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Celiac.com 04/17/2024 - Maintaining optimal health involves ensuring that our bodies receive essential nutrients, including magnesium, a vital mineral crucial for various bodily functions. Magnesium deficiency can arise from various factors, including medical conditions like celiac disease, poor absorption, increased need, or excessive elimination. Understanding the signs, causes, and remedies for magnesium deficiency is essential for overall well-being. Identifying Magnesium Deficiency Symptoms Magnesium deficiency symptoms may initially manifest subtly, including muscle spasms, fatigue, decreased appetite, and nausea. However, if left unaddressed, more severe effects such as abnormal heart rhythm, seizures, anxiety, and personality changes may occur. As these symptoms overlap with those of other health conditions, a blood test from a medical provider is crucial to confirm magnesium deficiency accurately. Causes of Magnesium Deficiency Malabsorption due to gastrointestinal conditions like celiac disease or inflammatory bowel disease can hinder magnesium absorption. Additionally, certain medications and increased magnesium needs, such as during pregnancy or in athletes, can contribute to deficiency. Factors that affect magnesium elimination, like alcohol consumption or medical conditions such as kidney disease, also play a role. The Role of Magnesium in the Body Magnesium plays a vital role in numerous bodily processes, including muscle and nerve function, heart rhythm maintenance, blood sugar control, bone health, and blood pressure regulation. Furthermore, magnesium influences hormone balance related to sleep, circadian rhythm, and mood regulation, and can alleviate conditions like migraine headaches. Sources of Magnesium To address magnesium deficiency, both oral supplements and magnesium-rich foods can be beneficial. Supplements, such as magnesium glycinate or magnesium citrate, offer an easily accessible solution, although they may cause mild gastrointestinal side effects. Alternatively, incorporating magnesium-rich foods like pumpkin seeds, almonds, spinach, soy, and black beans into one's diet can help meet daily magnesium requirements. Frequently Asked Questions About Magnesium What is the best magnesium supplement? Magnesium glycinate and magnesium citrate are generally well-tolerated forms of magnesium supplements. Are there supplements best avoided when taking magnesium? Calcium supplements should be taken separately from magnesium to prevent competition for absorption. What medications interfere with magnesium: Certain medications, including proton pump inhibitors, antibiotics, diuretics, and chemotherapy drugs, can hinder magnesium absorption and should be managed accordingly. In conclusion, recognizing the signs of magnesium deficiency, understanding its causes, and knowing how to address it through supplementation or dietary adjustments are essential for maintaining optimal health. Consulting healthcare providers for accurate diagnosis and personalized treatment plans is vital in managing magnesium deficiency effectively. This article is not intended to offer medical advice, and is for informational purposes only. Please consult a medical professional for personal advice on celiac disease, magnesium deficiency, and/or any other medical concern.

Celiac.com 04/15/2023 - Celiac disease is a chronic autoimmune disorder that affects the small intestine, triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. One often overlooked consequence of untreated and undiagnosed celiac disease is the potential for nutrient deficiencies. Due to the damage caused to the lining of the small intestine, absorption of various essential nutrients may be impaired, leading to deficiencies that can have wide-ranging health effects. In this article, we will explore the connection between celiac disease and nutrient deficiencies, focusing on several key vitamins, minerals, and other essential nutrients. The most common nutrient deficiencies associated with celiac disease that may lead to testing for the condition include iron, vitamin D, folate (vitamin B9), vitamin B12, calcium, zinc, and magnesium. Celiac disease can disrupt the absorption of these essential nutrients, potentially leading to anemia, bone health issues, and other health complications. After a celiac disease diagnosis it is important to do follow up testing for these nutrient deficiencies, as well as a follow-up endoscopies/biopsies to make sure that a patient's damaged villi are healing properly. Many of those with celiac disease will need to take vitamin and mineral supplements at the time of their diagnosis, and some will need to continue taking them for life. Note that having nutrient deficiencies alone would not be enough for a definitive diagnosis of celiac disease, and further testing is required to make a formal diagnosis. Boron Boron is a trace mineral that plays a role in bone health, brain function, and metabolism of certain nutrients. Deficiency in boron is rare, but it can lead to symptoms such as muscle weakness, joint pain, and impaired cognitive function. Untreated and undiagnosed celiac disease can cause malabsorption of boron due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of boron may be needed for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Calcium Calcium is an essential mineral that is crucial for bone health, nerve function, and muscle contraction. Deficiency in calcium can lead to symptoms such as weakened bones, muscle cramps, and numbness and tingling in the extremities. Malabsorption of calcium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis and other bone-related complications in individuals with celiac disease. Measuring blood levels of calcium alone is not always an accurate indicator of calcium deficiency because the body will leach calcium from the bones to maintain normal blood levels of calcium. Therefore, bone density loss and other secondary indicators are often better diagnostic tools for detecting calcium deficiency. Calcium supplementation, along with a calcium-rich diet, may be necessary for individuals with celiac disease to maintain adequate calcium levels and support bone health. Chloride Chloride is an electrolyte that is involved in maintaining proper fluid balance, nerve function, and acid-base balance in the body. Deficiency in chloride is rare, but it can lead to symptoms such as muscle weakness, lethargy, and irregular heartbeat. Malabsorption of chloride can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can disrupt the body's fluid balance and electrolyte levels, further complicating the health of individuals with celiac disease. Proper monitoring of chloride levels and supplementation may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Choline Choline is an essential nutrient that plays a role in brain development, nerve function, and liver health. Deficiency in choline can lead to symptoms such as cognitive decline, liver dysfunction, and muscle damage. In celiac disease, malabsorption of choline can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of choline may be necessary for individuals with celiac disease, especially if they have prolonged untreated celiac disease or other risk factors for deficiency. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons:User: Greg Robson Chromium Chromium is a trace mineral that is important for glucose metabolism and insulin function. Deficiency in chromium can lead to symptoms such as impaired glucose tolerance, increased insulin resistance, and poor blood sugar control. Malabsorption of chromium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of chromium may be needed for individuals with celiac disease, especially if they have poor blood sugar control or other risk factors for deficiency. Copper Copper is an essential trace mineral that plays a role in various processes in the body, including energy production, connective tissue formation, and immune function. Deficiency in copper can cause symptoms such as anemia, bone abnormalities, and impaired immune function. In celiac disease, malabsorption of copper can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further compromise the overall health of individuals with celiac disease and increase the risk of related complications. Supplementation of copper may be necessary for individuals with celiac disease to maintain adequate copper levels and support overall health. Iodine Iodine is a trace mineral that is essential for thyroid function, metabolism, and brain development. Deficiency in iodine can cause symptoms such as goiter, fatigue, weight gain, and impaired cognitive function. Malabsorption of iodine can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further disrupt thyroid function and metabolism, and impair cognitive development in individuals with celiac disease, especially in children. Iodine supplementation, along with a well-balanced diet that includes iodine-rich foods such as seafood and iodized salt, may be necessary for individuals with celiac disease to maintain adequate iodine levels and support overall health. Iron Iron is an essential mineral that is required for the production of hemoglobin, the protein in red blood cells that carries oxygen to all parts of the body. Deficiency in iron can cause symptoms such as anemia, fatigue, weakness, and pale skin. Malabsorption of iron