Tag Archives: weight loss

Why do we get celiac disease?

I know why I got celiac disease. Do you?

We all have our special origin stories when it comes to why we are the way we are. Humans love to reach back through the strands of our past and attempt to reweave them retrospectively into a narrative we can understand. “X happened, and Y happened, and Z happened” isn’t an appealing way to view our life story: it’s disorganized and random. “X happened, and therefore Y happened, and it all came to a head with Z” is neater and much more satisfying.

So, I know why I have celiac—or, at least, I like to believe I do. I’ve taken all my precious, faulty memories and molded them into a story that makes sense.

My Theory

It’s simple enough: I was born with the celiac gene and lived happily in my glutenous environment, eating whatever I darn well pleased, without so much as a twinge from my cast-iron stomach. Then, I lost sixty pounds in a year, messing with my gut bacteria in ways not even scientists understand. Immediately after I stopped losing and started maintaining, I got sick. Eventually, I learned it was celiac.

To me, the timing is too coincidental to be coincidence. Thus, with no hard evidence whatsoever, I’m convinced: I wreaked havoc on my body’s bacteria, then I gave them some gluten and ruined everything—all in pursuit of thinness. (How many pounds my body has reacquired in revenge is not an important part of the story.)

“But Molly,” you may protest, “I’m a naturally svelte god/goddess who has never actively tried to lose a pound in my life, yet I too have celiac disease. How can this be?”

If that’s so, then after mumbling something less polite, I would thank you for the insightful question, because it leads nicely into the second half of my post.

The Pie Theory

One of the best parts of the recent Columbia conference was Dr. Benjamin Lebwohl’s discussion of causal pies. This is a yummier name for a fundamental principle of epidemiology known as “the sufficient-cause model.” According to it, multiple risk factors for a disease come together in one person, like pieces of a pie. Once the sufficient factors (or ingredients) are there, the person gets the disease.

However, more than one set of ingredients can be combined to make a pie (as any gluten-free baker who has ever had to choose between all-purpose blends knows all too well). Similarly, most diseases have more than one sufficient cause; there’s more than one way to develop them.

For celiac disease to develop, two pieces of the pie must be there: genes (HLA DQ2 or DQ8), and gluten. But by themselves, they’re insufficient cause; almost a third of the US population has the gene and eats gluten, but most of them don’t have celiac. (There could be other universally necessary causes, but no one’s found them yet.) The rest of the pie needs to be filled in, perhaps completely differently for you and for me, with other causes.

causal-pies The other pieces might include:

  • early OR late gluten introduction by parents (which I have complained about before)
  • spring or summer birthday (because you probably started eating gluten in the winter, when infections were going around)
  • microbiotic dysbiosis (messed-up gut bacteria)
  • antibiotic usage (possibly insofar as it contributes to the above)
  • GMOs (but I doubt it. As Dr. Alessio Fasano pointed out, “There are no GMOs in Europe, but we still have celiac disease!”)
  • leaky gut (which Dr. Fasano talks up in his new book, Gluten Freedom)
  • headache medication (possibly because it makes your gut leak; the aspirin-based ones I regularly overused in high school before discovering caffeine are not included here)
  • other autoimmune diseases (though they may in fact be consequences of the same factors as celiac—pies rather than pieces)
  • excessive hygiene (which I’ve joked about before)
  • and so on.

Why all the theories?

It’s important to determine causes of celiac disease not only because humans hunger for coherent life stories, but also because discovering causes could help us prevent, treat, or even cure future cases. This is particularly crucial because celiac disease is increasing in prevalence.

Plus, differently constructed pies may require different treatments. The baking metaphor breaks down a bit here, but we know that some people take longer to heal than others, and that some people must adopt additional measures beyond the gluten-free diet to get well, while others get cross-contaminated regularly with no consequences. Maybe that’s because their identical disease has different causes.

Why do we get celiac disease? (It's all because of pie.)

