Celiac Disease and Eating Disorders: What is the Connection?

Diets frequently trend in our culture over years and decades.

Going “gluten-free” has become a popular diet trend as of late that many individuals choose to follow without any real medical necessity. You have likely seen this in grocery stores, restaurants, etc., where advertisers are appealing to consumers who believe that “gluten-free” is indeed the healthier and more desirable option.

What exactly is the purpose of following a gluten-free diet?

Understanding Celiac Disease

A gluten-free diet is prescribed for individuals with celiac disease, which is an autoimmune condition in which the ingestion of gluten leads to damage of the small intestine.

According to the Celiac Disease Foundation, one in 100 people worldwide are estimated to be affected by celiac disease, and approximately 2.5 million Americans are undiagnosed and are at risk for long-term health complications [1].

A person with celiac disease will suffer an immune response in reaction to gluten, which attacks the lining of the small intestine. This results in malabsorption of nutrients, which can lead to many long-term health conditions, such as osteoporosis, infertility, nervous system disorders, and more [1].

The diagnosis of celiac disease can be difficult, with over 200 symptoms associated with this autoimmune disorder. Some of the most common symptoms include:

  • Weight loss
  • Chronic Diarrhea
  • Abdominal Bloating and Pain
  • Fatigue
  • Delayed Growth
  • Seizures
  • Migraines
  • Irregular Menstrual Periods
  • Infertility or recurrent miscarriage

A blood test can help identify certain antibodies associated with celiac disease, though the only way to confirm this diagnosis is through an endoscopic biopsy of the small intestine.

Once a diagnosis for celiac disease is confirmed, a lifelong adherence to a gluten-free diet is recommended as the only known treatment for managing this chronic illness. Gluten is the protein found in food products that contain wheat, barley, and rye, including foods like pasta, bread, cereal, crackers, even some seasonings and spice mixes.

Many individuals with celiac disease require extra caution around foods that could be possibly cross-contaminated, as the ingestion of even the smallest amounts of gluten can trigger intestinal damage.

Connection Between Celiac Disease and Eating Disorders

Because the sole treatment for celiac disease involves strict dietary regulation, many individuals managing this autoimmune disease can excessively focus on their diet. This might involve checking nutrient labels constantly, limiting entire food groups, and more.

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 [2].

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 [2]. Researchers also identified that a misdiagnosis of celiac disease can occur during adolescence, potentially delaying life-saving treatment [3].

While following a gluten-free diet is a crucial treatment intervention for managing celiac disease, this can become complicated for an individual who is susceptible to having an eating disorder, particularly anorexia. A person who may be dealing with both celiac disease and anorexia can be triggered by the need to follow a “gluten-free” diet and restrict the consumption of certain foods, or may perhaps use this as a guise for developing further restrictive eating habits.

Dietary limitations in the name of disease management can become very tricky to identify, but early intervention is key.

Screening and Treatment

The association of celiac disease with anorexia, both before and after celiac disease diagnosis, should encourage thorough assessments of both illnesses and a multidisciplinary approach to management.

When it is necessary to avoid several foods for celiac disease management, it is crucial to work with other health care providers to ensure that nutrient requirements are being met, especially for a person who also has an eating disorder. The presentation of these conditions often mimic one another, and the delay of diagnosis or misdiagnosis of either disease can create severe health complications.

Oftentimes, the attempt to follow a specialized diet, especially when recommended by a healthcare professional, can quickly spiral out of control for an individual with other risk factors for an eating disorder.

If you are struggling with celiac disease and an eating disorder, be sure to reach out to a specialized health professional. Watch for early signs that may indicate problematic behaviors and recognize red flags, like extreme self-criticism, withdrawal from others, obsessiveness about food, irritability, anxiety, and the like.

Effectively managing celiac disease with anorexia is a complex issue, but this is not something you have to do alone. Reach out for help today.

 

Maggie Geraci HeadshotAbout the Author: Margaret Geraci, RD, LDN, is Director of Nutrition Services at Timberline Knolls Residential Treatment Center.

As Director of Nutrition Services, Maggie‘s job entails many duties. She oversees the dietitians and diet technicians, carries a caseload of adolescents, supervises the menu and meal planning stages and develops nutrition-related protocols. She also implements current nutrition recommendations, participates in community outreach and trains dietitians.

Prior to joining Timberline Knolls, Maggie was the Nutrition Manager at Revolution in Chicago. She started with Timberline Knolls as a diet technician and progressed to a Registered Dietitian.

Maggie attended Eastern Illinois University for her undergraduate degree in Dietetics and Nutrition and then completed her dietetic internship at Ingalls Memorial Hospital.

She is a member of the Academy of Nutrition and Dietetics, Behavioral Health DPG and South Suburban Academy of Nutrition and Dietetics.

References:

[1]: Celiac Disease Foundation, “What is Celiac Disease?”, https://celiac.org/celiac-disease/understanding-celiac-disease-2/what-is-celiac-disease/ Accessed 13 April 2017
[2]: Neville H. Golden, MD, et al. Celiac Disease and Anorexia Nervosa – An Association Well Worth Considering. Pediatrics April 2017.
[3]: Marild K, et al. Celiac disease and anorexia nervosa: a nationwide study. Pediatrics. 2017;139(5):e20164367

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.


Published on April 29, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on April 29, 2017.
Published on EatingDisorderHope.com