can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the risk of anemia and related health issues in individuals with celiac disease. Iron supplementation, along with a well-balanced diet that includes iron-rich foods such as meat, poultry, beans, and fortified cereals, may be necessary for individuals with celiac disease to maintain adequate iron levels and support overall health. Lutein Lutein is a carotenoid antioxidant that is important for eye health and vision. Deficiency in lutein can cause symptoms such as blurred vision, macular degeneration, and increased risk of eye-related disorders. Malabsorption of lutein can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of eye-related issues and compromised vision in individuals with celiac disease. Lutein supplementation, along with a diet rich in lutein-containing foods such as leafy green vegetables, egg yolks, and corn, may be necessary for individuals with celiac disease to maintain adequate lutein levels and support overall eye health. Lycopene Lycopene is a carotenoid antioxidant that is known for its role in prostate health and reducing the risk of certain cancers. Deficiency in lycopene can cause symptoms such as increased risk of prostate cancer, cardiovascular disease, and oxidative stress. Malabsorption of lycopene can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of prostate cancer, cardiovascular issues, and other health complications in individuals with celiac disease. Lycopene supplementation, along with a diet rich in lycopene-containing foods such as tomatoes, watermelon, and red bell peppers, may be necessary for individuals with celiac disease to maintain adequate lycopene levels and support overall health. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson) Magnesium Magnesium is a vital mineral that plays a critical role in numerous physiological processes, including nerve function, muscle contraction, and bone health. Deficiency in magnesium can cause symptoms such as muscle weakness, tremors, irregular heartbeat, and bone loss. Malabsorption of magnesium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of muscle weakness, nerve-related issues, and compromised bone health in individuals with celiac disease. Magnesium supplementation, along with a diet rich in magnesium-containing foods such as leafy green vegetables, nuts, seeds, and whole grains, may be necessary for individuals with celiac disease to maintain adequate magnesium levels and support overall health. Manganese Manganese is an essential trace mineral that is involved in various metabolic processes, including carbohydrate metabolism and bone formation. Deficiency in manganese can cause symptoms such as impaired glucose tolerance, bone abnormalities, and altered cholesterol levels. Malabsorption of manganese can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of metabolic issues, bone-related complications, and altered cholesterol levels in individuals with celiac disease. Manganese supplementation, along with a diet rich in manganese-containing foods such as whole grains, nuts, seeds, and legumes, may be necessary for individuals with celiac disease to maintain adequate manganese levels and support overall health. Molybdenum Molybdenum is a trace mineral that is essential for various enzymatic reactions in the body, including detoxification processes and metabolism of certain nutrients. Deficiency in molybdenum is rare but can cause symptoms such as rapid heartbeat, neurological issues, and growth retardation. Malabsorption of molybdenum can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues, neurological complications, and growth retardation in individuals with celiac disease. Molybdenum supplementation, along with a diet rich in molybdenum-containing foods such as legumes, whole grains, and nuts, may be necessary for individuals with celiac disease to maintain adequate molybdenum levels and support overall health. Nickel Nickel is a trace mineral that is required in very small amounts for various enzymatic reactions in the body. Deficiency in nickel is rare and typically occurs in individuals with specific health conditions. Malabsorption of nickel can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised enzymatic reactions and related health issues in individuals with celiac disease. Nickel supplementation is not typically necessary, as the body requires only trace amounts of nickel. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes nickel-containing foods such as nuts, legumes, and whole grains to support overall health. Phosphorus Phosphorus is an essential mineral that plays a crucial role in bone formation, energy metabolism, and cellular function. Deficiency in phosphorus is rare and usually occurs in individuals with specific health conditions or imbalanced diets. Malabsorption of phosphorus can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, energy metabolism, and cellular function in individuals with celiac disease. Phosphorus supplementation is not typically necessary, as phosphorus is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes phosphorus-containing foods such as dairy products, meat, fish, nuts, seeds, and whole grains to support overall health. Image: CC BY-SA 2.0--User: Pumbaa (original work by commons: User: Greg Robson) Potassium Potassium is a crucial mineral that is involved in numerous physiological processes, including nerve function, muscle contraction, and heart health. Deficiency in potassium can cause symptoms such as muscle weakness, fatigue, irregular heartbeat, and increased blood pressure. Malabsorption of potassium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of nerve-related issues, muscle weakness, and cardiovascular complications in individuals with celiac disease. Potassium supplementation, along with a diet rich in potassium-containing foods such as fruits, vegetables, dairy products, meat, and legumes, may be necessary for individuals with celiac disease to maintain adequate potassium levels and support overall health. Selenium Selenium is an essential trace mineral that is involved in various antioxidant and immune functions in the body. Deficiency in selenium can cause symptoms such as compromised immune function, muscle weakness, fatigue, and hair loss. Malabsorption of selenium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of impaired immune function, muscle weakness, and related health issues in individuals with celiac disease. Selenium supplementation, along with a diet rich in selenium-containing foods such as fish, meat, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate selenium levels and support overall health. Silicon Silicon is a trace mineral that is involved in various processes such as bone formation, connective tissue health, and hair, skin, and nail health. Deficiency in silicon is rare, as it is found in many foods, but it can cause symptoms such as compromised bone health, weak connective tissue, and brittle nails. Malabsorption of silicon can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised bone health, connective tissue issues, and related health concerns in individuals with celiac disease. Silicon supplementation is not typically necessary, as silicon is abundant in many foods. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes silicon-containing foods such as whole grains, fruits, vegetables, nuts, and seeds to support overall health and prevent deficiency. Vanadium Vanadium is a trace mineral that has been suggested to play a role in blood sugar regulation and bone health, although its exact functions are not yet fully understood. Vanadium deficiency is rare, as it is found in small amounts in many foods, and its requirement in the body is low. However, malabsorption of vanadium can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised blood sugar regulation and bone health in individuals with celiac disease. Vanadium supplementation is not typically necessary, as the body's requirement for vanadium is minimal, and excessive intake can be toxic. However, it is important for individuals with celiac disease to maintain a well-balanced diet that includes foods rich in vanadium, such as seafood, mushrooms, whole grains, and vegetable oils, to support overall health. Vitamin A (Preformed) Vitamin A is a fat-soluble vitamin that plays a crucial role in vision, immune function, and cellular growth. Deficiency in vitamin A can lead to night blindness, dry skin, and increased susceptibility to infections. Untreated celiac disease can cause malabsorption of vitamin A due to damage to the small intestine lining, leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin A levels and consider supplementation if necessary. Vitamin A (Betacarotenes) Vitamin A in the form of betacarotenes is a precursor that is converted to vitamin A in the body as needed. Betacarotenes are found in colorful fruits and vegetables, and they play a role in maintaining healthy skin, vision, and immune function. Deficiency in betacarotenes can result in similar symptoms as vitamin A deficiency, including impaired vision and weakened immune system. In celiac disease, impaired absorption of betacarotenes can occur due to damage to the small intestine lining, leading to a potential deficiency. Vitamin B1 (Thiamine) Vitamin B1, also known as thiamine, is a water-soluble vitamin that is essential for energy metabolism, nerve function, and brain health. Deficiency