Diet fads can be an economical boost for individuals in the health and fitness world and can be devastating for those in the mental health field. Today, it is nearly impossible to stroll the aisles at the grocery store or look through a menu at a restaurant where you do not come across the term “gluten-free”. “Gluten-free” diets have been trending for a few years and it is no surprise that gluten-free foods are a nearly $1-billion industry (and growing). Giving up gluten does not necessarily make you lose weight but in fact it can cause you to consume less fiber, more arsenic and will most likely have a higher grocery bill. The specific relationship between the brain and the gut in relation to gluten is still poorly understood and research has not yet come to a conclusion that eliminating gluten from your diet will make you feel better, unless you have celiac disease, an autoimmune disorder that damages the small intestine when the smallest amount of gluten is consumed. Giving up gluten for the “health benefits” and the diet fads can potentially lead you to look at food differently resulting in disordered eating. Having to eliminate the food that a gluten-free diet requires can easily lead a young person to become extremely preoccupied with food and may cause unwanted weight gain, and this can also provide a trigger for disordered eating behaviors.

Celiac disease vs. gluten sensitivity

Celiac disease is a chronic disorder of the digestion tract due to the inability to tolerate gliadin, the alcohol-soluble fraction of gluten. Gluten is a protein commonly found in wheat, rye, and barley. When an individual consumes gluten in the form of bread, soy sauce, beer or other gluten enriched foods, an immunologically mediated (your body attacks itself) inflammatory response occurs that damages the mucosa of the intestines, resulting in poor digestion and malabsorption of food nutrients. This results in extreme abdominal discomfort, bloating, weight loss, fatigue and diarrhea. Skin rashes are also common in this disorder and systemic effects such as anemia and nutrient depletion can occur since food nutrients cannot be absorbed into the gut. This specific diagnosis is confirmed via a blood test and a biopsy of the small intestine, which is usually done via endoscopy. The treatment is a strict gluten-free diet.

Gluten sensitivity, formally called non-celiac gluten sensitivity (NCGS), is a very little studied and documented disorder that is contributing to the growing billion-dollar market for gluten-free diets and products. More than likely this "disorder" could be misidentified for irritable bowel syndrome (IBS) and other related disorders however our society markets NCGS for the sake of diet trends, not realizing this can lead to disordered eating behaviors such as anorexia nervosa and bulimia nervosa.

Eliminating gluten to gain an eating disorder

Eating disorders affect 30 million individuals in the United States alone and have the highest mortality rate out of all mental health disorders. Eating disorders often result out of the need for self-control when self-control is lacking in all other aspects of the individual’s life. The need to control body image, weight and calories may be the only way a young girl or boy can gain control over their thoughts and emotions. Eliminating certain food groups and restricting calories can result in an obsessive behavior with controlling what we put in our bodies. Eliminating gluten from the diet, even when it is necessary due to celiac disease, can increase the risk of anorexia nervosa and bulimia nervosa. The more food items an individual avoids the more fanatical they can become about food.

In a recent study, researchers found a positive association between celiac disease and anorexia nervosa in a large population-based study of women with a biopsy-proven celiac diagnosis. More specifically, the authors of this study identified that participants above the age of 20 had almost twice the risk of developing anorexia after an initial diagnosis of celiac disease. Researchers also identified that a misdiagnosis of celiac disease can occur during adolescence, potentially delaying life-saving treatment. It is important to keep in mind when treating celiac disease that individuals can be at risk for developing another life threatening disorder. In no way should celiac disease go untreated but screening individuals for red flags associated with eating disorders could be helpful.

Red flags associated with eating disorders

  • Intense fear of weight gain
  • Obsession with body image
  • Compulsive behaviors such as counting calories and tracking weight
  • Distorted body image
  • Participating in ritualistic behaviors while eating a meal
  • Frequently weighing oneself
  • Isolating oneself from the outside world
  • Refusing to wear revealing or bright colored clothing
  • Food hiding or hoarding
  • Weighing food
  • Obsession with weighing onself
  • Obsession with neutral and baggy clothing
  • Erosion of teeth enamel
  • Dental cavities
  • Erosions or scabs on the back of the hands
  • Swollen cheeks (parotid glands)
  • Thinning hair
  • Swollen gums
  • Abnormal or missed menstrual cycles

Kristen Fuller M.D. is a writer for Center For Discovery

References

Celiac Disease Foundation, “What is Celiac Disease?”, https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/ Accessed 13 April 2017  

Neville H. Golden, MD, et al. Celiac Disease and Anorexia Nervosa – An Association Well Worth Considering. Pediatrics April 2017.  

Marild K, et al. Celiac disease and anorexia nervosa: a nationwide study. Pediatrics. 2017;139(5):e20164367

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