Gluten Free Choice Consulting

Is Gluten Sensitivity Part of Your Bladder Symptom Picture?

It’s a problem no one feels comfortable talking about—always running to the bathroom! Are you one of those people who know the location of every available loo on your daily commute? Are long staff meetings a nightmare? There may be good news in your future, as two recent studies and numerous anecdotal reports point to a frequent and overlooked cause of urinary symptoms such as frequency, urgency, and discomfort—untreated food sensitivities!

We’ve heard quite a bit about growing incidence of food sensitivities in the news lately, especially in children. But adults have food sensitivities, too, and they’re more often likely to be undiagnosed. According to the US Dept. of Agriculture, there are eight top food allergens, which include dairy products, eggs, fish and shellfish, soy, peanuts, tree nuts (like pecans and walnuts), and wheat. Consuming any of these foods, or food ingredients, can trigger an allergic reaction which induces the body to release inflammatory chemicals like histamine from mast cells. And, guess what? The bladder lining contains mast cells, too, and they are capable of releasing large amounts of histamine and other inflammatory substances, which can irritate the bladder and trigger uncomfortable symptoms.

Food allergies are not the only form of food sensitivities. Food allergies involve an immune-mediated response—your body produces antibodies to certain foods, and these antibodies help your body recognize and react to specific foods each and every time you ingest them. Other foods may simply be difficult to digest, or they tend to create inflammation in the body, which can worsen or trigger conditions like chronic pelvic pain and contribute to bladder symptoms.

Some of these inflammatory foods can include members of the nightshade family, such as tomatoes, eggplant, or red peppers. Sugar, whether from cane or sugar beets, is a common trigger of bladder spasms and urinary frequency. Sugar in these forms can also alter conditions of the bladder lining, making it more vulnerable to the microorganisms that cause urinary tract infections.

Let’s go back to wheat, one of the top eight allergens. It’s true that anyone can develop an allergy to wheat, but wheat is also the most plentiful source of a substance known as “gluten”. Gluten is a common name for a group of proteins found in wheat, barley, rye, and related grains, including spelt, triticale, and faro. Gluten is the substance that makes pizza dough stretchy and gives artisan breads their great texture. But in some people, gluten can cause toxicity and inflammation, and our body’s response to gluten can wreak havoc, causing neurological, gastrointestinal, and dermatological symptoms. Recently it has been shown that gluten sensitivity can and does cause symptoms in the urinary tract, including a syndrome, or group of associated symptoms, known as interstitial cystitis, or IC.

In IC, the feeling of nervous tension in the bladder, similar to the feeling you might have when trapped in a rush-hour commute after a sixteen-ounce espresso, is constant. You want to go, and you need to go NOW! Holding your urine in causes extreme tension, anxiety, and pain. For many people, having IC feels like having a bladder infection, one that never goes away. Over time, these sensations escalate and patients often develop pelvic floor tension, which further worsens their condition. Sleep becomes difficult. Bladder capacity can decrease due to the formation of scar tissue, and pain can become unbearable. In fact, those with IC can void extremely frequently—25 times per day or more!

Physicians often find IC difficult to diagnose and treat, but for patients, IC is a very difficult condition to bear. One of the difficult challenges for patients is the “hidden” nature of their condition. There are no outward physical clues to the turmoil taking place inside. Often, even close family members have a difficult time understanding how severe, constant, and overwhelming moderate-to-advanced IC symptoms can be. Until recently, it wasn’t known what “triggers” or provokes periods of worsening symptoms in some people. Experienced IC patients are usually careful to eliminate “extreme” foods like coffee, vinegar, soy sauce, and alcohol, in favor of bland, neutral, and non-acidic foods. Still, they often continue to suffer painful “flares”.