in thiamine can cause symptoms such as muscle weakness, fatigue, and mental confusion. Severe, prolonged thiamine deficiency can result in beriberi, and symptoms include loss of sensation in extremities, symptoms of heart failure, swelling of the hands and feet, chest pain, feelings of vertigo, double vision, and memory loss. Untreated celiac disease can impair thiamine absorption due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their thiamine levels and consider supplementation if needed. Vitamin B2 (Riboflavin) Vitamin B2, also known as riboflavin, is another water-soluble vitamin that plays a key role in energy production, growth, and red blood cell formation. Deficiency in riboflavin can lead to symptoms such as cracked lips, sore throat, and skin rash. Celiac disease can cause impaired absorption of riboflavin due to damage to the small intestine lining, leading to a potential deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate riboflavin levels. Vitamin B3 (Niacin) Vitamin B3, also known as niacin, is essential for energy metabolism, nervous system function, and DNA repair. Deficiency in niacin can result in a condition known as pellagra, characterized by symptoms such as diarrhea, dermatitis, and mental confusion. Malabsorption of niacin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their niacin levels and consider supplementation if necessary. Vitamin B5 (Pantothenic Acid) Vitamin B5, also known as pantothenic acid, is involved in energy production, hormone synthesis, and nerve function. Deficiency in pantothenic acid can lead to symptoms such as fatigue, numbness and tingling in the hands and feet, and difficulty in coordination. In celiac disease, malabsorption of pantothenic acid can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate pantothenic acid levels. Vitamin B6 Vitamin B6, also known as pyridoxine, is a water-soluble vitamin that is important for brain development, immune function, and protein metabolism. Deficiency in vitamin B6 can cause symptoms such as depression, irritability, and weakened immune system. Untreated celiac disease can impair the absorption of vitamin B6 due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their vitamin B6 levels and consider supplementation if needed. Vitamin B7 (Biotin) Vitamin B7, also known as biotin, is essential for healthy skin, hair, and nails, as well as for metabolism of carbohydrates, fats, and proteins. Deficiency in biotin can result in symptoms such as hair loss, brittle nails, and skin rash. Malabsorption of biotin can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation may be necessary for individuals with celiac disease to maintain adequate biotin levels. Vitamin B8 (Inositol) Vitamin B8, also known as inositol, is involved in cell signaling, nerve function, and brain health. Deficiency in inositol can lead to symptoms such as mood swings, anxiety, and difficulty in concentration. In celiac disease, impaired absorption of inositol can occur due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their inositol levels and consider supplementation if necessary. Vitamin B9 (Folate) Vitamin B9, also known as folate, is important for DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folate can result in symptoms such as anemia, fatigue, and neural tube defects in newborns. Malabsorption of folate can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of folate may be necessary for individuals with celiac disease, especially during pregnancy. Vitamin B9 (Folic Acid) Folic acid is the synthetic form of folate, often used in dietary supplements and fortified foods. It is converted to folate in the body and plays similar roles in DNA synthesis, red blood cell formation, and fetal development during pregnancy. Deficiency in folic acid can lead to the same symptoms as folate deficiency, including anemia and neural tube defects in newborns. Malabsorption of folic acid can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. It is important for individuals with celiac disease to monitor their folic acid levels and consider supplementation if needed. Vitamin B12 ( Cobalamin) Vitamin B12, also known as cobalamin, is essential for nerve function, DNA synthesis, and red blood cell formation. Deficiency in vitamin B12 can cause symptoms such as fatigue, weakness, and numbness and tingling in the hands and feet. In celiac disease, malabsorption of vitamin B12 can occur due to damage to the small intestine lining, potentially leading to a deficiency. This can further exacerbate the symptoms of celiac disease and affect overall health. Supplementation of vitamin B12 may be necessary for individuals with celiac disease to maintain adequate levels and prevent deficiency-related complications. Vitamin C (Ascorbic Acid) Vitamin C, also known as ascorbic acid, is a powerful antioxidant that plays a critical role in immune function, collagen synthesis, and wound healing. Deficiency in vitamin C can cause symptoms such as fatigue, weakened immune system, and slow wound healing. A severe vitamin C deficiency can also result in scurvy, and early symptoms of scurvy include weakness, feeling tired and having sore arms and legs. In celiac disease, malabsorption of vitamin C can occur due to damage to the small intestine lining, potentially leading to a deficiency. Supplementation of vitamin C may be necessary for individuals with celiac disease to maintain adequate levels and support immune function. Vitamin D3 Vitamin D3, also known as the "sunshine vitamin," is crucial for bone health, immune function, and mood regulation. Deficiency in vitamin D3 can cause symptoms such as bone pain, muscle weakness, and increased susceptibility to infections. Malabsorption of vitamin D3 is common in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of osteoporosis, weakened immune system, and mood disorders in individuals with celiac disease. Vitamin D3 supplementation, along with adequate sunlight exposure and a vitamin D-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin D levels and support overall health. Vitamin E (Food Sourced) Vitamin E is a powerful antioxidant that protects cells from damage, supports immune function, and helps with DNA repair. Deficiency in vitamin E can cause symptoms such as muscle weakness, impaired vision, and increased oxidative stress. Malabsorption of vitamin E can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of oxidative stress and related health issues in individuals with celiac disease. Vitamin E supplementation, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate vitamin E levels and support overall health. Vitamin E (Alpha-Tocopherol) Vitamin E, specifically alpha-tocopherol, is the most active and common form of vitamin E in the body. It plays a crucial role in protecting cells from damage, supporting immune function, and maintaining cardiovascular health. Deficiency in alpha-tocopherol can cause symptoms such as muscle weakness, vision problems, and increased risk of cardiovascular disease. Malabsorption of alpha-tocopherol can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of cardiovascular issues and other health complications in individuals with celiac disease. Supplementation of alpha-tocopherol, along with a vitamin E-rich diet, may be necessary for individuals with celiac disease to maintain adequate alpha-tocopherol levels and support overall health. Vitamin K Vitamin K is a fat-soluble vitamin that plays a crucial role in blood clotting and bone metabolism. Deficiency in vitamin K can cause symptoms such as easy bruising, prolonged bleeding, and weakened bones. Malabsorption of vitamin K can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of bleeding disorders and weakened bones in individuals with celiac disease. Vitamin K supplementation, along with a well-balanced diet that includes vitamin K-rich foods such as leafy green vegetables, may be necessary for individuals with celiac disease to maintain adequate vitamin K levels and support overall health. Zinc Zinc is an essential mineral that is involved in various enzymatic reactions, immune function, and wound healing. Deficiency in zinc can cause symptoms such as impaired immune function, delayed wound healing, hair loss, and skin issues. Malabsorption of zinc can occur in celiac disease due to damage to the small intestine lining, potentially leading to a deficiency. This can further increase the risk of compromised immune function, delayed wound healing, and related health issues in individuals with celiac disease. Zinc supplementation, along with a diet rich in zinc-containing foods such as meat, fish, dairy products, nuts, and seeds, may be necessary for individuals with celiac disease to maintain adequate zinc levels and support overall health. Conclusion In conclusion, untreated and undiagnosed celiac disease can lead to deficiencies in various nutrients due to malabsorption caused by damage to the small intestine lining. These deficiencies can result in a wide range of symptoms and health effects, including compromised bone health, impaired immune function, nerve-related issues, skin, hair, and nail problems, and other related health concerns. Therefore, it is crucial for individuals with celiac disease to be vigilant about their nutrient intake and work with healthcare professionals to ensure proper monitoring and management of their nutrient levels through a well-balanced diet and, if