Articles
The Scientific Validation of Nutritional Supplementation in Celiac Disease
~Christine Doherty, N.D.
People are led to eliminating gluten from their diets for many reasons. Gluten, a protein found in wheat, rye and barley causes a multitude of problems for certain individuals. Celiac disease, a hereditary autoimmune disease, can cause hundreds of seemingly unrelated, multi-systemic symptoms. Other wheat related illnesses include wheat allergies and fructan (a form of fructose) intolerance, which is a digestive issue similar to lactose intolerance affecting one of the carbohydrates present in wheat. Any of these conditions is treated by a gluten-free diet. For those with celiac, the diet must be a strict, lifelong avoidance of gluten. An added challenge for those with celiac is the nutritional malabsorption often preceding their diagnosis for years.
Studies have found that celiac nutrient deficiencies require specific management (García-Manzanares & Lucendo, 2011). The gluten-free diet can be a low nutrient diet; many of the wheat replacement grain products rely on white rice, tapioca and potato flours. Low nutritional status at the time of starting the diet coupled with an often low nutrient content of the gluten-free diet can lead to poor long term nutritional status. “The diet and gluten-free products are often low in B vitamins, calcium, vitamin D, iron, zinc, magnesium, and fiber. Few gluten-free products are enriched or fortified, adding to the risk of nutrient deficiencies. Patients newly diagnosed or inadequately treated have low bone mineral density, imbalanced macronutrients, low fiber intake, and micronutrient deficiencies” (Kupper, 2005). It has been found that fifty percent of celiacs still have multiple nutritional deficiencies up to ten years after going gluten free (Hallert et al., 2002). Treatment of a broad spectrum of nutritional deficiencies and nutritional management of osteoporosis are a critical part of the treatment of people with celiac disease and for those who are on a gluten-free diet for any reason.
Nutritional supplementation can reverse pre-existing deficiencies, prevent future ones and is an important part of a healthy gluten-free diet. Dr. Christine Doherty developed the formula for C-liac Vitality packs. The formula is made of key components: a B complex vitamin, fat-soluble vitamins (A, D, E and K), vitamin C, minerals (Wild, Robins, Burley, & Howdle, 2010), probiotics and digestive enzymes. The calcium pills contain other bone supportive nutrients as osteoporosis is a major complication of celiac disease. Dr. Doherty has found the digestive enzyme formula to be the key to absorbing the fat-soluble vitamins and often to improve lingering digestive symptoms.
In several other studies, B complex vitamin supplementation has been found to have important benefits for those with celiac (Hallert, Svensson, Tholstrup, & Hultberg, 2009)(Thompson, 1999). “B-vitamin supplements is effective in reduction of homocysteine levels in patients with celiac disease and should be considered in disease management.” (Hadithi et al., 2009). Folic acid deficiency has recently been implicated in celiacs with epilepsy (Licchetta et al., 2011). "To enzymaticaly activate dietary and supplementary folic acid in to 5MTHF requires an enzyme that is genetically programmed. Studies have shown that 50% of celiacs lack the genes for this enzyme (Wilcox & Mattia, 2006)." Fertility issues are common in the celiac population and are attributed to poor nutritional status. “Regarding a potential pathogenic mechanism, since CD (celiac disease) causes malabsorption of folic acid and other nutrients, this pathway has been proposed to explain the unfavourable outcomes of pregnancy ” (Pellicano, Astegiano, Bruno, Fagoonee, & Rizzetto, 2007). There are implications with low folic acid status in both mothers and fathers with celiac leading to cleft palate (Arakeri, Arali, & Brennan, 2010).
People with celiac disease have been shown to have a higher need for antioxidants. Dietary supplementation with antioxidant molecules, like those contained in the C-liac Vitality Packs, may offer some benefit (Odetti et al., 1998). Osteoporosis is a common and serious complication of celiac disease (Katz, 2010). This population has an ongoing need for bone support, which is an important part of this formula. Beyond calcium and vitamin D, magnesium is important for celiac bone support (Rude & Olerich, 1996). Other minerals play a special role in supporting those with celiac disease and those on a gluten-free diet. Selenium has an important role in preserving thyroid function in this population (Stazi & Trinti, 2008). Vitamin C also plays a special role in celiac disease by decreasing the mucosal inflammatory response to gluten (Bernardo et al., 2011). General vitamin deficiency in celiacs has been found to increase the risk of cataracts in this group as well (Mollazadegan, Kugelberg, Lindblad, & Ludvigsson, 2011).
The following quote sums up the need for ongoing nutritional supplements for people with celiac disease: “Due to the increased immune activation in the intestinal tract of people with celiac disease, the digestive and absorptive processes of those affected may be compromised. Individuals with celiac disease are more susceptible to pancreatic insufficiencies, dysbiosis, lactase insufficiencies, folic acid, vitamin B12, iron, and vitamin D deficiencies, as well as accelerated bone loss due to an increase in inflammatory signaling molecules. Beyond strict maintenance of a gluten-free diet, research has shown benefit with additional nutritional supplementation to assist in regulation of several of these complications” (Malterre, 2009). C-liac Vitality Packs are designed to restore key nutrients in a safe and convenient way. Dr. Doherty’s mission is to make it easy for people who are gluten-free to enjoy the benefits of being in good nutritional status, which is essential to a better quality of life.
References
Arakeri, G., Arali, V., & Brennan, P. A. (2010). Cleft lip and palate: an adverse pregnancy outcome due to undiagnosed maternal and paternal coeliac disease Medical hypotheses, 75(1), 93–98. doi:10.1016/j.mehy.2010.01.047
Bernardo, D., Martínez-Abad, B., Vallejo-Diez, S., Montalvillo, E., Benito, V., Anta, B., Fernández-Salazar, L., et al. (2011). Ascorbate-dependent decrease of the mucosal immune inflammatory response to gliadin in coeliac disease patients Allergologia et immunopathologia. doi:10.1016/j.aller.2010.11.003
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Hadithi, M., Mulder, C. J. J., Stam, F., Azizi, J., Crusius, J. B. A., Peña, A. S., Stehouwer, C. D. A., et al. (2009). Effect of B vitamin supplementation on plasma homocysteine levels in celiac disease World journal of gastroenterology : WJG, 15(8), 955–960.
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Hallert, C., Svensson, M., Tholstrup, J., & Hultberg, B. (2009). Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet Alimentary pharmacology & therapeutics, 29(8), 811–816. doi:10.1111/j.1365-2036.2009.03945.x
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Wilcox, G. M., & Mattia, A. R. (2006). Celiac sprue, hyperhomocysteinemia, and MTHFR gene variants Journal of clinical gastroenterology, 40(7), 596–601.
Wild, D., Robins, G. G., Burley, V. J., & Howdle, P. D. (2010). Evidence of high sugar intake, and low fibre and mineral intake, in the gluten-free diet Alimentary pharmacology & therapeutics, 32(4), 573–581. doi:10.1111/j.1365-2036.2010.04386.x
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