Anemia and Celiac Disease: A Complete Guide Anemia is common in celiac disease. This is because there are quite a few nutrient deficiencies that occur with celiac disease that can lead to dietary anemias. In this post, we will discuss celiac disease and anemia, signs …
Month: October 2021
Celiac and Bone Health
When we think about celiac disease our bone health is not usually the first thing that comes to mind, but it is an important factor that we must understand. Our bones provide us with a strong structure to help support and move our entire bodies.
Celiac disease can affect the way we absorb nutrients. Many of the nutrients necessary to keep our bones healthy are not absorbed due to damage to the gut. That’s why it’s important to understand the relationship between celiac disease and bone health and what we can do to maintain healthy bones.
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Written by dietetic intern Amanda Jones and revised by Tayler Silfverduk, RDN.
What are Bone Diseases
Bone diseases are diseases like osteoporosis, osteopenia, and low bone density. These things cause low bone mass and weakening of the bone tissue. These factors can cause bones to be more fragile and more likely to break.
Widely thought to be a disease of older people, bone density complications can affect people at any age. A study found that low bone mineral density affects about 75% of celiac patients.
Does Celiac Affect Your Bones Health?
This impact on bone health is likely due to small intestinal damage. This damage to the small intestine from gluten can impair absorption of essential bone nutrients and may play a role in the high bone disease prevalence found in celiacs.
Widely thought to be a disease of older people, osteoporosis can affect people at any age. In fact a study found that low bone mineral density affects about 75% of celiac patients.
Does Gluten Affect Bone Density?
Gluten itself doesn’t affect bone density, but for people with celiac disease, it can impact their ability to absorb the necessary nutrients that do affect bone density.
When a person with celiac disease consumes gluten, their immune system responds by attacking and destroying the lining of the small intestine. The small intestine is the area of the intestines that absorb the most nutrients from the foods we consume.
This absorption happens through the lining of the small intestine. When this lining becomes damaged, the small intestines lose their ability to absorb nutrients, including the ones we need to support healthy bones.
How does Celiac Directly Impact Bone Health?
Celiac disease can impact your bone heath. Bone health is linked to celiac disease due to vitamin D deficiency, calcium malabsorption, magnesium malabsorption, and chronic inflammation related to small intestinal damage from gluten.
Vitamin D, calcium, and magnesium are all essential nutrients in bone health. If we don’t have the proper nutrients to support bone health then it can start to deplete our current stores. Meaning, it can start to affect our bone density.
This happens because many of those minerals are essential to life. For example, we need a certain level of calcium circulating in our blood to maintain life. Our body pulls this calcium from our bones and if we aren’t getting enough calcium in our diet to replace what’s been pulled for circulation, then our bones start to lose mass.
Why is Calcium Low in Celiac Disease?
Calcium is essential for bone health with celiac disease. It’s vital for building and rebuilding bones. Low levels of calcium can be common in people with celiac because of intestinal damage.
More specifically, the duodenum of the small intestine is damaged, a primary site for calcium absorption in the body. If the duodenum continues to face damage from gluten,it can lead to the inability to absorb enough calcium.
Therefore, people with celiac disease who consume an adequate amount of calcium can still be deficient in calcium because their small intestines are not absorbing the calcium.
Additionally, calcium absorption also depends on vitamin D and magnesium, yet the absorption of these is also affected by damage to the lining of the small intestine.
It’s a vicious cycle and is why nutrition is such a vital part of celiac treatment to make sure you’re healing and replenishing nutrient stores.
Vitamin D and Bone Health
Vitamin D is essential to maintaining bone health with celiac disease. It helps with bone mineralization and calcium absorption, both of which are associated with a healthy bone mineral density.
A research study Vitamin D is built up over time and our bones reach a peak mass around the third decade of life. Although the bones reach a peak bone mass, maintenance, and continued vitamin D intake to support them is still necessary to maintain healthy bones and prevent the development of bone diseases later on in life.
Research has shown that prolonged periods of inadequate vitamin D levels can lead to bone demineralization. This happens when vitamin D levels are so low that the bones release stored calcium to restore the calcium concentration that circulates throughout our systems.
The prolonged-release of stored calcium in the bones weakens them and increases the chances of fractures, osteomalacia, osteopenia, and osteoporosis.
To prevent vitamin D deficiency with celiac disease, consider vitamin D-rich foods, discuss supplements with your doctor, and consider exposing your wrists to the sun for at least 15 minutes a day (bonus points if it’s at peak sun hours).
Magnesium and Celiac Disease
Magnesium is a key nutrient in celiac disease bone health. Magnesium helps absorb calcium and convert vitamin D into its active form which helps to absorb calcium.
