Be grateful if you’ve been diagnosed with celiac disease or gluten intolerance. Be very, very grateful.
Why? Typically, it takes a long time to get a diagnosis. As a result, many people who have the disease don’t know they have it. But once you do get a diagnosis, your pathway to healing is clear.
For most people with a serious chronic illness, healing is anything but simple. They need to find the right medications, the right doses, seek out alternative and complementary therapies, hassle with side effects, hope for the best. But if you have celiac disease, you go on a completely gluten-free diet and know that your healing is under way!
Admittedly, following a gluten-free diet can be a hassle these days when it seems like gluten is added to everything. But to help you meet that challenge, you can turn to a multitude of new products, cookbooks, and resources.
Much has changed for people with celiac disease. For one thing, they have a lot more company. Until fairly recently, researchers thought that this condition was rare.
Depending upon which studies you look at, researchers now know that celiac disease affects somewhere between 1 in 100 to 1 in 200 people worldwide, according to Shari Lieberman, PhD, nutrition scientist and author of The Gluten Connection. Dr. Lieberman is also a nutrition consultant in private practice in Florida.
For some populations—notably in some Western European countries and among people of Western European ancestry—celiac disease is even more prevalent, says Dr. Lieberman.
Unfortunately, many doctors are still under the impression that celiac disease is rare and often don’t think to look for it, says Dr. Lieberman. So the damage that this disease causes can continue in some people for decades. And it is progressive.
Celiac disease is the name given to the inability to properly digest gluten. And gluten, as you undoubtedly know if you have the disease, is the protein in wheat and a couple of other grains that gives bread its chewy texture and dough its stickiness. What starts out as a negative bodily reaction to gluten—at the early stages known as gluten intolerance—can over time do considerable damage to the body.
Another thing that’s new is that more and more people are being diagnosed, says Dr. Lieberman. In fact, she says, the fastest-growing population of people newly diagnosed with celiac disease is women in their forties.
More people are getting this diagnosis in part because more doctors are learning to look for it. But the disease is also becoming more of a problem because there’s more gluten in our food, explains Dr. Lieberman.
The bread we eat today is not our grandparents’ bread. Let’s be clear about one thing: This chapter is not anti-bread. For a good part of the population, bread deserves its wholesome reputation. Bread, cereals, and other foods made from whole wheat and the other whole grains that contain gluten—rye and barley—are great additions to the diet. If you can digest gluten. And that is one great big “IF.”
But today’s bread is different. For one thing, says Dr. Lieberman, bio-engineers have altered wheat in order to give it more gluten than it had before. As we already noted, gluten gives bread its chewiness, and food scientists have done what they can to increase that springy, satisfying, chewy texture by engineering wheat to contain more gluten. And to get that same satisfying texture, companies add gluten to all kinds of other foods, from salad dressings to canned soups.
So if you were born with the genes that give you gluten sensitivity—and many of us are—your condition will progress to celiac disease much sooner than it would have decades ago, according to Dr. Lieberman.
An intolerance is not the same thing as a food allergy. Food allergies can be deadly serious. They can also be fairly mild, and it’s possible that the food allergies you had as a child will resolve and disappear.
Food intolerances involve a different part of your immune system, and they do not go away. Instead, as you continue to eat substances to which you are intolerant, they do more and more damage to your body.
As gluten sensitivity progresses into celiac disease, it starts to destroy the sensitive lining of your intestines. You might think that would produce a host of gastrointestinal symptoms. And it does. Celiac disease can be a hidden cause of things like Crohn’s disease, ulcerative colitis, and ulcers.
Studies now show that celiac disease can cause or contribute in a major way to many other diseases as well, says Dr. Lieberman. These include skin conditions, such as acne, psoriasis, and eczema; neurological disorders, such as severe headaches, and behavioral problems in children, including attention deficit disorder; and autoimmune disorders, such as diabetes, lupus, multiple sclerosis, and rheumatoid arthritis.
