Delayed growth: Complementary and nutritional treatment/mgmt of celiac disease growth delay

[Valerie415]

My 14 yo son was diagnosed with celiac disease in August after falling off his growth curve -- his main symptom is delayed growth & delayed puberty.  He has been gluten-free (and nutrient dense and cautious/digestible diet since while gut healing + nutrient supplements) since 9/6/22 and has not shown growth recovery yet. He grew 3/4 inch from September to January. For context, he is currently 14.5 years old, 5 ft 0.5 inches tall now, and is projected to be 5'-10" based on his genetic potential.  I read that growth recovery/catchup mainly occurs in first six months GFD, but my son has continued in his slow growth, remaining in the 2nd percentile. We are working with a pediatric endocrinologist who says his growth hormone factors are all relatively normal, given his bone age (which is 3 years younger than his chronological age).

Blood tests show that he has no nutrient deficiency (only limited testing donw). So I am wondering about the role of chronic inflammation in slowing his growth. Has anybody investigated / tried diet, supplements, exercise for control of inflammation in celiac disease? Or is there further testing (blood serum levels of something or other tests) that anyone has experience with or information about to address delayed growth in celiac?

Many thanks in advance for any ideas or information. 

[trents]

Chronic inflammation as a general body condition or are you talking about inflammation mainly in his gut?

Welcome to the forum, Valerie!

[Scott Adams]

It can be very tough for teenagers to maintain a 100% gluten-free diet. I had issues with my daughter who would cheat on her diet when she was with her high school friends, but luckily she's learned to be more strict and just say no when offered foods with gluten in them.

Is it possible your son is not 100% gluten-free? A follow up celiac disease blood panel may give you an idea of how well he's doing on his diet, although that isn't what those tests are designed to do. If his antibodies remain high it usually means his inflammation may also be elevated, and this is an interesting new article on this:

 

[Valerie415]

23 hours ago, Scott Adams said:

It can be very tough for teenagers to maintain a 100% gluten-free diet. I had issues with my daughter who would cheat on her diet when she was with her high school friends, but luckily she's learned to be more strict and just say no when offered foods with gluten in them.

Is it possible your son is not 100% gluten-free? A follow up celiac disease blood panel may give you an idea of how well he's doing on his diet, although that isn't what those tests are designed to do. If his antibodies remain high it usually means his inflammation may also be elevated, and this is an interesting new article on this:

 

 

Hi Scott,

I'm not sure i'm putting this text in the right box, but here goes. 

Thanks for your response. My son is highly motivated to grow so he is very compliant with GFD.  

Thanks for posting the article. Interesting. Seems this study found that TTG IgA level correlates with histological scoring of mucosal damage. 

Another study I came across recently found that EMA correlates best with mucosal healing which is why earlier today I talked our peds GI doc into including that with the latest blood tests. SHe was a good sport but I don't understand why all peds GI docs wouldn't want to follow that as level mucosal healing after GFD is quite variable, even at 1 yr or 2 yrs into GFD. Give me as much data as possible on the celiac disease recovery dashboard, I say.   

Vécsei et al. BMC Gastroenterology 2014, 14:28
http://www.biomedcentral.com/1471-230X/14/28

TTG IgA is one form of inflammation. There's also the cytokine storm and related inflammatory responses in the native and adaptive immune systems. 

[Valerie415]

On 2/5/2023 at 2:23 PM, trents said:

Chronic inflammation as a general body condition or are you talking about inflammation mainly in his gut?

Welcome to the forum, Valerie!

Chronic inflammation results from celiac disease. There's the inflammatory cytokine before GFD that takes a while to resolve, plus TTG IgA in the gut and more -- for example. 

Int. J. Mol. Sci. 2022, 23, 7177. https://doi.org/10.3390/ijms23137177

Abstract:

Abstract: Celiac disease (celiac disease) is an immune-mediated enteropathy triggered in genetically susceptible
individuals by gluten-containing cereals. A central role in the pathogenesis of celiac disease is played by the

HLA-restricted gliadin-specific intestinal T cell response generated in a pro-inflammatory environ-
ment. The mechanisms that generate this pro-inflammatory environment in celiac disease is now starting to be

addressed. In vitro study on celiac disease cells and organoids, shows that constant low-grade inflammation is
present also in the absence of gluten. In vivo studies on a population at risk, show before the onset
of the disease and before the introduction of gluten in the diet, cellular and metabolic alterations in
the absence of a T cell-mediated response. Gluten exacerbates these constitutive alterations in vitro
and in vivo. Inflammation, may have a main role in celiac disease, adding this disease tout court to the big
family of chronic inflammatory diseases. Nutrients can have pro-inflammatory or anti-inflammatory
effects, also mediated by intestinal microbiota. The intestine function as a crossroad for the control of
inflammation both locally and at distance. The aim of this review is to discuss the recent literature
on the main role of inflammation in the natural history of celiac disease, supported by cellular fragility with
increased sensitivity to gluten and other pro-inflammatory agents.

[trents]

Very interesting article, Valarie. Thank you.

[knitty kitty]

@Valerie415,

Was your son's Vitamin D level checked?  Was it above 80 nmols/l?  

Impaired Height Growth Associated with Vitamin D Deficiency in Young Children

https://pubmed.ncbi.nlm.nih.gov/36014831/

And...

The Effects of Vitamin D on Immune System and Inflammatory Diseases

https://pubmed.ncbi.nlm.nih.gov/34827621/

And...

Inflammation and Vitamin D

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160567/

Hope this helps! 

Edited February 7, 2023 by knitty kitty
Typo correction