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Study Shows Clear Link Between Celiac Disease and Anorexia Nervosa

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

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 CD was 2.18, with a 95% CI.

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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 CD 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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6 Responses:

Mary Thorpe
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said this on
10 Apr 2017 5:52:53 PM PDT
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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said this on
11 Apr 2017 8:47:54 AM PDT
Among the reason they listed between anorexia and celiac they did not see the most obvious one: rnIf 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.

Jefferson Adams
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said this on
14 Apr 2017 11:28:27 AM PDT
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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said this on
11 Apr 2017 1:44:52 PM PDT
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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said this on
12 Apr 2017 7:14:32 AM PDT
I am riposting this, as it had many typos in the previous post: rnAmong 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. rnUndiagnosed celiac and gluten sensitivity CAN cause anorexia, simply because you don't want to feel sick every time you eat.

Janice Lamb
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said this on
16 Apr 2017 9:36:41 AM PDT
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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Cycling Lady, LMAO at IBeStumped! So true. Yes, he is trying the band aid approach it seems. That's probably the most frustrating thing of all. So yesterday I get a call back from his office and they say to stop taking the Viberzi and switch back to Imodium! I reminded them that Imodium didn't work, I had already used it 8 days with no changes. His assistant informed me that that is all he can recommend at this time until he sees me at my next appointment which is 5/24! I live near Chicago and I am about to make an appointment to go to the University of Chicago hospital which is the top celiac research hospital in the country. Hopefully they can give me better answers.

7Hi jen and welcome No-one can diagnose remotely via nterwe posts but if there was such a game as celiac / gluten sensitive bingo, I would be calling 'House!' having read your account above... Lots of things fit the pattern as I'm sure your lurking has revealed. It's a tricky condition to diagnose however so you may have a little wait before you join the coolest club in town and get your funky celiac membership card For now it's really important that you stay on gluten. Keep eating it as accurate testing requires it. Ask your doctor to check the boxes for celiac testing alongside your liver blood tests. There should be enough in your history to get this without hassle but if they're reluctant INSIST and don't be afraid to assert your reasonable suspicion and wish to clarify and exclude. A good liver specialis will be aware of the possible links so you should be ok. If not gt second opinion. Ask for a full celiac panel as there are variety of tests. Find further info here There's a lot to take in, but be positive, I think you are on the right track and if so, you could soon be feeling better than you ever thought possible!

Hello, I am in a job that I travel every 3rd week...It gets challenging becuase many times I am doing audits of warehouses and they dont even have a cafeteria. I usually bring gluten-free protein bars as a back up if I have to miss a meal and then eat when I get back to the hotel. Just a suggestion because they certainly fill me up....Have a safe trip...Kelly

Hello all, I'm a new member here but have lurked for a while. I'm looking for some advice regarding my medical history, possible symptoms of celiac and next steps. General info: female, low level smoker, drink alcohol, aged 32. I started having bad gastro issues when I was around 17. Since then I've consistently suffered from chronic diarrhoea, frequent discomfort in the tummy area, feelings of dehydration despite drinking at least eight glasses a day and frequent fatigue for no real reason. In 2008/9 I visited the doctor as my diarrhoea was having an effect on my studies at the time. The doctor tested me for allergies; eggs, fish, gluten and lactose and did a "standard" blood test. Everything came back fine except my liver results, which were elevated to double (I did not the see the results for myself so can't say which enzymes etc). I was told to drink less and take Imodium. The doctor implied that perhaps I was stressed and / or anxious and, still being young plus a student who regularly went out drinking, I accepted this advice and carried on with my life. I would here add that I am not an unusually stressed person - in fact, learning to deal with my unpredictable bowels has forced me to be quite a laid-back person! Fast forward to 2016. I had been living with my partner for two years by this point who had noticed my bowel habits and informed me that this was definitely not normal. He encouraged me to try out a gluten free diet since I was apprehensive about visiting a doctor only to be fobbed off with Imodium again. I did the diet as strictly as a newbie can for around two months before we set off travelling. During the diet I noticed that after a couple of weeks of extreme tiredness I felt quite a lot better - I kept a food journal at the time which showed that I almost immediately had diarrhoea once after eating an ice-cream, i felt bloated and unwell after an attempt to make oat muffins (maybe i didn't cook them very well though!) and I felt bloated and had diarrhoea after eating some fish fried in flour (We made a mistake in ordering them but I didn't want to complain). My partner also reported that my mood swings (which I admit can be a little unpredictable) were much better. Once we started travelling I gave up and ate what I was given as we were staying with friends etc much of the time. Toward the end of our trip I started to feel extremely tired, to the point of having to stay in for "rest" days, and my guts were very unhappy. I chalked it up to irregular eating patterns, too many beers and late nights in general. During the trip I also had an extreme hangover after drinking wheat beer. And, while of course I accept that any overindulgence can make you ill, I really felt that that level of hangover was quite out of the ordinary. Finally, I developed a strange lump under my armpit during this period. Now back at home, I decided to go to the doc and check out the odd lump under my armpit. The doctor was pretty confident that it was nothing to worry about cancer-wise but she ordered a battery of blood tests just to be sure. The lump is fine (good news) but the results showed elevated GGT, high-ish ALT and normal AST liver enzymes plus signs of dehydration in red bloods / higher (but not concerning) levels of white bloods. I'm scheduled to go back for another blood test to double-check liver function and discuss results - if it is again high she will send me for a ultrasound. Does this history chime with anyone here? I know that the correct course in basic health terms is to stop drinking for some time (easily done) and stop smoking forever (easy to say...) but I cannot help but think that something else is going on here. I will discuss this with my doctor and make clear that my bowel issues have not been resolved and that the initial IBS diagnosis wasn't based on any thorough testing so to speak. In the meantime - does anyone have any advice for me in times of avenues to research or experience of similar symptoms? Gluten remains in my diet but in all other respects it could be regarded as very healthy, I think anyway... (pescatarian, plenty of fruit and veg, little to no sugar on a daily basis, not much dairy to speak of...) Thanks in advance and sorry for bending everyone's' ear about this... I guess it's just taken a long time for me to admit I might be sick and I need some help. Jen

Wish I could give you a hug. Unfortunately I know how that feels with Neurologists, Internists, Endocrinologists, Rheumatologists, GIs..... I got so tired of crying my drive home after refusing yet another script for Prozac. I do hope your GI can give you some answers even if it is just to rule out other possible issues. Keep on the gluten and we are here for you.