Gluten-free is a new dietary trend that has emerged over the past several years. In individuals who struggle with eating disorders, the concern is whether they may actually have celiac disease or these individuals are self diagnosing as a way to restrict intake of food.
Celiac disease is defined by the National Institutes of Health as a condition that damages the lining of the small intestine and prevents proper absorption of nutrients that are important for staying healthy. The damage is due to an autoimmune reaction to eating gluten. The cause of celiac disease remains unknown at this time.
Gluten (a protein) is found in wheat, barley and rye. Avoiding these three foods can be a challenge when shopping for food. These products are found in the vast majority of items in the grocery store and even in some makeup products and medications. For individuals with an eating disorder, this can be an easy way to restrict or exclude many foods from their diet. One way to check if this is a method of restriction is to offer gluten free alternatives to see if the individual in question will consume these foods. Individuals with celiac disease tend to be well informed of gluten free alternatives and seek out a nutritionally balanced diet that provides efficient energy.
When an individual with an eating disorder begins the re-feeding process, he or she will likely experience gastrointestinal symptoms such as bloating, abdominal pain, diarrhea, or constipation. These symptoms are similar to those seen in individuals with celiac disease or gluten sensitivity, making it difficult sometimes to determine the true cause of the GI upset – is it because of reintroduction of food in a person with severe restriction? Or is it something more?
It is very important to consult with your medical doctor prior to self diagnosing or starting your own personal treatment plan such as excluding gluten from your diet completely. The Academy of Nutrition and Dietetics recommends the following tests to diagnose celiac disease:
Serologic tests—including immunoglobulin A (IgA), antihuman tissue transglutaminase, and IgA endomysial antibody immunofluorescence—are currently used to screen patients for celiac disease. These tests reportedly have high sensitivities and specificities and are presently considered the best available in terms of diagnostic accuracy. Biopsy of the small intestine remains the gold standard for diagnosing celiac disease. Several biopsy specimens should be taken because mucosal abnormalities may be localized. Tests for genetic markers also are available to help determine the likelihood a person has celiac disease. Almost all persons with celiac disease have the DQ2 and/or DQ8 marker as compared with 40% of the general population. If a person does not have the DQ2 or DQ8 marker, it is unlikely they have celiac disease.
At this time, there is not a proven test to check for gluten intolerance. It is very important to work with a medical doctor who specializes in gastrointestinal issues (a gastroenterologist) to find the source of your discomfort. IgA testing will be used at times by some medical doctors to check for intolerance, however this is not a common practice.
At Inner Door Center®, we will accommodate clients in our eating disorder programs who have been diagnosed with celiac disease by providing gluten free alternatives. We recommend that all of our clients that believe they have a gluten sensitivity/intolerance or celiac meet with our medical doctor to determine the true cause of their GI upset.
Overall, it is very important that individuals with celiac disease, especially those suffering from an eating disorder, consult with a Registered Dietitian to ensure that they receive a nutritionally balanced diet that is efficient in energy.
If you or a loved one is dealing with an eating disorder, or if you have been diagnosed with celiac and need to consult with a Registered Dietitian, please call Inner Door Center® at (248) 336-2868 to find out more about our programs.