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  • Scott Adams
    Scott Adams

    Celiac Disease and Obesity—There is a Connection by Melissa Croda q

    Reviewed and edited by a celiac disease expert.

    This article appeared in the Winter 2006 edition of Celiac.coms Scott-Free Newsletter.

    Celiac.com 07/10/2006 - Three years ago my father was diagnosed with celiac disease and I was told by my mother that it is hereditary and that I too should get screened for it. I did some research and immediately knew that I had this disease. I wouldn't admit it to anyone at the time because how on earth could I possibly live without pasta and fresh-baked bread for the rest of my life?! You should know that I have been sick for my entire life—I had colic until I was six, got ulcers when I was eight, appendicitis at 14, calcium bone spurs at 17, 19, 24 and 36, infertility at 24, gall stones at 37—just to mention a few of the conditions Ive had that were likely related to my untreated celiac disease.

    About six months later I decided to go see my doctor—I was in a severe state of depression, and I had lost the ability to think—much less talk. Carrying on a full conversation was nearly impossible because of my inability to speak in full sentences. I was extremely sick with a severe cold, and I had an infection or the flu at least once each month for the preceding two to three years. I told my doctor that I thought that he should test me for celiac disease. Since I weighed in at over 300 pounds he literally laughed at this idea. According to him there was absolutely no way that I could have celiac disease—because I was fat!

    Shortly after that my parents came to visit and tried to talk me into eating gluten-free—at least during the time that they were here. I agreed because I had to cook gluten-free for them anyway. Within three days of starting a gluten-free diet I felt like a million bucks. My depression lifted and within a month I was losing weight and my brain started working again. I have been gluten-free for three years now—not only do I feel like a million bucks, but I have lost over 100 pounds. I shudder at the idea that I was literally eating myself to death—and it was not because I didn't have any will power or that I was eating bad food—it was because my body couldnt process and absorb the food that I was eating. My personal experience, combined with my research, has left me completely convinced that celiac disease is (and will continue to be) a significant cause of obesity—and that this will continue to be the case until there is a better understanding of the disease and its relationship to obesity.

    What is Celiac Disease?
    Celiac disease is a permanent intolerance to gluten1, which is a protein found in, wheat, rye, and barley. When gluten is ingested the digestive system is unable to properly break it down, and an autoimmune response is triggered in the gut that causes the villi of the small intestine to become damaged—leading to malabsorption of crucial nutrients. There is no cure, and the only way to control it is through a 100% gluten-free diet.

    The disease has a vast array of symptoms, and it is rare that two people will exhibit the same ones. Some will have diarrhea while others will have constipation, and some will not have either but instead may have osteoporosis, diabetes, headaches, fatigue, autoimmune thyroid disorder or any number of other conditions and symptoms found to be associated with it. In many cases these symptoms are associated with the inability to gain weight—children with celiac disease are often small and fail to thrive 1.

    Nearly every source that I consulted for this paper referred to malabsorption and how most people with celiac disease lost weight or couldn't gain weight. Only a few sources even mentioned obesity—and when they did it was only in passing. As celiac disease awareness steadily increases and more research is done on it hopefully it will become apparent that many cases of obesity are also related to it.

    The Common Thread
    Autoimmune thyroid disease has recently been linked to celiac disease. Recent research has demonstrated that 3.4% of patients with autoimmune thyroid disease also have celiac disease2. The thyroid gland secretes hormones to control the body's metabolic rate3, and to accomplish this it must have iodine. When celiac disease is present along with autoimmune thyroid disorder, the body does not have the ability to absorb the iodine to produce the necessary hormones. Additionally there are many different disorders such as obesity, diabetes, allergies, weight-loss, gastrointestinal problems, etc., that can be caused by having a damaged or compromised thyroid gland3 (all of these disorders, by the way, can be related to celiac disease). It has been known for years that obesity has been linked to thyroid problems, and that the thyroid produces 5-monodeiodinase, the bodys natural method of conserving fuel during shortage," and the body "elicits the same physical reaction as famine," which can then cause the affected person to gain weight3.