But there was a glimmer of hope from the small percentage of people who seemed to heal spontaneously through a holistic approach involving self-treatment, relaxation, stress reduction, and purposeful attention to diet. One of the food sensitivities mentioned frequently was gluten. Patients in support groups for disorders like IC and celiac disease, a hereditary, autoimmune form of gluten intolerance, self-reported that eliminating gluten helped resolve their bladder symptoms, and in many cases, it was the only “treatment” that made a significant difference.

Wendy Cohan, a registered nurse and IC patient from the Pacific Northwest, was one of the first health professionals to notice and suggest dietary exclusion of gluten in the treatment of IC. After writing several articles for IC and celiac websites, and trying unsuccessfully to interest the scientific community in developing a clinical study, she began writing a book about her experiences in 2008. Her book, The Better Bladder Book – A Holistic Approach to Healing Interstitial Cystitis & Chronic Pelvic Pain, was released in November, 2010. Coincidentally, since beginning her book, two small research studies have found a significant correlation between gluten sensitivity and bladder symptoms, especially in IC.

Below is an excerpt from The Better Bladder Book:

“In some people, chronic inflammation and accompanying irritation may indicate the existence of an autoimmune condition like celiac disease. CD and IC often occur together, as reported by participants in support groups for both diseases. These anecdotal stories may have inspired researchers to take a closer look at a possible association between these two disorders. I was extremely pleased to learn that one of the first clinical studies was recently conducted by Chris Smith, MD; Peter Lotze, MD; Chris Jayne, MD; David Goldfarb, MD; and Fred Emmite, RPh, through Texas Medical Center, Baylor College of Medicine, in Houston, Texas. Preliminary results indicate a strong association between celiac disease/gluten sensitivity and IC in all 39 subjects studied, and promising results in the subset of patients placed on a strict gluten-free diet.”

In a separate study based on a self-reported patient survey, the ICA found that 12% of IC patients reported being diagnosed with celiac disease in an online survey of 1,000 participants, supported by the ICA (Interstitial Cystitis Association) http://www.ichelp.org/Page.aspx?pid=450. But even if you don’t test positive for celiac disease, your bladder may still be sensitive when you consume gluten. Non-celiac gluten intolerance affects many more people with a variety of symptoms, but the bladder and or prostate seem particularly sensitive to gluten.  

If your IC isn’t getting any better on standard treatments, testing for food sensitivities should be a priority. Eliminating gluten from your diet isn’t difficult. In fact, following a gluten-free diet is less restrictive and easier to follow than the recommended “IC diet”.

Help is widely available through online sources, including www.glutenfreechoice.com, www.WellBladder.com, dozens of gluten-free cookbooks, and through support organizations like the NFCA (National Foundation for Celiac Awareness).

Copyright Dec. 29, 2010, Wendy L. Cohan, RN

GLUTEN INTOLERANCE HEAD TO TOE...

Gluten intolerance in the form of celiac disease (a hereditary autoimmune disorder) or non-celiac gluten sensitivity, may affect virtually any part of the body. In it’s involvement in multiple health disorders, gluten intolerance is a major driver of health care delivery and associated costs.  While this may seem to be an outrageous claim to make, a discussion of some of the many ways in which gluten intolerance can negatively affect the body can illustrate this point. So, let’s work our way down from the top…

Normal, healthy hair is usually glossy and thick.  An autoimmune disorder known as alopecia areata results in abnormal loss of hair, either in patches, or total body hair-loss, and is one of many autoimmune disorders associated with celiac disease. Malabsorption severe enough to cause malnutrition can also result in thin, sparse, fragile hair. One of the outward signs of hypothyroidism is thinning hair and a loss of the outer third of the eyebrow; hypothyroidism is strongly associated with celiac disease.

Now let’s look at the brain.  There are, unfortunately, a large number of neurological disorders associated with gluten intolerance and celiac disease, including narcolepsy, depression, panic disorders, ADD/ADHD, Autism Spectrum Disorders, and schizophrenia.

