I used to say that all the time before I went gluten-free. Matter of fact, when I get glutened (name for accidently ingesting gluten), the first things that hurt are my back and neck. Thankfully, I don’t have pain anymore, but this week I attended a talk at our local hospital about the damaging effects of gluten in women with celiac, specifically Calcium and Vitamin D deficiencies and their relationship to osteoporosis.
The speaker was Dr. Keith Laskin, MD who went to New York University School of Medicine and is a gastroenterologist in the Philadelphia region. He opened his talk telling the audience about the updated prevalence of celiac (previously 1 in 133 is now 1 in 1001) worldwide and for whatever reasons, is becoming more common. His statistics on the hereditary factors of celiac and how the disease is 65% more common in women was astonishing. No one is really sure why it is more common in women, but in general (and as a woman), I think we take our health much more seriously than men and look for reasons for symptoms rather than just live with them.
In the past, doctors would only test patients who were severely malnourished, but now there are many more symptoms that could present as celiac. Patients are getting smarter in asking to be screened for symptoms, like the ones below, which are not the typical G.I. symptoms celiac was thought of presenting.
• Iron Deficiency
• Increased liver enzymes
• Skin rash
• Bone Diseases
I was familiar with all the symptoms above, but honestly, I didn’t think about bone diseases as being a concern. Boy was I wrong! Until Gluten is removed from a Celiacs diet, nutrients like calcium and vitamin D cannot be absorbed, which puts women at a higher risk of osteoporosis. Osteoporosis is a condition in which bones become less dense and more likely to fracture2. Matter of fact, it puts people at 6 times greater risk of having a hip fracture3. Nutrients like calcium are absorbed in the small intestines, which is the exact spot where Celiacs villi atrophy occurs most frequently.
Once a gluten-free diet is in place, there are three things that can be done to support bone health.
1. Good Nutrition: Dark green leafy greens (collard greens, kale, etc.), broccoli, soy beans, bok choy and even dried figs are good sources of calcium. Dairy products and fortified non-dairy beverages (almond, soy, rice milks) can have as much as 300 mg of calcium as well.
Some vitamin D rich foods are egg yolks, saltwater fish and liver. But a supplement might be the easiest and fastest way to get vitamin D, especially if you live in northern areas of the United States. The Vitamin D Council is a great online source for information regarding safety and dosing.
2. Exercise: Weight bearing and muscle strengthening exercise can help strengthen muscle and build bone.
Weight bearing exercises make you move against gravity and stay upright and can be easily done
• Jumping rope
• Stair climbing
Muscle strengthening exercises
• Lifting weights
• Elastic exercise bands
• Weight machines
• Lifting your own body weight
3. Healthy Lifestyle: Smoking and drinking excessively are very detrimental to bone health. Did you know that women who smoke go through menopause earlier than non-smokers resulting in lower estrogen levels which can decrease calcium. Alcohol can suppress new bone growth and not to mention, feeling “tipsy” can cause falls and possible bone break.
Dr. Laskin recommended getting a Dexa scan (bone mass test) about one year after adapting a gluten-free diet. It may take up to that amount of time for your body to recover from nutritional deficiencies, depending on how much damage is done to the small intestines. The good news is, adhering to a strict gluten-free diet will allow the gut to heal in most Celiacs. It just may take time, but with good nutrition, exercise and lifestyle changes calcium and vitamin D deficiencies can be reversed.