Maximizing Your Health

Supplementing the Gluten-Free Diet
Celiac disease (CD) prevents the body from absorbing nutrients properly. There are no longer as many functioning "holes in the sieve" for nutrients to get through to the blood stream. Even after the villi in the small intestine are described as being "back to normal," there remains the potential of some nutrients being absorbed at lower levels. Because of this, the monitoring physician may recommend a blood test analysis to learn if selected vitamins or nutrients are being absorbed at adequate levels.

Once a determination is made, supplementation of the gluten-free (GF) diet may be advised. This recommendation may include selected intake of iron and folate and, in a few cases, one of the B vitamins. Occasionally there is need for replacement of fluids and electrolytes, including calcium, potassium and magnesium. Both men and women with low bone density may require vitamin D replacement. If there are associated conditions, such as lactose intolerance or diabetes, a series of additional treatment elements may apply.

It is important to remember that the immune system of a person with celiac disease is weak. The auto-immune system functions at a lower than normal level. Infections may not be handled as well as in other people. Stamina and resilience may not be at the level they once were. Most vitamins, food supplements and over-the-counter medications are based on and measured for persons at full-functioning, full-absorbing levels. A person with CD may need less or perhaps more of a particular vitamin, mineral or medication. Again, working with a monitoring physician will help determine what and how much is the appropriate allowance of a particular medical or supplemental product. If symptoms persist after adopting a GF diet, further refinement may be necessary.

Additional Sensitivities May Be Present
Even after the GF diet is well established, one or more of the original symptoms may persist. If this occurs, it is important to again consult the monitoring physician as there may be additional food sensitivities or other health considerations involved.

Lactose Intolerance One generally transient condition that is common in those with CD is lactose intolerance. If lactase is not present to facilitate digestion of the milk sugar, lactose, the body reacts with symptoms such as bloating, gas and/or diarrhea. A simple test for lactose intolerance can be administered during a routine physician visit.

Molds Also common for newly diagnosed CD patients is sensitivity to food and air-borne molds. This is likely to include such common foods as mold-based cheeses, mushrooms, yeast and yeast products and xanthan, which may be used as a binder in some gluten-free breads.

Food Allergies A lesser number of celiacs report that one or more food allergies also affect them. Approximately 90% of food-based allergies in the U.S. are linked to eight major categories: milk, soy, eggs, fish, Crustacean shellfish, tree nuts, peanuts and wheat. It is important to note that one can have an allergy to wheat and not have celiac disease.

For each of these conditions, appropriate dietary changes and related adjustments will need to be made with the help of the monitoring physician. However, for the majority of celiac patients, the gluten-free diet is the entire treatment. If symptoms continue to persist after adopting a GF diet and checking for additional sensitivities, further refinement may be necessary.

Associated Conditions
For the patient who may have had active, untreated celiac disease for a number of months or even years, there may be associated immune-related conditions. There is an established association between CD and insulin-dependent diabetes mellitus and with thyroid disease. Not so common, but occasionally found in patients with CD are hyposplenism, splenic atrophy and selected neurological disorders. It must be emphasized, however, that none of these conditions is specific for CD.

The conditions of osteoporosis and osteopenia (a loss of bone mineral density) are serious complications for persons with CD. Most authors report the incidence to be about ten times higher among celiac patients than is found in the general population. It is likely that about 4 out of 10 celiac patients will need aggressive treatment for low bone mineral density-related problems. While it can be a problem for both men and women, it affects post-menopausal women at a higher level. Diagnosis of this complication can now be made using bone densitometry. Treatment typically includes calcium supplement intake along with estrogen replacement. Any pattern of treatment must be based on individual evaluation and physician recommendation.

A link has also been discovered between untreated CD and enteropathy-associated T-cell lymphoma. This is true also for patients with dermatitis herpetiformis. Studies have shown, however, that the risk of contracting this condition is reduced when the gluten-free diet is strictly maintained. It has also been found that bowel adenocarcinoma may develop when celiac disease is untreated for a long period of time.

Health Maintenence
Be proactive! In order to allow for accurate and timely assessments, the monitoring physician needs to know when health screenings and evaluations are made in the following areas:

• up-to-date flu shots and pneumovax 23, the vaccine for pneumonia
• bone mineral density
• diabetes
• GI malignancies, colon cancer and hemo cell
• Iga levels in patients with recurring infections
• glandular function (thyroid)
• anemia