There are also movement and balance disorders associated with gluten intolerance, including ataxia - the inability to coordinate movements and balance (gluten ataxia, celiac ataxia, some cases of sporadic idiopathic ataxia). In some cases, when symptoms are severe, this disorder mimics other disorders such as Parkinson’s, Normal Pressure Hydrocephalus, and even Alzheimer’s disease.In addition, gluten is one of the five known food triggers for exacerbating the symptoms of MS.

Headaches are a very common symptom of wheat allergy, as well as gluten intolerance.  Migraines are common in those with celiac disease and gluten intolerance, as are sinus headaches.  These symptoms often decline dramatically after excluding gluten grains from the diet. Sinus problems are common in those with celiac disease, gluten intolerance, and sensitivity to dairy products as well, and are often reversible by making dietary changes. Some people with celiac disease seem to have an altered, highly acute sense of smell – for unknown reasons.

Night blindness associated with vitamin A deficiency is reversible when malabsorption is resolved and with the addition of a vitamin A supplement. Xeropthalmia, or chronic, often severe, dry eyes, is also related to severe vitamin A deficiency.  It is rare in developed countries, but can be found in some people with malnutrition due to celiac disease.

Apthous stomatitis is the name for the mouth ulcers associated with food allergies and intolerances, and is strongly associated with celiac disease and gluten intolerance. Even people who do not have gluten sensitivity get these once in a while but in those with gluten intolerance they are more frequent and especially long-lasting. Dental enamel defectsare also common. While they are usually identified in childhood, they can continue to cause problems throughout life, because they often lead to more frequent dental cavities. Halitosis, or bad breath, is a reflection of our internal environment and gastrointestinal health, and is often present in those with untreated celiac disease, gluten sensitivity, or gut dysbiosis – an upset in the balance of our internal microorganisms caused by poor diet, anti-biotic use, and other factors. And, another of the autoimmune disorders strongly associated with celiac disease, and one of the most prevalent is Sjogren’s syndrome, which impairs the normal production of body fluids like tears, saliva, and vaginal secretions. Insufficient saliva production can also lead to dental problems. 

Following the path our food takes to the stomach, we can look for effects in the esophagus too.  Eosinophilic esophagitis is a rarely encountered inflammation in the tissue of the esophagus which makes swallowing painful and difficult and can result in bleeding ulcerations.  When doctors do see it, they sometimes test for celiac disease, since there is a strong correlation.  Fortunately, if specifically associated with gluten intolerance, this painful chronic disorder can also benefit from a gluten free diet.

Now we’re getting to the area most people associate with gluten intolerance – the gastro-intestinal system. In the past, celiac disease was usually described as causing gas,  bloating, discomfort, cramping, and malabsorption. Diarrhea my be present, sometimes alternating with constipation. Sometimes non-specific abdominal pain is the only symptom described by patients, but it may be severe.  But as you’ve already seen above, there is a whole lot more to this disorder, and we’re only halfway to the toes.

In addition to the above symptoms, the body’s reaction to gluten can cause inflammation anywhere, but a common location is in the illeo-cecal junction and the cecum. This can sometimes be confused with appendicitis, or ovarian pain or an ovarian cyst in women experiencing right-sided lower abdominal discomfort.  Irritable bowel syndrome is suspected to affect at least 10-15% of adults (estimates vary). It is differentiated from IBD, or inflammatory bowel disorders (which include Crohn’s disease and ulcerative colitis). But, taken together, there are an awful lot of people out there with uncomfortable gut issues.  One fact to consider is that many of those with celiac disease were previously, and wrongly, misdiagnosed with IBS before discovering they actually had celiac disease.

Let’s take a look at the urological system.  Even though gluten from the food we eat isn’t directly processed here, can it still be affected?  The answer is yes. Kidney problems in association with celiac disease are well documented, including oxalate kidney stones. Bladder problems are increasingly shown to be responsive to a gluten-free diet. This is kind of my specialty and I would estimate that at least a quarter of those with interstitial cystitis, and many people with recurrent urinary tract infections, have a sensitivity to gluten. Even prostate inflammation in some men can be triggered by eating gluten grains.

