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Supplements, mineral deficiencies and celiac disease

Question

What are dietary supplements you would recommend for a patient diagnosed with celiac disease? Would your recommendations for the patient with celiac disease differ from what you would recommend for a patient who has non-celiac gluten sensitivity?

Answer

For dietary supplements, I would advise meeting with your doctor to check for any vitamin or mineral deficiencies before taking a supplement. If you are deficient in any particular nutrient, you could meet with a registered dietitian to discuss increasing food sources of that particular nutrient and/or look into a supplement. Nutritional deficiencies may be more common in the early stages of diagnosis, and it may take some time to heal the lining of the small intestine before the body can absorb nutrients optimally.  Nutritional recommendations would not vary between the person with celiac disease and someone with non-celiac gluten sensitivity. Both scenarios involve going on the gluten-free diet long-term, creating similar nutritional deficiency risks. While on the gluten-free diet there are particular nutrients you’ll want to make sure you’re getting enough of, including fiber, vitamin B12, folate, calcium, vitamin D, magnesium, phosphorus, vitamin K, and vitamin E.  Gluten-free foods that will help meet these vitamin and mineral recommendations include beef, poultry, fish, certified gluten-free lentils, eggs, milk, yogurt, gluten-free whole grains, gluten-free fortified breakfast cereals, legumes, green leafy vegetables, fortified orange juice, dried fruits, bananas, avocados, nuts, and seeds. Eating a well-balanced diet with plenty of gluten-free whole grains, fruits, vegetables, nuts, seeds, lean protein, and healthy fats should provide ample nutrition.  If you want to take a supplement, make sure the supplement you choose has been verified for quality by a third party, because in the United States supplements are not regulated by the FDA. Third party verification groups include USP and NSF, and you’ll see their logo on the supplement bottle.    Sincerely,  Julie Kennedy, MPH, MEd, RDN, LDN  Dietitian Julie Kennedy used to be a teacher, but when she and her daughter were diagnosed with celiac disease she switched her career path to focus on nutrition. Visit her at Julie Kennedy Nutrition.
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Celiac Disease and Diverticulitis
Question: I have just been diagnosed with diverticulitis and also have celiac. Food choices are becoming more challenging for me. I am also allergic to raw (fresh) fruits and vegetables. Any suggestions for a healthy meal plan? Thank you for your time. From, Irene Answer: Hi Irene. Diverticular disease has two forms: diverticulosis and diverticulitis. Diverticulosis occurs when pouches form in the intestine. If you have been diagnosed with diverticulitis, then the pouches in the intestine have become inflamed, and I am hoping that you keep in touch with your physician to prevent complications. When diverticulitis is present, physicians often recommend rest, antibiotics and/or a bland liquid or low fiber diet to give the colon a rest. If symptoms improve, you can gradually introduce high fiber foods back into your diet. In diverticulosis, a high fiber diet is recommended to keep the bowels moving regularly. If you are allergic to only raw fruits and vegetables, you can still consume dairy, gluten-free grains, lean protein and cooked fruits and vegetables, which are all part of a healthy diet. I would recommend seeing an allergist who can do some tests to determine if there are any raw fruits and vegetables that are safe to eat. You may also want to meet with a registered dietitian in your area to give you more specific meal plan ideas based on your food preferences. For more information: Sincerely, Nancy Dickens, BS, RD, LDN
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Follow-Up Testing
Question: What are the follow-up tests that I should get to monitor celiac disease, and what can I do if my tests are abnormal? Answer: Standard follow-up tests to monitor gluten-free diet adherence routinely are antibody blood tests. These typically include at least the tissue transglutaminase (tTG) IgA since it appears in about 98 percent of those with active celiac disease. The tTG IgG also may be checked if IgA deficiency, a condition in which individuals do not make or have very low blood levels of IgA antibodies, is a concern. Diaminated gliadin peptides (DGP) IgA and IgG and the endomysial antibody (EMA) may be also ordered, although less commonly. Incidentally, the antigliadin peptide antibodies (AGA), not to be confused with the DGP antibodies, are obsolete. When antibody testing is done for monitoring, the same lab used for the blood tests at diagnosis should be used for follow-up because there are no universal normal standards and a comparison of the change in each patients’ results is what is important more so than the absolute values. Although