As the gluten free diet has become a rising trend, there has been increased awareness and marketing over the last few years. Gluten free varieties of packaged foods have hit grocery store shelves and restaurants are increasingly offering options that are gluten free. These options are extremely important for those living a gluten free lifestyle due to a Celiac or gluten intolerance diagnosis. If a strict gluten free diet is not adhered to, health issues may arise due to nutritional deficiencies and intestinal wall damage. Below are a few common health issues associated with consuming a gluten filled diet after being diagnosed with Celiac disease or gluten intolerance.
Iron Deficiency Anemia
Red blood cells are responsible for transporting oxygen throughout the body and iron is necessary for the production of these blood cells in your body. Without enough iron, your body cannot produce sufficient red bloods cells to adequately distribute oxygen, a condition called iron deficiency anemia. Malabsorption of nutrients, such as iron, is common for individuals with Celiac disease and gluten intolerance due to damaged or inflamed villi. There is a high occurrence of anemia in Celiac disease patients, with approximately 33 percent of those suffering from anemia due to iron deficiency, also have some sort of gluten sensitivity. In fact, the relationship is so strong that people whose anemia has no obvious cause should be tested for Celiac disease or non-Celiac gluten intolerance.
Early Onset Osteoporosis
Osteopenia is the thinning of bone mass, occurring when the body uses up bone mass faster than it is being replaced. At its most severe, this condition becomes osteoporosis, in which bones become so brittle and fragile that even a cough might cause bone breakage. Damage to the small intestine, such as is present for untreated or newly diagnosed Celiac and non-Celiac gluten intolerant patients, can prohibit calcium absorption, leading to osteopenia and osteoporosis at a much younger age than for unaffected individuals. Adherence to a gluten-free diet can result in improved bone density, though it is also important to take other, more traditional precautions to maximize bone health in addition.
Infertility and Miscarriage
Infertility is defined as the inability of a couple to achieve pregnancy after 12 month of regular intercourse without contraceptive use. Several studies over the last couple of decades have suggested uncertain links between infertility and/or miscarriage and Celiac disease, though the relationship is not yet completely clear. There is a slightly higher prevalence of undiagnosed Celiac disease and gluten intolerance in women experiencing infertility and adoption of a gluten-free diet has seemed to lead to increased fertility in those patients.
Lactose intolerance is the inability to properly digest the sugar (called lactose) found in milk and other dairy products. As this type of digestion occurs in the small intestine, it is not surprising that lactose intolerance and Celiac disease commonly co-occur, in a condition called secondary lactose intolerance. The same villi being damaged or inflamed by gluten in Celiac and gluten sensitive patients house the enzyme lactase, which is responsible for breaking down lactose; if the villi are being impaired by gluten consumption, lactase levels deplete and lactose cannot be processed by the body. As many as approximately 25 percent of people with lactose intolerance may also have Celiac disease or a gluten sensitivity. Interestingly, by following a gluten-free diet and allowing the intestinal villi to heal, lactase enzyme production may be re-established, effectively ending the lactose intolerance.
Vitamin and Mineral Deficiencies
A vast amount of our vitamin and mineral absorption occurs through the small intestine, particularly via the gatekeepers for nutrition in the body: fingerlike protrusions lining the wall of the small intestine, called villi. When the intestinal villi are damaged or inflamed, as is the circumstance when Celiac and non-Celiac gluten intolerant patients consume gluten, the body is unable to absorb the necessary vitamins and minerals from nutrients as they pass through the digestive system. This can lead to deficiencies of iron (anemia), calcium (osteopenia), fiber, zinc, magnesium, folate, niacin, riboflavin, vitamin B-12, vitamin D and less commonly, copper and vitamin B-6. Many of these deficiencies can be treated with supplements, once a gluten free diet is in place and the villi begin to heal and nutritional processes will return to normal.
Exocrine pancreatic insufficiency (EPI) is a condition in which the pancreas fails to produce enzymes necessary to break down and digest food properly. While the Celiac and non-Celiac gluten sensitivity and this condition do not seem to have a readily noticeable cause-effect relationship, there is indication that they co-exist in about 5 percent of gluten intolerance cases. For those patients with a formal diagnosis of Celiac disease for whom adherence to a gluten free diet does not seem to be enough to treat symptoms, testing for EPI is recommended, as it may be responsible for the non-responsiveness.
Gall Bladder Malfunction
The gallbladder is a tiny organ below the liver that produces bile to assist in the breakdown and digestion of fats. This is a function critical to digestion, and a malfunctioning gallbladder can lead to a vast array of symptoms from heartburn and indigestion to crippling abdominal pain. Damage to the small intestine can cause communication difficulties with organs, like the gallbladder, that secretes digestive enzymes, leading to a domino effect. An estimated 60 percent of Celiac and gluten intolerant patients have liver, gallbladder or pancreatic issues. Some sources even suggest that Celiac disease is the cause of gallbladder disease. It is important that people suffering with gallbladder problems, as a precaution, seek testing for Celiac as well.
After diagnosis, it is important to remember to continue to work closely with your physician to address any health issues that you may currently have and to work towards prevention. Ask your physician for a recommendation to see a registered dietitian, who specializes in Celiac disease. Registered dietitians can be a great source of information for you as you begin your gluten free journey.
For more information about living a gluten free lifestyle, check out our Gluten Free 101 tab on our home page.