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  • Jefferson Adams
    Jefferson Adams

    Study Shows Clear Link Between Celiac Disease and Anorexia Nervosa

    Reviewed and edited by a celiac disease expert.

      A new study shows that celiac disease and anorexia nervosa are connected, but how?


    Caption: Celiac disease and anorexia nervosa are connected, but how? Photo: CC--Benjamin Watson

    Celiac.com 04/06/2017 - A new study showing connections between anorexia nervosa and celiac disease, both before and after celiac diagnosis, is raising eyebrows and inviting questions. Results of the study appear in the April 3 issue of Pediatrics.

    Because the two conditions share a number of symptoms, including abdominal pain, bloating, diarrhea, and underweight, doctors can have some difficulty telling them apart.

    Until now, previous data linking anorexia with celiac disease came mostly from individual case reports. To get a better picture, Karl Mårild, MD, PhD, from the Barbara Davis Center, University of Colorado, Aurora, and colleagues conducted a cohort and case-control investigation examining the connection between celiac disease and timing of diagnosis for anorexia nervosa.

    To do this, the research team reviewed records from Sweden's 28 pathology departments. They looked at 17,959 cases of small intestinal biopsy-verified celiac disease in women from 1969 through 2008, and compared them with 89,379 sex- and age-matched population-based controls. The team confirmed cases of anorexia nervosa through inpatient and hospital-based outpatient records.

    They also looked at individuals undergoing biopsy who showed small intestinal inflammation or normal mucosa, but tested positive for celiac-related autoantibodies. They recorded educational level, socioeconomic status, and type 1 diabetes status.

    Their results showed that the hazard ratio for developing anorexia nervosa after a celiac diagnosis was 1.46, which fell to 1.31 beyond the first year after celiac diagnosis (with a 95% confidence interval for both). The odds ratio for association of previous anorexia nervosa diagnosis among people with a diagnosis of celiac disease was 2.18, with a 95% CI.

    The findings remain the same, even after the team adjusted for type 1 diabetes status and socioeconomic levels. Women who had positive celiac serology, but with no signs of villous atrophy, were also more likely to be diagnosed with anorexia nervosa, both before and after celiac diagnosis.

    The researchers propose three explanations for these findings: First, celiac disease may have been misdiagnosed earlier as anorexia nervosa, or vice versa. Second, it's possible that closer scrutiny of patients diagnosed with one condition may have prompted a bias in detecting the second condition. Third, it's possible that people with a shared genetic susceptibility may face a higher risk of developing both conditions.

    Whatever the reason behind the association, the study indicates that the connections between the two conditions are likely complex, and definitely invites further study.

    In the meantime, the researchers write that the "bidirectional association between diagnosis of anorexia nervosa and celiac disease warrants attention in both the initial assessment, and in the follow-up of women with these illnesses."

    As a result of this study, the team encourages "physicians to closely monitor these patients and calls for heightened understanding of factors that contribute to their co-occurrence."

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    When I was much younger, I knew a girl with anorexia. I couldn't understand it because I loved to eat. But after I figured out that I couldn't tolerate gluten, I experienced what it was like to be suspicious of everything that I put in my mouth, and I reminded myself of that young lady that I knew. So I wondered then if she might have been so cautious about food because it made her feel badly as it had begun to do with me.

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    Among the reason they listed between anorexia and celiac they did not see the most obvious one: If a person with undiagnosed celiac gets pain, bloating and all the miserable feeling and health conveniences that come after ingesting gluten, it is to far fetched that they will stop eating all together? Especially a young person, if they had been tested for celiac and if was not confirmed--as it happened to me-- they could come to think that it is something of themselves that causes their symptoms and refuse to eat at all. As gluten is in all kinds of unsuspected forms and products it is highly possible that we have if ever time we eat. Undiagnosed celiac is gluten sensitivity CAN cause anorexia, simply because you don't want feel sick every time you eat.

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    Your statement; " Anorexia, simply because you don't want feel sick every time you eat" is the only conclusion that deserves merit. Chronic gluten exposure resulted in my health down-spiral that led to severe malnutrition, peripheral neuralgia, encephalopathy and the eventual need for surgical intervention. Eating out? Forget it! Taking risks? NO more! I eat less because there is less to eat. Just how much plain beef, chicken, fruits & vegetables can one eat in a day? It was a sad time when the FDA did not intervene with wheat hybridization. The extensive ramifications were neither suspected nor proposed. Persons who state that gluten is good and more gluten is better should live in my shoes for one month: No gluten, egg, yeast, dairy, oils (except cold pressed), preservatives, artificial flavorings, coloring agents. This list of toxins has removed; 99% of processed foods from my grocery list and 100% of restaurants visits. Cross contamination is an unacceptable risk. The Cooperating Parties continue to modify reportable code sets for celiac and non-celiac gluten sensitivities. I project gluten will impact 15% of the population by 2027. We will see!

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    I am riposting this, as it had many typos in the previous post: Among the reason they listed which link anorexia and celiac they did not see the most obvious one: a person with undiagnosed celiac gets pain, bloating and all the miserable feelings and health consequences that come after ingesting gluten. Is it too far fetched that they will stop eating all together? Especially a young person, if they had been tested for celiac and if it was not confirmed--as it happened to me-- they could come to think that it is something of themselves that causes their symptoms and refuse to eat at all. As gluten is in all kinds of unsuspected forms and products it is highly possible that we have it every time we eat. Undiagnosed celiac and gluten sensitivity CAN cause anorexia, simply because you don't want to feel sick every time you eat.

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    Guest Jefferson Adams

    Posted

    Among the reason they listed between anorexia and celiac they did not see the most obvious one: If a person with undiagnosed celiac gets pain, bloating and all the miserable feeling and health conveniences that come after ingesting gluten, it is to far fetched that they will stop eating all together? Especially a young person, if they had been tested for celiac and if was not confirmed--as it happened to me-- they could come to think that it is something of themselves that causes their symptoms and refuse to eat at all. As gluten is in all kinds of unsuspected forms and products it is highly possible that we have if ever time we eat. Undiagnosed celiac is gluten sensitivity CAN cause anorexia, simply because you don't want feel sick every time you eat.

    My understanding is that anorexia nervosa is much more than simply avoiding food because one does not wish to get sick. It is a psychological and medical condition with clear features. As such, I'm not sure your hypothesis holds water. It may very well be the case that gluten damage and the desire to avoid it could be a contributing factor before diagnosis, but what about after? Most people with celiac disease work hard to avoid gluten once diagnosed, and most are usually successful, even with a steep learning curve and occasional contamination. As they find a diet that works for them, they get healthier. Since this study shows a connection both before and after diagnosis, the data indicate that the answer likely lies somewhere else.

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    I can understand if there is a correlation between celiac disease and some anorexia cases, as your body will definitely tell you there is something wrong if you listen... It's sometimes really hard to figure it out though until you have to do something about it. I'm celiac with dairy, egg, yeast and additives allergies, which sometimes feels like l'm a walking science experiment. Still feels good to figure things out!

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  • About Me

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University, and has authored more than 2,000 articles on celiac disease. His coursework includes studies in science, scientific methodology, biology, anatomy, medicine, logic, and advanced research. He previously served as SF Health News Examiner for Examiner.com, and devised health and medical content for Sharecare.com. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of the book "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

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