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:
- Diseases that require dietary restrictions have been associated with AN (like food allergies and type 1 diabetes)
- Diseases or self-imposed "diets" can trigger obsessive eating patterns and/or diets with a long-term energy imbalance
- 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)?
- 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
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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
Thank you
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