    Another disorder commonly associated with celiac disease is malabsorption, which can also lead to malnutrition. When someone with celiac disease eats foods that contain gluten it results in damage to the surface of the small intestine and destruction of their nutrient-absorbing villi. This can lead to leaky gut and an inability for them to absorb vital nutrients from their food. By continuing to eat foods containing gluten, eventually vital organs including the brain, thyroid, liver, kidneys—essentially any organ that depends heavily on nutrients—will be starved, which will leave them susceptible to other diseases and conditions. I personally experienced brain malfunctions, gall bladder problems, and was diagnosed numerous times with an under-active thyroid. Naturally treatments for this proposed thyroid condition didnt work because their true cause had not yet been found. At one point a doctor asked me to consider the idea that my obesity was the result of my bodys attempt to cope with malnourishment4. This phenomenon is similar to yo-yo dieting, where dieters who have deprived themselves or proper nutrition for too long gain weight at faster rates than non-dieters after they resume eating normally. I always thought that I had fallen victim to yo-yo dieting, and that I had dieted myself into a permanent state of obesity. I now understand that it was because I had undiagnosed celiac disease, and my body was actually malnourished.

    Under normal nutritional conditions humans only absorb about 80 percent of the nutrients from the food they eat, and the rest of the nutrients pass through the body4. With celiac disease, however, the body is unable to absorb the necessary nutrients, which causes some peoples bodies to become a super-efficient machine that begins storing as much fat as possible in order to survive. This nutrient deficiency convinces the body that it is starving to death, which sends it into starvation-mode. Since humans need a certain percentage of body fat reserves to stay alive—and because it takes more work for the body to burn fats than carbohydrates—a body that is in starvation mode tends to crave carbohydrates and more efficiently convert them to fat for later use4.

    There has been much research that links celiac disease to diabetes. Diabetes occurs when the bodys cells are unable to absorb enough blood sugar5. Although the cause is different, the resulting malabsorption is similar to that seem in celiac disease—although in the latter the malabsorption is not just limited to sugar. The connection between diabetes and celiac disease as described by Marschilok:

    Both diseases have genetic and environmental origins. This means an individual is more at risk of developing either problem when a close relative also has it. On the genetic side, development of one reveals the pre-existing and larger risk that the genes for the other may be present. At least two genes and gene locations are connected with each disease. One gene for each disease is near one gene for the other on the same chromosome. Nearby genes are more likely to pass together to offspring.

    However, while the genes are necessary, they are not sufficient to produce the diseases. On the environmental side, researchers know gluten is needed to produce celiac disease, but they also know its not the only environmental cause. With diabetes, the environmental causes are being extensively studied for prevention and cure. Roughly ten percent of celiacs either have Type I diabetes or might develop Type II diabetes6 .

    An astonishing 40% of people with diabetes are also obese—even though there was not very much in the way of medical research to indicate why this is so. Diabetes is described as your cells inability to produce or absorb insulin, which leads to an excess of sugar in the blood stream7. If a person injects or produces too much insulin it will increase the level of hunger and cause obesity. I personally find this information disturbing as there are some in the medical community who still blame obesity on character flaws—I cant begin to tell you how many times I have been told: if you just didn't eat so much you wouldn't be fat.

    A number of overweight and obese acquaintances of mine have asked me how I managed to lose over 100 pounds and look so healthy while doing it. I explained my celiac disease diagnosis and gluten-free diet to them, and how the diet has made me not feel hungry for the first time in my life—due to the fact that I am now absorbing nutrients properly. Six of these extremely obese people have actually gone to their physicians to get tested for celiac disease—and each was met with the same skepticism as me. They persisted and finally got their doctors to perform the necessary tests—and to the surprise of all each were diagnosed with celiac disease! Immediately after going on the gluten-free diet they all experienced a decrease in hunger and massive weight-loss. For the first time they were eating only when their bodies were truly hungry, instead of eating too much due to starvation signals caused by malabsorption.