And that’s just the short list. Sound like it’s impossible for an intolerance to a single food to cause this much trouble? Many doctors think so as well until they look at the scientific studies, says Dr. Lieberman. Perhaps what’s even more convincing are the results that people with celiac disease see once they completely eliminate gluten from their diets. That means totally eliminating foods containing wheat, rye, and barley. (No cheating allowed!) People with celiac disease or gluten intolerance are generally advised to avoid oats as well. While oats do not contain gluten, they are frequently contaminated with gluten when processed on the same machinery.
Results that come from following a gluten-free diet are often dramatic, says Dr. Lieberman. They include clear skin, the disappearance of gastrointestinal symptoms, pain-free joints, more energy. . . . This list goes on and on.
Dr. Lieberman has been watching the results of going gluten free in her own patients since the 1980s. “Remember in the ’80s when everyone was being diagnosed with yeast? No one was getting better, at least that I saw,” she recalls. “Then I came across this information on gluten.”
She had what she calls an epiphany, began advising a gluten-free diet to appropriate patients, and started seeing truly dramatic results.
In one case she describes, a woman with ulcerative colitis, an inflammatory bowel disease (IBD), came in for nutritional counseling accompanied by her cousin, who had a different form of IBD—Crohn’s disease—so severe that he had had a portion of his intestines (the lower ileum) surgically removed.
While the woman was getting the details from Dr. Lieberman on how to follow a gluten-free diet, her cousin, who had come in for moral support, simply listened. When the two came in a month later, recalls Dr. Lieberman, the woman reported with delight that her symptoms had resolved. Then, to Dr. Lieberman’s surprise, the male cousin spoke up. He said he, too, had started following a gluten-free diet and had begun having his first normal bowel movements in years.
If you have unresolved chronic bowel problems or other chronic conditions that have resisted diagnosis, advises Dr. Lieberman, it’s worth giving a gluten-free diet a trial: “What on Earth do you have to lose?”
If you have celiac disease or are gluten-sensitive, then once you eliminate gluten, your healing is under way. Depending upon how long you’ve been consuming gluten and accumulating the resulting bodily damage, you could be looking at a great deal of healing, however. A number of nutritional supplements can be helpful in supporting that process, according to Dr. Lieberman.
You’re going to need to take “the full spectrum of everything,” because you haven’t been getting it in your food, says Dr. Lieberman.
If you have had celiac disease for a time, damage to your digestive system has likely prevented you from properly absorbing nutrients from your food, she explains. Even if you’ve been eating an otherwise healthy diet, the nutrients simply haven’t been getting where they need to go in your body. So as you begin to heal, you must make up for long-term inadequate nutrition. “We’re really looking at across-the-board nutritional deficiencies,” says Dr. Lieberman, and that means paying serious attention to supplements.
Dr. Lieberman divides the supplements she recommends into three stages. If your gastrointestinal tract has sustained a lot of damage, she explains, you may not be able to take certain supplements immediately. She offers the more easily tolerated ones during the first stage.
Stage One
You can take a full-spectrum multivitamin and a B-complex supplement to get most of the nutrients recommended for Stage One, says Dr. Lieberman. Just make sure that you’re getting the appropriate amounts for each nutrient mentioned, she says.
As soon as you begin your gluten-free diet, you can begin Stage One, says Dr. Lieberman.
Anyone with a chronic illness has been under oxidative stress, says Dr. Lieberman. Oxidative stress is caused by free radicals, highly reactive molecules that damage the body. Antioxidant nutrients help alleviate oxidative stress and also help reduce inflammation, explains Dr. Lieberman. She recommends the following antioxidants: vitamin A, 5,000 IU; beta-carotene, 11,000 IU; vitamin E, 400 IU in the form of d-alpha-succinate; and vitamin D, 400 IU.
Many Americans, especially those who spend little time outdoors, are deficient in vitamin D, notes Dr. Lieberman. It’s a good idea to ask your doctor to give you a blood test for vitamin D levels. If you’re low in this important nutrient, your doctor may suggest that you take 2,000 to 4,000 IU daily, she says.
In a 2009 Swedish study, 65 people with celiac disease who had been on a gluten-free diet for a number of years were divided into two groups by researchers. One group was given a B-vitamin supplement and the other a placebo for 6 months. The group taking the B vitamins experienced “a significant improvement in general well-being.” The researchers concluded that “B vitamins should be considered in people advised to follow a gluten-free diet.”
