‘Pie hole’, colloquial for one’s mouth, is believed to have evolved in the USA in the 1980s from the British expression ‘cake hole’ (coined in the mid 20th century). Pie hole refers to a mouth, as in: Shut your pie hole or, in this case: Put less in your pie hole.

Thursday, June 15, 2017

The Critical Connection Between Gluten-Free and Eating Disorders

Since the gluten-free craze is still going strong and people are still really excited about it, I thought it was time for another gluten-related article. And yes, this one too is a spirit-crushing, shoulder shaking, face slap for those on the diet for an undiagnosed, non-medically necessary reason.

Let me preface this with the usual disclaimer that people who have been objectively biopsied and have true celiac disease should indeed follow a gluten-free diet. For the rest of you, and particularly other medical professionals, some interesting new research came across my desk recently about the association between celiac disease (CD) and anorexia nervosa (AN).

I know, right? Not what you were expecting. I'll do my best to lighten things up, but this article is on the serious side... Eating disorders aren't funny, but being on an unnecessary restrictive diet is a bit amusing.

Ok, so as it turns out, it appears there is a bidirectional association between celiac disease and anorexia nervosa. Well, what the heck does that mean?
  • A positive relationship between CD and AN, both before and after (bidirectional) CD diagnosis exists
    • Positive in this case ≠ a good thing, positive in this case means CD diagnosis and AN diagnosis increased together (this is a correlation)  
  • CD is associated with a significant two-to-threefold increase in diagnosis of AN and vice versa
    • Meaning having either CD or AN increases the chance of diagnosis with the other condition
Why might this be? The researchers offered several factors that could contribute to this relationship:
  1. Diseases that require dietary restrictions have been associated with AN (like food allergies and type 1 diabetes)
  2. Diseases or self-imposed "diets" can trigger obsessive eating patterns and/or diets with a long-term energy imbalance
  3. The positive association between CD and AN before and after CD diagnosis could be:
    • Because of a misdiagnosis with the other condition
    • Due to a genetic susceptibility - genomewide association studies of AN show genetic regions shared with type 1 diabetes and other autoimmune diseases
What's important here?
  • 1 in 5 Americans restricts gluten daily as a means to "eat healthier", the number is even higher in young females (who are already at a higher risk of eating disorders)
    • These people have no evidence (biopsy) to objectively evaluate the presence of true CD, meaning they are self-diagnosed, or just on the trendy bandwagon
  • Eating disorders often begin with well-meaning, self-imposed diets or attempts to eat healthy
    • This often includes banishing "bad" or "unhealthy" foods
    • Think about your social media channels... how many friends do you have posting about being on this diet, that "cleanse", or this "food challenge" (like no sugar for 30 days)?
      • Read more about these diets and make up your own mind here, here, and here
    • Orthorexia nervosa is the unhealthy obsession with eating healthy foods, see link below to read more
  • CD (or a medically-unnecessary gluten-free diet) requires dietary restriction that could easily become obsessive in susceptible individuals
  • Medical professionals would benefit to understand this association during screenings for patients with either AN or CD
For the rest of you on the gluten-free bandwagon without a medical diagnosis by a proper small intestinal biopsy (having followed the gluten-loading protocol) you might want to consider jumping ship and focus your efforts on just eating a healthier diet all around. Need some eating healthy help and resources? You can get some tips and info here, here, here, and here.

More on eating disorders here.
Read about orthorexia nervosa here.
Read more about gluten-free diets by yours truly:
- Gluten-free and microbiome health (or not)
-Gluten-free eating for the gluten-intolerant
-Why gluten-free doesn't = guilt-free