Sitting just atop the kidneys are our adrenal glands.  They have a difficult job, helping our bodies respond to stress, helping modulate our immune system and our hormone output, and controlling inflammation in the body. Every time we experience a reaction to gluten, and our adrenals respond by sending out a surge of cortisol to help control inflammation, we are depleting our adrenal reserve.  When this happens chronically, over time, our adrenal system cannot keep up and becomes fatigued.  Symptoms of adrenal fatigue have far-reaching consequences throughout the body, including, of course, feeling fatigued and run down. But, adrenal fatigue can also affect our hormones, our blood sugar regulation, our mental acuity, our temperature regulation, and our ability to cope with food allergies, environmental allergies, and infections.

There is another important reason for fatigue that is very common in celiac disease.  In fact, it's often the most common presenting symptom in women seeking treatment that can lead to a celiac diagnosis - iron deficiency anemia. Other blood disorders can be present in celiac disease.  These may be attributable to the autoimmune response.  ITP or Idopathic Thrombocytopenia is one.  It's a deficiency in platelet production.  Platelets are responsible for helping with normal blood clotting. A deficiency of Vitamin K, one of the fat-soluble vitamins often affected by malabsorption and other factors, is also important to blood clotting.

Easy bruising and bleeding may be a sign of either  a deficiency of Vitamin K, or an autoimmune platelet disorder, although it is a common symptom and may be related to other factors.

Can the liver, the body’s largest internal organ, be affected by gluten intolerance too?  One example is autoimmune hepatitis, in which can be untreated celiac disease can be found in large numbers. Early screening testing for celiac disease is now strongly recommended for patients diagnosed with autoimmune hepatitis.

The pancreas, which is key in blood sugar regulation, is highly affected by gluten intolerance.  Autoimmune disease triggers the development of Type I DM, and is becoming more closely associated with celiac disease, and it's rise in incidence among children both in Europe and the US parallels the rise in celiac disease.  Testing for celiac disease is now becoming a routine part of examination when a child develops Type I DM, and now that physicians are looking for celiac disease in juvenile diabetes, they’re finding it with greater frequency. Blood sugar regulation problems are also associated with non-diabetes hypoglycemia in those affected by gluten intolerance and appear to resolve with a low-glycemic gluten free diet.

So, we’ve covered most of the body’s major internal systems. Now, let’s look at the extremities, our upper and lower limbs, where gluten-associated problems are also found. Ehlers-Danlos Syndrome, a collagen disorder resulting in shoulder, elbow, and wrist joints that dislocate easily (and other characteristics) is a genetic disorder that may also be associated with celiac disease.  I had mild symptoms of this disorder as a child, but never knew it had a name until I ran across it recently.  With a child who has this disorder, a simple game of swinging a child by the arms, or swinging a child between two sets of their parent’s arms, can result in a trip to the emergency to put their joints back into proper alignment. This is not to say that a reaction to gluten causes this genetic disorder, but that if you have a personal or family history of Ehlers-Danlos Syndrome, and symptoms that may be related to celiac disease, you should consider being tested.

Rheumatoid arthritis is another of the autoimmune disorders associated with celiac disease. This disease  often affects the fingers with crippling joint deformation, and other joints in the body can also be affected. Scleroderma is another terribly disfiguring and sometimes fatal autoimmune disorder affecting every part of the body. It is often first identified in the extremities, particularly the fingers. In scleroderma, normal tissue loses it’s flexibility as the body’s autoimmune response produces inflammation and an overproduction of collagen.  Collagen is the tough fibrous protein that helps form connective tissues including tendons, bones, and ligaments. Excess collagen is deposited in the skin and body organs, eventually causing loss of function.  Scleroderma can be associated with celiac disease.

