In Part 1, I told you how I was a cheater when it came to implementing the gluten free diet. Today, we’ll go over some mechanisms behind why we see weight gain and weight loss with celiac disease.
Physical and psychological causes
There are 2 categories to take a look at-the physical, and the psychological. Both have impact on weight management-the psychological is just as powerful as the physiological. We’ll look at issues in both categories. In parts 3 and 4 we’ll cover steps you can take to positively impact your weight and health.
First, the physical.
Physical reasons behind weight loss and celiac disease/gluten intolerance:
- With celiac disease (gluten sensitive enteropathy), there is damage done to the villi in the small intestine. The damage limits the ability of the intestine to absorb nutrients. With limited absorption, less overall calories and also less vitamins, minerals, etc. Many times a person may feel so sick that they just can’t eat enough to make up for the poor absorption. Worse, they may be eating more of the foods that are actually making them sick without realizing it.
- People can feel so unwell when they eat they just eat less. Less often, and less in amount. Decreased calories.
Physical reasons behind weight gain and celiac disease/gluten intolerance:
- Decreased absorption of nutrients can contribute to people never feeling “full.”
They eat more, in frequency and/or amount. Eventually the calories get absorbed, and it catches up. After diagnosis, there may also be a small overcompensation effect of the gut to absorb nutrition.
- When your gut begins to heal and absorb nutrients, you may find that you gain weight.
The nutrition and calories that was just going thru you before in now being assimilated into your body. This is a good thing from a health standpoint. If you listened to part 3 of the podcast with Shelly Stuart she mentioned how she gained a bunch of weight after her gut began to heal. She had been accustomed to eating large amounts of food because it wasn’t being absorbed. When absorption increased, so did her weight. So she recognized that and scaled back on portions, focusing on quality and nutritionally dense foods. The upshot here-you may have been eating more food than you actually needed before, but some of it was going straight into the toilet. How’s that for a visual?
- The damage and affects of celiac disease may impact the hormones in our gut that control appetite and satiety (the sense of being full.)
2 main hormones are leptin and ghrelin.
Quick definitions per Medical Dictionary.com:
hormone indicating degree of hunger: a hormone produced by fat cells that indicates the degree of hunger to the hypothalamus of the brain. (Tells you when you feel full and stop eating. Problems with leptin can lead to eating too much because “I’m full” doesn’t kick on.) Leptin resistance also appears to be a problem, as many obese indivduals have high levels of leptin, but are not recognizing the full sensation.
a gastrointestinal hormone produced by epithelial cells lining the fundus of the stomach; appears to be a stimulant for appetite and feeding.
A study done in 2005 in Italy using classic symptom female celiac patients (the underweight/malnourished classic) showed decreased ghrelin levels after 2 years of being on a gluten free diet, even though their body mass and fat mass had increased.
Another study completed on children with celiac disease showed leptin levels lower than non-celiac children, which then increased after one year on a gluten free diet.
A study in 2003 showed high levels of circulating ghrelin levels in adults with active untreated celiac disease, and normal levels of ghrelin in those who had been treated with a gluten free diet.
So why does this all matter?
We still don’t know, to be honest. This is an example of how our gut affects our hormones, and especially that as someone who has been newly diagnosed with celiac disease or gluten intolerance, you may feel especially hungry. There’s much more research to be done, and I’ve only begun to scratch the surface of what has already been done. But the take home is that our hormones dealing with hunger and the sense of fullness may be affected, and so may not be too accurate when it comes to saying we’ve had enough to eat.
Which brings me to the psychological impact of celiac disease/gluten intolerance on weight:
- After diagnosis there is an immediate reaction of “What can I eat?”
The gluten free diet can feel overwhelming, with the huge lists of ingredients to avoid. First instinct may be to gravitate toward comfort foods labeled “gluten free,” and the attempt to replicate a “normal” carb based diet with their gluten free substitutes. Unfortunately, this can lead to weight gain. Many gluten free substitutes of ordinarily gluten foods have a higher number of calories. Many times this is due to the need to add additional fats to get a decent “mouth feel” in the product. With the proliferation of gluten free foods in the marketplace (a great thing for choice) also comes an increased need to be aware of the nutritional content and value of what we eat-to look “beyond the gluten free label.” Just because it’s gluten free doesn’t mean it’s good to eat in large quantities.
- There is also a sense of Thank Goodness I can eat without feeling sick!
This can lead to eating an increased volume of food as well-just being so happy that you don’t feel sick any more, and taking advantage of that.
Couple that with the fact that our innate mechanism of knowing when to stop eating because we feel full may be affected (we don’t know this for sure yet) because of some hormonal wackiness, and we’ve got some challenges.
In Parts 3 and 4 we’re going to look at steps you can take to impact your weight in a positive way, whether it’s a need to gain, or a need to lose.
If you have questions/comments/experiences, please leave them below. I like to hear from you-don’t be shy!