necessary, appropriate supplementation. Proper management of celiac disease, including adherence to a gluten-free diet, regular monitoring of nutrient levels, and appropriate supplementation when needed, can help individuals with celiac disease maintain optimal health and prevent nutrient deficiencies. Vitamins and Minerals Generally Safe in Excess of Recommended Daily Allowance (RDA): Vitamin C (Ascorbic Acid): Excess vitamin C is usually excreted in the urine and is considered safe in higher doses. However, very high doses may cause digestive upset in some individuals. Vitamin B1 (Thiamine): Water-soluble, excess thiamine is generally excreted through urine. It is considered safe in higher doses but consult with a healthcare professional. Vitamin B2 (Riboflavin): Water-soluble, excess riboflavin is excreted in the urine and is generally safe in higher doses. Vitamin B3 (Niacin): Water-soluble, niacin has a well-defined upper limit, but moderate excess is often excreted. Consultation with a healthcare professional is advisable. Vitamin B5 (Pantothenic Acid): Water-soluble, excess pantothenic acid is generally excreted through urine and considered safe in higher doses. Vitamin B6 (Pyridoxine): While excessive intake from supplements can lead to nerve damage, moderate overages are generally excreted through urine. Vitamin B7 (Biotin): Water-soluble, excess biotin is typically excreted and is considered safe in higher doses. Vitamin B9 (Folate): Excess folate is usually excreted, but extremely high levels from supplements may have potential risks. It's generally safe when consumed through natural food sources. Vitamin B12 (Cobalamin): Water-soluble, excess B12 is typically excreted in the urine and is considered safe in higher doses. Consultation with a healthcare professional is advisable. Choline: While not a true vitamin, choline is water-soluble, and excess is usually excreted. It's considered safe in higher doses but consult with a healthcare professional. Vitamins and Minerals with Potential for Toxicity in Excess of Recommended Daily Allowance (RDA): Vitamin A (Retinol): Excessive vitamin A intake, especially from supplements, can lead to toxicity, causing symptoms like nausea, dizziness, and, in severe cases, organ damage. Vitamin D - While moderate excess may be excreted, prolonged high doses can lead to vitamin D toxicity, resulting in hypercalcemia, kidney damage, and other complications. Vitamin E (Tocopherols): Excess vitamin E is usually excreted, but high doses from supplements may have adverse effects. Obtaining it through a balanced diet is preferable. Vitamin K: Excess vitamin K from supplements can interfere with blood thinning medications and cause issues in some individuals. Iron: Excessive iron intake, especially from supplements, can lead to iron toxicity, causing symptoms like nausea, abdominal pain, and, in severe cases, organ failure. Zinc: While zinc is essential, excessive intake can lead to zinc toxicity, affecting the immune system and causing digestive issues. Copper: High copper levels, often from supplements, can lead to toxicity, causing symptoms such as nausea, vomiting, and liver damage. Selenium: Excessive selenium intake, especially from supplements, can lead to selenosis, causing symptoms like hair loss, gastrointestinal issues, and neurological problems. It's crucial to note that individual tolerances can vary, and supplementation should be done under the guidance of a healthcare professional. Sources: National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Celiac Disease. Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/celiac-disease Rubio-Tapia, A., Hill, I. D., Kelly, C. P., Calderwood, A. H., & Murray, J. A. (2013). ACG clinical guidelines: Diagnosis and management of celiac disease. The American Journal of Gastroenterology, 108(5), 656-676. doi:10.1038/ajg.2013.79 Complementary Medicine, Penn State Hershey. (n.d.). B vitamins. Retrieved from https://pennstatehershey.adam.com/content.aspx?productId=107&pid=33&gid=000336 National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B5 (Pantothenic Acid) - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vitamin B12 - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chloride - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iodine - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Magnesium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Phosphorus - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Silicon - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Vanadium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Manganese - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lycopene - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Lutein and Zeaxanthin - Fact Sheet for Health Professionals. https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Nickel - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Selenium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Iron - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Calcium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Zinc - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/ National Institutes of Health, Office of Dietary Supplements. (2021). Chromium - Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/list-all/

Celiac.com 04/29/2024 - Getting enough calcium in the diet is essential for people of all ages, as this mineral performs many important functions in the body. In addition to bone health, calcium is required for muscle contractions, nerve impulses, normal blood clotting and regulating blood pressure. It may also offer protection from colon cancer. Children and adults with celiac disease need to pay particular attention to calcium and other nutrients as many already have or will develop early bone disease such as osteopenia or osteoporosis. Osteopenia is low bone mineral density and osteoporosis is characterized by a significant decrease in bone mass resulting in brittle, easily broken bones. The hip, spine and wrist are most susceptible to fracture. Early diagnosis and treatment of celiac disease is critical for the prevention of bone disease. To maintain good bone health it is important that all people with celiac disease have routine bone density tests done to assess their overall bone health, and to follow the tips outlined below. Follow a strict gluten-free diet Healthy villi will result in normal absorption of nutrients. Meet your daily calcium requirements Table 1: Dietary Reference Intake for Calcium /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Age Calcium (mg/day) Infants 0- 6 months 7-12 months 210 270 Children 1-3 years 4-8 years 500 800 Females and Males 9-13 14-18 19-30 31-50 51-70 71 + 1300 1300 1000 1000 1200 1200 Choose calcium-rich foods See Table 2 for a list of gluten-free foods. Remember that not all calcium sources are created equal. Milk (fl uid, powdered or evaporated) and milk products such as cheese and yogurt contain the most readily available source of calcium. Other foods such as salmon and sardines with the bones, calcium-fortifi ed beverages (soy, rice and orange juice), tofu made with calcium sulfate and vegetables (broccoli, collards, kale, mustard greens, turnip greens and bok choy) also contain calcium that is easily absorbed by the body. However, the calcium found in almonds, sesame seeds, dried beans and spinach are absorbed less effi ciently because these foods contain calcium-binding substances called oxalates. Although the calcium content of these foods should not be counted as part of your daily calcium intake; they do provide many other nutrients important for good health. Table 2 Calcium Content of Gluten-Free Dairy Foods /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Food Serving Calcium (mg) Buttermilk 1 cup (250 ml) 303 Cheddar cheese 2 oz. (50 g) 350 Cottage cheese, creamed ½ cup (125 ml) 76 Feta cheese 2 oz (50 g) 255 Ice cream ½ cup (125 ml) 90 Milk (whole, 2%, 1%, skim) 1 cup (250 ml) 315 Milk (chocolate) 1 cup (250 ml) 301 Milk, powder, dry 3 Tbsp. (45 ml) 308 Mozzarella cheese 2 oz (50 g) 287 Parmesan cheese, grated 3 Tbsp. (45 ml) 261 Processed cheese slices 2 regular (62 g) 384 Swiss cheese 2 oz (50 g) 480 Yogurt, fruit-flavored ¾ cup (175 g) 240 Yogurt, plain ¾ cup (175 g) 296 Table 2: Calcium Content of Other Gluten-Free Foods /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Food Serving Calcium (mg) Almonds ½ cup (125 ml) 200* Baked beans 1 cup (250 ml) 163* Bok choy, cooked ½ cup (125 ml) 84 Broccoli, cooked ½ cup (125 ml) 38 Collards, cooked ½ cup (125 ml) 81 Orange juice, calcium fortified 1 cup (250 ml) 300-350 Salmon, sockeye, canned with bones Half a 7.5 oz (213 g) can 243 Sardines, canned with bones 6 medium (72 g) 275 Sesame seeds ½ cup (125 ml) 89* Soybeans, cooked ½ cup(125 ml) 93 Soy beverage, fortified 1 cup (250 ml) 312 Tofu, regular, processed with calcium sulfate** 1/3 cup (100 g) 150 * The calcium from these sources is absorbed less efficiently by the body. ** The calcium content of tofu is an approximation based on products available on the market. Calcium content can vary greatly from one brand to another and can be low. Tofu processed with magnesium chloride also contains less calcium. Consider calcium supplementation If you are unable to consume enough dietary calcium you many to need a gluten-free calcium supplement. Look for the amount of “elemental calcium” on the label. Your body can only