vitaminsWhen having Celiac Disease is just a fact of life, it is important to understand that your diet requires modifications beyond the exclusion of gluten containing products. Due to malabsorption, many celiacs suffer from
deficiencies that result in preventable conditions.

Common nutritional deficiencies among celiacs are iron, calcium, Vitamin D, Zinc & Vitamin B12. As your intestinal lining heals, these deficiencies often improve, but it is still a good idea to ensure proper balance with a few targeted supplements.

Probiotics

It has been observed that Bifidobacterium levels are lower in individuals with CD. On the other hand, Clostridium, E. Coli, Staphiloccocus and other proinflammatory bacteria are often present in their fecal samples. Unfortunately, a gluten free diet does not seem to completely normalize the quality of the intestinal flora. For this reason, supplementation with prebiotics and probiotics is necessary to reduce inflammation not only in the intestine but also throughout the body. The recommended doses range from 1 billion to 10 billion colony-forming units (CFU)—the amount contained in a capsule or two—several days per week.

Folic acid

Folate levels are found to be lower in gluten free breads and other similar products. In addition, when the pH of the duodenum changes and becomes slightly elevated (as it is the case with CD sufferers) the absorption of folic acid decreases sharply. Preserving the health of the stomach so that acidic chyme travels into the duodenum is essential for proper folate absorption. PPIs (proton pump inhibitors) are strongly discouraged for individuals with Celiac Disease as they alter the natural ability of the stomach to produce acid. To ensure good levels of folate, CD patients should take a methylated form of folic acid called 5-MTHF. It is the preferred form of supplementation because it is absorbed better within a wide range of intestinal pH. Some sulfa drugs commonly prescribed for intestinal complaints are also folate depleting, which only increases the deficit. The RDA for folic acid is 400 mcg.

Vitamin B12

The prevalence of deficiency related to Vitamin B12 increases with age. As we reach old age, the destruction of the parietal cells in the stomach responsible for secreting intrinsic factor speeds up. As in the case of folate, the use of PPIs is contraindicated in patients with vitamin B12 deficiency. Supplementation with Vitamin B12 in CD patients is effective in treating neurological disorders associated with the disease. The upper limit for daily ingestion of Vitamin B12 is not known. However, a RDA of 2.4 mcg for both men and women is recommended.

Enzymes

Adequate gastric acid is necessary for proper absorption of vitamin B12 and many other nutrients. Celiac patients often have compromised digestions, an issue that tends to get worse with age. In order to enhance the digestive process, CD patients should supplement with a variety of enzymes, which break down specific molecules in food. One specific kind of enzyme essential to celiacs is proteases. They break down proteins. In particular, DPP-IV (dipeptidyl peptidase IV), helps break down gluten peptides responsible for the destructive autoimmune reaction characteristic of Celiac Disease. Again, since one kind of enzyme cannot perform optimally in isolation, it is advisable to supplement with a combination of them.

Vitamin D

Bone disorders are very common among Celiac Disease sufferers. More than 70% of patients show a considerable bone mineral density reduction. One of the reasons is that Vitamin D is primarily absorbed in the duodenum. It is metabolized the same way as many other fat soluble substances. If the CKK (cholecystokinin) mechanism does not initiate the production of bile and pancreatic lipase, absorption is greatly compromised. Without enough vitamin D calcium present in the intestine can only be absorbed by 15%. Therefore, when noticeable atrophy of the mucosa in the upper intestine has occurred, a patient needs to follow a gluten free diet but also supplement with 25-hydroxyvitamin D and calcium to achieve normal levels. In addition, Vitamin D lowers inflammation throughout the intestinal tract. The recommended amounts of Vitamin D vary from 200 IU to 600 IU, but CD patients may need a much higher intake (up to 2000 IU) to achieve proper serum levels.

Curcumin

Curcumin is derived from turmeric, a bright colored tuber that is used in Indian cuisine primarily. Curcumin has a modulating effect on the inflammatory cascade in the intestine per se and in other parts of the body as well. It is being studied for the treatment of bowel inflammatory disease and CD. It also seems to be effective in treating dyspepsia. Some research shows that taking turmeric extract by mouth helps improve an upset stomach and regulates digestion.

L-Glutamine

Glutamine is the most abundant amino acid in the body. The body produces sufficient glutamine for its needs, but in cases of extreme stress, illness or injury, an individual may need more glutamine. Most glutamine is stored in muscles, but also in the lungs.

Glutamine removes excess ammonia (a common waste product) from the body. It also helps with proper immune system function. Healthy brain function and digestion are also in need of ample stores of glutamine.

Most individuals get enough glutamine from their diet in addition to what they produce internally. However, a number of conditions such as injuries, surgery, infections and prolonged stress, can lower glutamine levels. In these cases, taking a glutamine supplement is advisable.
L-Glutamine is an essential supplement for CD patients. It aids in the recovery and revitalization of the lining of the small intestine. It also protects from further damage from NSAIDs (aspirin, ibuprofen) which are the main cause of leakage through the intestinal wall.

Glutamine regenerates the lining of the gastrointestinal tract known as the mucosa. Therefore, people suffering from inflammatory bowel disease may take a glutamine supplement in order to aid the recovery of their damaged intestinal tract. For adults 500 mg 1 – 3 times daily is generally considered safe. Foods with the highest amounts of glutamine are meat and seafood. Beans, raw spinach, raw parsley and cabbage are good plant sources of glutamine as well.

References
Autodore, Jennifer and Muralidhar Jatla. “Nutritional Complications of Celiac Disease”. Practical Gastroenterology. July 2009: 34-39.
Bauman, E., Friedlander, J. (2011). Therapeutic Nutrition. Penngrove, CA: Bauman College.
Case S, Kaplan CR. “Gluten-Free Guidance: Practical Tips for Dietitians and their Celiac Patients”. Today’s Dietitian. March 2003: 44-49.
Celiac Central. National Foundation for Celiac Awareness, 2014. Web. 22 Feb. 2014. <http://www.celiaccentral.org>.
Celiac.com. Celiac Disease and Gluten-free Diet Information Since 1995. Web. 22 Feb. 2014. <http://www.celiac.com>
Celiac Support Association. 2014. Web. 22 Feb. 2014. <http://www.csaceliacs.info>.
Malterre, Tom MS, CN. “Digestive and Nutritional Considerations in Celiac Disease: Could Supplementation Help?” Alternative Medicine Review Vol. 14, Number 3, 2009: 247-257.