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More Sanctioned Food Restriction: Eating Gluten Free

More Sanctioned Food Restriction: Eating Gluten Free
Is a Gluten-Free Diet a “Cover” for an Eating Disorder?

Over the past week there has been media discussion of some medical controversy over the growing trend of a gluten-free diet. Gluten-Free, Whether You Need It Or Not (New York Times, February 4, 2013) discussed the gluten-free diet as a medical necessity for individuals with celiac disease. The author, Kenneth Chang, describes the trend of eating gluten-free and individuals who claim some benefit, in the absence of celiac disease.

The article describes developments in research supporting the possibility that 1% of the population may also have sensitivity to gluten and benefit from decreasing gluten in the diet. However, Dr. Stefano Guandalini, from the Celiac Disease Center is quoted in the article stating that a gluten-free diet “is not a healthier diet for those who don’t need it.” In my treatment of eating disorders, I have seen the addition of the gluten-free diet as yet another sanctioned form of food restriction that is celebrated by the diet industry and the popular media.

The New York Times parenting blog Motherlode discussed the Kenneth Chang article with regard to parents choosing to have children eat a gluten-free diet. It quotes a New York dietician giving mixed reviews of this decision. She warns that the gluten-free diet can be a “cover” for an eating disorder. Journalist Meghan Casserly, in a 2011 Forbes post, discussed the trend of young women with eating disorders using a gluten-free diet as a cover for their restrictive eating. She quotes an adolescent girl on a Pro-Ana (pro-anorexia) website who recommends to other anorexics the use of a gluten-free diet as justification for dramatically limiting food intake.

Given the deceptive nature of an eating disorder, it would not surprise me that some anorexics would use this medical excuse to justify food restriction. What I have seen more often in my practice, are eating disorders that begin in adolescents who are influenced by cultural health trends promoted by sources that they consider reliable: health teachers, nutritionists, coaches, and parents. Multiple celebrities have publicly promoted a gluten-free diet, claiming positive benefits for themselves and their children. Given the rampant nature of eating disorders in the entertainment industry, celebrity endorsements are dubious.

Nonetheless, teenagers and adults experiment with this idealized health regimen. I have seen this happen with many dieting trends including individuals who subscribe to a vegan lifestyle, The Paleo Diet, or any diet that eliminates carbohydrates, sugar, or fat. Once someone begins to restrict food intake and make every eating decision based on stringent rules, the effects of starvation quickly set in. This was documented in the Keys starvation study in 1950 when healthy men who dramatically reduced their food intake developed symptoms associated with anorexia, including preoccupation with food, distorted body image, depressed and anxious mood. What we know from this study is that individuals who restrict their eating soon become increasingly obsessive about their food, having difficulty thinking or talking about anything else. Most of us have seen this behavior at one time or another. Unfortunately, individuals who have a genetic and/or psychological predisposition for developing an eating disorder who adopt gluten-free or other diet trends can quickly become consumed by an illness that can overshadow everything else in their lives and put them at grave medical risk.

Celiac disease and true gluten-sensitivity are rare. If your teenager insists she cannot eat because of stomachaches, think twice before allowing further food restriction. Stomachaches can be another consequence of starvation. When the proper amount of food is not consistently moving through the gut, the system becomes less efficient, causing GI discomfort.

I have seen parents too often, who have innocently permitted their child to follow a health trend that has triggered a life threatening eating disorder. When new recovery-focused food options are presented, these patients do cling to the rules of the gluten-free diet or assert that they are vegan, lactose intolerant, “paleo,” and so on. Adolescence is a time when we want to respect a teenager’s growing autonomy and individual expression. When these ideas lead to starvation, however, we must find other ways for kids to be independent.

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Risks of the Campaign Against Obesity

If Michelle Obama thinks it is okay for children to diet, I fear you might too.

At President Obama’s first state of the union address he announced that First Lady Michelle Obama would champion the childhood obesity problem. Now, I will share that I am a huge fan of the President and Mrs. Obama, but I see the world through the eyes of an eating disorder specialist and was disappointed when I learned that Obesity would be Michelle’s focus.

In my practice I have seen many eating disorders triggered by medical interventions made in the name of obesity prevention. For this reason my heart sank when I read today of her comments about the weight of her daughters and her statements about putting them on diets.  I can only assume that Michelle Obama has the best intentions, but like so many well-educated people I meet is seriously unaware of the risks of dieting.