The arms and legs are also common spots for yet another autoimmune disorder, psoriasis, to develop.  Some patients with psoriasis are responsive to a gluten-free diet, but unfortunately, not everyone. Another skin condition that often shows up on the arms is dermatitis herpetiformis (DH), although this itchy blistering skin rash can occur in other places as well.  Common sites are the backs of the elbows and the backs of the knees, or on the lower legs.

Peripheral neuropathy is a disorder that results in numbness, tingling, and sometimes severe nerve pain in the extremities.  Finger, hands, toes, feet, and lower legs may all be affected. Although usually associated with diabetes, peripheral neuropathy shows up fairly frequently in those with celiac disease, and is fortunately often reversible on a gluten free diet supplemented by B-vitamins and the amino acid L-Carnitine.  Peripheral neuropathy is usually associated with older people, yet some of the cases I’ve observed recently have been in very young children who had severe malabsorption issues.  Fortunately they healed quickly and their neuropathy symptoms resolved completely.

There a few last symptoms related to malabsorption that tend to show up in those with celiac disease or gluten intolerance.  Rickets, or osteomalacia – a softening of the bones in the legs related to vitamin D deficiency – is one. Osteoporosis, or an actual loss or breakdown of bone, is another.  This is a very important sign in women, especially when occuring before menopause. And any child with a frequency in broken bones should be examined for osteoporosis, as osteoporosis in childhood is closely associated with malabsorption from celiac disease.

Inflammation goes along with celiac disease and gluten intolerance and can affect any part of the body, but a common site for inflammation is the lower extremities.  Sometimes this can be profound, and trigger doctors to think heart disease, however, if it's associated with celiac disease or gluten intolerance, this type of inflammation is often unresponsive to Lasix and other diuretics. Lower extremity edema associated with gluten intolerance is often responsive to a gluten-free diet.

As for me, I’ll be happy to be gluten-free, from head to toe.

NEW BOOK REVIEW 

Gluten Toxicity – The Mysterious Symptoms of Celiac Disease, Dermatitis Herpetiformis, and Non-Celiac Gluten Intolerance - Shelly Stuart RN

By Wendy Cohan, RN

After reading this new book by celiac nurse specialist Shelly Stuart, RN, what shines through above all is her true understanding of the complex nature of gluten-related illnesses, and her heartfelt compassion for patients who suffer from them. Her book is extremely well researched and documented. As a registered nurse and celiac herself,  Ms. Stuart is able to use her strong patient teaching experience to clearly educate the reader about even very complicated subjects. She provides excellent explanations of leaky gut and the pathophysiology of celiac disease, and she is one of the first clinicians to write in-depth about non-celiac gluten intolerance.  Importantly, she makes the point that immune mediated reactions can and do occur in non-celiac gluten intolerance, and backs this up by citing clinical evidence. Another important point made concerns pancreatic insufficiency, which can accompany celiac disease, but few know that this condition can persist even after diagnosis and transition to a gluten-free diet. Her discussion of the many, varied health disorders associated with celiac disease is very comprehensive.

One of the most compelling aspects to Gluten Toxicity is the many important questions asked regarding the future of clinical research. Ms. Stuart makes it crystal clear that we need to know much more about the physical and mental health effects of gluten-related illness. This can only come about by increasing awareness both within the medical and research communities, and throughout each of our communities. We must all become advocates for greater testing and more accurate diagnosis.

Shelly’s personal story, woven throughout the book, adds interest and a personal appeal, but never attempts to substitute anecdote for the hard science she relies on throughout the book. In fact, at first glance, the book seemed rather technical to me, and I thought it would be best-suited for clinicians, but after reading through to the end, I changed my mind. This is an excellent resource, offering really insightful and accurate explanations for anyone suffering from or attempting to treat gluten related illness. Some of you may be familiar with Cleo Libonati, RN, and the book Recognizing Celiac Disease, which was one of the first books to comprehensively make connections between a vast array of medical conditions and celiac disease, and back them up with clinical research citations. Shelly Stuart’s book goes quite a bit farther, to discuss the pathophysiology, symptoms, and diagnosis of a huge number of health conditions associated with celiac disease and also non-celiac gluten intolerance.  Thank you, Shelly Stuart, for this great, new resource for the gluten-free world.