the antibody blood tests are the best we have to assess celiac disease improvement after starting a gluten-free diet, they were really designed for diagnosis. Consequently, ‘normal’ test results can provide a false sense of wellbeing as they cannot detect occasional harmful transgressions in the diet, hence leading healthcare providers and patients to believe they are following the gluten-free diet sufficiently when that’s not necessarily the case. Until recently, there have been no reliable tests for evaluating dietary compliance. However, a validated rapid at-home stool and urine test for gluten was recently launched in the US.. The test, Gluten Detective can determine if someone has consumed as little as 50 milligrams of gluten within the previous 2-3 days using stool, or 500 milligrams or more over the previous 24 hours using urine. If blood tests or the stool test have results that indicate gluten is getting into the diet, you should consult an experienced registered dietician (RD/RDN). A dietitian can help get to the bottom of the problem by providing comprehensive nutrition education or an update on the gluten-free diet with emphasis on eliminating cross-contact. Since the stool test is most likely to reveal if gluten has been consumed in the previous one to seven days, it can help identify the source of short-term gluten exposure. Joining a celiac support group, especially a face-to-face group, along with routine follow up with a dietitian can also help with managing the gluten-free lifestyle. To further manage for psychosocial challenges, especially in social eating settings you may benefit from a counselor or therapist. Best, Nancy Patin Falini, MA, RDN, LDN Nutritional Graces, LLC Private Practice. Consultant/Author/National Speaker. Conducts both face-to-face and virtual nutrition and wellness education and counseling.
Why Monitor
Question: I know I should do follow-up tests to monitor my celiac disease, but I know that I get gluten exposure because I have symptoms. What’s the point? Answer: Assuming gluten is still getting into your diet can lead to anxiety and fear, while finding out for sure and doing something about it can make you feel empowered and in control of your health. If you suspect you are still being exposed to gluten, consult a skilled registered dietitian. His or her advice can help you figure out where it might be coming from and allow you to live more fully gluten-free. You can also use the Gluten Detective urine and stool tests at home to determine if you have been exposed to 50 mg or more of gluten in the previous one to seven days (50+ mg over previous 2-3 days using stool and 500+ mg over previous 24 hours using urine) Eliminating gluten can heal your intestine, remediate many symptoms, and protect against gluten-related complications, for example:
  • long-term inflammation that can precipitate numerous health abnormalities
  • nutrient deficiencies (affecting mood, energy and concentration)
  • anemia
  • bone conditions such as osteopenia and osteoporosis
  • infertility
  • onset of other autoimmune diseases
  • malignancy (cancer)
Being proactive rather than reactive by routinely monitoring your gluten consumption with at-home tests and also consulting a physician and dietitian knowledgeable about celiac disease and taking steps of your own to manage your gluten-free diet can lead to your feeling your best. Best, Nancy Patin Falini, MA, RDN, LDN Nutritional Graces, LLC Private Practice. Consultant/Author/National Speaker. Conducts both face-to-face and virtual nutrition and wellness education and counseling.
Ongoing Symptoms
Question: After diagnosis, how can I tell if my child’s ongoing symptoms are from celiac disease? Answer: Identifying the cause of on-going symptoms can be confusing because other conditions can coexist with celiac disease or result from it. Generally, if symptoms persist first seek the confirmation of the celiac disease diagnosis and have follow-up antibody blood tests done. If these are positive, consult a registered dietitian (RD/RDN). To determine recent gluten ingestion consider using the Gluten Detective stool or urine test. The stool test will be positive if your child has eaten as little as 50 mg of gluten (equivalent to a crumb of bread) within the previous 2-3 days or 500 mg of gluten (equivalent to a couple bites of bread) within the previous 24 hours using the urine test. One slice of wheat bread contains about 2500 mg gluten, so the test is sensitive enough to pick up much smaller amounts. If the stool test results for gluten are consistently negative when assessing ongoing issues, your child’s symptoms might be the result of other conditions, including lactose intolerance, FODMAP intolerance, small intestinal bacterial overgrowth (SIBO) and small intestinal fungal overgrowth (SIFO). Best, Nancy Patin Falini, MA, RDN, LDN Nutritional Graces, LLC Private Practice. Consultant/Author/National Speaker. Conducts both face-to-face and virtual nutrition and wellness education and counseling.
Gluten-Free vs. Wheat-Free

