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FeaturesAug/Sep 2012 Issue

Celiac Disease and Eating Disorders

Diet Danger

A strict, lifelong gluten-free diet is currently the only treatment for celiac disease. With the constant attention on food and it’s preparation, it’s natural to wonder—particularly for those who develop an eating disorder after their diagnosis—how much the diet is to blame.

There are many reasons why someone may develop an eating disorder, according to Steven Crawford, MD, associate director of the Center for Eating Disorders at Sheppard Pratt in Baltimore, Maryland. “We know there’s a biologic basis, including a strong genetic component, to eating disorders,” he says. “Factors like depression, low self-esteem, perfectionism, as well as cultural influences to be thin can all play a role, too.” However, Crawford gives a nod to the possibility that the gluten-free diet—or other special diets—could contribute to an eating disorder, although probably not cause one on its own.

“Any time there’s a focus on food, as in the case with the gluten-free diet, it sets the potential for the development of an eating disorder, if someone is predisposed to one,” he explains. “Preoccupation with food is, on some level, necessary to manage celiac disease, but it can also promote obsessional food-related behaviors.”

There’s a major burden that comes with having a chronic illness, Mukherjee adds. When you couple that with a restrictive diet, it can lead to issues of wanting to exert control and autonomy.

“Very often, eating disorders can be associated with the feeling that you don’t have control over events in your life,” explains Crawford. “One’s weight or meal plan can be something to turn to and exert a sense of control over.”

In fact, celiac disease isn’t the only diet-mediated, chronic condition linked with eating disorders. The metabolic disorder phenylketonuria (PKU) has also been associated with them. In PKU, the body can’t metabolize the protein, phenylalanine (Phe), which is present in many foods, particularly high-protein ones. As a result, persons with PKU must follow a lifelong, low-Phe diet, which means no meat, milk, eggs, nuts and more. One study found 23 percent of women with PKU had “eating-disordered behavior.”

The same study found 33 percent of women with type-1 diabetes had “significant eating problems.” Type-1 diabetes is an autoimmune condition in which the body can’t make the hormone, insulin. Before each meal or snack, diabetics must carefully count the carbohydrates in their food and then calculate the amount of insulin needed to “cover” the carbs. This helps keep blood sugar regulated—the goal of treatment in diabetes.

“Unfortunately, people with diabetes may end up utilizing aspects of their illness in a misguided attempt to control body shape or weight” says Crawford. “For example, misuse of insulin may result in under-absorption of calories.”

A similar practice has been reported in those with celiac disease: they may intentionally eat gluten to facilitate weight loss.

Laura, 39, admits to this. When she was diagnosed with celiac two years ago, she gained ten pounds on the gluten-free diet. “I became really anxious about my weight until one day it hit me, if I cheated, I might shed a few pounds.”

The next day, Laura ate a few slices of regular, gluten-containing pizza. As she suspected, she lost three pounds, thanks to three days of unrelenting diarrhea. Since then, Laura’s cheated at least a dozen times, even though she knows it wreaks havoc with her body and compromises her future health.

Next: Red Flags

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