Search the Community

Celiac.com 05/03/2021 - Some research data suggests that a vegan diet may be associated with impaired bone health. To get an idea of the potential impact of a vegan diet on bone mass, a team of researchers recently set out to investigate the associations of veganism with calcaneal quantitative ultrasound (QUS) measurements, along with the investigation of differences in the concentrations of nutrition- and bone-related biomarkers between vegans and omnivores. Scientific evidence suggests that a vegan diet might be associated with impaired bone health. The team used a cross-sectional study of 36 vegans, and 36 omnivores to assess the associations between a vegan diet and calcaneal quantitative ultrasound (QUS) measurements, along with comparing concentrations of nutrition- and bone-related biomarkers between vegans and omnivores. The data showed lower QUS parameters in vegans compared to omnivores. For example, broadband ultrasound attenuation shows a low QUS parameter of 111.8 ± 10.7 dB/MHz for vegans, compared with 118.0 ± 10.8 dB/MHz for omnivores. Compared with omnivores, vegans had lower levels of vitamin A, B2, lysine, zinc, selenoprotein P, n-3 fatty acids, urinary iodine, and calcium, but higher concentrations of vitamin K1, folate, and glutamine. Applying a reduced rank regression, the team found 12 out of the 28 biomarkers that contribute most to bone health, including lysine, urinary iodine, thyroid-stimulating hormone, selenoprotein P, vitamin A, leucine, α-klotho, n-3 fatty acids, urinary calcium/magnesium, vitamin B6, and FGF23. They found that all QUS parameters rose across the tertiles of the pattern score. The study offers evidence of reduced bone health in vegans compared to omnivores, in addition to highlighting a combination of nutrition-related biomarkers, which may reduce bone health. The team calls for additional studies to confirm these findings. Since a number of studies have shown celiacs to be at greater risk for reduced bone health, especially bone density, bone health is a major concern for people with celiac disease. Learning more about the role of diet in improving bone health will benefit celiacs and non-celiacs alike. Read more in Nutrients 2021, 13(2), 685. The research team included Juliane Menzel, Klaus Abraham,Gabriele I. Stangl, Per Magne Ueland, Rima Obeid, Matthias B. Schulze, Isabelle Herter-Aeberli, Tanja Schwerdtle, and Cornelia Weikert. They are variously affiliated with the Department of Food Safety, German Federal Institute for Risk Assessment in Berlin, Germany; the Institute for Social Medicine, Epidemiology and Health Economics, Charité, Universitätsmedizin Berlin in Berlin, Germany; the Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany; the Section for Pharmacology, Department of Clinical Science, University of Bergen in Bergen, Norway; the Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany; the Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam–Rehbruecke, Nuthetal, Germany; the Institute of Nutritional Science, University of Potsdam, Nuthetal, Germany; the Laboratory of Human Nutrition, Institute of Food, Nutrition and Health, ETH Zurich in Zurich, Switzerland; the German Federal Institute for Risk Assessment, Berlin, Germany; and the Department of Food Chemistry, Institute of Nutritional Science, University of Potsdam in Nuthetal, Germany.

