Background: The prevalence of depression in celiac disease (CD) is high, and patients are often burdened socially and financially by a gluten-free diet. However, the relationship between depression, somatic symptoms and dietary adherence in CD is complex and poorly understood. We used a patient powered research network (iCureCeliac^®) to explore the effect that depression has on patients’ symptomatic response to a gluten-free diet (GFD). Methods: We identified patients with biopsy-diagnosed celiac disease who answered questions pertaining to symptoms (Celiac Symptom Index (CSI)), GFD adherence (Celiac Dietary Adherence Test (CDAT)), and a 5-point, scaled question regarding depressive symptoms relating to patients’ celiac disease. We then measured the correlation between symptoms and adherence (CSI vs. CDAT) in patients with depression versus those without depression. We also tested for interaction of depression with regard to the association with symptoms using a multiple linear regression model. Results: Among 519 patients, 86% were female and the mean age was 40.9 years. 46% of patients indicated that they felt “somewhat,” “quite a bit,” or “very much” depressed because of their disorder. There was a moderate correlation between worsened celiac symptoms and poorer GFD adherence (r = 0.6, p < 0.0001). In those with a positive depression screen, there was a moderate correlation between worsening symptoms and worsening dietary adherence (r = 0.5, p < 0.0001) whereas in those without depression, the correlation was stronger (r = 0.64, p < 0.0001). We performed a linear regression analysis, which suggests that the relationship between CSI and CDAT is modified by depression. Conclusions: In patients with depressive symptoms related to their disorder, correlation between adherence and symptoms was weaker than those without depressive symptoms. This finding was confirmed with a linear regression analysis, showing that depressive symptoms may modify the effect of a GFD on celiac symptoms. Depressive symptoms may therefore mask the relationship between inadvertent gluten exposure and symptoms. Additional longitudinal and prospective studies are needed to further explore this potentially important finding.

Background and Aims: Patients with celiac disease (CD) commonly use supplements for perceived health benefits despite scant evidence. We aimed to characterize the prevalence and predictors of probiotic use among CD patients. Methods: We analyzed data from iCureCeliac®; a patient-powered research network questionnaire distributed by the Celiac Disease Foundation. We included adults with self-reported CD who answered questions regarding demographics, diagnosis, symptoms, and treatment. We compared probiotic users versus probiotic non-users and subsequently performed multivariable logistic regression, assessing for independent predictors of probiotic use. Results: 4,909 patients met the criteria for inclusion in the study. Of these, 1,160 (23.6%) responded to a question regarding probiotic use. The mean age of participants was 38.8 years and 82% were female. 381 patients (33%) reported using probiotics. More probiotic users sought nutritional counseling at time of diagnosis (36% vs. 30%, p=0.05) and remained symptomatic despite a gluten-free diet (40% vs. 25%, p <0.001). Probiotic users had lower scores on the pain subscale of the SF36 (63.7±21.6 vs. 69.5±22.1, p=0.006). On multivariable analysis, patients diagnosed after age 50 (OR=2.04, 95%CI: 1.37-3.04), and those with persistent symptoms despite a gluten-free diet (OR=1.94, 95%CI: 1.44-2.63) were more likely to use probiotics. Conclusion: In this large study of a national CD registry, roughly one-third of CD patients reported using probiotics. Patients diagnosed later in life were more likely to use probiotics and those who remained symptomatic despite a gluten-free diet were twice as likely to take probiotics. Patients may be seeking additional means of treatment for persistent symptoms.