    This could also be part of the reason that high protein, low carbohydrate diets work so well for many people. By removing the carbohydrates from ones diet you generally remove a large portion of the gluten as well, which can cause those with celiac disease who are obese to lose weight quickly—at least for a month or so. However, on the high protein diet you are still not removing all gluten which will eventually cause them to gain the weight back—even though they are still on the diet. This was my experience with the low carbohydrate diet, and I suspect that a lot of others who are obese and have undiagnosed celiac disease had or will have the same experience.

    Conclusion
    I once had a family member literally yell at me about my weight and ask me why I was being so selfish and not thinking about my husband and daughter—they told me that I should just lose the weight. I was devastated, I truly had tried every diet on the face of the earth and each and every time I would loose 20-30 pounds quickly (regardless of the type of diet), only to gain it back (while still following the program)—sometimes as much as two fold! Since being diagnosed with celiac disease three years ago I have not only lost the weight but I have also kept it off, and each week a little bit more comes off. I am completely convinced that celiac disease does and will continue to be a common cause of obesity until the medical community—through scientific research—realizes that there is a connection.

    Many obese people might not be overweight if they were just properly diagnosed and treated. Certainly it is not the case that all obese people are that way because they just plain eat too much and do not have any will power. I suspect that there are better medical reasons to explain most cases of obesity, and celiac disease is just one of them. Not too long ago it was estimated that celiac disease only affected 1 in 10,000 Americans8. That figure was then revised to 1 in 5,000, and now, after much research, it is at least 1 in 133. The actual diagnosis rate, however, is only about 1 in 5,000, which is only a small fraction of those who have it. Similarly, the causes of obesity in America are not fully understood, and more research needs to be done to determine just how many cases of obesity are caused by untreated celiac disease. I believe that a significant percentage of obese people have undiagnosed celiac disease, and that celiac disease screening should be part of ordinary blood workups for all obese people.

    References:

    • Adams, S. (May 2005). A Celiac Disease and Gluten-Free Resource since 1995. Retrieved May 18, 2005, from www.celiac.com.
    • Collin, Kaukinen, Valimaki & Salmi, (2002). Endocinological Disorders and Celiac Disease, Endocrine Reviews (pp 1-38).
      3. Life Extension, Thyroid Deficiency, Online reference for Health Concerns. Retrieved May 26, 2005 from www.lef.org/protocols/prtcls-txt/t-prtcl-104.html.
    • Balley, L. (June 2004) Obesity in Developing Countries Compares to U.S. Yo-Yo Dieting. Retrieved June 16, 2005 from: http://www.eurekalert.org/pub_releases/2004-06/uom-oid060804.php.
    • Katz H., (2005). Hope for Obesity and Diabetes. Retrieved June 19, 2005 from http://www.reporter-archive.mcgill.ca/Rep/r3112/mice.html.
    • Marschilok, K., (1997). Diabetes and celiac Disease. Gluten-free Living.
    • Hoover, J., (2001). Obesity Causes Diabetes–Fat Chance! Diabetes Health Magazine. Retrieved June 19, 2005 from http://www.diabeteshealth.com/read,1009,2168.html
    • Vogren, C.L., (September 15, 2003). Awareness Can Be Best Medicine: Parents who lost son to celiac disease want to shed light on often-overlooked ailment. The Gazette. Retrieved June 19, 2005 from http://www.csaceliacs.org/CDintheNews/COSpringsGazette091503.php

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    I was diagnosed 2 years ago with celiac 2 years ago, after 2 hospital admissions for vomiting blood and blood in the stool.

    I had a problem with what was suspected to be GERD, but never any treatment for this "suspect problem", thus I spent over 40 years with both emisses of foods and severe diarrhea. Needless to say I was severely underweight.....now I am far from that! I have tried many diet plans, not effective as most only added to my accelerating weight gain, I'd like to know if others have had similar problems and if they have found a diet solution that is livable, doable, and works! This is not a question this is a problem solver attempt.