absorb 500 mg at one time therefore it is best to divide your dose throughout the day. Calcium carbonate is more slowly absorbed and should be consumed with meals. Calcium citrate is well absorbed with meals or an empty stomach. Bone meal or dolomite calcium supplements are not recommended as some products have been found to contain lead and mercury. Limit caffeine intake Studies have shown that caffeine increases calcium loss through the urine. Most experts agree that 2-3 cups of coffee/day is probably not harmful provided that calcium intake is adequate, so limit your coffee and cola intake. Limit sodium intake Sodium also has been shown to increase the loss of calcium through the urine. Therefore it is advisable to limit your intake of processed foods, table salt and salt in cooking. Get enough Vitamin D Vitamin D helps the body use the calcium in food. It can increase calcium absorption by as much as 30-80 %. See Table 3 for the Dietary Reference Intake for vitamin D. The easiest way to get vitamin D is from exposure to sunlight, which causes the body to make its own vitamin D. All you need is 15 minutes per day; however, aging significantly decreases 1) the ability of the skin to produce vitamin D and 2) kidney function that is involved in converting the inactive to active form of vitamin D. Also, sunscreen blocks the production of vitamin D in the skin. Another concern is that between the months of October and March in Canada and the northern USA, vitamin D synthesis in the skin is very limited. To make up for the lack of sunlight look for other sources of vitamin D listed in Table 4, and remember the points below. Table 3: Dietary Reference Intake for Vitamin D /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Age Vitamin D (IU) Birth – 50 years 200 51- 70 years 400 Over 70 years 600 Milk is fortified with vitamin D but most other dairy products such as cheese, yogurt and ice cream are not fortified. Recently some companies have been adding vitamin D to other dairy products so be sure to read the ingredient label and nutrition panel. Fatty fish (sardines, salmon and herring) and cod liver oil and halibut liver oil are high in vitamin D. Many soy and rice beverages are fortified with vitamin D. Check the ingredient list carefully as some products may contain barley malt extract/flavoring and must be avoided. Nut beverages (e.g. Blue Diamond Almond Breeze) and potato beverages (e.g. Vances DariFree) are fortified with vitamin D. Multivitamin supplements usually contain 200-400 IU of vitamin D. Some calcium supplements may contain vitamin D. Amounts vary so check the label. Table 4: Sources of Vitamin D /* DivTable.com */ .divTable{ display: table; width: 100%; } .divTableRow { display: table-row; } .divTableHeading { background-color: #EEE; display: table-header-group; } .divTableCell, .divTableHead { border: 1px solid #999999; display: table-cell; padding: 3px 10px; } .divTableHeading { background-color: #EEE; display: table-header-group; font-weight: bold; } .divTableFoot { background-color: #EEE; display: table-footer-group; font-weight: bold; } .divTableBody { display: table-row-group; } Food Serving Size Vitamin D (IU) Cod liver oil Cod liver oil capsule 1 tsp. (5 ml) 1 capsule 450 100 Halibut liver oil capsule 1 capsule 400 Sardines, canned 3.5 oz (100 g.) 300 Salmon, canned, with bones 3.5 oz (100 g.) 500 Egg 1 medium 25 Milk 1 cup (250 ml) 90 Soy Beverage (fortified) 1 cup (250 ml) 90 Don’t just sit there…get moving! Regular weight bearing exercises such as walking, stair climbing, dancing and tennis and muscle-strengthening exercises can reduce the risks of falls and fractures. Consult your doctor before beginning a vigorous exercise program. So remember the ABC’s…All Bones Need Calcium, Vitamin D and Exercise!

Celiac.com 04/05/2022 - You have just been diagnosed with celiac disease. Wonderful! Now all your gastro problems, aches and pains and fatigue and food allergies will go away. All you need to do is maintain a gluten-free diet—NOT! Many—if not most—of us who are gluten intolerant have quickly found our various health problems, sadly, do not go away simply by eliminating gluten from our lives. In fact, our health problems may increase over time. Many futilely and desperately search in vain for “hidden” gluten which they are sure must be present in something they missed causing them problems. If you are among the lucky ones whose health fully recovers after starting a gluten-free diet, great! The fact is, your gastrointestinal tract and immune system may have been under attack for years. Malabsorption is likely to have caused years of vitamin, mineral, and amino acid deficiencies resulting in damage to your body systems. You may have acquired various other autoimmune conditions along the way. If you are diagnosed over age 40, your body systems may be slowing down and not able to fully recover. The mix of beneficial bacteria and microorganisms which inhabit your gut may have become altered, depleted, or in complete disarray. Your stomach may no longer be producing a sufficient quantity of stomach acid, affecting your ability to digest food and absorb essential vitamins and minerals. Intestinal permeability and perhaps a thymus gland impaired by mineral and vitamin deficiencies may have resulted in the acquisition of multiple food allergies and intolerances. Vitamin B12 deficiency could have caused permanent neurological damage. Bones may have weakened. There may be weak, brittle and malformed finger and toe nails, skin rashes, bruising, and inflammation. Fatigue and muscle pains may be present. The list goes on. So what can one do? Low Stomach Acid After a diagnosis of celiac disease or gluten intolerance , you should first immediately assess if you have a low stomach acid condition. Low stomach acid or hypochlorhydria will continue to cause malabsorption problems and vitamin, mineral and amino acid deficiencies. Hypochlorhydria can lead to multiple food allergies. Low stomach acid also allows potentially harmful bacteria and microorganisms to colonize the stomach where they should not be at all. The stomach cells which produce stomach acid also produce a substance called “intrinsic factor” which is necessary to allow the intestine to absorb vitamin B12. If you have low stomach acid, intrinsic factor may be low and you may not be able to absorb vitamin B12 sufficiently. In this case, sublingual or “under-the-tongue” vitamin B12 tablets can be taken to improve absorption. In some cases, vitamin B12 injections are necessary to prevent pernicious anemia. During digestion, stomach acid levels normally increase. The higher acid level results in a secretion of hormones which, in turn, signal the pancreas to release digestive enzymes and acid-neutralizing bicarbonate ions into the small intestine to complete the digestion of contents leaving the stomach. Maintaining a normal stomach acid level is, thus, crucial for digestion in both the stomach and intestine. Low stomach acid is also present in the vast majority of heartburn sufferers, and improper digestion due to low acid is the cause of most heartburn. Taking acid suppressors for heartburn is exactly the wrong thing to do if you have low stomach acid. Taking an acid supplement to normalize digestion can actually prevent heartburn in most cases. An excellent reference on stomach acid is the paperback book Why Stomach Acid Is Good for You by Jonathan V. Wright, M.D. and Lane Lenard, Ph.D. Low stomach acid can be treated by taking digestive enzymes and an acid supplement, such as betaine HCl, with every meal, likely for the rest of one’s life. There are many digestive enzyme formulations available, and the choice depends on your individual metabolism. I prefer the pricey but high-quality fungal derived enzymes from Enzymedica, and take one Carbo capsule with every meal. The Carbo formulation has a modest level of protease enzymes. High levels of protease can cause a burning sensation in the bowels in some people, including myself, which normally goes away after a few weeks of use. Since I am mostly vegetarian, my need for protease to digest meat and proteins is reduced. Betaine HCl is available in tablet form, or as 10-grain capsules containing powdered betaine HCl, which works faster. You need to adjust the number of betaine HCl capsules to suit your low acid condition, and this usually means taking more than just one or two capsules with each meal. The number is adjusted by increasing it until you experience a warm sensation in your stomach, and then backing off by one capsule. I take three 10-grain capsules with breakfast and lunch, and six with dinner. I buy quantities of 250 capsule bottles of Solaray High Potency HCl from a discount health food company over the internet at a very reasonable price. Enzymedica products can also be purchased at discount over the internet. Treating hypochlorhydria greatly reduced or eliminated my allergic responses to numerous foods. A quick and simple test for low stomach acid makes use of fresh baking soda. You should not be taking antacids or acid suppressors to perform this test. Stomach acid and baking soda react to form carbon dioxide gas. First thing in the morning, before eating or drinking, add one quarter teaspoon of baking soda to an eight ounce glass of water. Mix, drink, and start timing for up to five minutes. You should normally belch within two to three minutes if your stomach acid