FeaturesAug/Sep 2012 Issue

Celiac Disease and Eating Disorders

Red Flags

Evelyn Tribole wants to be clear: It’s normal to be preoccupied by food when you’re first diagnosed with celiac disease. It’s normal to feel awkward in social situations with food or at restaurants. That’s not an eating disorder, she stresses.

Most experts recommend meeting with a dietician knowledgeable about celiac disease soon after diagnosis. If, after the initial stage of understanding how to eat gluten free, you still feel very overwhelmed or preoccupied by food, then it may be something to look at more carefully, Tribole says.

Warning signs of an eating disorder can include obsessively weighing yourself, over-exercising, compensating if you think you ate too much, avoiding social outings because you don’t like how you feel in your body and excessive anxiety about what you may eat in social settings. (Note: Concern that safe food is available outside the home is valid for those with celiac disease; however, once planning and safety precautions are in place, there shouldn’t be extreme anxiety.)

“An eating disorder may start with disordered eating—lots of rules and time spent around the eating process,” says Tribole. “Rules that don’t involve celiac disease can be a red flag.”

If you suspect someone has an eating disorder, try to talk to them very objectively about what you see, she suggests. Eating disorders can have very serious and permanent health consequences, including stunted growth, dental problems, osteoporosis, infertility, electrolyte imbalances, cardiac abnormalities and even death. According to the National Alliance on Mental Illness, anorexia has the highest mortality rate of any psychiatric illness.

However, eating disorders are treatable.

“We always recommend professional treatment and the earlier it begins, the better the outcome,” says Crawford. Treatment depends on the specific needs of the individual but often involves cognitive behavioral therapy (CBT), a type of counseling aimed at changing one’s thinking about food, eating and body image.

In general, about a third of patients with eating disorders do quite well with appropriate treatment, says Crawford. Another third improve with some good intervals followed by setbacks requiring additional treatment. Unfortunately, the other third have an ongoing, daily struggle with their illness.

“We don’t know if people who have chronic conditions like celiac disease have different recovery rates,” he says.

Crawford’s advice for those newly diagnosed with celiac disease? “Find variety and creativity in the gluten-free diet so that you don’t feel deprived. You never want to eat less—just differently.”

Next: Hope Ahead

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