Original photo of a probably glutenous lemon pie © speedbug | Flickr

Dr. Lebwohl did not make any jokes about a) the gluten content of causal pies, or b) celiac disease being “easy as pie” to develop, so please consider those bad jokes my contribution to the scientific conversation.

Now, it’s your turn to contribute: Why do you think you got celiac disease, or another GRD? Do you have a pet theory about why they are increasing in prevalence?

This is the latest installment in my Sprue/False series of simple but difficult-to-answer questions about celiac disease. (See also Is a Gluten-Free Diet Good Enough? and More on Drugs.) By the way, although “Why do we get other gluten-related disorders?” is a great question too, I focused on celiac because, unfortunately, we’re even farther from answers when it comes to other GRDs.

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Are Food Allergies the New Eating Disorders? Cosmo tells all.

Yesterday, I bought my first (and quite possibly last) copy of Cosmopolitan ever. The February 2014 issue boasts a flashy pink cover, “85 ways to get your dream hair,” and a 4-step “bikini body plan.” Good stuff.

But what really interested me was this:

I’d heard about the article the night before (thanks to Anna Luke, @Gfreegimme3), and I opened to page 182 ready to hate it. 

I wasn’t totally disappointed.

The piece, by freelance health writer Jessica Girdwain, makes the case that some people use allergies as an excuse to eat less, and so control their weight. It urges readers to determine whether they’re truly allergic or intolerant to a food, or in fact struggling with disordered eating.

[Edit: You can now read the entire story online here, so you don’t have to spend the four bucks. No, I don’t know why it’s categorized under “Party Ideas & Tips.”]

The story bugs me in several ways. It:

  1. Features a truly repulsive visual of a lipsticked, nail-painted hottie sensuously devouring what looks like an entire naked pizza crust. It also prints the phrase “eating disorders” in the title with a backwards S and a couple misaligned letters. Like, get it? It’s disordered. Cute!
  2. Muddies the waters about celiac disease: Girdwain calls celiac “an extreme form of gluten intolerance,” then states that “with an intolerance, you may be able to eat dairy, gluten, sugar, or eggs in limited amounts . . . And you may be able to reintroduce the food into your diet in the future.”
        Girdwain and her editors might know that people with celiac can’t eat even small amounts of gluten ever again, but Cosmo’s 78 million readers worldwide may not. The way this article is worded, they still won’t.
        Note: The world’s leading experts on celiac disease now agree that the umbrella term gluten intolerance “carries inherent weaknesses and contradictions” and should be ditched in favor of gluten-related disorders. So let’s start. (I’ll abbreviate it to GRDs for the rest of this post.)
  3. Completely ignores the existence of male eating disorders. Then again, it is a women’s magazine. In its pages, men are merely gods who demand satisfaction by the ritual sacrifice of female dignity.
  4. Appears opposite an ad for Hydroxycut: Really, Cosmo? You’re going to lecture us to avoid restrictive diets, then sell us a weight loss supplement? That’s . . . well, that’s exactly what I’d expect.

Still, the article gets some things right. Girdwain recognizes that food allergies and intolerances are real and are serious. Her primary example is a woman who gets her doctor’s approval to go gluten-free, then spirals into orthorexia (an unhealthy obsession with eating only “healthy” foods).

It’s a realistic story, but the argument it illustrates is guaranteed to get eyerolls from the food allergy and gluten-free community. Many of us struggle to have our needs taken seriously, precisely because we’re perceived as fad dieters or disordered eaters.

There is a connection, though.

Looking into it, I found there are many links between eating disorders and food allergies, intolerances, and GRDs. For example:

  • Celiac disease can be misdiagnosed as an eating disorder.
  • Made-up or perceived allergies can mask or exacerbate an eating disorder.
  • A person with celiac disease can develop an eating disorder.
  • A person with an eating disorder can develop food intolerances.