level is adequate. Rapid and repeated belching may mean excessive stomach acid is present. Late or no belching indicates low stomach acid. Acid levels can be confirmed by measuring stomach pH using a small radio capsule (Heidelberg capsule) that is swallowed, a test which some gastroenterologists or naturopathic doctors can perform. Probiotics Probiotics provide beneficial microbes to help replace and restore order to the bacteria and micro flora which reside in the gastrointestinal tract. Celiac disease, hypochlorhydria, immune system disorders, and accompanying gastrointestinal distress can wreck havoc on the balance and mixture of the beneficial and necessary micro flora of the gut. Low stomach acid permits entry of undesirable and pathogenic bacteria. Malabsorption results in an excess of undigested nutrients in the gut, feeding and promoting an overabundance of undesirable bacteria species. Taking a probiotic supplement helps to re-colonize the gastrointestinal tract with beneficial bacteria which, in turn, displace the undesired bacteria. Probiotics come in the form of foods, such as yogurt and kefir containing live cultures of beneficial bacteria, or in capsule, tablet, liquid or powdered form. Choosing a probiotic may not be easy. Research on probiotics is a very young field, and which species of bacteria provide the greatest benefit remains uncertain. You may need to try a number of different probiotic products to find one that best suits your needs. A probiotic containing a mixture of a number of different bacteria species might be more likely to provide the bacteria combination that works for you. Ideally, a dose of probiotic should provide billions, 10, 20, or even 30 billion or more bacteria, to effectively colonize the bowel. Probiotic capsules which provide such a high dosage are expensive. A good yogurt or kefir is a much more cost effective probiotic providing many billions of bacteria per serving. Yogurt and kefir are both fermented milk products, but kefir contains yeast in addition to bacteria. Sensitivity to yeast is a common problem among celiacs, and, hence, kefir may not be suitable for everyone. Soy yogurt and kefir are also available if you are sensitive to dairy products. Some health food stores can provide yogurt and kefir made with goats milk if cow’s milk is a particular problem. Labels on some probiotic products warn that flu-like symptoms may result during the first few weeks of use and recommend a lower dose until the symptoms disappear. Personally, I consume a plain yogurt, without gelatin or corn syrup, preferring Nancy’s Yogurt. I had a six month bout of diarrhea after a prolonged summer cold. I had been taking a probiotic capsule, and decided to switch to yogurt to provide a larger and cheaper dose of bacteria. The website for Nancy’s Yogurt, which contains six live bacteria cultures, was the only one which provided a bacteria count from an independent laboratory. Nancy’s Yogurt seemed to be instrumental in finally clearing up the diarrhea problem for me. I consume a heaping tablespoon of yogurt on each of two rice cakes every morning and two heaping tablespoons on my salad at dinner. Depending on the age of the yogurt, this provides up to over 30 billion bacteria per two tablespoon serving. I have also tried Stonyfield Farms Yogurt, which also contains six bacteria cultures, but the product is “runny” compared to Nancy’s firm texture. I have not yet tried Mountain High Yogurt, containing five bacteria cultures, which may be another good alternative. I suggest you contact yogurt makers about their bacteria content if you try other brands. However, such information is not always reliable. Nails Your nails are a barometer to your health and provide a good visual aide in recognizing vitamin and mineral deficiencies and other problems. White spots and poor nail growth can indicate a zinc deficiency. Thin, brittle, spoon or concave shaped nails, and ridges running lengthwise indicate possible iron deficiency. A deficiency in vitamin A can cause slow growing brittle nails lacking pink a glow underneath. Vitamin C, folic acid, or protein deficiency can cause hangnails. A deficiency of B vitamins causes fragility, with horizontal or vertical ridges. A deficiency of vitamin B12 leads to excessive dryness, very rounded and curved nail ends, and darkened nails. Splitting, thin, chipping, or peeling nails may mean low stomach acid or low sulphur amino acid. White bands across the nails can indicate a protein deficiency. Probiotics can help fend off nail fungal infections by displacing yeasts and fungi in the gut. A host of medical problems such as thyroid, kidney, and diabetes conditions can be indicated by various malformations and discolorations of the nails. For more on these medical conditions try reading Nail Abnormalities: Clues to Systemic Disease by Robert S. Fawcett, M.D., M.S., Sean Linford, M.D., Daniel L. Stulberg, M.D. I developed a problem with nails deteriorating on the edges of the large toe nails and on one edge of the thumb and index finger of the right hand. In addition, for years I had a chronic periodic swelling and inflammation of the toes around the toe nails. When I began taking betaine HCl for hypochlorhydria, the nail deterioration seemed to stop, but there was little or no nail growth to repair the damage. Searching the internet for solutions, I came across websites which suggested that supplementing with MSM (methylsulfonylmethane) frequently resulted in increased nail growth as well as improved hair condition. MSM is a sulfur compound, and numerous health benefits have been claimed for it for which I cannot vouch. Sulfur is a component of keratin, and keratin is a protein important for the maintenance and growth of nails, hair and skin. MSM has a bitter taste, but it does not leave an aftertaste. The powder can be mixed with fruit juice, if desired. I began taking one half teaspoon of powdered MSM in a glass of water once daily, and soon noticed an apparent increase in nail growth after a few weeks. Encouraged, I began to take one half teaspoon MSM twice daily, in the morning and evening. I also began taking 500 mg L-methionine, an essential sulfur amino acid, twice daily. This increased nail growth even more, and, quite unexpectedly, within two weeks the chronic periodic swelling and inflammation of the toes completely ceased and has never returned to this day (I also noticed my hair seemed softer and had more luster, but, hey, us males aren’t supposed to care about such things). I started taking MSM in January 2003. I’ve had a few relapses resulting in some temporary nail deterioration, especially during the six month bout of diarrhea. Consuming yogurt seemed to help clear up the nail problem as well as the diarrhea. I also now have further increased my take of MSM powder to a heaping teaspoon in water twice daily with no side effects noticed. After nearly two years my nails are almost completely normal and healthy. Only the slow growing large toe nails still show any obvious signs of the prior condition, and they are nearly fully grown back and healthy. I buy MSM powder in 35 oz (1000 g) containers at discount over the internet. Vitamins, Minerals and Amino Acids Our intestines have been damaged. We may have low stomach acid. We may be vegetarian. Our metabolisms differ. Our lifestyles differ. All of these factors affect how nutrients are absorbed and how much of each nutrient we require. Does that multi-vitamin/multi-mineral supplement supplying the recommended daily allowance (RDA) of vitamins and minerals really meet your needs? Remember, these are the amounts needed to maintain a healthy normal individual. You need to look at your own condition to determine the amount of vitamins and minerals you need. This is no easy task. I am still trying to deal with it myself. Wouldn’t it be nice if there were some little meter we could poke ourselves with, much like the glucose meter used by diabetics, that could tell us which vitamins and minerals and amino acids were low and what and how much we needed to take? After first being diagnosed with celiac disease, you are probably deficient in numerous nutrients. Once on a gluten-free diet, many of these deficiencies will return to normal levels. Some may not. In addition, some nutrients, such as vitamin B12, may not be sufficiently absorbed via the intestine, and must be take sublingually or by injection. Paradoxically, some of the very nutrients needed to repair the intestine so that it can absorb them are not being absorbed because of the damage to the intestine. Deficiencies may require higher than RDA amounts, at first, which must be reduced, later, to avoid overdosing. Without some form of testing and monitoring to determine our need for and levels of nutrients, there is no good way to manage our nutrient needs. I have already suggested that your nails can provide a clue to some deficiencies. Are there tests which can help us decide what we need? Yes, there are tests which can provide you with serum levels of many nutrients. But these tests can add up and become very costly if tests are done for many nutrients and if follow up tests are performed. Some clinical labs offer package deals which might not be a bad idea for an initial assessment of your health condition. For example, many Web sites offer various nutrient blood tests. I do not think your insurance company is going to be willing to pay for a multitude of tests and follow up tests. A few well-chosen tests may fit within your budget. If you have the means, having the test information is better than not having it. Also, if you can find and afford a good doctor or clinical nutritionist or naturopath to work with you, so much the better. If doctors and tests are not within your means, self-education and trial and error is an alternative approach. Besides books and libraries, the internet has a wealth of helpful websites on nutrition and nutrients. One of the best websites is the Linus Pauling Institute’s Micronutrient Information Center which provides an excellent source of information on vitamins, minerals and some other nutrients. This website also offer good information on vitamins and minerals: https://www.springboard4health.com/notebook/ Amino acids, the building blocks of protein, are also important. 