Celiac.com 04/10/2021 - It was gratifying to learn, from a recent post to the Celiac Listserv, that some celiac-savvy medical practitioners are now ordering bone density testing as soon as a patient’s serology indicates celiac disease. This emerging standard of care is well rooted in the medical and scientific literature and constitutes a reasonable and appropriate strategy for the effective care and treatment of celiac disease patients. Investigators have been recommending this approach for more than a decade(1,2) and these recommendations are particularly important given the more recent data that showing a dramatic fracture rate among celiac patients that is seven times that of controls(3,4). Although the sensitivity of endomysium (EMA) and tissue transglutaminase (tTG) may be open to criticism, there can be little doubt that these tests are quite specific and usually reported as close to 100%. Simply put, almost everyone who has positive serological test results will be shown to have celiac disease. Thus, when an EMA or tTG test is positive for celiac disease it is very likely that the individual in question has, or soon will have, celiac disease. Although a controversial approach, some practitioners are even diagnosing celiac disease based on serology alone. Researchers have long known that celiac disease is associated with significant bone demineralization and increased risk of fractures(5). Relevant research also shows that therapeutic intervention in celiac patients can require a very different approach than with non-celiac patients(6-7) and there is considerable variation from one celiac patient to the next(1) which practitioners must also consider. Suspected causes of the increased bone disease and fracture risk include: reduced intestinal absorption area and compromised active transport of calcium across the intestinal barrier3; hyperparathyroidism, possibly as the result of cross reaction of endomysium antibodies with parathyroid tissues(8); autoimmune hyperthyroid disease, which is frequently found in association with celiac disease(9); excessive mineral release from the bones and excretion(3); vitamin D deficiency(10); along with a host of other celiac-associated possibilities. Each or many of the above factors are likely contributors to the unique needs of every newly diagnosed celiac patient. Even when bone density testing reveals metabolic bone disease, it does not reveal the exact nature of the underlying problem(3) and celiac disease patients with bone mineral losses often can not be predicted clinically(1) so testing is the only rational option. While a strict gluten-free diet will usually have a positive impact on bone density, that improvement falls far short of control values(11). Bone density values and trends will provide assistance in determining individual fracture risk, which is an important clinical consideration(2). Every person, regardless of their celiac disease diagnosis, is unique. It is especially important that each one should have early testing to determine their bone mineral status at diagnosis because of the very strong association between celiac disease and bone disease. Such test results enable health care providers to monitor their celiac patients’ bone health and fracture risk. Simply put, if we can not see where we started from, how can we tell how far we have come or whether we are moving in the right direction? Early bone density testing is the first step in therapeutic intervention. In many cases, coupled with follow-up testing, it will be the only intervention needed. In other cases, however, bone density testing will be the first step in a lengthy therapeutic process that may involve several changes in treatment as the individual progresses. Some patients may require magnesium supplementation as part of a therapeutic intervention for parathyroid disease(6). Others may need treatment for autoimmune thyroid disease which afflicts more than 12.9% of newly diagnosed celiac patients(12). Most celiac patients have been shown to have low vitamin D status(10) which, depending on a variety of factors, may indicate a need for vitamin D supplementation. Still others may require pharmacological interventions. Alert practitioners will, in keeping with the literature, order bone density testing. Abnormal results should identify concurrent bone disease and alert the practitioner to the need for further testing to determine the exact nature of the pathology/pathologies that may be at work. Regardless of the particular cause of bone disease or abnormality, bone density testing is the very first step in each of these interventions. Follow-up bone density testing will usually provide meaningful information to direct treatment and is especially useful when juxtaposed with initial test results. There can be little doubt that bone density testing is appropriate for newly diagnosed