Weight gain is common for newly diagnosed celiacs.
[Updated July 27, 2018]
If you’re underweight from longstanding malabsorption, putting on a few pounds after going gluten-free can be a good thing. For the rest of us, it’s frustrating to see the scale tip as we eliminate gluten from our diets. While it’s true that processed, packaged gluten-free foods are often higher in calories and fat, many of us aren’t overindulging. So why are the pounds piling up?
In the months directly after my celiac diagnosis, I gained nearly ten pounds. I’d been monitoring my diet more closely than ever, yet my jeans were snug and the bridesmaid dress I was supposed to wear that summer didn’t fit.
It turns out my weight gain was just about on target. Adults with celiac disease gain an average of six pounds after starting the gluten-free diet, research suggests.
In her clinical experience, Amy Burkhart, MD, RD, frequently sees an 8- to 10-pound bump. This initial gain is thought to be largely the result of more efficient absorption of the nutrients and calories in food. It can also be due to larger portion sizes, says Burkhart, an integrative medicine and celiac specialist who practices in Northern California. “After years of malabsorption, people may be used to eating larger quantities of food without gaining weight. So they may be eating larger portions than needed.”
In the past, celiac doctors typically welcomed this “freshman 15.” But for a growing number of celiacs, weight gain doesn’t stop there—or they’re already overweight at diagnosis.
About a third of the patients at the University of Chicago’s Celiac Disease Center are overweight or obese, according to recent data. This could reflect general population trends in weight or earlier detection of celiac disease.
“We’re seeing many more celiac patients with weight concerns,” says Lori Welstead, MS, RD, LDN, a dietitian at the University of Chicago’s Celiac Disease Center. Efforts to curb unwanted weight gain on the gluten-free diet are more important than ever, she says.
Hidden Factors in Weight Gain on the GF Diet
Not everyone starting the gluten-free diet gains weight. Some gain, some lose and some stay the same, says Burkhart, noting there’s little research on weight change in people with non-celiac gluten sensitivity.
There are plenty of reasons behind weight gain. Being out of the habit of exercise due to years of not feeling well can contribute to excess pounds. Small intestinal bacterial overgrowth (SIBO), common in new celiacs, can cause feelings of hunger (due to ongoing malabsorption) and ravenous cravings for high-calorie foods, especially sweets. A sluggish thyroid can lead to weight gain and trouble shedding stubborn pounds. Feelings of deprivation can lead to overindulging and even binging.
People don’t tend to blame lack of sleep but it’s a factor in weight management, says Burkhart. Studies show people who don’t sleep enough have increased risk of weight gain. Clinicians frequently see disruptions in sleep in people with celiac disease and even in those with non-celiac gluten sensitivity, says Burkhart. Underlying anxiety or depression, which are well documented in celiac disease before and after diagnosis, can cause sleep disturbances.
So can stress. A celiac diagnosis is a stressful life event, says Burkhart. “It’s stressful to adapt to a whole new lifestyle of food planning and preparation.”
Chronic stress ups levels of cortisol, a hormone that helps regulate blood sugar, metabolism and inflammation. Ideally, cortisol levels follow a circadian-type rhythm, with highest levels in the morning to help get you going and lowest levels at night. Stress can invert these levels. Other serious medical conditions, including Addison’s and Cushing’s diseases, also can lead to abnormal changes in cortisol levels.
Cortisol’s role in weight management is a big topic in integrative medicine, says Burkhart. “There’s increasing talk about a spectrum where you’re not in a disease state, like Addison’s, but your cortisol levels are a bit above normal or they’re peaking and dipping at the wrong time of day.”
Cortisol levels can be measured with a baseline cortisol level test (usually done at 8 in the morning) or a cortisol stimulation test (typically administered by an endocrinologist). The good news is cortisol levels can be improved, much like blood pressure, through exercise, meditation and other relaxation techniques.
Managing Your Weight on A Gluten-Free Diet
Celiac experts recommend consulting a skilled celiac dietitian at diagnosis, once or twice in the months following diagnosis, and then annually. But many newly diagnosed celiacs don’t see a dietitian that often—or at all. They end up navigating the gluten-free diet all on their own.
“One of our goals it to make sure celiac patients are maintaining or moving toward a healthy weight,” says Welstead.
Healthcare practitioners will first look at what their patients are eating, says Burkhart. They discuss calorie intake, reducing unhealthy processed foods and blood sugar regulation.
“We look at diet composition, especially those unhealthy carbs that lead to insulin (blood sugar) fluctuations that promote weight gain,” she says. After that, health practitioners will zero in on other contributors, including lack of exercise, disturbed sleep patterns and ongoing stress.
For help finding a dietitian skilled in celiac disease, visit Gluten Free Dietitian.
Christine Boyd, MPH, is Gluten Free & More’s health editor.