When people with celiac disease start on a gluten-free diet, they often have questions about whether or not the dietary restrictions will cause them to lose or gain weight. The answer depends on a number of factors:
• Are you underweight? If you have active celiac disease, have you lost a lot of weight due to the illness?
• Are you overweight? Do you have few intestinal symptoms and your weight is above normal?
• Are you at the weight you want to be?
• Are you a picky eater, who does not do well with changes in diet? Will you dislike the wheat substitutes and other aspects of the gluten-free diet?
• Can you or a family member cook so that you will have food that is nutritious, gluten-free and tasty?
Based on some of these variables, it is possible to predict who will gain weight and who will lose weight on a gluten-free diet.
In the past, children who would be diagnosed with celiac disease had what is called “failure to thrive,” which means they are not growing. Older children and adults would have significant weight loss.
Part of this is because of the cramps and diarrhea which make people less likely to want to eat. But a large part of the weight loss is from the damage to the intestine done by gluten in patients with celiac disease. They cannot absorb nutrients including enough calories into their systems.
Anyone who is very sick as the result of celiac disease will see their symptoms improve on a gluten-free diet. Even if they cannot eat what might have been favorite foods, they will be able to eat more and absorb more.
As time goes by their intestines will heal and if they are presented with enough nutritious food they will gain weight. Children should start to grow normally and older people should reach a healthy weight. So, for people very ill with celiac disease, a gluten- free diet is a weight-gaining diet.
On the other end of the spectrum would be someone with no intestinal symptoms at all, diagnosed with celiac disease because he or she had unusually severe osteoporosis (thin bones). A doctor thought to run the antibody tests, and after they came back positive, he or she underwent an intestinal biopsy which confirmed celiac disease, although the bowel changes were not severe. This person is overweight and loves breads and pasta. He or she does not like the substitutes allowed in the gluten-free diet, and winds up eating less. This person could certainly lose weight on a gluten-free diet.
There are other ways the gluten-free diet can affect people’s weight. If a family is adopting a gluten-free diet because one member of the family has celiac disease, there is a chance other people may lose weight, hopefully not a lot unless that is what they want. When you start to look at everything you are eating, and you have to stay away from gluten, you can chose healthy, fresh food.
Even though there are gluten substitutes for baking, and there are increasingly more companies making delicious gluten-free desserts, a gluten-free diet tends to be lower in carbohydrates and calories than many people usually eat.
This can lead to healthy eating for an entire family and weight loss for those who tended to overeat in the past. This can easily happen when the person with celiac disease is a child, and the parents want to show that they are eating the way that she is.
However, the gluten-free diet is not a weight-loss diet. It has become a fad diet to a certain extent, because celebrities who have celiac disease themselves or children with celiac disease can talk about the diet in public; consequently a lot of attention gets paid to the diet. Eating gluten free tends to cost more, and it takes a lot more creativity to learn how to cook with wheat substitutes.
There is no reason not to stop eating gluten, especially if you chose to do so because of a family member. But there is no medical reason to stop eating gluten unless you are allergic to wheat or have celiac disease.