celiac disease patients. This practice is strongly advocated in the medical and scientific literature, and promises to mitigate the sometimes ghastly consequences of bone disease, demineralization, and degeneration that are too often found in association with celiac disease. Ultimately, such testing will not only improve quality of life for celiac patients, but in combination with appropriate supplementation, dietary, and pharmacological practices, this testing will save health care dollars through reduced needs for acute care. For these reasons, I was surprised to read that the insurance company of the person who posted that message to the celiac listserv had refused to pay for the bone density testing ordered by her health care practitioner on the basis of positive celiac serology. In the early days of endomysium and tissue transglutaminase testing, some insurance companies also failed to see that serological testing would one day save substantial sums by reducing the number of endoscopic biopsies required for a celiac diagnosis. My own diagnosis required three endoscopic biopsies. Similarly, it appears that at least one insurance company is overlooking the savings from acute care that they will accrue from the emerging standard of care in which bone density testing is ordered for all patients with positive celiac serology tests. One can only hope that they will soon recognize the real cash value such testing offers to health insurance providers. References: 1. Walters JR, Banks LM, Butcher GP, Fowler CR. Detection of low bone mineral density by dual energy x ray absorptiometry in unsuspected suboptimally treated celiac disease. Gut. 1995 Aug;37(2):220-4. 2. Pistorius LR, Sweidan WH, Purdie DW, Steel SA, Howey S, Bennett JR, Sutton DR. Coeliac disease and bone mineral density in adult female patients. Gut. 1995 Nov;37(5):639-42. 3. Fickling WE, McFarlane XA, Bhalla AK, Robertson DAF. The clinical impact of metabolic bone disease in coeliac disease. Postgrad Med J. 2001; 77:33-36 4. Vitoria JC, Arrieta A, Arranz C, Ayesta A, Sojo A, Maruri N, Garcia-Masdevall MD. Antibodies to gliadin, endomysium, and tissue transglutaminase for the diagnosis of celiac disease. J Pediatr Gastroenterol Nutr. 1999 Nov;29(5):571-4. 5. Marsh MN. Bone disease and gluten sensitivity: time to act, to treat, and to prevent. Am J Gastroenterol. 1994 Dec;89(12):2105-7. 6. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int. 1996;6(6):453-61. 7. Hoggan R. 8. Kumar V, Valeski JE, Wortsman J. Celiac disease and hypoparathyroidism: cross-reaction of endomysial antibodies with parathyroid tissue. Clin Diagn Lab Immunol. 1996 Mar;3(2):143-6. 9. Kisakol G, Kaya A, Gonen S, Tunc R. Bone and Calcium Metabolism in Subclinical Autoimmune Hyperthyroidism and Hypothyroidism. Endocrine Journal Vol. 50 (2003) , No. 6 657-661 10. .Kemppainen T, Kröger H, Janatuinen E, Arnala I, Kosma VM, Pikkarainen P, Julkunen R, Jurvelin J, Alhava E, Uusitupa M. Osteoporosis in adult patients with celiac disease. Bone. 1999 Mar;24(3):249-55. 11. McFarlane XA, Bhalla AK, Robertson DA.Effect of a gluten free diet on osteopenia in adults with newly diagnosed coeliac disease. Gut. 1996 Aug;39(2):180-4. 12. Sategna-Guidetti C, Volta U, Ciacci C, Usai P, Carlino A, De Franceschi L, Camera A, Pelli A, Brossa C. Prevalence of thyroid disorders in untreated adult celiac disease patients and effect of gluten withdrawal: an Italian multicenter study. Am J Gastroenterol. 2001 Mar;96(3):751-7.

Celiac.com 01/28/2019 - Research shows that people with celiac disease have an increased risk of bone fractures, compared to the regular population, but there's not much good data on fracture risk in patients with dermatitis herpetiformis. A team of researchers recently compared self-reported bone fractures in patients with dermatitis herpetiformis against those with celiac disease. The research team included C Pasternack, E Mansikka, K Kaukinen, K Hervonen, T Reunala, P Collin, H Huhtala, VM Mattila, and T Salmi. In all, they looked at self-reported fracture rates in 222 dermatitis herpetiformis patients, and in 129 control subjects with celiac disease. The team provided a Disease Related Questionnaire and the Gastrointestinal Symptom Rating Scale and Psychological General Well-Being questionnaires to study members. They received 45 replies from the 222 dermatitis herpetiformis patients, and 35 replies from the 129 celiac disease control subjects. All patients had experienced at least one fracture. Overall, cumulative lifetime fracture rates were about the same for both dermatitis herpetiformis and celiac disease patients. Fractures More Common in Women with Celiac Disease However, when the team looked at the cumulative incidence of fracture after disease diagnosis, they found a significantly higher risk in women with celiac disease than in women with dermatitis herpetiformis. Acid