May is Celiac Awareness Month and my plan for the next month is to educate you on some of the nutritional deficiencies and needs of a patient with celiac disease (CD). Coincidently, there was an article in the current month’s issue of Nutrition in Clinical Practice on this very topic.
As many of you know, celiac is primarily a digestive systemic disease triggered and maintained by the ingestion of gluten in the diet. Gluten is the name given to proteins that are present in wheat, rye and barley. Oats are often contaminated with these other grains, rendering them not safe for celiac patients to ingest. With the ingestion of gluten, an auto-immune response is triggered that damages the villi of the small intestine, affecting its function. The classic form of the disease is characterized by the appearance of symptoms of malabsorption such as diarrhea, fat in the stools, lack of appetite, growth retardation and deficiencies of various nutrients. Other symptoms may include fatigue, anemia, dermatitis herpetiformis (a skin manifestation), constipation, irregular menstruation, infertility, abdominal pain, irritable bowel syndrome, osteoporosis or osteopenia, neurological alternations and neuropsychiatric disorders such as depression.
The nutritional status of patients diagnosed with CD at the time of diagnosis depends on the length of time the disease is active and has not been treated, the extent of the intestinal damage, and the degree of malabsorption. It is common to find that these patients have deficiencies of the fat soluble vitamins. These include vitamins A, D, E and K. There is no universal recommendation for fat-soluble vitamin supplementation and so recommendations should be tailored to each individual. Universal supplementation at the time of diagnosis is appropriate, until the small bowel has healed and is fully functional, allowing the absorption of the fat soluble vitamins again. It is reported that 10% of patients with CD are deficient in vitamin K at diagnosis, which is critical to proper blood clotting. Therefore, it is important to correct a vitamin K deficiency before the intestinal biopsy is done to confirm the diagnosis to prevent bleeding problems.
Once a patient with CD is diagnosed and removes gluten from their diet, many of the nutritional deficiencies will correct themselves as the gut heals.
In good health,