22 amino acids are used in human metabolism. Some amino acids can be synthesized by the body, but there are 8 essential amino acids which can only be obtained from diet. The following website provides a good overview of the amino acids: https://www.springboard4health.com/notebook/cat_proteins.html Additionally, you need to know how much of these nutrients your diet may be providing. The USDA National Nutrient Database for Standard Reference provides a comprehensive list of nutrients from a huge database of foods and food products. Just remember that the amount of a nutrient given for a food does not represent how much of that nutrient your body will actually absorb. In some cases, the food may have a very high nutrient content, but only a very small percentage will actually be absorbed because the nutrient is not in a readily absorbable form. By noting your symptoms and health condition and comparing them to symptoms caused by nutrient deficiencies, you may be able to determine or guess which nutrients you may be lacking. As similar symptoms can be caused by deficiencies of any number of other nutrients, the task is not easy. You may be able to correct the deficiency by including in your diet foods rich in the particular nutrient. You may need to take the nutrient as a supplement to insure sufficient absorption. You also must determine the dose of supplementation you require. In order to be able to assess whether the supplementation is improving your symptoms and health, you must add only one supplement at a time and make no major changes to your diet, and it may take days or weeks or months to note if the symptoms improve. This process can easily become tedious, time-consuming, expensive, and frustrating. If you have narrowed down possible nutrient deficiencies, you may opt to get tested for those particular nutrients. Vegetarians also have special needs, as there are some nutrients better provided by animal products in the diet. The American Dietetic Association has a comprehensive paper on Vegetarian Diets which discusses these nutritional needs. Vegetarians must make sure their diets are sufficient in protein (essential amino acids), iron, zinc, calcium, vitamin D, riboflavin, vitamin B12, vitamin A, n-3 fatty acids, and iodine. Higher RDA levels and supplementation of some of these nutrients may be necessary to maintain proper levels. Malabsorption caused by celiac disease compounds the likelihood of deficiencies. Here is an example of tracking down a deficiency problem. A symptom I have been dealing with is fatigue. I take a multivitamin/mineral supplement, sublingual vitamin B12, plenty of vitamin C, plus additional supplements. At first, I suspected adrenal fatigue and achieved some limited relief from fatigue by drinking salted water several times daily to replace lost sodium caused by an insufficient level of the hormone, aldosterone, produced by the adrenals which regulate sodium retention in the kidneys. But lately, salted water is not having much affect, possibly because my aldosterone level is improving. In addition to fatigue and lack of energy, I was experiencing episodes of daytime drowsiness while driving to work. In a self-experiment supplementing with tin in the form of stannous chloride, I actually seemed to have completely cured myself of daytime drowsiness. However, fatigue still remains a problem. Evaluating my supplements and considering which nutrient deficiencies are likely to cause fatigue, I noted that my multivitamin/mineral supplement provides only 10 mg iron. The RDA of iron for adult males is 8 mg and for pre-menopausal adult females is 18 mg. However, vegetarians face a lower bioavailability of iron from their diets. In meat, iron is available in a “heme” form that is more readily absorbed than the inorganic form of iron found in plants. Red meat and spinach both have a high iron content. 20% of the heme iron available in a lean steak is absorbed, but only 2% of the iron in cooked spinach is actually absorbed. The iron RDA for vegetarians is 14 mg for men and 33 mg for pre-menopausal women. Physical activity can also deplete iron stores. Sports activities, exercise, and heavy labor can raise the daily requirement for iron. Any bleeding causes iron depletion. A loss of one ml of blood results in a loss of 0.5 mg iron. Low stomach acid results in poor iron absorption, and intestinal damage from celiac disease often causes iron deficiency. Other dietary factors also affect how much iron is absorbed. Vitamin C consumed in the same meal as non-heme iron improves the absorption of the non-heme iron by up to 50%. Heme iron also increases the absorption of non-heme iron. Tea, coffee and certain types of fiber (eg. phytate) can inhibit the absorption of iron. Taking a look at myself, I am mostly vegetarian. I have low stomach acid. My intestines may still be impaired from celiac disease, and reactions to food intolerances or allergies could also impair absorption. I sometimes experience loss of blood from rectal bleeding through an anal fissure as a result of bowel distress. I do a long series of stretching exercises every morning, and my work involves moderate physical activity. Suddenly, a supplement providing only 10 mg of iron daily seems totally inadequate for my needs. Iron deficiency could definitely explain my fatigue. Recently, I have begun daily supplementation of iron in the form of 28 mg iron from ferrous gluconate in addition to the 10 mg of iron I already take. It is too soon to tell if iron supplementation is improving my fatigue, but I do seem to be a little less fatigued. Hopefully, I will see continued improvement. Food Allergies and Intolerances Multiple food allergies often accompany celiac disease. In addition, temporary intolerances to dairy products and sugars may result from celiac disease. Enzymes which digest lactose and various other forms of sugar are produced in the lining of the small intestine. Production of these enzymes is impaired by damage to the intestine from celiac disease. Sugars and lactose are thus not properly absorbed. Low stomach acid, if present, also results in incomplete digestion of proteins, fats and carbohydrates. Damage to the intestine results in the intestine being less capable of absorbing nutrients. An accumulation of undigested sugars, and other nutrients promotes an overabundance of intestinal bacteria and other micro flora which feed on the ready supply of unabsorbed nutrients. The secretions and toxins generated by these micro flora can cause gas, discomfort, and other symptoms of intolerance and bowel distress. Intestinal damage also increases intestinal permeability or “leaky gut”. Undigested and normally harmless food proteins can “leak” into the blood stream and into other body systems where they may be identified as intruders, initiating allergic and immune responses. I have come to believe that the thymus gland may also be involved in the acquisition of food allergies. The thymus is located behind the breastbone and is responsible for the generation of T cells, critical to the function of the immune system. Until quite recently, it was thought the thymus stopped producing T cells after puberty when the thymus begins to shrink. However, it is now known the thymus continues to produce T cells in adults and throughout life. Certain regulatory T cells help the immune system decide whether foreign proteins should be tolerated or attacked. If these regulatory T cells are not in sufficient supply, allergic reactions to harmless proteins may result. The thymus is particularly sensitive to malnutrition. Hence, malabsorption from celiac disease or low stomach acid may adversely affect the thymus and its ability to produce regulatory T cells, thus leading to or contributing to multiple food allergies. Maintaining a gluten-free diet allows the gut to heal. In most cases, the intestine will again produce the enzymes to digest lactose and other sugars, and these intolerances may go away. Intestinal permeability will decrease, and food allergies and sensitivities may lessen. The thymus may also recover from malnutrition, if not too severely damaged. If you have low stomach acid, food allergies will continue to be a problem unless you take acid supplementation (eg. betaine HCl) and digestive enzymes with every meal. Some food allergies or sensitivities may not completely go away. To help speed healing, it is probably best to avoid foods which are causing problems. If you have a reaction shortly after consuming the food, typically less than 30 minutes, it may be