About 1% of the population has celiac disease, and up to 1 in 13 kids has one or more food allergy. Similarly, data from the National Association of Anorexia Nervosa and Associated Disorders (ANAD) suggests that about 8% of Americans have an eating disorder. With so many people affected by these conditions, there’s bound to be some crossover.

But there’s more than just coincidental crossover.

Run a Google Scholar search on, say, “celiac disease and anorexia,” and you’ll find that the two often go hand in hand. The University of Chicago Celiac Disease Center even includes the disorder on its list of celiac disease symptoms.

The association may be because:

  • Sticking to “food rules” or diets can lead to obsessing over food, restricting intake, and/or binge eating.
  • Associating food with suffering can encourage eating less.
  • Social and familial issues related to health issues can spur an eating disorder.

If you think about it, a gluten-free (or dairy-free, nut-free, soy-free, and so on) diet is disordered eating. It’s highly restrictive; it encourages religious avoidance of minute quantities of certain foods; it brings fear and anxiety to the dinner table; it drives a wedge between you and those with whom you dine. Sure, for us, it’s the healthiest option, but that doesn’t make it entirely healthy.

Someone already “on the spectrum” of restricting and binging could easily slip, once allergies and GRDs (real or fictional) get involved. And (according to the ANAD) 7 to 9% of people who go on any kind of diet eventually develop a partial or full-blown eating disorder. Small wonder, then, that embarking on an ultra-restrictive diet for health reasons might point people down that path.

Getting personal . . .

In my experience, disordered eating and celiac disease are intimately linked. Though I don’t have an eating disorder (and don’t want to co-opt the term), I’ve got my own share of food issues. When I was diagnosed with celiac disease myself, one of my first and nastiest thoughts was, “Yes! A new, valid excuse to refuse food when it’s offered to me. Maybe I’ll lose weight!”

Sure, I didn’t actually need to lose weight, I knew that more people who go gluten-free gain weight than lose it, and I had more important things to think about—like my health, and what to do about my kitchen. But still, I thought it.

I wrote about this more when the topic came up at Gluten Dude almost a year ago (the firebombs thing was a joke), and I’m sure I’ll write about it again. For now, I’ll conclude, with some surprise, that . . .

I agree. With Cosmo. Do you?

Some women (and men) do rely on excuses to avoid food, consciously or unconsciously; and the actual rise in food allergies and GRDs lends the “fakers” more credence. And people with legitimate reasons to avoid foods sometimes take it too far.

Cosmopolitan February 2014 issue

Oh, Cosmo.

To be honest, I find it refreshing that a magazine like Cosmo would include an article warning against restricting foods to lose weight. Of course, the very next spread is an “I Dream of Bikini” workout, and the women pictured in the issue are the very Photoshopped, personally trained waifs we’re all killing ourselves to imitate. But what’s a little hypocrisy among friends?

The article, with all its flaws, spotlights a real issue, albeit an uncomfortable one. I’m interested to see how others in the community respond, and I’d especially love to hear YOUR thoughts.

Have you read the article? What did you think? Do you have thoughts or personal experience you’re comfortable sharing about the GRD/allergy and eating disorder connection, or the blurry lines between them?

Sources (I accessed the full texts through my alumni network, so you may just have to trust me):Anorexia Nervosa and Celiac Disease: Two Case Reports,” “Eating disorders and celiac disease: a case report,” “Coeliac disease and eating disorders – forgotten comorbidities?

Other reading on this topic: “Eating Disorder or Celiac Disease?…Or Both?” on About.com, Carrots and (Candy) Stick‘s response to the Cosmo articleLiving Without‘s 2012 article, “Celiac Disease and Eating Disorders”

Thanks for reading! If you stuck through to the end, double thanks! When me and my dream hair and bikini bod are lounging on the beach this summer, I’ll think of you.

