When I was a kid, I was aware that my grandmother was frequently sick as a result of something called “sprue.” It meant she had a weird diet, and was very thin. Sadly, she also had no sense of smell, so the world of food was entirely unremarkable for her. No one else we knew had sprue, an autoimmune disorder, but it made sense because she had other autoimmune stuff going on too.
In 11th grade I went on a trip to what was then the Soviet Union. I made the mistake of eating something from a street vendor. I got very sick, and the sickness lasted through senior year. Regular ol’ tourist bacteria was quickly ruled out, but when the gastroenterologist found out my grandmother had sprue, he got excited: It skips a generation, he said, and might be the cause of my problems. I underwent endless tests and then a biopsy of my small intestine. The results were inconclusive. But a gluten allergy has very specific symptoms—very. Trust me, you don’t want to know what they are, because they’re related to poop, but they are pretty unmistakable and I had them. The doctor diagnosed sprue.
I was put on a gluten-free diet. In high school, that kind of sucks. It’s hard to go to pizza joints and Burger King with all your friends and be so limited. My parents took me to a celiac sprue support group, and I can only tell you that we laughed all the way home. This was 1985, remember, and the delicious! “cornbread” they served to prove that it wasn’t so bad to be gluten-free was not encouraging. The conversation was unintentionally hilarious.
The weird thing was, I got better. My symptoms disappeared. Then, at my high school graduation party, I unthinkingly plucked a piece of macaroni from a bowl of macaroni salad on the sideboard and popped it into my mouth. As soon as I realized it was gluten, I started to cry. What had I done? I told my mom in a panic and she said she thought it was okay. And it was. Gradually, I introduced gluten back into my diet. And you know what? Nothing happened. From that day to this I’ve been eating gluten and never had a problem again.
Nowadays the mysterious sprue is known as gluten allergy and it’s everywhere. It seems half the people I meet are allergic to wheat, and the allergy has spawned an industry of foodstuffs and cookbooks. (For a funny take on this kind of thing, check out the Allergy Pride Parade on the new season of Portlandia.)
Dealing with allergies of any kind can get you down, but when the allergies pertain to something we do every day—something as fundamental as eating—it can truly be a pain in the ass. Now a new study says it’s rather more serious than that for women. From MedPage Today:
In celiac disease, ingested gluten can damage the surface villi and impede nutrient absorption, but 37% of women with the condition met the clinical threshold for depression on the 20-item Center for Disease Studies Depression Scale, according to Joshua M. Smyth, PhD, of Pennsylvania State University in University Park, and colleagues.
Moreover, 22% also met the criteria for disordered eating assessed on a 29-item questionnaire, the researchers reported online in Chronic Illness.
Following a gluten-free diet is the usual recommended treatment for celiac disease, however, because of the near ubiquity of gluten in common foods, many patients with the immune disorder have difficulty keeping to their diet.
And even those who do adhere to the diet can remain symptomatic, which can interfere with normal functioning and lead to psychological difficulties.
Unsurprisingly, women who are forced to focus on food due to the disease can get consumed by the worry, and segue into eating disorders like anorexia and bulimia. Given that eating disorders are frequently about control issues, this makes sense—you have no control over your celiac diet but you exert control otherwise. Also, women who are on the celiac diet have excessive concerns about weight, according to the study. On the other hand, I don’t know one single woman who doesn’t worry about her weight.
Worse celiac symptoms were associated with poorer physical functioning and mental health (P<0.001 for both).
Correlations also were seen between different areas of psychiatric functioning, such as depression and stress (r=0.54, P<0.001), as well as stress and eating concerns (r=0.85, P<0.001).
The average level of depressive symptoms was 14.93, with a cutoff for clinical depression of 16.
The 65 women whose depression scores were at or above the cutoff had worse celiac symptoms (P<0.001), greater stress (P<0.001), lower dietary adherence (P<0.05), and worse quality of life for both physical and emotional domains (P<0.001 for both). ....
The study confirmed that women with celiac disease are at risk for psychiatric distress, implying that screening may be useful and that psychosocial support may be an important aspect to overall care for these patients, they observed.
Lesson to be learned from the study? Women who adhere to the diet and do not obsess about their weight are far less likely to experience depression.
No wonder women get eating disorders.
A photo of plus-sized model Lizzie Miller that ran in Glamour magazine has caused a bit of a stir. Here’s that photo:
Actually, Miller would like to be a plus-sized model, but has been generally rejected by the industry for being too heavy.
This isn’t the first time this has happened in the modeling world, of course. There was the famous photo of Filippa Hamilton, who at 5′ 10″ and 120 pounds, was deemed too fat to work for Ralph Lauren. As a result, the company Photoshopped the hell out of her, making her look preposterously thin.
Hamilton was understandably distressed by this manipulated image of herself and she protested it. Ralph Lauren apologized and removed the image from the web. But they still let Hamilton go because she could no longer fit into their sample sizes. At a size 4, she was now too heavy.