easy to determine the offending food. Some foods may cause a delayed reaction. It may be hours or even days or weeks before antibody production reaches a level high enough to cause a noticeable reaction. This makes identification of the offending food difficult. Elimination diets can be used to identify which foods are safe and which are not. Stick with eating a few basic foods that you know you can tolerate well, and then add suspected foods to your diet one at a time, allowing sufficient time—days or longer if necessary—to observe a possible reaction. Elimination diets are tedious. Some tests are available which can help to identify possible food sensitivities. These tests include the skin prick test, the RAST (Radioallergosorbent test), the ELISA (Enzyme-Linked Immunosorbent Assay) test, and the newest test, the ImmunoCAP® Specific IgE test (a fluoroenzymeimmunoassay (FEIA) ). The skin prick test is performed in a doctor’s office, a prick for each allergen being tested, and can be expensive. RAST testing uses a blood sample to test for the amount of specific IgE antibodies present. ELISA testing also uses a blood sample, but tests for specific IgG antibodies instead of IgE antibodies (associated with true allergies.) IgG reactions can typically occur hours or days after encountering a food or antigen. The ELISA test can be useful in identifying foods which cause delayed reactions. ELISA tests which can test for 190 or so food sensitivities in one blood draw are available for a relatively modest cost. However, the reliability of ELISA tests depends on the laboratory performing the test, and results between different laboratories vary greatly. RAST test results also vary from lab to lab. RAST tests are being replaced by ImmunoCAP® tests. The ImmunoCAP® Specific IgE test is much more accurate and reliable than the RAST test, and test results are consistent from lab to lab. Costs for ImmunoCAP® or RAST tests can add up as the cost increases for each different allergen being tested for. When I first put myself on a gluten-free diet after years of chronic diarrhea and learning about celiac disease, within a few days I had the first solid bowel movement I could remember in years. But the elation was short-lived. For months afterward, my bowel movement kept changing form from solid to liquid, and the chronic diarrhea kept reappearing. Then, finally, my first breakthrough came. The growing season for melons ended. When melons were no longer a part of my diet, the chronic diarrhea finally disappeared. I had made my first discovery that other foods besides gluten were causing me problems. I began to pay close attention to any reaction or bowel distress that occurred after eating any foods. Soon I was finding foods I had been freely consuming daily and all my life were creating reactions. Fruits were especially troublesome. In response to apples, pears, bananas, oranges, tangerines, hot chocolate, popcorn and more, I was sniffling, experiencing throat irritation, a general malaise, fatigue, and bowel distress within 20 minutes after ingestion. I started to eliminate these foods from my diet. Since, childhood, I have had a chronic throat-clearing problem, and, now, decades later, I finally learned the throat-clearing was due to a sensitivity to corn. I eliminated all corn and products containing corn from my diet, and the throat-clearing finally stopped. Every time I eliminated one food, however, I soon found myself sensitive to a new food. Finally it got to the point where I was reacting to almost everything I ate, even to potatoes and rice cakes. You can imagine the desperation I felt standing in the supermarket produce aisle, one day, hopelessly searching for something I could safely eat. Meanwhile, on the internet I noted that some people were reporting that taking digestive enzymes had allowed them to consume foods they had not been able to eat for years without getting ill. Enzymes were theorized to breakdown proteins into pieces too small to cause reactions. That sounded reasonable to me. So I went to a health food store and bought some digestive enzymes, Enzymedica Digest, to be specific. Taking one capsule with each meal, the effect was immediate. I quickly found myself able to consume at least some foods again without reaction. All seemed to be going well for about a month, until I again started reacting to an increasing number of foods. Now what was I supposed to do? Back to the internet! This time I learned about hypochlorhydria, low stomach acid. Back at the health food store, I bought betaine HCl. Taking betaine HCl and digestive enzymes with every meal once again caused the food sensitivities to go away—and this time stay away. I still keep melons, citrus fruit, and corn, as well as gluten, out of my diet. I rotate other fruits so I do not consume them on consecutive days. I find that new foods I have never eaten before can cause me problems. Montina (Indian rice grass flour) and sorghum flour cause me to have a sore throat reaction. I tried to add avocados to my diet, which I have never eaten before. After eating a couple of avocados a week for a few weeks, I broke out in hives for the first time in my life, an experience I do not want to repeat. I guess the tolerance mechanism of my immune system is now so screwed up, my immune system will no longer tolerate the introduction of any new foods into my diet. As long as I stick with old dependable foods, betaine HCl, and digestive enzymes, I seem to be on the road to recovery. Health Basics While all or some of the above mentioned suggestions may help you fully recover from celiac disease, it is still important to remember the basics of keeping healthy—and that is to eat a healthy diet, keep the weight off, keep active, and exercise regularly. Celiac disease has been associated with diabetes, so it is even all the more important to keep those sugary junk foods and simple carbohydrates under control and out of your diet. In addition to improving mobility and muscle tone, exercise can just plain make you feel better and help keep your bowel movement regular. For years I have been doing daily morning yoga-like stretching exercises, becoming evermore flexible and able to obtain extreme positions as well as great balance control. I began the stretching exercises when I developed pains and cramping in my legs and it became uncomfortable just to bend my legs at the knee. My ankles would also easily buckle while walking up stairs. That was many years ago, and the leg pains and other aches are long gone. I am much more flexible now than I was as a teenager in high school. I find that the exercise almost always helps to induce a bowel movement. Conclusion It took me years to diagnose myself as being gluten intolerant and five more years to discover the steps toward recovery I have presented here. I am still not completely well, but, little by little I am improving. If I had not taken these steps, I would hate to think of the condition I would be in now. If I had had this knowledge years ago and acted on it—think of all the suffering and discomfort I could have avoided. It is my hope that you will use and find this information helpful to speed your recovery so your suffering will not be prolonged needlessly. Feeling ill is no way to live a life.

Celiac.com 08/23/2021 - Ever worry about whether your doctor is properly knowledgeable about the risk of nutritional deficiencies for celiac patients on a gluten-free diet? A gluten-free diet offers the best symptom relief for patients with celiac disease, but a number of researchers and nutritionists have expressed concern about the potential for nutritional deficiencies for some patients. A team of researchers recently set determine how well medical students and healthcare professionals in Poland understand nutritional deficiencies, and the prevention of such deficiencies, in celiac patients on a gluten-free diet. The research team included Łukasz Dembiński, Artur Mazur, Mariusz Dąbrowski, Teresa Jackowska, and Aleksandra Banaszkiewicz. They are variously affiliated with the Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw in Warsaw, Poland; the College of Medical Sciences, University of Rzeszow in Rzeszów, Poland; and the Department of Pediatrics, Center of Postgraduate Medical Education in Warsaw, Poland. Because many gluten-free foods are high in fat, sugar and salt, and also have insufficient amounts of fiber, iron, vitamin D, and calcium, celiac patients on a gluten-free diet may be at risk for nutritional deficiencies. Nearly half of the 430 of the survey subjects did not realize that celiac patients may face a higher risk of nutritional deficiencies. The knowledge of those surveyed was lowest regarding the risk of celiacs being overweight or obese. Just over one in three of the healthcare professionals surveyed gave provided sufficiently correct answers, with the dietitians doing the best overall. The team's finding show that improvement is warranted in the education of healthcare professionals regarding nutrition in celiac patients on a gluten-free diet. Because celiac patients need prompt, proper treatment, and monitoring by health professionals, it is crucial that those professionals be properly educated on the issues and challenges faced by people with celiac disease, especially those on a gluten-free diet. Stay tuned for more on this and related stories. Read more in Nutrients 2021, 13(6), 1771