Gluten intolerance is associated with severe vitamin and mineral deficiencies

Gluten intolerance is associated with severe vitamin and mineral deficienciesPeople with celiac disease are hyper-sensitive towards gluten, which we get from wheat and other grains. Gluten triggers inflammatory processes in the mucosa of the small intestine, impairing the uptake of nutrients. At the time of being diagnosed with the condition, people are often severely deficient in vitamin B12, vitamin D, folic acid, zinc, and copper. That problem should be addressed, according to a large study from the Mayo Clinic, a large, non-profit medical center based in Minnesota, USA. A growing number of people are affected by celiac disease that is linked to digestive problems plus other symptoms that are often misdiagnosed because the patient lacks vital nutrients. In this article, you can read about the difference between celiac disease and other types of gluten intolerance and find out how to deal with the problem.

Celiac disease is a chronic, autoimmune disease that is caused by gluten intolerance. Gluten is primarily found in wheat but also in rye and barley. Gluten is made of two different proteins called gliadin and glutenin. If a person with celiac disease eats gluten, it triggers the immune system to react, primarily against gliadin, by treating it as a microbe and attacking it. This sets off chronic inflammation in the mucosa of the small intestine. At the same time, the intestinal villi in the small intestine are destroyed. Normally, their job is to increase the surface area (and potential for nutrient absorption) of the intestine, so when the villi are destroyed, it impairs the small intestine’s uptake of vitamins, minerals, carbohydrate, and fat. The increased risk of diarrhea may also result in the loss of nutrients. In toddlers, the risk of getting celiac disease increases if they begin eating bread and porridge before the age of six months. Some people may even be genetically predisposed. Also, the risk of celiac disease goes up with age.

  • As many as 50,000 Danes may have celiac disease without knowing it
  • This is because doctors do not screen for the disease, and blood samples may provide misleading results
  • Other types of gluten intolerance represent an even larger grey zone

A new view on celiac disease and severe lack of nutrients

The new study was carried out on 308 adults, all of whom had been diagnosed with celiac disease in the period between 2000-2014. Contrary to what the scientists had expected, weight loss was only observed in 25.5 percent of the participants, which is not all that much. What surprised the researchers, however, was that nutrient deficiencies were far more widespread than they had imagined. They found that a whopping 59.4 percent of the patients lacked zinc, and that can affect health in a number of ways, as this mineral is involved in around 1,000 different enzyme processes, which are relevant for growth, fertility, vision, skin, hair, appetite, smell sense, and mental balance.
Lack of vitamin B12, vitamin D, folic acid, and copper was also quite widespread. This may affect physical and mental health in a number of ways. The study also showed that an increasing number of patients with celiac disease appears to suffer from other symptoms than the classic ones like diarrhea, weight loss, and anemia. Nutrient deficiencies may impair quality of life and damage your health in the short and the long run, but the Mayo Clinic scientists state that more research is needed to fully understand these mechanisms.
In any case, patients with celiac disease should be checked for any vitamin or mineral deficiencies as soon as they are diagnosed with the disease so they can take the necessary supplements as compensation. It is worth noting that some deficiencies are insidious, especially when it comes to vitamin B12 that may not show until months or years later, when the liver’s stores of the nutrient have been depleted. With regard to vitamin B12 supplements, it is best to use lozenges that ensure better absorption through the oral mucosa.
It is also known that lack of vitamin A and calcium may occur at later stage, and it is also important to consider that magnesium is necessary for the activation of vitamin D and also for the proper calcium distribution, which makes sure that most of the ingested calcium ends up in the bones and teeth. However, it is difficult to measure magnesium levels because we nearly all of our magnesium inside our cells.

Symptoms of celiac disease:

Symptoms vary and most people only experience minor symptoms, which makes it difficult to diagnose the condition. In fact, there is a term called subclinical celiac disease or silent celiac disease with somewhat unspecific symptoms. Still, the disease may be linked to serious and potentially life-threatening symptoms if it is not treated in time.

