Obesity and Celiac Disease
Friday, March 16, 2012
Tanis Fenton, PhD, RD, Daniel A. Leffler, MS, MD, Jacqueline Chaisson, BA, RN, BN, Arya M. Sharma, MD - courtesy of Palliser Primary Care Network
Yesterday, I was in Medicine Hat (Southern Alberta), speaking at a Nutrition and Metabolism Workshop, hosted by the Palliser Primary Care Network.
While I spoke on obesity management in primary care, I was very much intrigued by a presentation on celiac disease given by Daniel Leffler from the Beth Israel Deaconess Medical Center in Boston, USA.
Leffler gave a most engaging talk on how to diagnose and manage celiac disease.
In his talk he referred to the interesting observation that patients who are successfully managed for their celiac disease often gain weight – not seldom, catching up in obesity rates with their non-celiac peers.
Thus, in a recent paper published in Alimentary Pharmacology and Therapeutics, Leffler and colleagues report on the weight increase in patients treated for celiac disease.
In their retrospective study of 679 patients with biopsy confirmed coeliac disease with at least two recorded BMIs, over a mean follow-up of 39.5 months, they noted that at baseline, the coeliac cohort was significantly less likely to be overweight or obese (32% vs. 59%) than the general population.
However, on beginning and maintaining a gluten-free diet, mean BMI increased significantly with about 22% of patients increasing their BMI by more than 2 BMI points, with about 16% of patients moving from a normal or low BMI class into an overweight BMI class.
Obviously, given the substantial morbidity and increased mortality associated with celiac disease, the fear of weight gain should not stop anyone with celiac disease from eliminating gluten from their diet. Nevertheless, as pointed out by Leffler in his talk, counselling regarding the prevention of excessive weight gain on commencement of a gluten-free diet may need to initiated, especially in those patients who are already carrying excess weight.
AMS
Edmonton, Alberta
Kabbani TA, Goldberg A, Kelly CP, Pallav K, Tariq S, Peer A, Hansen J, Dennis M, & Leffler DA (2012). Body mass index and the risk of obesity in coeliac disease treated with the gluten-free diet. Alimentary pharmacology & therapeutics, 35 (6), 723-9 PMID: 22316503
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Friday, March 16, 2012
Probably important to note that undiagnosed celiac will manifest with impaired nutrient absorption and unintended weight loss due to malnutrition. When discussing weight gain with these patients, it is important to note that their body weight before starting a GF diet is not an accurate reflection of their usual body weight. Weight gain is likely a result of reversed effects of malabsorption/malnutrition. This is a very complex issue that appears to have been oversimplified when viewed from a weigiht-focussed perspective.
Friday, March 16, 2012
I think it should be mentioned that the main reason for weight gain is due to the healing of the intestine, which now allows the proper absorption of nutrients. (Malapsorption was most likely occuring when not following the gluten free diet) However, any person following a gluten free diet needs to follow the same rules for weight management as everyone else…portion control, restriction of treat foods etc. And yes, the replacement bread products do tend to be lower in fibre and possibly higher in fat and sugar, so a reminder to stay within Canada Food Guide recommended servings and look to other sources for fibre such as beans, lentils and legumes.
Friday, March 16, 2012
Isn’t the first thing a person does, on learning that they’re gluten-intolerant, is run out and buy a basketful of gluten-free treats? Perhaps, when the doctor says “you’re a celiac,” s/he should immediately add “and gluten-free junk food is STILL junk food”….
Friday, March 16, 2012
Interesting – anecdotally, I have noted that several of my patients have actually lost weight since being diagnosed with celiac, which I attributed to the necessary avoidance of many quick grab foods which often contain gluten (eg bakery products).
Tuesday, October 30, 2012
I gained almost 15 pounds over the past 6 months before finding out I had celiac disease. I have been strictly gluten free for over 3 weeks and still contiue to gain weight! My belly and face are fat and I bloat on top of that every time I eat. Can you help with some insight?