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Common nutrient absorption issues with celiac and what to do about it

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As we all are far too familiar with, celiac disease can present some challenges with absorbing nutrients from our foods.

Villi

Prior to being diagnosed, the inflammation and damage in the small intestine can cause food to “run right through us” so to speak, and even when that doesn’t happen those little villi aren’t up to par. (Which makes me think-those of use with intestinal issues are certainly a but more familiar with anatomy than the average person, aren’t we?

Villi to anyone else may sound like a shape of pasta-but I digress.) And just in case you are not familiar with the word “villi”, it’s not a pasta or a grape varietal, they are the little finger-like projections that stick out from the walls of the small intestine, sucking up the good stuff-nutrients, vitamins, minerals, etc.

When the lovely little villi get mad at us if we eat what they consider to be the wrong thing, they don’t work so well.

They get riled up and inflamed, and then they don’t do a good job absorbing the good stuff anymore. Over time they can also get smaller (“villous atrophy”, anyone-prior to that are “flattened villi”) and then there’s even less surface area to absorb the good stuff. This continues on as long as the irritant is ingested-in this case, gluten.

The good news

The good news is that the gut can heal to a large extent as long as gluten is not ingested-the irritant is removed and healing can begin. Some of us as are very fortunate and are diagnosed quickly, before too much permanent damage has been done. Others who have suffered through a lengthy diagnosing/mis diagnosing process have a bit more of an intestinal structural challenge when it comes to absorbing properly.

This impaired ability to absorb nutrients can create several issues, of which I’m going to touch on just a few, and lump some together as well. A good idea is to get tested for baseline levels of these items by your doctor (the ones that can be tested for,) generally a simple blood test will do the trick and give you a starting point.

1) Overall lack of nutrient absorption can cause weight loss while undiagnosed.

This is not a good thing. Conversely, after being diagnosed people may find they gain weight. Up to a normal weight this is a good thing, and necessary if an individual has been malnourished due to lack of nutrients. Weight gain after diagnosis is not uncommon, and something I will be touching on in greater depth in another article.

2) Essential fatty acids-Omega 3 and 6’s.

They are all over the media lately, so you’ve probably heard of them. In general, we get enough Omega 6’s from everyday stuff. However, unless you eat a lot of fish, you may want to actively get more Omega 3’s in your diet. Fatty fish like wild salmon are great sources. You can also get some vegetarian sources from walnuts, pumpkin seeds and flax. I also supplement with a fish oil. A TBSP a day of Carlson Fish Oil covers me, and really isn’t bad at all, I promise. Pour into a measuring spoon and just slam it.

3) Vitamin D, Calcium and Magnesium.

I lumped these together because they are all important for bone health. At age 30 I was diagnosed with osteopenia, and here I am an athlete who lifts weights! Bone health is a huge issue for celiacs in general, especially the females amongst us. Calcium is obviously in dairy, but that doesn’t help the casein intolerant, does it?

Food sources of calcium: spinach, greens, (turnip, mustard, collard, kale) broccoli, molasses, squash, cabbage

Food sources of magnesium: pumpkin seeds, brazil nuts, halibut, spinach (see a pattern…) beans, artichokes

Food sources of Vitamin D: cod liver oil, salmon, milk. Other dairy products are generally NOT fortified with D.

Even with all this, in regards to Vitamin D that’s more than likely not going to get you enough. And I’m sure you’ve heard about how Vitamin D is the “sunshine vitamin” which we don’t produce enough due to our largely indoor-dwelling and sunscreen-wearing lives. I supplement with all 3-calcium, magnesium and Vitamin D in pill form.

The The Food and Nutrition Board of the Institute of Medicine has established 2000 IU as generally safe for adults. There’s also a lot of talk about the RDA for Vitamin D being raised significantly. There are also many anecdotal reports of much larger doses being used without adverse affect.

I say, do your research and read, then make an informed personal decision. My personal decision involves 2000 IU of Vitamin D, plus the amounts in my multivitamin, Cal/Mag supplement, and limited sunshine from walking the dog.

4) Iron.

There are 2 types of iron: heme and non heme. According to the McKinley Illinois website:

HEME iron is found only in meat, fish and poultry and is absorbed much more easily than NON-HEME iron, which is found primarily in fruits, vegetables, dried beans, and nuts.

The absorption of non heme foods can be enhanced by eating it with a Vitmain C source (such as citrus fruit, strawberries, red bell pepper) or by being cooked in a cast iron skillet.

Heme iron sources: liver (you knew that was coming, didn’t you?), beef, chicken, pork, salmon, tuna, turkey

Non-heme sources: almonds, apricots, beans, molasses, rice, broccoli

This just begins to scratch the surface. I always take a multivitamin/mineral to cover my nutritional bases. I think a digestive enzyme supplement and pro/prebiotics could also be helpful to assist in maximizing nutrient uptake.