Reflux and Proton-Pump Inhibitor Connection Interestingly, both dermatitis herpetiformis and celiac disease patients with fractures reported more severe reflux symptoms compared to those without. Dermatitis herpetiformis and celiac disease patients with fractures also reported using more proton-pump inhibitor medication. More research needs to be done to explore this connection. To sum it up, self-reported lifetime bone fracture risk is about the same for both DH and celiac disease patients. However, after diagnosis, fracture risk is higher in women with celiac disease than in women with dermatitis herpetiformis. This means that women with celiac disease need to work with doctors to keep a tight eye on bone integrity, even when eating a gluten-free diet. Source: Nutrients. 2018 Mar 14;10(3). pii: E351. doi: 10.3390/nu10030351

Celiac.com 10/23/2020 - As people age, their bones become less dense, and their risk of developing osteoporosis, leaving them susceptible to fractures. A recent study indicates that celiac disease may increase that risk, even in younger people. According to the Canadian study, people with celiac disease have a higher risk of serious osteoporotic fracture that is unrelated to their fracture risk assessment tool (FRAX) score. FRAX scores accurately predict fracture risk when celiac disease is added as a secondary osteoporosis risk factor, or when BMD is included in the FRAX assessment. A research team used data from the Manitoba Bone Mineral Density Registry to determine the 10-year risk of major osteoporotic fractures in nearly 700 people with celiac disease, over a period of about seven years. They also followed just over 68,000 people from the general population subjects for a similar period. The research team included D.R. Duerksen, L.M. Lix, H. Johansson, E.V. McCloskey, N.C. Harvey, J.A. Kanis & W.D. Leslie. The team found that about 8.5 percent of people in each group suffered one or more major osteoporotic fractures, even though the celiac disease group was younger, and contained more men. In the general population, there FRAX predictions and the observed 10-year major osteoporotic fracture probabilities matched up cleanly. In patients with celiac disease, however, predicted and observed fracture predictions only aligned when celiac disease was factored as secondary osteoporosis; otherwise, FRAX underestimated the celiac patients' 10-year major fracture risk by more than 4 percent. Celiac disease patients face an increased risk of major osteoporotic fractures. When celiac disease is considered as a secondary osteoporosis risk factor, or when BMD is included in FRAX assessment, FRAX can accurately predict future fracture risk. Do you have celiac disease and also suffer from osteoporosis? Have you broken bones? Share your thoughts below. Read more in Osteoporosis International (2020)

Celiac.com 06/19/2017 - Adults with celiac disease often show atypical symptoms, though it is not uncommon for them to suffer from malabsorption of vitamins and minerals, which can result in disrupt normal bone metabolism. A team of researchers recently set out to evaluate laboratory deficiencies related to bone metabolism, and to assess the relationship between severity of histological damage and the degree of bone mass loss at celiac diagnosis. The research team included L. Posthumus, and A. Al-Toma A of the Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands. Their team conducted a retrospective cross-sectional study of 176 adult celiac patients. All patients met the histopathological criteria for clinical celiac disease. The team analyzed biochemical data, including calcium, phosphate, alkaline-phosphatase, vitamin D and parathormone. They classified duodenal histology based on Marsh parameters. They used dual X-ray absorptiometry to determine bone mass density (BMD) at the lumbar and femoral regions. P-values below 0.05 were considered significant. They found no correlation between gastrointestinal symptoms and Marsh histopathological stage (P>0.05). Nearly 50 percent of patients showed vitamin D deficiency (44.5%), while only 5.7% showed hypocalcaemia. Patients with Marsh III did show lower calcium (P<0.05) and parathormone was higher (P=0.01). These patients had lower lumbar T-score (P<0.05). Although low BMD occurred in all age groups, most osteoporotic patients were aged 45-49 years (81.8%). A multiple regression analysis did show that Marsh stage could indicate lower lumbar BMD (r=0.322, B=-1.146, P<0.05). At celiac diagnosis, Marsh histopathological stage can predict low BMD, which can develop into osteoporosis. Based on these data, the team suggests that doctors should consider evaluating bone biomarkers and conducting a dual X-ray absorptiometry exam in celiac patients over 30 years of age. Source: Eur J Gastroenterol Hepatol. 2017 Apr 27. doi: 10.1097/MEG.0000000000000880.

