Could celiac disorder cause disordered eating? Israeli researchers find a link
Research by a team at Tel Aviv University found a link between celiac disease (CD) and higher incidence of disordered eating behavior during adolescence and young adulthood.
The research team, led by Dr. Itay Tokatly-Latzer of TAU’s Sackler Faculty of Medicine and the Department of Pediatrics at Chaim Sheba Medical Center, released a report on Monday showing that 19% of female teens and 7% of male teens with CD exhibited eating disorders, compared to 8% and 4% of adolescents who did not have CD.
Disordered eating behaviors affect about 10% of adolescents in Israel and other Western countries, and refer to a wide range of abnormal eating behaviors, including binge eating, dieting, skipping meals regularly, self-induced vomiting and obsessive calorie counting.
CD is a chronic condition characterized by inflammation and atrophy of the small intestine. According to Tokatly-Latzer, a higher percentage of Jews suffer from the disease than in the general population.
“We don’t know by what number, but we do know that celiac is more prevalent in the Jewish community and linked to Ashkenazi inheritance,” he explained. “In Israel, about 1% to 1.5% of the population has celiac.”
Tokatly-Latzer said surveys were disseminated via email to 136 adolescents aged 12-18 with CD, which assessed their rate of disordered eating behavior as well as their adherence to a gluten-free diet. It took one year to complete the surveys, which included two self-rating questionnaires: the Eating Attitudes Test-26, and the gluten-free diet questionnaire.
The doctor said he expected those participants who reported a strict adherence to a gluten-free diet (32%) to have more disordered eating behaviors. While that tendency was revealed, “it was not significant,” he said.
Rather, the link seems to stem “from the fact that any restriction of food in general leads to further preoccupation with food,” Tokatly-Latzer said.
Also, those with celiac – and he surmises other chronic diseases as well – often use food restriction as a means of control. “When you don’t have control of many aspects in your life because of a chronic disease, you feel food is the only place you can have control,” the researcher said. “What a lot of patients told us are things like, ‘If I want to fast for 12 or 16 hours, no one can tell me not to.’ They need control.”
Tokatly-Latzer said the research is important because disordered eating tends to develop into full-blown eating disorders for about 25% of patients, “which have tremendous mortality and morbidity associated with them.”
Eating disorders can “lead to a failure to meet nutritional and metabolic needs, which cause severe impairment to psychosocial functioning,” he said.
Some 30% of anorexic girls will never recover, which can have major consequences on their health, according to Tokatly-Latzer. Furthermore, those who do recover, never recover completely, he said.
“Early identification and intervention may improve therapeutic outcomes,” the doctor said, recommending that primary care physicians proactively ask about the eating habits of patients with celiac.
Next, his team is considering doing a prospective study, examining young adults for a number of years from the time they are diagnosed with celiac.
The results of the study were published in the journal Eating and Weight Disorders.