There are many more stories like this. I recognize that eating disorders are not caused by media portrayals, or not exclusively, at any rate. And men have eating disorders as well. But this latest story about Lizzie Miller demonstrates how damaged Western society is on this subject, and for women who struggle with food issues, it makes it so much harder to get beyond them.
I had a dream the other night about a high school friend of mine who died of anorexia. I dream about her once a year and wake up feeling guilty every time. I remember going out to lunch with her one day shortly after she told me about her diagnosis. I begged her to eat with me. I said, “Can’t you just have a bite?” I had no idea what she was going through. Later on in her illness, I was equally inept. I know it doesn’t make a difference. But I still hate myself when I think about how little I understood.
One thing that confused me was why, when she went into the hospital, they couldn’t fix her. According to Andrea Garber, associate professor of pediatrics at University of California San Francisco, “Our [research] show[s] that the current recommendations are just not effective.”
Rick Nauert, senior news editor at PsychCentral, explains that the research conducted by Garber and her colleagues reveal that current hospital practices related to anorexia treatment may need to be reevaluated.
According to the researchers, current guidelines recommend starting with about 1,200 calories per day and advancing slowly by 200 calories every other day.
This “start low and go slow” approach is intended to avoid “re-feeding syndrome” — a potentially fatal condition resulting from rapid electrolyte shifts, a well-known risk when starting nutrition therapy in a starving patient.
The new research is the first to test these recommendations, which have been in place since 2000. ….
“Studies show that weight gain during hospitalization is crucial for patients’ long-term recovery,” she said. “We have to make the most out of their short time in the hospital.”
In the new study a range of diets were evaluated from 800 to 2,200 calories. This caloric variation allowed the researchers to examine the effect of increasing calories. According to Garber, two important findings emerged:
-The calorie level of the starting diet predicted the amount of weight that would be lost in the hospital. In other words, those on lower calorie diets lost significantly more weight.
-Higher calorie diets led to less time in the hospital.
In fact, Garber said, “we showed that for every 100 calories higher, the hospital stay was almost one day shorter.”
It’s distressing to think that so much of what matters these days is how many days insurance will pay for. Fortunately, given that people can’t stay as long as they need to, a higher-calorie diet had no adverse health effects in this study’s participants.
I don’t mean to belabor this topic, but this one hit my radar as it’s “about” Quakertown, Pa., where I’ve spent sufficient time.
Anorexic Realizes She Just Has To Eat
Quakertown, PA resident Jasmine Strotz, a 22 year-old who has been struggling with the eating disorder anorexia for three years now, was relieved to hear, during a class discussion at the college she attends, that all she has to do is eat and her disease will be cured.
“For years, I’ve wondered, ‘How can I stop this?’” she said in an exclusive interview. “I thought and thought, but I just couldn’t figure it out. It was the hardest problem I had ever faced.”
When the problem first surfaced, Strotz was reluctant to go to a doctor, believing she could fix matters herself.
“I tried some home remedies, like trying to pack clay onto my body in hopes that it would absorb into my skin and become weight,” she explained. “I also tried sleeping with the food, as well as looking at pictures of food. But still I remained hungry!”
Normally, I don’t offer my opinions on these ForOs. But this one? Its poor writing offends me. Click here for the rest.
The New York Times last night posted a story about orthorexia, a sort of eating disorder in children whose parents have been strict about what they’re allowed to eat.
While scarcely any expert would criticize parents for paying attention to children’s diets, many doctors, dietitians and eating disorder specialists worry that some parents are becoming overzealous, even obsessive, in efforts to engender good eating habits in children. With the best of intentions, these parents may be creating an unhealthy aura around food.
“We’re seeing a lot of anxiety in these kids,” said Cynthia Bulik, the director of the eating disorders program at the University of North Carolina at Chapel Hill. “They go to birthday parties, and if it’s not a granola cake they feel like they can’t eat it. The culture has led both them and their parents to take the public health messages to an extreme.”
Tiffany Rush-Wilson, an eating disorder counselor in Pepper Pike, Ohio, has seen the same thing. “I have lots of children or adolescent clients or young adults who complain about how their parents micromanage their eating based on their own health standards and beliefs,” she said. “The kids’ eating became very restrictive, and that’s how they came to me.”
This kind of problem includes a dramatic increase in kids who won’t eat certain foods because they believe them to contain pesticides. The Times profiles one woman whose obsession with health food turned deadly:
But whatever the behavior is called, those who have lived through a disorder fueled by an obsession with healthful eating say that the experience can be agonizing. Kristie Rutzel, a 26-year-old marketing coordinator in Richmond, Va., began eliminating carbohydrates, meats, refined sugars and processed foods from her diet at 18. She became so fixated on eating only “pure” foods, she said, that she slashed her daily calorie intake to 500. Eventually, her weight fell to 68 pounds and she was repeatedly hospitalized for anorexia.
Today Ms. Rutzel, who said she is normal weight, often talks to young girls in schools and churches about the perils of becoming health-food obsessed.
When I think about childhood food, I have such lovely memories — hoagies, Whopper Juniors, Big Macs, Yankee Doodle cupcakes, you name it. I guess this is one disease I’ll never have to worry about.
liz | 11:24 AM | eating disorders