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    Excellent information....I'm astounded how little doctors know, even specialists, in this regard. How many are truly suffering from gluten sensitivity or celiac disease and are only having symptoms treated? I was diagnosed w/Hashimotos hypothyroidism several months ago, I had my gall bladder removed in 1995 due to gallstone/attack, I had ulcerative colitis as far back as 1988. I've had upper respiratory problems, having walking pneumonia 3 times in my life....I could go on. I started to research on my own and educated myself. I found the possible gluten connection to all these things that I have or had suffered with. I went to my gastro/doc and asked to have blood test for celiacs. It just came back negative. Now I see that they can be wrong. Why have a blood test then?!!! Is the saliva test more accurate? I'm so tired of doctors appointments and am thinking to just go gluten-free and see if my symptoms get better. It makes me put little faith in doctors as they are only seemingly treating symptoms and not addressing the cause to many diseases or conditions. I do appreciate the info. I found here, it is like a breath of fresh air....thank you.

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    I was diagnosed with celiac seven years ago and have been on wheat and gluten free diet since then. Since then I have gained 60 pounds and cannot lose any, as much as I try.

    Some days I feel very hungry and weak. A glass of water helps me to get back to normal and think right.

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    FABULOUS ARTICLE!

     

    Typically, most doctors look at a common symptom of celiac - unexplained weight loss. However, a few doctors are actually looking into celiac as a possible cause of unexplained obesity, especially in patients who are following a reduced calorie plan and exercise plan, and they're only losing a very small amount of weight.

     

    Some doctors are "in the know" about celiac. The ones that are "in the know" are not depending on blood tests for a diagnosis because the blood test has a tendency to give false negatives. Rather, they're scheduling endoscopies to perform a biopsy on the intestines because more and more proof is coming out that the biopsy is a more accurate test for celiac.

     

    I've recently been diagnosed with celiac because my health began failing a few months ago - I eat mostly fruits and vegetables and exercise regularly, but I gained 40 lbs without explanation and I couldn't lose it no matter what I did, I have toxic multinodular goiters on my thyroid, I have multiple cysts in my ovaries, I have a fibroid tumor, I have a fatty ileocecal valve, I was extremely fatigued, and my blood tests show that I have very low levels of vitamin D and vitamin B12. I've suspected celiac for about 6 years, but the blood tests always came back negative. I changed doctors, and she scheduled the biopsy, which came back positive. I've been gluten free for about two weeks, and I feel a dramatic difference. I'm actually losing weight.

     

    For the celiacs who are gaining weight - my friend's mother also has celiac disease, and she gained some weight when she started gluten-free. The reason why is a lot of the bread and baked goods substitutes for celiacs have a lot more calories than gluten-containing breads and baked goods because they have to add a lot more ingredients (like sugars and fats) to compensate for the lack of gluten. The trick to not gaining excess weight is to eat the processed gluten-free foods (pastas, breads, baked goods) sparingly and eat the natural food instead (rice, quinoa, millet, potatoes, corn). Once my friend's mom did that, she started losing weight.

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    Guest All in the family

    Posted

    Celiac has recently appeared in my family. My brother and two nieces were diagnosed. I know I have it also after listening to all the information. I have also always had thyroid disease and fibromyalgia. But the weight thing had me confused also. But I also had leaky gut. It's so nice to finally know why all of this is happening.

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    Guest All in the family

    Posted

    I have a question for you: like a lot of Americans these days, I am unemployed and do not have health insurance. The care at my local clinics is fair, at best, and far from free. Under-active thyroid, over-active thyroid, diabetes, and rheumtoid arthritis all run in my family. (I was diagnosed with juvenile onset rheumatoid arthritis at 18 and am now 31 and 200 lbs. at 5' 8" tall.) Would it be harmful just to try a gluten-free diet for a week, and see how I feel? (I can't imagine so, but I thought I'd ask.) My brain is foggy, I'm very "air-headed" (as I call it), forgetful, and just plain exhausted all the time, which doctors in the past have contributed to the rheumatoid arthritis, extra weight, and depression. I'm curious to see if it helps!

    You should definitely do it. I haven't been diagnosed either, but have been on the diet for 2 years now. I can tell the difference now from just a touch of gluten. See if it helps. There are so many gluten free grains (mixes and pastas and cereals, breads) out there now. I don't ever feel deprived but I do feel better.

