House CallFeb/Mar 2013 Issue

Trouble Losing Weight?

Avoiding gluten is a sure way to lose weight, right? Not so fast...

By the time 56-year-old Marcy* walked into my office, she was a veteran of many weight-loss programs.

“I know I need to lose weight,” she said preemptively, “but I get so hungry.” She then went on to accuse herself of lack of discipline and will power. After a few more self-disparaging remarks about her poor self-control, she sighed deeply.

“I don’t know if something is wrong with me or if the only way to lose weight is to feel like I’m starving all the time.”

Marcy’s dilemma is surprisingly common among those trying to shed extra pounds. Instead of feeling lighter and more energetic on sufficient calories, many are plagued with persistent hunger and cravings that undermine their efforts. There is no known scientific reason why some people, including certain children, feel chronic hunger and continuously overeat—but there may be clues in autism research.

Several decades ago, researchers in Europe discovered that a gluten-free, casein-free diet (GFCF) reduced self-abusive behaviors and improved communication skills in many children with autism. One explanation of why this occurs is called the opioid theory. According to this theory, some children with autism (as well as certain people with schizophrenia) do not properly break down casein (a dairy protein) and/or gluten (the protein in wheat, barley and rye). This incomplete digestion prompts opioid-like activity in the brain. Opioids are natural painkillers and nervous system modulators that affect mood, cognition, desire to interact with people, sleep and other behaviors—including appetite modulation and craving.

The idea that eating gluten can make you fat is practically gospel in the weight-loss world with many of the most popular diets (South Beach, Paleo, Atkins) advocating gluten avoidance. The number of celebrities touting the benefits of going gluten-free has only added momentum to this increasingly popular dietary trend.

Marcy’s eating patterns suggested that she might be having appetite trouble from ingesting gluten. Although she had tried many reduced-calorie diets, she still consumed a high-gluten cereal for breakfast, a half (rather than a whole) sandwich at lunch and pretzels for snack. She said she was afraid to “cut out wheat” entirely because it would make her feel even hungrier.

I explained she may need a few days to withdraw from the possible opioid effect of eating gluten but within a week or so, her appetite should stabilize. Because obesity increases inflammation, I suggested she take a fish oil supplement with higher amounts of EPA. Fish oil contains therapeutic eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). EPA has anti-inflammatory properties while DHA is important for cognition.

For extra nutritional support and to further reduce any need for foraging, I also put Marcy on a gluten-free multiple vitamin and mineral supplement.

Two months later, Marcy had lost several pounds but more importantly, she was not hungry all the time. She said she missed eating wheat bread but found if she cheated and had a piece with dinner, the craving started again and her appetite ballooned. She was working hard to keep gluten out of her diet and was happy to know the cause of her distress.

Licensed clinical nutritionist Kelly Dorfman is author of Cure Your Child with Food (Workman 2012), which contains a chapter on excessive hunger in children. Note that celiac experts strongly advise getting tested for celiac disease before going on a gluten-free diet.

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