Women who are unable to tolerate gluten are at increased risk of depression – even if they’re on a gluten-free diet, a new study has found.

People with celiac disease are unable to process foods containing gluten – such as wheat, barley and rye. Thus, they are usually required to adhere to strict dietary guidelines to avoid foods with gluten.

But researchers at Penn State University have found that this dietary restriction is linked to higher rates of stress, depression and a heap of issues over body image, weight and shape. For the study, they polled just under 200 women diagnosed with celiac disease and compared their answers with prior research of the same issues among non-celiac patients.

Celiac patients were more likely to become depressed and develop eating issues, regardless of their diet, the team noted. The findings will be published in the journal Chronic Illness.

Celiac disease affects one in every 1,750 Americans. It causes abdominal pain, lack of appetite, constipation, nausea, vomiting and diarrhea.