You need B vitamins for every single biochemical reaction in your body, states Dr. Lieberman. You need Bs to make red blood, you need them to make neurotransmitters, you need them to make enzymes, she says. And, she says, if you haven’t been getting enough for a while, you need them in therapeutic doses. She recommends taking a multi or B complex that delivers the following: thiamin (B1), 25 milligrams; riboflavin (B2), 25 milligrams; niacin (B3), 25 milligrams; pyridoxine (B6), 25 milligrams; pantothenic acid, 25 milligrams; PABA, 25 milligrams; choline, 25 milligrams; inositol, 25 milligrams; vitamin B12, 12 to 25 micrograms; folic acid, 400 micrograms; and biotin, 300 micrograms.
Our bodies make their own supply of coenzyme Q10, but people with chronic illnesses typically do not make enough to meet their needs, says Dr. Lieberman. The tiny energy factories inside your cells—the mitochondria—all need coenzyme Q10 to give you the energy you need, she notes. Coenzyme Q10 is also a powerful antioxidant, she says.
You won’t find coenzyme Q10 in a multivitamin, so you’ll need to take a separate supplement to get this one. Dr. Lieberman recommends taking 100 to 200 milligrams daily.
“If you have gluten intolerance, the hallmark of what you’re experiencing is inflammation,” says Dr. Lieberman. “It’s run amok.”
While the antioxidant vitamins in a multi help with inflammation, you don’t find essential fatty acids in a multivitamin. The essential fatty acids—specifically EPA and DHA—found in fish oil have “huge anti-inflammatory action,” says Dr. Lieberman. She recommends taking 2 to 3 grams of fish oil daily. You can take fish oil in liquid form, but you might find it easier to take it in enteric-coated capsules, she says.
In a small 2007 Italian study, researchers looked at the amino acid L-carnitine as a supplement potentially helpful for dealing with fatigue, a common complaint in people with celiac disease. The researchers divided 60 people with celiac disease into two groups. The first group received 2 grams of L-carnitine daily for 180 days. The second group received a placebo. Researchers found that fatigue was “significantly reduced” in the group receiving L-carnitine.
At the close of the study, researchers concluded: “L-carnitine therapy is safe and effective in ameliorating fatigue in celiac disease.”
“There’s a real propensity to bone loss in people with celiac disease,” says Dr. Lieberman. “You can have rampant bone loss.” You need several minerals to protect your bones, and you need zinc for your immune system.
Dr Lieberman recommends getting the following minerals in supplement form: boron, 3 milligrams; calcium, 500 milligrams; chromium, 200 micrograms; iodine, 150 micrograms; magnesium, 250 milligrams; manganese, 15 milligrams; and selenium, 100 micrograms.
You need a bit more calcium and magnesium than the amounts listed above, says Dr. Lieberman, a total of 1,000 to 1,500 milligrams of calcium and 500 to 750 milligrams of magnesium. But at least some of these minerals must come from your diet. Good sources of calcium include dairy products. Many people with gluten sensitivity are also sensitive to dairy foods, however. Other good calcium sources include canned salmon, spinach, fortified orange juice, and broccoli. Good sources of magnesium include nuts, fish, beans, lentils, and spinach.
You’ll get a good supply of minerals in your multivitamin.
Just a caution on the mineral iron: Iron can make inflammation worse, says Dr. Lieberman. You should not take iron unless your doctor specifically tells you to, she says. Look for a multivitamin that does not contain iron.
Stage Two
After 3 weeks, begin taking Stage Two supplements.
The nutrient quercetin has tremendous anti-inflammatory action when combined with vitamin C, says Dr. Lieberman. She recommends taking 500 to 2,000 milligrams daily.
Vitamin C, when combined with quercetin, is a powerful anti-inflammatory nutrient, says Dr. Lieberman. You’re already getting a little vitamin C from your multivitamin. Begin taking more vitamin C now, from 1,000 to 4,000 milligrams a day, she says, adding that the buffered, nonacidic form is best.
