adults between 18 and 65 years old who had at least one health care visit between January 2007 and December 2025. The original dataset included more than 64,000 adults with celiac disease and more than 28 million adults without celiac disease. To make the comparison fairer, researchers used matching methods to create two similar groups. After matching for demographics and several mental, behavioral, and developmental health conditions, the final analysis included more than 63,000 people with celiac disease and more than 63,000 people without celiac disease.

The celiac disease group required stronger evidence of the diagnosis, either through biopsy-based endoscopy or positive blood testing. Researchers also excluded people who already had a history of anorexia, bulimia, or another eating disorder before the study period, so they could focus on the risk of developing an eating disorder after celiac disease was identified.

The study found that adults with celiac disease were more than six times as likely to develop an eating disorder compared with matched adults who did not have celiac disease. This is a striking difference and supports earlier research suggesting a connection between celiac disease and eating disorder risk. The researchers noted that earlier studies have pointed in the same direction, especially among women and children, but many of those studies were smaller. This newer analysis is important because it used a very large number of patients and attempted to balance the two groups for several major differences that could otherwise distort the results.

How to Recognize Warning Signs of Disordered Eating in Celiac Disease

It is important to understand that strict gluten avoidance is not the same as an eating disorder. People with celiac disease have a real medical need to avoid gluten, and their caution should not be dismissed as fearfulness or overreaction. However, warning signs may appear when food restriction expands beyond what is medically necessary. Health care providers and patients should watch for these patterns:

• Food Restriction Expansion: When avoidance grows beyond gluten to include broad categories of safe foods without a clear medical reason.
• Anxiety and Avoidance Behaviors: When anxiety around eating becomes overwhelming, or a person begins avoiding meals, social events, restaurants, travel, or entire food groups.
• Physical and Behavioral Warning Signs: Rapid weight loss, obsessive calorie tracking, fear of weight gain, secretive eating, guilt after eating, compulsive exercise, or frequent comments about food being "bad" or "unsafe" even when it is gluten-free.

For people with celiac disease, eating disorder screening must be done carefully. Health care providers should understand that gluten avoidance is required, but they should also recognize when necessary medical caution may be turning into harmful restriction or fear-based eating.

The study does not mean that the gluten-free diet causes eating disorders. It does suggest that people with celiac disease may be a higher-risk group and may benefit from earlier mental health support, better nutrition guidance, and more careful screening for unhealthy eating patterns. Other factors may contribute to the increased risk, including anxiety, digestive symptoms, social isolation, fear of gluten exposure, body image concerns, or the stress of managing a lifelong medical diet.

What Mental Health Support Looks Like for Celiac Disease

The study authors suggested that celiac care may need to better connect digestive health and mental health. That is an important point. Celiac disease is often treated mainly as a digestive or autoimmune condition, but the daily burden of the gluten-free diet reaches into family life, school, work, dating, travel, and social events.

People newly diagnosed with celiac disease may benefit from working with a dietitian who understands the gluten-free diet and can help them build a diet that is safe but not unnecessarily restrictive. Mental health support may also be helpful, especially for people who feel anxious, overwhelmed, isolated, or fearful around food. For children, teenagers, and young adults, early support may be especially important. These are years when body image, social eating, peer pressure, and independence around food can become complicated. Parents and caregivers should encourage strict gluten-free safety while also supporting a healthy, relaxed relationship with safe foods.

A healthy gluten-free diet should still include enough calories, nutrients, variety, fiber, protein, and enjoyment. The distinction between medically necessary restriction and disordered eating is critical. A person with celiac disease must avoid gluten, but that does not mean they should avoid broad categories of safe foods unless there is another medical reason.

Why This Matters Beyond Celiac Disease

Although this study focused on celiac disease, the findings may also be relevant to people with gluten sensitivity. People with gluten sensitivity may also follow a gluten-free diet, avoid restaurants, read labels, and worry about symptoms after eating. However, unlike celiac disease, gluten sensitivity does not usually involve the same autoimmune intestinal damage, and the level of strictness needed may vary from person to person.

This makes good medical and nutritional guidance especially important. People with gluten sensitivity should avoid foods that clearly trigger symptoms, but they should also be careful not to over-restrict their diet unnecessarily. A balanced approach can help reduce symptoms while protecting quality of life, nutrition, and mental health.

The connection between autoimmune conditions and mental health is increasingly recognized as important. As more research emerges on conditions like celiac disease, lupus, rheumatoid arthritis, and other autoimmune disorders, the psychological burden of managing these conditions is becoming clearer. Healthcare providers are beginning to understand that treating the physical disease alone may not be enough; addressing the emotional and psychological impact is equally important for overall health and quality of life.