Food Anxiety and the Gluten-Free Diet

Walking the Gluten-Free Tightrope

Celiac disease can make you more prone to anxiety, depression, eating disorders, and disordered eating. Following a gluten-free diet isn’t always easy, especially as you begin buying food without your parents, have to navigate a dining hall, or start living with a roommate who has no clue what celiac disease is. It can make you debate whether going to that dorm pizza night is even worth the stress. Because a gluten-free diet is currently the only effective treatment for celiac disease, restrictions around specific foods can be necessary for your health. Unlike other nutrition-related conditions where diet flexibility is sometimes possible, celiac disease requires complete elimination of gluten. This black-and-white thinking can be mentally exhausting. Food may start looking like something to be feared, instead of something nourishing. It makes total sense to want to protect yourself from gluten, especially if prior to diagnosis, you experienced uncomfortable or even painful symptoms. But when non-gluten-containing foods get eliminated out of fear or anxiety, disordered eating may be creeping in. Are you…

• Cutting out more and more foods “just in case”?
• Avoiding social events because of food anxiety?
• Feeling panic (not just caution) around eating?
• Feeling guilt after eating gluten-free foods that are “too processed”?

If this feels familiar, consider speaking with a registered dietitian or mental health professional to help reduce this food anxiety.

When Fear Feels in Control  

Eating disorders and disordered eating can sometimes overlap with celiac disease because they may involve fear or control around food. But, when disordered eating is at play, the fear and control of food can extend beyond the medical necessity of the gluten-free diet.  Eating disorders are serious, diagnosable mental health conditions. Disordered eating patterns may not meet a formal diagnosis but can still make food feel stressful, overwhelming, or controlling.

• Anorexia Nervosa (AN): characterized by extreme restrictions around food and fear of weight gain.
• Bulimia Nervosa (BN): observed with cycles of binging and purging.
• Binge Eating Disorder (BED): marked by periods of extreme, uncontrolled overeating, often followed by extreme distress.
• Avoidant-Restrictive Food Intake Disorder (ARFID): defined by extreme food restriction due to fears or anxiety about the taste, texture, smell, or appearance of food.
• Orthorexia: an unhealthy focus on eating only foods considered “clean” or “perfect.”

Each of these eating disorders looks different for each person they impact. Anorexia, bulimia, and binge eating all include restriction, motivated by the desire to alter body shape or size. Avoidant/restrictive food intake disorder is different. It is not related to body image. Instead, it is driven by fear or discomfort with the sensory experience of food, such as taste, texture, or smell.

Other mental health disorders can negatively impact eating behaviors. Conditions such as obsessive compulsive disorder (OCD), anxiety, or even depression can cause people to adjust their eating behaviors in a way that negatively affects their nutritional well-being.