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    Thanks so much for this article. I was recently diagnosed with Coeliac disease (Australian spelling!) and have been on the diet for one month. I feel so much better now. My mother, sister and two daughters have all had thyroid problems and so far I have been clear. I am about 15 kilos overweight and have been trying for years to lose it. I am a life-long vegetarian and get plenty of varied exercise. It's great to read everyone's stories, they're all so similar.

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    Well written and informatve.

    Finally the puzzle comes together. I remember being 10 years old and suffering with burning tummy aches and daily diarrhea. I was also chubby, and have been for most of my life. Our meals at home were cereal, bread, and pasta, etc. I had my appendix out when I was 22. When I first went on Atkins I was a new woman, but as soon as I picked up a carbohydrate it was all over. I have been diagnosed with depression, anxiety which has been blamed for causing the diarrhea and now my thyroid panel looks weird. My doctor does not believe that I am possibly celiac because my blood test came back negative, but I also don't eat a lot of carbohydrates because it makes me sick. I have three aunts who are celiac and am sick of fighting with the doctor, i think I will just go gluten free on my own. Thanks for the article, it's nice to know I am not alone!!

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    Thanks for the excellent article; it confirmed a lot of my suspicions. I was diagnosed 25 years ago (I'm now 52) with Graves disease (an autoimmune thyroid disorder). Two of my siblings have type I diabetes, and 2 have rheumatoid arthritis. Until I reached age 40, I was very athletic and never weighed more than 130 lbs. Slowly, during my 40's, I began to gain weight until I reached my high of 178. During this period I suffered from unexplained severe abdominal pain, excessive gas, and a feeling of constant "bubbling" in my stomach; various tests produced no answers other than noting 6 cysts on my liver. I suffered from severe joint and muscle pain which prevented me from exercising. Also migraines (which I had never had previously); and extreme fatigue. Unexplained sores in my mouth which would mysteriously appear almost instantly (always during or just after eating), then disappear a few days later. Blood work revealed Vitamin D and B12 deficiencies, and weirdly, my toenails would just fall off for no reason. For me, the worst though was being overweight. For a person who had always been in great physical shape, it was humiliating to be seen in such a state, and I avoided social situations. Six weeks ago, I happened upon an article about celiac disease, and on my own gave the gluten free diet a try. Within a couple of days the stomach discomfort stopped, and over the last six weeks I have regained much of my energy and have begun to lose weight; ten lbs already which is amazing as I am not dieting, and my attempts at dieting over the last ten years have produced weight gain, not loss. The joint and muscle pain is much improved and in general I feel like a new woman. I don't know that I will try to get a diagnosis as I do not want to eat gluten again in order to get tested. I'm not sure I need the confirmation of a medical diagnosis; I know how I feel. Thanks again for the excellent article.

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    I was amazed to read Jennifer's and Deb's stories - mine is very similar! I stopped eating food with gluten 7 months ago on my own because my doctor couldn't find anything wrong. I weighed 300 pounds, was depressed, exhausted, severe abdominal pains, joint pains, couldn't think straight, terrible memory, was constantly hungry and was actually becoming incontinent at age 45. I had severe vitamin D and B12 deficiencies. I bruised easily, caught every virus going around, and even minor paper cuts got infected and took weeks to heal. Two weeks after changing my diet, the pain and incontinence were virtually gone. At this point, I've lost 70 pounds without diet or exercise and I'm pain-free. My friends, family and doctor are amazed at the change! I find out the results of the blood test tomorrow, but even if it's negative, I'm not going back to eating foods with gluten. It's been truly life-changing. I never would have guessed my problem was celiac disease because I am overweight, instead of traditionally underweight.

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  • About Me

    Celiac.com's Founder and CEO, Scott was diagnosed with celiac disease  in 1994, and, due to the nearly total lack of information available at that time, was forced to become an expert on the disease in order to recover. Scott launched the site that later became Celiac.com in 1995 "To help as many people as possible with celiac disease get diagnosed so they can begin to live happy, healthy gluten-free lives."  In 1998 he founded The Gluten-Free Mall which he sold in 2014. He is co-author of the book Cereal Killers, and founder and publisher of Journal of Gluten Sensitivity.

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