Objectives: We aimed to develop expert-informed recommendations for colleges and universities to support students with celiac disease (CeD) managing a gluten-free (GF) diet. Methods: A multidisciplinary panel of 40 stakeholders, including physicians, dietitians, a disability rights attorney, university staff, and students, was convened by the Celiac Disease Foundation to create expert-based and experience-informed recommendations. Over a 6-month period, the group conducted literature reviews, stakeholder interviews, and expert consensus discussions to identify common barriers and accommodations aligned with federal disability law. The expert panel collaboratively developed and revised an initial set of recommendations. Two rounds of structured voting were held during which panelists provided feedback to refine content and ensure clarity. All final recommendations were adopted with at least 90% of panelists voting in support. Results: The panel identified 24 accommodations across four domains: academics, housing, dining, and campus life. Academic recommendations include flexibility for illness-related absences, support for remote learning, and classroom modifications. Housing recommendations emphasize access to priority placement, appropriate appliances, and proximity to safe dining. Dining accommodations address GF food availability, ingredient transparency, staff training, and meal plan flexibility. Campus life recommendations ensure full participation in athletics, study abroad, social events, and internships, with supports for psychosocial well-being. Conclusions: This manuscript presents the first expert-informed recommendations focused specifically on the needs of college students with CeD. These recommendations are intended to support institutions as they develop strategies to enhance access to GF food, quality of life, educational supports, and student experience for those living with this chronic autoimmune condition.

Background: Shared fryers are commonly perceived as a high-risk source of gluten cross-contact for individuals with celiac disease (CeD), leading to widespread avoidance of foods such as French fries and tortilla chips. However, limited real-world data exist evaluating gluten concentrations in foods prepared in shared fryers under routine food service conditions. Because long-term health outcomes in celiac disease depend on minimizing cumulative dietary gluten exposure and intestinal injury is dose-dependent, characterizing gluten contamination from common dining practices has important implications for nutritional management and disease counseling. Objective: The aim of this study was to quantify gluten concentrations in naturally gluten-free (GF) foods prepared in shared fryers across U.S. food service establishments and to evaluate how fryer management practices, restaurant type, and geographic distribution influence gluten content. Methods: This cross-sectional observational study analyzed gluten concentrations in 98 samples of French fries (n = 55) and tortilla chips (n = 43) collected from fast food, fast casual, casual dining, and fine dining establishments, cafés, and other food service settings across multiple U.S. states. All samples were naturally GF prior to frying and prepared in fryers shared with gluten-containing foods. Gluten concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Recorded variables included sample type, restaurant type, state location, and fryer oil change frequency (daily, weekly, or unknown). In accordance with the U.S. Food and Drug Administration (FDA) GF labeling standard, foods containing <20 ppm gluten were considered GF, while values ≥20 ppm were classified as exceeding the GF threshold. Values <5 ppm were considered below the assay’s limit of quantification (LOQ). Results: Of the 98 samples analyzed, six (6.1%) exceeded the FDA GF threshold of 20 ppm. The majority of samples (84/98, 85.7%) measured below the assay’s lower LOQ (<5 ppm gluten). All 43 tortilla chip samples tested <5 ppm. Among samples from fast food establishments, 9/12 (75.0%) measured <5 ppm, 2/12 (16.7%) measured 5–20 ppm, and 1/12 (8.3%) exceeded 20 ppm. Among samples from fast casual establishments, 13/15 (86.7%) measured <5 ppm, 1/15 (6.7%) measured 5–20 ppm, and 1/15 (6.7%) exceeded 20 ppm. Greater variability was observed in casual dining establishments, including samples exceeding 20 ppm. All samples collected from establishments reporting daily oil changes measured <20 ppm, while samples from establishments reporting weekly oil changes demonstrated higher and more variable gluten concentrations, including values greater than 20 ppm. Conclusions: In this multi-site observational study, shared fryers were not uniformly associated with meaningful gluten cross-contact. Gluten concentrations varied by food service context and fryer management practices, with consistently low or below-LOQ gluten levels observed in establishments reporting daily fryer oil replacement, and greater variability observed in settings with less frequent oil changes. These results indicate that shared fryers are not inherently high-risk sources of gluten cross-contact and highlight daily fryer oil replacement as a key operational factor significantly associated with lower measured gluten levels. These findings have direct nutritional implications. Estimating gluten concentrations in shared-fryer environments allows for more accurate assessment of potential daily gluten intake, which is the key determinant of mucosal healing, serologic normalization, and long-term nutritional and health outcomes in individuals with celiac disease.