A study found that about 20% of untreated celiac disease patients had a magnesium deficiency. Just like with calcium and vitamin D, the absorption of magnesium is also affected. The destruction of gluten on the lining of the small intestine interferes with the absorption of this important nutrient.
Foods for Bone Health With Celiac Disease
Diet can play a major role in bone health with celiac disease. Following a gluten-free diet can prevent further destruction of the small intestinal lining and can give the small intestine a chance to heal.
This prevention and healing of small intestinal damage can support the absorption of key nutrients that keep your bones strong.
On top of staying gluten-free to support your bone health, it is important to consume foods that are rich in calcium, magnesium, and vitamin D.
Sources of gluten-free calcium-rich foods include low fat dairy products, calcium-fortified foods like gluten-free cereals and orange juice, and leafy greens such as kale, okra, and collard greens. Figs, papayas and oranges are also high in calcium.
Fortified dairy products are high in vitamin D. Another way to consume more vitamin D is to eat fatty fish like salmon.
Gluten-free foods high in magnesium are nuts and seeds, and dark leafy vegetables like spinach, chard, and broccoli. Beans and whole grains are also good sources of magnesium. Anecdotally, I have noticed an increased need for magnesium in people with celiac. In those cases, a supplement that’s easy on the gut (like this one) may be needed.
Gluten-Free Dairy-Free Recipes for Bone Health
The damage to the small intestine in celiac disease often leads to many patients with celiac disease with lactose intolerance. Out of respect for how common lactose intolerance is with celiac, below are some delicious gluten-free and dairy-free recipes to support bone health:
- Vegan Caramel Chia Pod – The chia seeds + fortified nut milk in this recipe help you get a ton of calcium at breakfast. Not to mention, the peanut butter in the vegan caramel topping provides protein to keep your muscles and hormones strong.
- Sardine Toast with Avocado, Tomato Relish, and Garlic Chips – Here’s a fun twist on avocado toast! Sardines are a great source of calcium and vitamin D to support your bones.
- Salmon Patties – Salmon patties can make a nutritious and delicious dinner. Thanks to the edible bones in canned salmon, it is loaded with calcium. Just what your bones need! (Note the substitute for gluten-free breadcrumbs to make this gluten-free and omit parmesan to keep it dairy-free)
- Creamy Vegan Greens – Looking for a delicious side dish that also supports your bones? Creamy (dairy-free) collard greens are the way to go. Collard greens contain significant amounts of calcium.
- Spicy Kale & Potato Curry – To add a little spice to your life try this spicy kale recipe. Not only will it give you added spice but it will also provide key nutrients to support your bones.
- Fresh Fig Clafoutis – Time for a sweet treat! You can enjoy the taste of dessert while maintaining bone health by eating figs. They are a good source of calcium and magnesium.
For more recipes high in calcium, check out my blog post on Calcium Rich Breakfast Recipes.
Supporting Your Bone Health With Celiac Disease
There are ways people living with celiac disease can support their bones, just because nutrient levels get low, doesn’t mean they have to stay low.
First, eliminate all gluten from your diet, to heal your gut so you can actually absorb nutrients essential to bone health.
Then eat plenty of foods that are rich sources of calcium, vitamin D, and calcium.
Supplements may also help increase nutrient levels, but be sure to check with your doctor first. Additionally, routine visits and tests with your doctor can also help maintain healthy bones. This includes routine bone density scans as needed, learn more about celiac follow-up testing here.
Additionally, physical movement like walking, dancing, or lifting weight has been shown to help support bone density. Find something that you enjoy doing and try to work it into your life.
Lastly, consider spending more time outside to soak up vitamin D.
Want more guidance on supporting your bones and other nutrient stores with celiac disease? Afraid of food and worried you’re not getting the right nutrients in?
Activated Charcoal for Gluten Exposure Taking activated charcoal for gluten exposure with celiac disease or gluten intolerance is not a clinically proven practice. However, many people will suggest you take activated charcoal if you’ve been glutened, despite the lack of evidence. So let’s talk all …
Sheet Pan Chicken and Vegetables with Butter and Parmesan
This sheet pan chicken and vegetables recipe makes for the best dinner. Why? Because I just throw everything onto a pan and call it day. That’s a win in my book.
Can you Cook Chicken and Vegetables Together?
It’s totally safe to cook chicken and vegetables together like you do in this sheet pan chicken and vegetables recipe. Just make sure the chicken and vegetables are cooked to the proper internal temperature (165F). This will ensure any bacteria from the chicken has been cooked off and can no longer contaminate the food on the sheet pan.
Are Sheet Pan Dinners Safe?
Sheet pan dinners are no dangerous than any other meal you might prepare. As long as you take general food safety precautions, you sheet pan dinner will be safe.