Did you notice any patterns in the lists of recommended foods? Green leafy veggies, lean protein sources, healthy fats in the form of nuts and fatty fish, high fiber food like beans and the veggies again….sounds pretty good, doesn’t it?

Go forth and absorb!!


References:
www.mayoclinic.com
www.health.gov
www.mckinley.illinois.edu

Is celiac disease a “blessing in disguise?”

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Is celiac a “blessing in disguise?”

Yes, I know, some of you are going to get a little upset about that. But really, think about it.

Having celiac disease makes us EXTREMELY aware of what we put into out bodies. Now the trick becomes making sure that it is high quality nutrition, not processed but “gluten free.” Now, I am not going to say all processed food is bad all the time. Heck no, I indulged in some Honey Nut gluten free Chex cereal after my weight training workout this morning. However, in my opinion that should be an exception.

I am a firm believer that if you eat well 90% of the time, (and that could easily be extended to 80%, keep in mind I am a physique athlete and so personally choose to be a bit stricter) that you can eat pretty well whatever you please the remaining 10-20% of the time. Including ice cream, my personal favorite splurge.
But I digress.

My point is, celiacs can’t chew mindlessly on the breadbasket while waiting for dinner. We can’t grab a pretzel at the movies. We have to THINK before we put food in our mouths. So really-if you’re already thinking about it anyway, why not take a little extra time.

Is what you are putting into your mouth not just gluten free, but free of empty calories? Free of artificial ingredients? Is it full of nutrition?

I was once told by a very wise person:

Everything you put in your mouth takes you one step closer to, or one step further away from your goals.

Which direction are you stepping?

You don’t have to have celiac disease to be sensitive to gluten

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By Dr. John Briffa Aug 13, 2009

Many grains people eat contain gluten, which can cause various gastrointestinal symptoms.

Irritable bowel syndrome (IBS), sometimes referred to as functional bowl disorder (FBD), is characterized by symptoms such as abdominal bloating and discomfort, constipation, and diarrhea. Its cause is often said to be unknown. However, I find two approaches to be effective in combating the symptoms of IBS:

  • Identification and elimination of food triggers.
  • Correction of any underling imbalance in the ecosystem in the gut.

It is possible that any food can trigger IBS symptoms. In my experience, wheat is the No. 1 offender. Sometimes wheat sensitivity is caused by sensitivity to a protein found in wheat (as well as oats, rye, and barley) known as gluten.

In conventional medicine, gluten sensitivity is a recognized condition that is known as celiac disease. This can be tested for using blood tests and biopsies of the lining of the small intestine. If the tests come back positive, celiac disease is diagnosed. If they come back negative, it is often assumed that not only is there no celiac disease, but also there’s no sensitivity to wheat or gluten. But is this really so?

I have seen over the years many patients who have turned up negative test results for celiac disease, but who nonetheless have IBS symptoms that seem to have a very clear relationship with wheat consumption. Last year, a 4-year-old girl came to my practice whose parents told me she got diarrhea when she ate wheat, but had no diarrhea if she didn’t eat it. The test of celiac disease was negative, and her dietician (with the support of her gastroenterologist) enthusiastically advocated a diet for this child that was full of grain-based foods, including wheat.

What are we to make of individuals who don’t appear to have celiac disease but nonetheless appear to react adversely to wheat? It’s possible that individuals may react to wheat in a way or through mechanisms that are not necessarily related to full-blown celiac disease.

This concept was put forward recently in a paper that appeared in the American Journal of Gastroenterology [1]. Doctors based at McMaster University in Hamilton, Canada, and the Mayo Clinic, Minnesota, United States, put forward the idea that gluten can induce symptoms similar to FBD “even in the absence of fully developed celiac disease.”

In short, just because someone doesn’t have celiac disease, doesn’t mean the bowel symptoms are not due to gluten.

Some people are keen to be tested for food sensitivity, though in my experience, no tests are foolproof. One reason is that the body can react to food through several mechanisms. Let’s imagine that someone has a food sensitivity as a result of an antibody reaction to that food. If the test specifically looks for this antibody, then it’s got a fair chance of picking up the problem. However, if it’s testing for something else, then it’s unlikely to identify the problem.

One simple but often effective way of identifying food sensitivities is to eliminate foods to see if it helps. One problem here is that some individuals are sensitive to a range of foods, and if all of them are not removed, symptoms may persist even though problem foods have been eliminated. To be on the safe side, I tend to recommend that when they take out wheat, they take out other gluten-containing grains and dairy products.

In my experience, the overwhelming majority of IBS sufferers improve dramatically on this regime. Foods can be added back into the diet (about one every two days) to see which foods cause a return of the IBS symptoms.

References:

1. Verdu EF, et al. Between Celiac Disease and Irritable Bowel Syndrome: The “No Man’s Land” of Gluten Sensitivity, American Journal of Gastroenterology, May 19, 2009 [epub ahead of print publication]


Dr. John Briffa is a London-based physician and health writer with an interest in nutrition and natural medicine.

His website is drbriffa.com