Disordered Eating and Gluten-Related Disorders
If you have been diagnosed with celiac disease or non-celiac gluten sensitivity (NCGS), the only treatment is a medically restricted diet. You must pay more attention to what you eat — or don’t eat — and stick to eating gluten-free. For some, paying close attention to food in this way can lead to disordered eating or an eating disorder.
What could cause disordered eating or eating disorders in certain people with medically restricted diets? Let’s look at some of the factors involved.
What is Disordered Eating?
The term disordered eating refers to a range of irregular eating behaviors that can be physically and emotionally disruptive. Disordered eating may include behaviors like those seen in some eating disorders, but they are less extensive and less severe. Even though they are less severe, in some cases disordered eating could lead to an eating disorder.
According to an article on EatRight (published by the APA), some signs and symptoms of disordered eating could include:
- Frequent dieting, anxiety associated with specific foods or meal skipping
- Chronic weight fluctuations
- Rigid rituals and routines surrounding food and exercise
- Feelings of guilt and shame associated with eating
- Preoccupation with food, weight, and body image that negatively impacts quality of life
- A feeling of loss of control around food, including compulsive eating habits
- Using exercise, food restriction, fasting, or purging to “make up for bad foods” consumed
An eating disorder is a more serious medical condition with specific diagnostic criteria defined by the American Psychiatric Association (APA). According to the APA, “eating disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. They can be very serious conditions affecting physical, psychological, and social function.” Most eating disorders, like anorexia nervosa and bulimia nervosa, are diagnosed based on specific and narrow criteria. Other eating disorders have fewer specific criteria, including orthorexia, which is an obsession with proper or “healthful” eating.
Many people, whether on a gluten-free diet or not, engage in “disordered eating” to some degree or on occasion. This means their eating patterns are erratic and “disorderly.” The question is: When do those patterns become a major health issue? According to the National Eating Disorders Association (NEDA), the three primary aspects to look at when determining if a person could be at risk for developing an eating disorder are:
- Behaviors – Involving food or relating to body image or one’s mood and happening multiple times a day or week.
- Obsession – All-consuming thoughts about food, weight loss, eating, etc.
- Functionality – Interfering with normal day-to-day activities including work- or school-related or social ones.
Disordered eating becomes a concern when any of these factors are prevalent and have an impact on a person’s health and daily life.
The Connection with Gluten-Related Disorders
Research has shown that following a gluten-free diet can affect a person’s quality of life. One reason is due to the psychological distress caused by the challenges around sticking to a restrictive diet. Research has found that psychological distress can be a risk factor for disordered eating in some people who also have celiac disease.
A literature review of chronic illness and disordered eating looked specifically at the prevalence of disordered eating and eating disorders among youth and young adults with diet-related chronic health conditions. For people with celiac disease, it was noted that preoccupation with dietary management and the fear of abdominal discomfort caused by food are both potential factors that increase the risk of developing disordered eating patterns.
In another study done in 2021 at the Columbia University Celiac Disease Center, survey responses of 644 adults with celiac disease revealed several trends. The results found that young adults (23–35 years of age), those on a gluten-free diet for one to four years (as opposed to longer), and those with a marital status of single or engaged may experience more anxiety, more disordered eating attitudes and beliefs, and a lower quality of life compared to others.
Another connection between celiac disease and eating disorders is the possible overlap of symptoms leading to a misdiagnosis. Patients diagnosed with anorexia due to restrictive eating and weight loss may have celiac disease instead. As noted in a publication from the University of Chicago Celiac Disease Center, anorexia patients who do not respond to psychiatric interventions should be assessed for celiac disease. While eating disorders are more common in females, males could be misdiagnosed more frequently. If celiac disease is ruled out in a male patient, don’t discount an eating disorder.
If you are on a gluten-free diet, or the parent or caregiver of gluten-free kids or teens, be aware of the potential connections between gluten-free eating and disordered eating. Access support networks like GIG’s Support Groups and resources to help reduce stress and maximize quality of life. Seek input and guidance from your personal healthcare team — ideally including a registered dietitian — as appropriate.
The information on this website is for educational purposes only. Consult your healthcare team when considering this information.
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