Celiac.com 05/11/2017 - As research continues to show the remarkable nutritional advantages of bone broth, it is gaining a spotlight in the nutritional world, especially in nutrient focused diets like the paleo diet, clean eating, and more. But though the attention may be new, it is actually an age old dietary staple dating back to paleo era days when utilizing every part of animals was essential. Bone broth has remained a dietary staple around the world for generations. It is an exceptionally nutrient dense broth made by simmering the bones and connective tissues of animals. It's surprisingly easy to make and the benefits offered are astounding. If you are new to this wonder food read on to find out about bone broth benefits and the real truth about all it offers! Top Benefits of Bone Broth Bone and Ligament Health. As bones are simmered in the making of bone broth, key bone health minerals such as calcium and phosphorous are infused into the broth. Additionally, the breakdown of the connective tissue used for bone broth provides a natural source of glucosamine and chondroitin which supports joint health. Gut Health. The gelatin produced from animal collagen provides a healing effect for the GI tract. People starting a gluten free or paleo diet in hopes of calming down an inflamed digestive tract may especially appreciate this benefit. Immune Health. Turns out the old wives tale of chicken soup to cure illness holds some truth. The rich mineral content and in particular the amino acids in bone broth support a healthy immune system. Women's Health. Bone broth also offers help when it comes to women's hormones. This is because poor nutrient absorption is closely tied to hormonal health. When the gut is inflamed, nutrient absorption suffers. By healing the gut, the body can better regulate hormone levels. Anti-Aging. The collagen rich gelatin found in bone broth may just be the fountain of youth. Adding to this anti-aging effect, the amino acid proline further helps to give strong and shiny hair, skin, and nails. Tips to Making Bone Broth Yourself Quality Matters. To avoid the chemicals conventionally raised animals are exposed to and gain maximal nutritional benefits, opt for bones from grass-fed cows and/or free range chickens. Pick the Right Parts. The bones, ligaments, and cartilage used in bone broth each offer benefits. The bones give the broth vitamins and minerals while the ligaments and cartilage provide all important collagen as they break down. Opt to include knuckles as much as possible as they are particularly collagen rich. Go Slow. The secret to bone broth is going 'low and slow.' Cooking broth in a slow cooker on a lower heat setting for a longer period of time allows the collagen, vitamins, and nutrients to best be released into your broth. Add an Acid. Be sure to add a spoonful of an acid such as apple cider vinegar to help break down the connective tissue and collagen. This is a very simple approach to adding something extremely beneficial to just about anyone's diet or health routine.

Celiac.com 12/19/2016 - Research conducted with high-resolution peripheral quantitative computed tomography (HRpQCT) has documented substantial bone micro-architecture in premenopausal women with newly diagnosed celiac disease. A team of researchers recently set out to assess changes in bone micro-architecture after 1 year on a gluten-free diet in a cohort of pre-menopausal women. The research team included MB Zanchetta, V Longobardi, F Costa, G Longarini, RM Mazure, ML Moreno, H Vázquez, F Silveira, S Niveloni, E Smecuol, Temprano M de la Paz, F Massari, E Sugai, A González, EC Mauriño, C Bogado, JR Zanchetta, and JC Bai. They are variously affiliated with the Instituto de Diagnóstico e Investigaciones Metabólicas (IDIM), Buenos Aires, Argentina; the Sección Intestino Delgado, Departamento de Medicina at the Hospital de Gastroenterología "Dr. C. Bonorino Udaondo” in Buenos Aires, Argentina; and with the Cátedra de Gastroenterología Facultad de Medicina and the Cátedra de Osteología y Metabolismo Mineral at the Universidad del Salvador in Buenos Aires, Argentina. Their team prospectively enrolled 31 consecutive females upon celiac diagnosis, and reassessed 26 of them after 1 year of gluten-free diet. All patients received HRpQCT scans of distal radius and tibia, areal BMD by DXA, and bone-specific parameters and celiac serology both times. The team then compared 1-year results against data from a control group of healthy pre-menopausal women of similar age and BMI in order to assess whether the micro-architectural parameters of treated celiac patients matched values expected for their age. Compared with baseline, the trabecular compartment in the distal radius and tibia showed marked improvement of trabecular density, trabecular/bone volume fraction [bV/TV] [p < 0.0001], and trabecular thickness [p = 0.0004]. Trabecular number remained stable in both regions. Cortical density increased only in the tibia (p = 0.0004). Cortical thickness decreased significantly in both sites (radius: p = 0.03; tibia: p = 0.05). DXA increased in all regions (lumbar spine [LS], p = 0.01; femoral neck [FN], p = 0.009; ultradistal [uD] radius, p = 0.001). Most parameters continued to be significantly lower than those of healthy controls. This prospective HRpQCT study showed that most trabecular parameters altered at celiac disease diagnosis improved significantly with a gluten-free diet, along with calcium and vitamin D supplementation. However, there were still significant differences with a control group of women of similar age and BMI. The team plans a prospective follow-up, in which they expect to be able to assess whether bone micro-architecture matches levels expected for a given patient's age. Source: J Bone Miner Res. 2016 Jul 22. doi: 10.1002/jbmr.2922.