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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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.