Stage Three
Wait until you feel substantially better before beginning Stage Three supplements.
Fiber can be tremendously helpful in detoxifying the body and promoting intestinal health, says Dr. Lieberman. However, people with celiac disease often have a great deal of difficulty handling fiber. She suggests taking 1 to 2 tablespoons of supplemental fiber daily, but only if you can tolerate it. Start with the smaller amount. If it causes gas or discomfort, back off. You can try again later. If it doesn’t cause discomfort, you can increase the amount.
If vegetables, beans, and other fiber-rich foods continue to give you discomfort, you may find that taking digestive enzymes helps, says Dr. Lieberman. It also helps to steam your vegetables rather than eating them raw, she notes.
The amino acid glutamine can help heal the intestines, says Dr. Lieberman. She suggests taking a daily dose of 500 to 3,000 milligrams of L-glutamine.
When you have celiac disease, inflammation and other gastrointestinal disruptions cause bad microorganisms to flourish, says Dr. Lieberman. Taking acidophilus and supplements of other beneficial microorganisms will encourage more healthy flora in your gut, she says.
“Don’t take acidophilus if you have active inflammation,” says Dr. Lieberman. “Put out the fire first.”
A number of foods and supplements contain beneficial microorganisms, says Dr. Lieberman. She especially recommends L. casei GG, one or two capsules daily. If you take other forms of probiotics, follow the package directions.
The Gluten Connection: How Gluten Sensitivity May Be Sabotaging Your Health by Shari Lieberman, PhD
If you have celiac disease or gluten sensitivity, the most important thing you can do—top of the list—is to strictly adhere to a gluten-free diet. No cheating allowed, whatsoever.
Begin Stage One supplements as soon as you start your gluten-free diet. Wait 3 weeks before starting Stage Two. Begin Stage Three only when you feel substantially better.
Stage One
You can take a full-spectrum multivitamin to get most of the nutrients listed below. Unless your doctor says you need an iron supplement, make sure your multivitamin does not contain iron. If you don’t get sufficient B vitamins in your multi, you might want to take a B-complex supplement as well.
Beta-carotene |
11,000 IU |
Biotin (a B vitamin) |
300 micrograms |
Boron |
3 milligrams |
Calcium |
1,000 to 1,500 milligrams from a combination of supplemental and dietary sources |
Choline (a B vitamin) |
25 milligrams |
Chromium |
200 micrograms |
Coenzyme Q10 |
100 to 200 milligrams |
Essential fatty acids |
2 to 3 grams of fish oil* |
Folic acid (a B vitamin) |
400 micrograms |
Inositol (a B vitamin) |
25 milligrams |
Iodine |
150 micrograms |
L-carnitine |
2 grams |
Magnesium |
500 to 750 milligrams from a combination of supplemental and dietary sources |
Manganese |
15 milligrams |
25 milligrams |
|
PABA (a B vitamin) |
25 milligrams |
Pantothenic acid (a B vitamin) |
25 milligrams |
Pyridoxine (vitamin B6) |
25 milligrams |
Riboflavin (vitamin B2) |
25 milligrams |
Selenium |
100 micrograms |
Thiamin (vitamin B1) |
25 milligrams |
Vitamin A† |
5,000 IU |
Vitamin B12 |
12 to 25 micrograms |
Vitamin D† |
400 IU |
Vitamin E |
400 IU in the form of d-alpha-succinate |
Stage Two
After 3 weeks on Stage One, add the following supplements to your regimen.
Quercetin |
500 to 2,000 milligrams |
Vitamin C |
1,000 to 4,000 milligrams, buffered form |
Stage Three
Fiber‡ |
1 to 2 tablespoons |
L-glutamine |
500 to 3,000 milligrams |
Probiotics |
Follow the package directions. |
*Fish oil has a blood-thinning effect. So does vitamin E. If you’re taking any kind of blood-thinning drug, talk to your doctor before taking these supplements.
†Ask your doctor to test your vitamin D levels. Depending upon test results, you may be asked to take much higher amounts.
‡Start with the smaller amount of fiber. If it gives you discomfort, try again at some future date. If it still gives you discomfort, do not take this supplement.