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Turns out Dunkin’ Donuts ain’t no fool

Looks like the top donut dunkers at a certain nationwide pastry shop got word of my April Fools post and decided to make it a reality. Thanks to my friend Jessica for tipping me off to the Bloomberg article saying so.

mall-334-e1359140947345According to the article, Dunkin’ Donuts “will sell gluten-free cinnamon-sugar doughnuts and blueberry muffins across its U.S. stores this year.” That’s confirmed by real spokespeople at the company, and it beats my prediction of a 2015 nationwide rollout by two years. Not too shabby. (Given my stellar forecasting abilities, I hope that all you GF Cancers are getting ready to heed my predictions when I roll ’em out in a few days. I promise to have everything right, give or take two years.)

No word yet about going all gluten-free by 2020, but I’ll keep my fingers crossed if you keep yours.

I’m excited that there will be more opportunities for all of us to try a Dunkin’ Donuts GF treat very soon, and it’s nice to see our “needs” being recognized by such a large industry player. By the way, the Bloomberg article claims Dunkin’ Donuts will have “the fast-food industry’s first gluten-free pastries nationwide,” which I imagine might have Au Bon Pain a little annoyed, considering that they partnered up with GG’s Original back in 2012 and have been serving gluten-free congo bars and other goodies since then. (Then again, Au Bon Pain may not be quite “fast food,” and congo bars may not be quite “pastries.” Webster tells me pastries are “sweet baked goods made of dough having a high fat content”…but what does that mean? Discuss).

Whoever came first, it seems other national chains may soon follow their lead. Stay tuned. My crystal ball tells me Starbucks is next.

Alongside breaking the good news and highlighting the recent rise in demand for gluten-free products, the Bloomberg article also quotes some buzzkills who point out the false health halo surrounding gluten-free goods. If you happen to have stumbled across this post in search of a miracle weight loss trick, I must warn you that donuts—gluten-free or otherwise—probably aren’t it. (And, at 350 calories and 36 grams of sugar, neither are congo bars.)

Gluten-free Cronuts, on the other hand…those will take inches off your waistline in seconds. Just as soon as someone gets around to developing some.

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Gluten-free runs on Dunkin

Have you heard the news about Dunkin Donuts? Apparently their introduction of gluten-free treats in select Massachusetts and Florida stores was so successful that the stores couldn’t keep them in stock. From what I’ve heard, the two varieties they introduced went over very well, and many people in the celiac community appreciated Dunkin’s cheeky disclaimer, “Still really unhealthy.” Didn’t stop folks from snapping ’em up like hot cakes, but it’s nice to see a chain bucking the trendy “go gluten-free, lose weight” angle.

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Did you have a chance to try one? I intended to on my last visit to Boston, but I didn’t manage to get to one of the few stores that carried them.

Turns out, it doesn’t matter much, because the success was so great that DD is rolling out gluten-free options nationwide. By 2015, all of their ~7,000 stores in the US will carry gluten-free options, and not just the cinnamon sugar donut and blueberry muffin they started out with but also other flavors currently being developed.

ht_gluten_free_dd_jp_121231_wblogThe spokesperson said people reported liking the gluten-free pastries better than the usual goodies on offer (perhaps, I’d wager, because they were shrinkwrapped rather than left out to get stale). He even confirmed there was talk of making all their products gluten-free by 2020, which would make Dunkin Donuts the first large mainstream franchise to go 100% gluten-free. This will be amazing for our community, both in terms of awareness and in terms of available donuts.

To be honest, I’ve never been much of a donut person. When I was younger, I had this odd insistence on only liking one flavor at any given time, so for a few months I’d accept only the powdered sugar donuts, then only the plain, old-fashioned donuts, then only the chocolate glazed donuts. Finally I just admitted defeat and moved on to the muffins (also the “healthier” option, each with only 100 to 300 calories more than the average donut).

Still, having grown up in its native Massachusetts, I do have a huge soft spot in my heart for Dunkin Donuts, mainly caused by a few too many iced coffees with cream and sugar. At the very least, I prefer DD to Starbucks. Less pretension, better coffee.

So I’m super excited for Dunkin Donuts to be all gluten-free by 2020! Are you?

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