“…Third, as a cross-sectional study, we were able to establish association, not causation. Others have noted that within the first year of diagnosis there is a high prevalence of anxiety and depression [44], which in many patients improves with time [45]. While such ''reactive'' psychological symptoms are possible in our study population, the average duration of symptoms was over 10 years, and the vast majority of patients were already on a gluten-free diet.…”