Generally food safe precautions include:
- Washing any raw produce used to remove bacteria that may be present
- Cut the vegetables before the raw chicken (or use separate cutting boards)
- Cook the chicken and vegetables to the right temperature (165F).
- Don’t let the food sit out for too long. As soon as your done serving, begin the cooling process to prevent pathogens from growing in the leftovers.
The Key to Amazing Sheet Pan Dinners
The key to amazing sheet pan dinners is to know the ingredients your cooking with and add them to the sheet pan at the appropriate time. That and be sure to be generous with cooking fats and seasonings.
For example, in this recipe we know we have potatoes, carrots, broccoli, and chicken. Potatoes take much longer to fully cook than broccoli, carrots, and chicken and thus, we start with baking the potatoes first.
You can apply this process to any other sheet pan meal as well. However, I’ll also say, on my most burnt out days, I throw everything on the pan at once and call it a day and no one complained… do with that what you will.
Sheet Pan Chicken and Vegetables
- 3 big chicken breasts
- 3 medium potatoes
- 5 cups broccoli and sliced carrots (fresh or frozen)
- 1/4 cup butter
- 1 tbsp garlic powder
- 2 tbsp dried onion flakes
- salt/pepper to taste
- 3/4 cup water
- 3 tbsp parmesan cheese
- Preheat oven to 400F
- Cut potatoes in bite size pieces
- Spray/spread cooking oil on sheet pan (or lay down a layer or foil/parchment paper so nothing sticks) and spread potatoes out evenly and cook for 10 minutes or until soft
- While the potatoes are cooking, place butter into a medium size microwave safe bowl and microwave about 1 minute or until melted.
- Mix water, salt, pepper, garlic and onion with the butter and put it to the side until ready to use
- Cut the chicken in to cubes
- Take potatoes out of the oven and place the diced chicken, broccoli and carrots on to the sheet pan.
- Pour butter mixture evenly throughout the sheet pan. Grab tongs or use your hands to make sure everything is coated.
- Place the sheet pan into the oven at 400F for about 20 minutes until the chicken is fully cooked on the inside
- Once out of the oven sprinkle parmesan cheese on top and serve.
Are Celiac Disease and Lactose Intolerance Related?
Are celiac disease and lactose intolerance related? Yes! I see this intolerance in many of my clients. The reason why lactose intolerance is associated with celiac disease lies in how damage from gluten with celiac impacts digestion.
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What is Celiac Disease?
Before we get into how celiac disease and lactose intolerance are related, let’s get on the same page on what celiac disease is.
Celiac disease is an autoimmune disease where the immune system launches an attack in the small intestine when gluten is consumed. This causes damage to the small intestine and launches a cascade of inflammatory reactions throughout the body.
More specifically, the damage to the gut occurs in the duodenum. In the duodenum, the reaction damages what’s known as villi. Villi are long finger-like projections that help absorb nutrients. The villi house what’s known as the microvilli and brush border.
How Does Celiac Damage Impact Digestion?
The key to celiac’s impact on digestion lie in where the damage from gluten is occurring. More specifically it lies with the microvilli and brush border found in the villi of the duodenum.
The microvilli help absorb even more nutrients, and the brush border releases digestive enzymes like lactase and sucrase to aid in the breakdown of food for absorption.
Basically, the villi of the small intestine house the brush border which releases enzymes that help with digestion and absorption of food. Because eating gluten with celiac disease causes damage to the villi, microvilli, and brush border, it can directly impact the digestion of foods other than gluten.
What is Lactose Intolerance
To build our understanding of the connection between celiac disease and lactose intolerance, we need to understand what lactose intolerance is.
Lactose intolerance is when the body does not digest the sugar lactose properly. Lactose is the complex sugar found in dairy products. To digest the sugar, it’s broken down into its components galactose and glucose through the use of the lactase enzyme.
So essentially, lactose intolerance is when you can’t break down the sugar lactose (from milk). Lactose intolerance can cause a variety of symptoms like diarrhea, cramping, bloating, constipation, and more. Symptoms that overlap with celiac.
How do you Know if You’re Lactose Intolerant With Celiac?
Usually, lactose intolerance is diagnosed by reported symptoms following eating dairy. There are some questionably reliable tests out there that can indicate lactose intolerance too, but the best way to know is to track your food and symptoms to see if you can find a relationship.
If you need help figuring out your food intolerances, let’s work together. I specialize in helping people with celiac identify other food triggers that might be impacting healing. And yes, I do see people virtually.
Are Celiac Disease and Lactose Intolerance Related?
After breaking down the basics of celiac disease and dairy intolerance, it’s clear to see there is a connection. So, yes, there is a connection between celiac disease and lactose intolerance.
Specifically, the damage to the small intestine can impair lactase enzyme activity. This impairment of lactse activity at the brush border can play a large role in lactose intolerance in celiacs.
