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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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    Recommended Comments



    Guest Lizane Courchesne

    Posted

    Well written and informatve.

    Thank you for this article. For the first time in my life I don't feel alone. I wasn't crazy that's for sure. This morning I went for the celiac disease test. I didn't think that I might have celiac disease since I was not loosing weight at all. Now it's reassuring to know that being overweight might be related to it. I am diabetic and lactose intolerant for years. I can't wait to have the result now. Anyway thank you, your article is very helpful.

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    I am 16 and ever since I was about 8 years old I have had a problem with my weight. When I was a little girl I was skinny and a normal weight for my age, but when I was around age 8 I began to rapidly gain weight out of nowhere. Also I had really bad sharp chest pains. I had many tests done to make sure there was nothing wrong with my heart and to see if I had any thyroid problems, but the tests came up negative. A few years ago in 8th grade I came down with a cough that never went away. I was then diagnosed with asthma induced by sports. Even with an inhaler and medicine the coughing and wheezing never went away and my doctor realized my asthma was worse than they thought. After having allergic reactions to almost all the medicines I was taking I finally found a medicine that worked, but only for a short period of time. To this day I am still coughing and wheezing daily and my doctor and I cannot figure out why my asthma gets better for a week or so and then comes back. I have done some research on celiac disease and I have found articles that say weight gain and asthma may be the cause of the disease. I am hoping to get the test so I can figure out whether my asthma is the product of celiac disease.

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    Well written and informatve.

    Thank you so much for writing this. My daughter was diagnosed with celiac disease 12 years ago. A few weeks ago, I was diagnosed with fibromyalgia and the doctor mentioned going on a gluten-free diet. It didn't even occur to me to get tested. I weight 280 pounds (I usually only weight about 230, but for the past few years they have kept me on steroids thinking it would help with my joint issues, also can be explained by undiagnosed celiac disease). I have an appointment with my doctor next week and I'm going to start the testing process. I know that this is celiac disease. I am so grateful that soon I will have my life back! Thank you for writing this!

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    I am celiac and have been off gluten for years but have been unable to lose any significant weight. Atkins diet works best for me so I am back to it but the constipation is a pain. In researching for constipation meds I looked up the use of inulin as fiber supplement and found out about Fructose Malabsorption. I had already surmised that fruits are a real issue with me since I still suffered from diarrhea even though I adhere to a strict no-gluten diet. It turns out that Fructose Malabsorption can go hand-in-hand with celiac disease. Please read more about this for yourself to help you better with your food choices.

    Check out candida as well - also goes hand in hand with celiacs.

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    This article, as well as the many comments submitted, has been very informative and helpful. Our 9-year-old grandson was recently diagnosed with celiac disease by way of a biopsy, after at least 4 years of our begging the parents to change pediatricians or do something to find out why he was not growing at all! He is nearly 10 now, is the size of an average 6 year old, is very thin, and rarely eats without experiencing pain.

    One of his new physicians mentioned that celiac disease is commonly found in those with an Irish-Scottish-British heritage, which is our grandchild's exclusive gene pool. Digestive aliments, as well as thyroid disease, are as commonplace as blue and green eyes in all of his family background. Even though a small, thin stature is evident in many of the extended family lines, what we were amazed to learn is that the obesity issues in the family might also be linked to undiagnosed celiac disease. This is amazing! So many of us have been living in desperate need of an answer for the constant pain, inability to digest, difficulty to avoid excess weight gain, and inability to shed pounds by any means.

    I now have information to begin to share with many, and perhaps we will uncover some of the health mysteries that exist. You have all given me hope that an answer is within our grasp! Thank you from the bottom of my heart!

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    I am celiac and have been off gluten for years but have been unable to lose any significant weight. Atkins diet works best for me so I am back to it but the constipation is a pain. In researching for constipation meds I looked up the use of inulin as fiber supplement and found out about Fructose Malabsorption. I had already surmised that fruits are a real issue with me since I still suffered from diarrhea even though I adhere to a strict no-gluten diet. It turns out that Fructose Malabsorption can go hand-in-hand with celiac disease. Please read more about this for yourself to help you better with your food choices.

    I've had diarrhea for 14 months straight and am still gaining weight. I've been eating more fruit, thinking it was safe! My GI mentioned cutting out certain fruits to reduce the diarrhea. It is really counter-intuitive, but maybe the solution.

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    Guest Heather Jane Brown

    Posted

    I totally understand, I was diagnosed with coeliac about 5 years ago and I rapidly gained weight (now 30 kgs above ideal) and have had trouble loosing it despite trying many different diets. Fairly sure there is no hidden gluten in my diet but have always struggled with weight loss until I spent 2 years really sick before my diagnosis. All the clear liquids and dry toast suggested as a remedy for diarrhea must have built up to eventually result in a positive blood test followed by biopsy. I would really like to know if anyone has any good advice on weight loss ideas too.

    I too have gained much weight. My sister said that her doctor mentioned to her that the rice flour and cornstarch do not metabolize the way it does with someone without celiac disease. She said it turns to fat and stays there. The gluten-free pasta that I eat twice a week should be eaten once a month according to her doctor. I recently switched from eating a protein bar for breakfast to cottage cheese and fresh fruit (no cherries, grapes, or bananas), no flour of any kind, no shortening, and no sugar. I feel so much better. I eat a large green salad with a lot of veggies ( no corn, peas, or dried beans). I drink about 36-48 oz. of water a day. I am going to my internist and asking about this weight gain, but I do think my sister's doc is right and how good I feel now is proof enough for me.

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    I've had diarrhea for 14 months straight and am still gaining weight. I've been eating more fruit, thinking it was safe! My GI mentioned cutting out certain fruits to reduce the diarrhea. It is really counter-intuitive, but maybe the solution.

    Curtis

    I've just finished a six year long bout with diarrhea - the GI and family doctors said it's just IBS. Unfortunately, I was gluten-free before being tested for celiac, so I came out negative, however, my cure for IBS has been the FODMAP diet - out of Australia. They categorize fruits and veggies as irritants or not for your bowel. You should definitely look it up.

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    Guest Celiac Disease Person

    Posted

    Celiac disease could be a ONE cause to obesity, but basically, people become obese because of lack of proper nutrition and exercise. I have celiac disease and I am not the skinniest person around. Even on a gluten-free diet, lots of packaged foods are processed and contain high sodium and sugars. So it's basically about eating right. Just because you are taking out wheat and rye, oats, etc. does not mean you will become skinny.

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    So, now that you have treated your celiac disease, you are no longer obese? Now you are slim and trim? Labeling a cause and solving a problem are two different things. I would challenge anyone to follow me around all day, be as active as I am, eat what I eat, and still be obese.

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    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!

    Try it it can't hurt - it can only help.

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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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