The scenario that Mrs. Obama described is one which I have heard far too often. A parent is told by a trusted pediatrician that the child’s BMI is too high and that the child needs to lose weight. There are numerous problems with this. One of them is related to campaigns against obesity. This movement has lead doctors to feel pressured to focus on the BMI (Body Mass Index) and make recommendations to families accordingly. What often gets disregarded in these assessments is genetics. Not everybody is genetically meant to be small or thin. What needs to be considered is the family history, weight, and eating trends for each child. I do not want to minimize the serious health risks that can often be related to poor diet and lack of physical activity, however, the anti-obesity movement has often focused only on numbers. I have had patients come to me who were told by physicians to lose weight based on their BMI but the doctors never bothered to learn that the patients had been restricting food and exercising compulsively in order to reach their current weight.

During my career there has been a shift in the demographics of eating disorders. While anorexia was once a disease predominantly in white affluent communities, it has moved into Hispanic and African American populations, among others. I attribute this change in part to the anti-obesity movement. Genetically, these individuals are not typically supposed to be small. If health is determined by size we should not be using the same measure for every racial population.

When a person begins to diet to become a size that is not genetically appropriate, there is a higher risk for an eating disorder. Often the adolescents or even children with anorexia that I have seen are prompted by a doctor’s orders to lose weight. Not everyone who diets will develop an eating disorder, but for those who are vulnerable to anorexia for a range of reasons are quite at risk when told by a doctor to diet. This can start a very tragic cycle. And anorexic thinking is quite rigid so for years, as they starve themselves and can barely function, they say, “but the doctor told me to lose weight.”

President and Mrs. Obama, by admission, refuse to miss a day of exercise. If this was reported to me by a family in my office I would have great concern for the message sent to their young daughters. I have held the Obama’s in such high regard that until now I never considered the meaning of their exercise routines. Clearly, through the lens of the media, it is hard to get the true picture of how restrictive Mrs. Obama has been with the girls’ food. However, drawing attention to their eating habits publicly and sending a message to the country at large that dieting is positive is alarming to me.

Laura Hauben, Psy.D.
Clinical Psychologist
(415)515-3772
http://www.drlaurahauben.com

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Stress in your Child

How to Identify Stress in Your Child

Symptoms of post-traumatic stress disorder (PTSD) in children and adolescents may include the following, but vary among individuals.  Such symptoms are indicative of PTSD when they reflect a change from the individual’s prior functioning, behavior, or emotional experience.

To identify stress in your child, look for these symptoms:

  • difficulty sleeping
  • sad or depressed mood
  • feeling jittery or on guard
  • being easily startled
  • loss of interest in things they used to enjoy
  • feelings of detachment, numbness, and lack of responsiveness
  • periods of blanking out, staring off while awake
  • discomfort with physical affection
  • irritability
  • increased thoughts about and fear of dying
  • regressive behaviors (baby talk, thumb sucking, bedwetting)
  • increased complaints of physical discomfort often with the bodily location changing frequently (headaches, stomach aches)
  • increase in aggressive behavior
  • avoiding certain places or situations that bring back memories
  • flashbacks or intrusive images
  • losing touch with reality
  • reenactment of an event for a period of seconds or hours or, very rarely, days
  • difficulty concentrating

If  your child has experienced a traumatic event, and you are noticing any of the above signs of distress or trauma, contact me or seek other professional help as soon as possible.

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Multiple Causes of an Eating Disorder

When I meet parents in a non-clinical setting and tell them I am an eating disorder specialist, they often ask if there is anything I would suggest to help insure their child would not develop an eating disorder.

I do have some suggestions in response to that question.  It is important, however, to be aware that we do not know exactly what causes an eating disorder.  There was a time that parents were held responsible, which only added to the trauma of having a child with a life-threatening illness.  What we do know is that there are multiple factors, different for each individual, which converge and lead to an eating disorder.  Biology, cultural messages, media, family patterns, and life circumstances all play a role.

With that said, here are ten suggestions I do have for parents:

  1. Eat and enjoy food with your children!
  2. Create family mealtimes and protect these routines.
  3. NEVER criticize yours or anyone’s size, shape, or appearance or speak idealizing of people who are thin.
  4. Help your child find physical activities that he or she enjoys and emphasize the pleasure of sports, not the pursuit of fitness or weight management.
  5. Do not categorize foods as good or bad.  Provide everything in moderation without restricting any one type of food.
  6. Be aware of the media your children view and discuss the influences of the messages and images to which they are exposed.
  7. Allow space for children’s big feelings and help them develop healthy ways of relaxing, comforting themselves, and expressing their emotions.
  8. Allow imperfection.
  9. Encourage children to ask for what they need and teach them how to cope when they don’t get it.
  10. NEVER, NEVER, NEVER encourage or permit dieting!!!

If you have any questions about any of these recommendation, feel free to email me or call me.