Do Celiacs Need to Avoid Lactose?
Just because celiac disease and lactose intolerance are related, does not mean every celiac needs to avoid lactose or dairy. Avoiding dairy requires an individualized approach. Just because the damage to the villi of the duodenum can impair lactose digestion, does not mean it will.
You only need to avoid or limit dairy if it’s triggering you. Sometimes lactose intolerance means you can’t tolerate any amount of dairy but in most cases, I find it depends on the amount and type of dairy consumed. If you need help figuring that out, again, let’s talk and figure it out together.
Additionally, lactose intolerance isn’t always forever if you are lactose intolerant because of celiac damage. That means as you heal celiac disease, your lactose intolerance can go away too as your brush border starts functioning properly again (notice I said heal not cure).
Dairy-Free vs. Lactose Free
Now that we understand the relationship between lactose intolerance and celiac, I want to make it clear: lactose-free does not mean dairy-free
Being lactose free means you are simply avoiding the sugar lactose in dairy. You can buy many lactose-free dairy products on the market.
However, if you’re lactose free you can also enjoy dairy-free substitutes as they’d also not have lactose.
But the same does not go for you if you are dairy-free. If you’re dairy-free, it’s likely due to an allergy to proteins found in dairy or intolerances to other parts of dairy. You can not enjoy lactose-free dairy products because you’re reacting to other parts of dairy.
Risks of Being Gluten-Free and Dairy-Free
It is ideal that celiacs continue to eat dairy if they do not have an allergy, or are not vegan. That’s because milk is a gluten-free calcium-rich food source. It also has a lot of vitamin D to help with vitamin D deficiency in celiac disease.
However, if you are gluten-free and vegan, or you’re gluten-free and dairy-free, that doesn’t mean you can’t still get these nutrients. It just requires more planning. Check out my post on How to Follow a Gluten-Free Vegan Diet to learn more.
If you have a lactose intolerance than it’s up to you to decide to avoid dairy completely, take a lactase enzyme, or buy lactose-free dairy products. A dietitian can help you determine the right option for you.
Dairy-Free, Lactose-Free, and Gluten-Free Alternatives:
So you’re lactose intolerance and you understand the connection between lactose intolerance celiac, now what? Now, you have a choice: avoid lactose, avoid all dairy, or consider taking a lactose digestive enzyme.
That being said whether your lactose or dairy-free, below are some gluten-free alternatives to consider.
Gluten-Free Lactose-Free Foods
Lactose-free or low-lactose foods are a great way to keep dairy in your life without all of the lactose intolerant symptoms.
Some gluten-free foods that are naturally lower in lactose include probiotic yogurt, hard/aged cheese, butter, heavy cream, most flavored coffee creamers, and kefir.
You can also buy lactose-free milk and ice cream (an example would be those from the brand Lactaid) where the lactose is predigested for you. Bryer’s also makes a lactose-free ice cream too.
Gluten-Free Dairy-Free Foods
Gluten-free and dairy-free alternatives will be your best friend should you need to cut out all dairy. Your best bet is to start trying to find delicious substitutes as soon as possible. Some of my gluten-free dairy-free alternatives are below:
- Yogurt: Silk has soy-based and almond-based yogurts. Though my favorite gluten-free and dairy-free yogurt is the Oui by Yoplait Coconut Yogurt line – so decadent and yummy.
- Cheese: Daiya has some good gluten-free and dairy-free cheeses but the trick I find is that you need to melt them to be good. Kite Hill and Violife have some gluten-free plant-based cheeses to try too.
- Ice Cream: You can not beat So Delicious’s dairy-free and gluten-free ice creams. They are delicious and are made with a variety of different milk alternatives depending on your preference.
- Milk: The best way to find a dairy-free milk alternative is to reflect on what you like about real milk. Is it the flavor? Fattyness? Mouthfeel? Sweetness? Or is it just an easy way to get in calcium? Once you’ve determined that, trying the different dairy-free kinds of milk will help you find your favorite. I personally love almond milk. A word of caution: if you are leaning towards oat-milk or oat-milk alternatives, make sure the products are using certified gluten-free or purity protocol oat. Learn more about when oats are celiac-safe here.
- Butter: use oil, coconut oil, etc. instead.
- Cream: when baking, use coconut cream (you get it by storing canned coconut milk in the fridge, and the cream rises to the top of the can). If you need a coffee creamer, you can use coconut cream or I personally love Califia farms dairy-free creamers. It doesn’t taste fake like some of the other coffee creamer lines.
- Buttermilk: combine 1 tbsp apple cider vinegar or lemon juice for every 1 cup of dairy-free milk of choice. Let it “curdle” for 5-10 minutes and then use as you would regular buttermilk.