Gluten-Free vs. Wheat-Free

October 21, 2016

Question: Are wheat-free products also gluten-free? Does gluten-free mean that a products is definitely wheat-free? Answer: Gluten is a protein found in wheat, rye and barley. So if a product is wheat-free, it may not be gluten-free. If a product is labeled gluten-free, based on FDA regulations, the product must contain less than 20 ppm of gluten. There may be traces of wheat protein in the product below that amount. Best, Natalie Menza, RD Corporate Dietitian for ShopRite Supermarkets
Dietary Supplements for Teens

Dietary Supplements for Teens

October 07, 2016

Question:

What dietary supplements would you recommend for teens with celiac disease?

Answer:

People with celiac disease often have nutritional deficiencies. This is sometimes due to incomplete intestinal healing and sometimes it is due to inherent deficiencies in the gluten-free diet. While there are some common nutrient deficiencies, your child’s doctor is the best person to monitor these deficiencies. It’s then best to meet with a registered dietitian to assess your teen's diet and help determine if supplements are right for them. Once you and your care team determine the best supplements, make sure to verify the gluten-free status of any vitamins or supplements before purchasing. ShopRite’s website can assist you in finding a Registered Dietitian that you can visit at any ShopRite store or look for a referral from the Academy of Nutrition and Dietetics to find one in your community.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Introducing Gluten, Soy and Dairy to an Infant

Introducing Gluten, Soy and Dairy to an Infant

September 21, 2016

Question:

I have been diagnosed with celiac disease for 20 years. I have a six month old who I have exclusively breast fed to avoid her having issues with formula. Should I avoid gluten, dairy and soy with her? Should I test her for celiac disease at a certain age?

Answer:

There is no indication in celiac disease literature that avoiding gluten, dairy or soy is indicated for children who may carry the gene for celiac disease. If you are interested in learning if your daughter is genetically at-risk, you should speak to your pediatrician about obtaining the gene test. If your daughter has the HLA-DQ2 or HLA-DQ8 gene, she should be tested for celiac disease and your doctor can help determine the appropriate age to do so.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Cross-Contact and Dry Pulses

Cross-Contact and Dry Pulses

September 21, 2016

Question:

Do I have to worry about cross-contact and foods like lentils, split peas and beans?

Answer:

Cross-contact in manufacturing can occur with any source ingredient, so if you are purchasing products that are not labeled gluten-free, it’s important to understand the risk so that you can make an educated decision when cooking for someone with celiac disease. Grains and flours are the highest risk due to overlapping farming and production practices, including crop rotation, transport, milling, etc. Pulses are a less risky ingredient than grains, but still do carry some risk. Fruits and vegetables, meat and dairy are the lowest risk ingredients. To minimize the risk with dry pulses even more, you can visually inspect and rinse them before cooking.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Reporting a Gluten-Free Product to the FDA

Reporting a Gluten-Free Product to the FDA

June 21, 2016

Question:

Is there someone to report falsely labeled gluten-free products to?

Answer:

If you believe you have experienced gluten exposure from consuming a product labeled gluten-free, contact both the manufacturer and the Food and Drug Administration (FDA). Save the packaging so that you can provide detailed information about the product in your complaint. Complaints can be filed to the FDA. Visit the Beyond Celiac hub for understanding the FDA's gluten-free labeling rule for specific steps on reporting products to the FDA.

Best,

Natalie Menza, RD
Corporate Dietitian for ShopRite Supermarkets

Think you may have celiac disease?

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