Celiac Disease & Nutrition & Lifestyle Discussion
It is established that eating grains with gluten - wheat, rye and barley - causes problems for patients with celiac disease. There is good evidence that oats are not a problem.2, 27-30 In one study about 95% of celiac patients were about to consume nearly two ounces of oats/daily for up a year.3
Improvement of symptoms generally appears within several weeks of carefully avoiding wheat and its cousins, rye and barley, and also carefully avoiding all foods and supplements which contain components that arise from those grains. Testing of the capacity of the body to again absorp nutrients demonstrates that it takes several months for best absorption functioning.4
While most people find relief from symptoms from a gluten-free diet, some do still have some symptoms. These may be either from tiny amounts of gluten taken in error, processed foods foods contained gluten but were mis-labeled gluten-free, or another substance such as soy12-14 or milk11 is still causing problems. One research study demonstrated that a careful gluten-free diet that completely removes all gluten including following double-blind and open challenges, brought about relief from symptoms in 77% of the patients.5 If symptoms remain after being perfectly gluten-free for 3 months, the next step is to test for other food allergies or intolerances.
Nutritional Supplement Treatments
Primary nutritional deficiencies
Celiac disease results in very poor absorption by the body of nutrients that can lead to multiple and serious deficiencies. These include, especially, iron, fatty acids, vitamins D and K, magnesium, calcium and folic acid.17 Zinc deficiencies also can result,18 and can be a problem even for people whose symptoms have mostly disappeared due to their changed diet.19 One of the first things to do when you have been diagnosed with celiac disease is to be checked for nutritional deficiencies. Furthermore, once you begin your gluten free diet you should supplement with high-potency minerals and multivitamins. In a few cases your health care provider may recommend very high doses for specific nutrients.
Once you begin your gluten-free diet, your nutritional stores will slowly get better. Some stores, such as for some of the B vitamins build up over time, and other deficiencies might continue even if you have eliminated gluten from your diet.
One study reported that magnesium deficiency existed in a third of 23 celiac patients on strict gluten-free diet and who had no symptoms. However when they began intake of magensium supplements, for 2 years, their bone mineral density improved markedly.20
Night blindness and Vitamin A
In one research study a few celiac patients on gluten-free diets, and who were also taking multivitamins with vitamin A, tested poorly for dark-adaptation, indicating night blindness. Some experienced improvement with greater supplementation of vitamin A. 21 If you have celiac disease vitamin A deficiency should be one of the things to be tested for and discussed with your medical professional.
Bone densitity and Vitamin D
When the body has been depleted of vitamin D, osteomalacia may be the result.22 This is a condition, contrasted to osteoporosis, where bone mass may or may not be alright, but the bone structure is deficient in minerals. Supplementation can increase the mineral content, but bone densitiy may still be a problem, leaving one at risk for fracture.
Subtle nutritional deficiencies
There may be other subtle vitamin or mineral deficiencies in celiac patients that are not completely resolved by the gluten-free diet. This is more likely if people are not carefully avoiding all gluten. There are many issues, balances and complexities for celiac disease patients so careful monitoring of your nutritional status is very important. It is recommended that you work with your doctor to determine which, if any, and the quantities of additional nutrients are needed beyond those provided by your multi-vitamin / multi-mineral supplementation.
Many celiac disease patients don't generate enough digestive secretions from the pancreas, such as the enzyme lipase.25 One study demonstrated that children who received such enzymes in the first month of their gluten-free diet gained much more weight during that month than those that did not receive the enzymes. Note that this supplementation was of value only in the first month of the new diet.26
Strategies There is a difference in enzyme strategies. Enzymes such as Vegie Zymes are typically taken with meals to help breakdown food.
Others, such as Serrapeptase and Nattokinase are best taken on an empty stomach to help breakdown debris in the blood and tissue as this debris may be the cause of underlying chronic inflammation. If these enzymes are taken with meals, they instead they end up acting as digestive enzymes.
27. Picarelli, A., and associates, 2001. Immunologic evidence of no harmful effect of oats in coeliac disease. American Journal of Clinical Nutritrion 74:137-140.;
28. Kilmartin, C., and associates, 2003. Avenin fails to induce a Th1 response in celiac tissue following in vitro culture. Gut 52:47-52
29. Janatuinen, E. K., and associates, 2000. Lack of cellular and humoral responses to oats in adults with coeliac disease. Gut 46:327-331 30. Hoffenberg, E. J., and associates, 2000. A trial of oats in children with newly diagnosed celiac disease. J. Pediatr. 137:361-366.