Exploring The Complicated Relationship Between Anorexia and Celiac Disease

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Celiac disease is a genetic autoimmune disorder characterized by an intolerance to gluten, a component of wheat, barley, and rye. According to a new study, the disorder is also linked to a heightened risk for being diagnosed with anorexia.

The researchers from the University of Colorado in Aurora believe the relationship due to a number of factors, but say the risk for developing the eating disorder was present both before and after being diagnosed with celiac.

“Before this study, there have been published a few small `case reports’ of patients with celiac disease developing eating disturbances after their celiac disease diagnosis,” said lead study author Dr. Karl Marild, a researcher at the University of Colorado in Aurora.

“This, however, is the first large study to show an association between celiac disease and anorexia nervosa,” Marild told Reuters via email.

As the team explains in the journal Pediatrics, they do not believe the results indicate celiac disease directly causes anorexia. However, several factors potentially make those with celiac more susceptible to an eating disorder. In fact, many experts on celiac disease and digestive health say they are not surprised by the finding.

“I think a lot of us are aware there is a possibility of [celiac] patients developing an eating disorder,” Dr. Hilary Jericho explained to WebMD. Jericho is an assistant professor of pediatrics at the University of Chicago’s School of Medicine specializing in treating celiac disease.

Jericho notes that those with celiac disease must follow a strict diet and that some patients may take those eating restrictions “too far.” Dr. Neville Golden, who wrote an editorial accompanying the study, agrees this is a possibility. However, he also suggests the relationship between celiac and anorexia is more complicated.

Golden believes many women with celiac may be initially misdiagnosed with anorexia.

The two disorders don’t seem innately similar at first glance, but they share a number of symptoms such as weight loss, fatigue, abdominal bloating, and even poor growth or delayed puberty in children.

“Diagnosing anorexia is not always easy,” Golden said. Golden is chief of adolescent medicine at Stanford University School of Medicine.

For the study, the team looked at records collected from Swedish citizens from 1987 through 2009 – including almost 18,000 Swedish women diagnosed with celiac disease and 89,000 women of the approximate same age without the autoimmune disorder.

Notably, the majority of those with celiac disease had no diagnosis of anorexia in their lifetime. However, they faced a significantly higher risk overall compared to those without the disease.

Overall, women with celiac were twice as likely to later be diagnosed with anorexia. They also showed higher rates of being diagnosed with anorexia before their celiac disease was identified.

The strongest relationship between women with celiac disease and an anorexia diagnosis was among women diagnosed with celiac disease before the age of 19. This group was almost 5 times more likely to have been previously diagnosed with anorexia.

Golden suggests, “that implies an initial misdiagnosis.”

As if matters weren’t complicated enough, Jericho observes that celiac disease has only recently become widely recognized.

“There’s much more awareness of it now, and doctors are more likely to think of it,” Jericho said.

The relationship between celiac disease and anorexia is concerning and calls for more research, but it is important to remember having one condition does not automatically mean you also have the other. For now, Jericho suggests that celiac patients (or their family) who believe their dietary restrictions are leading to unhealthy eating behaviors should consult their doctor.

If you think you or someone you know may be living with an eating disorder, call us at (888) 298-4673. We can answer any questions you have and see if treatment is right for you.

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