Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Gluten Sensitivity as Eating Disorder

How orthorexia nervosa becomes anorexia nervosa via gluten sensitivity

A previous blog discussed the questions surrounding the reality of non-celiac gluten sensitivity. Lately, there have been discussions by others regarding the excuse of non-celiac gluten sensitivity: Has at least the notion—no matter the reality—of non-celiac gluten sensitivity become another excuse for an eating disorder?

While there appears to be no shortage of celebrity endorsements of a gluten-free diet, there is certainly a lack of data supporting a gluten-free diet for those individuals who have not been diagnosed with celiac disease. But the numbers are impressive: As I wrote last year, a 2008 article in USA Today estimated that "15% to 25% of consumers want gluten-free foods." And a Washington Post article in 2011 declared that "17 million Americans are gluten-sensitive."

Celiac disease is an autoimmune disorder that damages the lining of the small intestine and prevents it from absorbing parts of food that are important for staying healthy. The damage is due to a reaction to eating gluten, which is found in wheat, barley, and rye, and the outcome is an inability to properly absorb nutrients. In other words, the celiac patient deals with a certain degree of malnourishment, no matter how healthy the diet. Symptoms of celiac disease commonly include abdominal pain, constipation, diarrhea, and weight loss; however, there can also be chronic pain due to concomitant arthritic and neuropathic involvement.

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A gluten-free diet is an answer for celiac disease.

A gluten-free diet is a question for the rest of us.

Many fail to appreciate the complexity of the foods we eat, and thus the difficulty of assigning blame to a certain component of those foods for clinical manifestations such as bloating or chronic pain. Gluten is only one component of the complex protein mixture contained in wheat flour. Other proteins such as certain enzyme inhibitors, or even yeast, may be involved with allergic reactions to wheat flour. Interestingly, carbohydrates may play a role, as some of those contained in bread and pasta have been shown to escape absorption in the intestine, resulting in abdominal pain and diarrhea. Thus, starch absorption defects may represent part or all of the gastrointestinal distress experienced by otherwise healthy people who eat wheat flour.

Not gluten sensitivity.

So, the gluten sensitivity debate continues, more in the mainstream media than the scientific journals, and in the meantime an encroaching shadow of medical and social problems associated with gluten sensitivity is threatening to turn the debate to new issues—issues in many ways more dangerous to individuals and their loved ones, and recently highlighted in “The Daily Beast” by journalist Rachel Krantz: Gluten-free has become the latest clarion call to those who fear food, advertised wherever food is, announced from labels in the aisles of supermarkets, and making us think that gluten-free is a necessary part of life.

Suddenly, the person claiming a sensitivity to gluten is now a patient with orthorexia nervosa—a term used by some scholars to describe individuals who develop an obsession with avoiding foods perceived to be unhealthy. This focus may turn into a fixation so extreme that it can lead to severe malnutrition or even death.

Gluten intolerance becomes one more socially acceptable reason for adopting a potentially dangerous diet that is a socially acceptable way to restrict food intake. If this is coupled with, say, veganism, another socially acceptable dietary stance, there is a real possibility of malnourishment.

One can imagine that declining a dish at Happy Hour by invoking one's veganism or gluten sensitivity sounds more socially acceptable compared to declaring, ‘No thanks, I’m an anorexic.’

One can also understand how easy orthorexia can grow in this society: We are told by so many media sources that we should only be eating organic foods; we are told we should not be eating processed foods; we are told we should eat gluten-free foods; we are told we should be super-thin. We are restricted more and more. We make more excuses. We become anorexic.

And then gluten sensitivity really has made us sick.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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