Just Say No to Beano

In the past five years of working with patients dealing with celiac disease and gluten intolerance, I have honed my detective skills in ferreting out hidden sources of gluten. It is repeatedly reinforced that persistent exposure to gluten mostly comes from two sources: cross-contamination, and very small amounts of gluten in products that people use often, but don’t necessarily think of as “food”.  This includes, not surprisingly, beverages like smoothies, but also breath mints, prescription drugs, supplements, and, believe it or not, Beano, an over-the-counter digestive aid. Beano is a product that is designed to help people reduce symptoms of gas and bloating following the ingestion of foods like legumes and cruciferous vegetables. People with celiac disease are more likely to suffer digestive issues, especially in the early stages of transitioning to a gluten-free diet, and surprisingly often, they turn to a product like Beano for help. Imagine their surprise when I tell them that this may be the source of their inadvertent gluten ingestion!

Unfortunately, this common over the counter aid, designed for people with unhappy digestion, contains three of the top eight food allergens: wheat, fish, and shellfish! So, for celiacs, those with gluten intolerance, and those with sensitivities to fish or shellfish, Beano is a pretty big No-No. I say this based on the experience of my clients, although the manufacturer’s website states,

“[t]he smallest amount of gluten that can be chemically detected in a product is 0.00016 percent. Results of our testing have shown that Beano contains less than 0.00016 percent gluten. Although the amount of gluten in Beano is less than the limit of detection, we would recommend that individuals who have concerns about the use of Beano speak with their physician.” (Note: they do not state equivalencies in parts per million (ppm).)

The good news is that alternatives aren’t hard to find. Peppermint oil or peppermint tea helps with gas, fennel seed or chamomile teas helps calm colicky spasms in the gut, and ginger, in almost any form, is a well-known digestive aid. A small amount of baking soda in water helps to relieve an acid stomach, while others swear by a daily dose of apple cider vinegar.

Other suggestions include eating smaller amounts of food more frequently, avoiding fried foods,  making sure you’re getting adequate amounts of good probiotics in your diet or as supplements, and  getting at least some moderate exercise every day. Exercising regularly helps to avoid constipation, which can cause uncomfortable symptoms of gas and bloating. And it’s also important to avoid the habit of lying down immediately after eating.

Copyright Wendy L. Cohan, 1/25/11

Thyroid Disease linked to Celiac Disease in Recent Studies

The Journal of Clinical Endocrinology and Metabolism published the results last month of a Swedish study on the risks people with Celiac Disease face in developing thyroid disease.  We have known of the link between Hashimoto's Thyroiditis from previous Italian studies, and now the Swedish epidemiological study shows that the diagnosis of hypothyroidism is found four times as often in celiacs as compared to non-celiacs.  The diagnosis of Hyperthyroidism has a similarly increased risk.  When looking at data for those with hypothroidism, hyperthyroidism and thyroiditis, researchers found greatly increased rates of Celiac Disease than in the general population.  According to Cleo Libonati's book, "Recognizing Celiac Disease", throid function can normalize on a gluten free diet if detected early enough, sometimes in as little as six months.  Persons with symptoms or diagnoses of Grave's Disease, Hashimoto's Thyroiditis or Autoimmune Thyroiditis should be screened for Celiac Disease. Some practitioners are finding an increased rate of thyroid disease in young women in recent years.  Roughly one quarter of my clients and cooking class attendees (mostly female) had thyroid disease at the time of their diagnosis with Celiac Disease.

WLC, 12/2/08

Gluten Intolerance & Bladder Sensitivity

This article can be accessed clicking on the title above.  This is a very popular article, and the feedback has been over-whelming.  If you know anyone with chronic bladder issues, please encourage them to read this article.  Published September, 2008.

