Celiac Disease
Fighting to Absorb Enough Nutrition
Weak and pale from fatigue, a woman waits patiently in the examination room for her doctor to return. She thinks she's just tired. But he has seen these symptoms before, and he knows better. His diagnosis: iron-deficiency anemia caused by celiac disease.
Triggered by a sensitivity to wheat, rye, barley and oats, celiac disease also often causes gastrointestinal problems such as gas and diarrhea. The culprit: gluten, an ingredient of these grains that damages the small intestine, causing inflammation and impaired absorption of nutrients, explains Jerry S. Trier, M.D., professor of medicine at Harvard Medical School and senior physician at Brigham and Women's Hospital in Boston.
Although researchers are still figuring out the chemistry, some experts believe an enzyme deficiency results in the incomplete digestion of gluten, allowing the buildup of a toxic substance. This toxin then damages the mucosal lining of the small intestine, says Jean Guest, R.D., former dietary adviser to the Celiac Sprue Association and former pediatric clinical dietitian for the Medical Center at the University of Nebraska at Omaha.
Like a sponge that no longer absorbs, the damaged mucosal lining can't soak up key nutrients, including iron, zinc, folate (the naturally occurring form of folic acid), magnesium and calcium, triggering diarrhea and fatigue, explains Guest. Even fat and fat-soluble vitamins such as A, D, E and K are passed through the body with only a portion of them being used, she says. In someone who has had celiac disease for a long time without the problem being diagnosed, calcium deficiency can result in the bone-thinning disease osteoporosis, she adds.
| Food Factors Because celiac disease is caused by a substance found in most grains, avoiding the offender is the top priority. Here is how it's done. Go on a grain watch. Tossing out your sandwich bread and pasta is a big step toward becoming gluten-free. But maintaining your independence from wheat, rye, barley and oats also requires careful reading of food labels. Many processed foods use wheat for a variety of purposes, such as for filler and flavoring. It may appear on the label as "hydrolyzed vegetable flavoring" or "textured vegetable protein," explains Jerry S. Trier, M.D., professor of medicine at Harvard Medical School and senior physician at Brigham and Women's Hospital in Boston. Sometimes the label won't give you even that much of a clue, says Jean Guest, R.D., former dietary adviser to the Celiac Sprue Association and former pediatric clinical dietitian for the Medical Center at the University of Nebraska at Omaha. Without any warning, flour is applied to chewing gum and corn tortillas to keep them from sticking to foil wrappers and conveyor belts during manufacturing. Even foods that have been cooked in restaurant deep fryers and grills that have been used to cook other foods with wheat-containing breadings and coatings can provoke a reaction, she says. "For these reasons, it's a diet that is hard to maintain," says Dr. Trier. "Even some pharmaceutical drugs contain wheat used as an extender." Mind your moo. Many people with celiac have yet another food sensitivity: They are unable to digest a sugar in milk called lactose. For this reason, some doctors suggest going easy on dairy products until your recovery is complete, says Dr. Trier. "You can have cream in your coffee, even milk on your rice- or corn-based cereal, but it's a good idea not to overdo with dairy products for a while," he says. Once you've healed, you should be able to eat as much dairy as you like, provided you don't have lactose intolerance. (You'll know that you have this problem if dairy products give you gas.) |
| Prescriptions for Healing The key treatment for anyone with celiac disease involves eliminating problem foods. Many experts also advise taking these nutrients. Nutrient Daily Amount
Calcium 1,000-2,000 milligrams Plus a multivitamin/mineral supplement containing the Daily Values of all essential vitamins and minerals
MEDICAL ALERT: If you have celiac disease, you should be under a doctor's care. |
Dietary Detective Work Pays Off
In most cases, treatment involves avoiding gluten, which isn't always easy. Even the glue on some envelopes contains gluten. "Some people are exquisitely sensitive to gluten, and even a minute amount such as envelope glue can cause a reaction, although that's not usually the case," says Dr. Trier.
But the effort needed to avoid gluten can be worthwhile. Once gluten is no longer included in the diet, nutrient absorption problems quickly disappear. In a yearlong study that looked at whether a gluten-free diet could help children with celiac, researchers found that the bone growth of those on a gluten-free diet was faster than that of healthy children. Since the children with celiac were behind their counterparts in bone growth, the exclusion of certain grains prompted their bodies to play catch-up.
Since a gluten-free diet is strict, it's wise to take a multivitamin/mineral supplement to make sure you get all of the nutrients you need, says Guest.
The Case for Extra Calcium
And since calcium absorption can be dramatically reduced by celiac disease, Dr. Trier recommends calcium supplements for many of his patients.
"It's a good idea," says Dr. Trier. "People are often calcium-depleted when they're diagnosed." In most cases, Dr. Trier says, 1,000 to 2,000 milligrams a day is enough to rebuild calcium stores. The Daily Value for calcium is 1,000 milligrams.