  • Growth retardation and failure to thrive (in children)
  • Compromised tooth formation
  • Bloating and rumbling stomach
  • Loose and frequent stool (in many cases fatty)
  • Fatigue
  • Mental imbalance
  • Weight loss
  • Anemia
  • Oedemas
  • Disturbed liver function
  • Itchy rash caused by dermatitis herpetiformis (a skin condition)
  • Increased risk of osteoporosis later in life
  • Increased risk of Hashimoto’s thyroiditis
  • Increased risk of abdominal cancer
  • Many symptoms from other parts of the body de to lack of nutrients

Treating celiac disease

In order to treat celiac disease, it is necessary to stick with a lifelong gluten-free diet with guidance of a trained dietician or nutritionist. As a general rule, the following principles should be followed:

  • Read the declarations and avoid gluten in any form (food or beverage) from all sorts of wheat, rye and barley. Oats do not contain gluten but may contain traces of it after being processed industrially
  • Instead, you can use rice, millet, corn, quinoa, sweet potatoes, gluten-free oats etc.
  • Avoid beer based on grain
  • To begin with, you should avoid dairy products due to transient lactose intolerance
  • There are various recipe books with gluten-free and nondairy recipes
  • Take a bioavailable multivitamin supplement and extra supplements of the nutrients that you may be lacking

What gluten sources are there?

  • Gluten is a type of protein that is found in all types of wheat and in rye and barley
  • There is a lot of gluten in wheat flour, Graham flour, spelt, durum, einkorn flour, Khorasan wheat (kamut), whole kernels, pasta, couscous, and bulgur
  • Rye contains substantially less gluten the different types of wheat
  • There may be concealed gluten in food products such as cold cuts, ready meals, breakfast cereals, cooking cream, cookies, crackers, candy, and ice cream.
  • In food labels, gluten is often referred to as stabilizer, emulsification, hydrolyzed starch, vegetable protein etc.
  • Several E-numbers (food additives) in the 1404-1451 category may contain traces of glutenOats do not contain gluten but may be contaminated after being processed industrially, which can leave traces of gluten

The difference between celiac disease and gluten intolerance

Celiac disease is an autoimmune disorder that should not be mistaken for gluten allergy, although both conditions are associated with similar symptoms. Also, with both these conditions it is vital to avoid the gluten-containing foods that trigger the symptoms. The whole difference lies in the way the immune defense is activated to handle the protein compounds in gluten. In the case of celiac disease, the immune defense produces various antibodies (IgA, IgE, and anti-TTG) that cause diarrhea and inflammation, which attacks the cells in the intestinal mucosa. These reactions normally show rather soon.
With gluten allergy, it is normally only IgG antibodies that trigger inflammation without initiating a targeted attack against the intestinal mucosa. However, many people experience digestive discomfort and different physical and/or mental symptoms. It may take up to several days before the symptoms show.
People with celiac disease should avoid any form of gluten for the rest of their lives in order to allow the intestinal mucosa to heal properly. With gluten allergy, it is often a matter of how much gluten they ingest or a matter of avoiding certain gluten sources such as wheat or rye. Grain quality and industrial processing may also make a difference. For instance, many people are better able to tolerate retarded bread based on sourdough.

How to diagnose celiac disease

The different symptoms may give rise for concern and a blood test that screens for e.g. gluten antibodies such as TG (transglutaminase) or auto-gliadin antibodies (IgA) can be used as confirmation. Nonetheless, such blood samples can also be misguiding and should therefore be accompanied by screening procedures or a colonoscopy that can determine if the small intestine is chronically inflamed.

  • Levels of IgA gliadin antibodies and IgG antibodies are often elevated in patients with celiac disease or other forms of gluten intolerance
  • The symptoms are often the same

 

  • Gluten intolerance may develop slowly and gradually lead to an increasing number of symptoms
  • Many people with gluten intolerance are not diagnosed properly
  • Gastrointestinal symptoms may be caused by other things than gluten intolerance
  • It is therefore always important to treat the cause so that people are not forced into unnecessary diet schemes

References:

Adam C Bledsoe et al. Micronutrient Deficiencies Are Common in Contemporary Celiac Disease Despite Lack of Overt Malabsorption Symptoms. Mayo Clinic Proceedings, 2019

Mayo Clinic. Micronutrient deficiencies common at time of celiac disease diagnosis. ScienceDaily 2019

Gerry K. Schwalfenberg and Stephen J. Genuis. The Importance of Magnesium in Clinical Healthcare. Scientifica (Carro) 2017

Krysiak R. The Effect of Gluten-free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A pilot Study. Exp. Clin Endocrinol Diabetes 2019

https://www.dr.dk/nyheder/regionale/oestjylland/op-mod-50000-danskere-kan-have-gluten-allergi-uden-vide-det

https://ato.dk/videndervirker/Fagligtarkiv/Sider/Artikler/2010-04%20Cøliaki%20og%20børnetandpleje.pdf

https://netdoktor.dk/sygdomme/fakta/levnedsmiddelallergi.htm

https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/mave-tarm/tilstande-og-sygdomme/tyndtarm/coeliaki/

https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/undersoegelser-og-proever/klinisk-biokemi/blodproever/transglutaminase-antistof-iga-igg-tga/