Link to my site on Bladder Health

www.WellBladder.com                              

"Thank you so much for this informative article.  I've spent the last month with a urologist testing me to figure our what was wrong.  The first thing I asked him was if there is any relation to my Celiac Disease, "of course not!"  I have piece of mind again!  Thank you!"

M. Terrill

Genito-Urinary Problems in Children and Food Allergy

For an informative look at the link between children's genito-urinary issues (such as bedwetting, recurrent cystitis, vaginitis), go to this article on Alpha Online:

www.nutramed.com/children/children_bladder_kidneys.htm

link to my site on Bladder Health

www.WellBladder.com

Eating Disorder or Celiac Disease?

What if a high-achieving young woman you care about, maybe a high school or college student, claims to have no appetite? She’s way too thin, but she says she’s not hungry, and you know she's vomiting after meals. In fact, she is showing some of the typical signs of an eating disorderanorexia nervosa or bulimia. Would you think that maybe she has an eating disorder, or celiac disease... or both? such as

At a college in Florida, the coaches were faced with just this problem. During a preseason conditioning program, one of their elite athletes, a National Collegiate Athletics Association Division I female volleyball player, began to lose a lot weight. She lost her appetite and was having diarrhea and vomiting. She became very tired. She fell asleep at meals, in the team van or bus, and before and during practices in which she was not participating. Her athletic performance suffered. She also struggled with fatigue during her classes and began to beg off from social engagements.

Because this athlete was under a lot of pressure from her coach, her teammates, and herself to improve her skills, the training staff believed that she might be trying to increase her fitness and performance beyond normal expectations, and that she had developed an eating disorder as an escape from the pressure and an attempt to meet these expectations. In fact, athletes have a higher rate of eating disorders than the general public.

But guess what? She didn’t have anorexia nervosa or bulimia – she had celiac disease. Luckily for her, the coaches sent her to a gastroenterologist, who quickly recognized her celiac disease. After she began following a gluten-free diet, her appetite improved, she gained weight, and she rejoined the volleyball team. According to her coaches and teammates, her athletic performance improved and even exceeded that of her pre-illness status.

As it turned out, this girl did not have an eating disorder -- but celiac disease and eating disorders can co-exist in the same individual more often than people realize. Dr. Daniel Leffler and colleagues from The Celiac Center at Beth Israel-Deaconess Medical Center in Boston published a report on this topic. Over a 5-year period, 2.3% of the female patients they treated either had celiac disease and an eating disorder, or they had celiac disease that was masquerading as an eating disorder.

The Boston doctors described 10 such patients in detail. In only one patient did recognizing and treating the celiac disease lead to outright improvement in the eating disorder. In others, the restrictions of the gluten-free diet made it difficult (but not impossible) for doctors to treat the eating disorder. For some patients, finding out that they had celiac disease and gaining weight on the gluten-free diet caused their eating disorder to worsen. And finally, it turned out that one patient didn’t have any eating disorder at all – her weight loss and poor appetite were due only to celiac disease.

Thus, in most of the patients, there were important interactions between their celiac disease and their eating disorder. In the small group of patients that Dr. Leffler and his colleagues reported on, 80% were able to achieve or maintain remission from their celiac disease and their eating disorder.

The bottom line? Celiac disease and eating disorders can sometimes be difficult to distinguish. Patients with either or both conditions need to be evaluated from a variety of perspectives: primary care, gastroenterology, nutrition, and psychiatry/psychology. That’s the only way to make sure the individual is not suffering from complicated interactions between physical and mental health problems.

_Sources:

_{Lindsey E Eberman and Michelle A Cleary. Celiac Disease in an Elite Female Collegiate Volleyball Athlete: A Case Report. Journal of Athletic Training 2005 Oct–Dec; 40(4): 360–364.}

_{Leffler DA et al. The interaction between eating disorders and celiac disease: an exploration of 10 cases. European Journal of Gastroenterology & Hepatology 2007;19:251-255.}