Celiac Disease and Your Bones

Celiac Disease in an inheritable autoimmune disorder that causes your body to have an adverse reaction to gluten (a protein found in wheat, barley and rye). Symptoms vary in adults and children and may or may not include symptoms of the digestive system. Many patients' symptoms of bloating, diarrhoea and abdominal pain are routinely dismissed as Irritable Bowel Syndrome, while other symptoms such as depression and irritability are easily missed and misdiagnosed. This delay in diagnosis (research shows it takes an average of 13 years for Celiac Disease to be diagnosed) may make the bone symptoms outlined here more prominent.

However, even when properly diagnosed and treated with a strict gluten-free diet, there are still several co-morbid conditions that may seriously effect the long-term health of your bones.

These conditions include: Lactose Intolerance, Osteoporosis, and Vitamin D deficiency.

Lactose Intolerance

Lactose is broken-down by an enzyme in your gut, "lactase". The lining of the gut is badly damaged by eating gluten, meaning that it cannot produce the lactase enzyme, causing symptoms of bloating, nausea, diarrhoea, stomach cramps, and foul-smelling stools if you eat milk products containing lactose (which is found in human's milk, cow's milk, goat's milk, and sheep's milk, but not in soy or rice milk).

Many celiacs have only temporary damage to their gut, and the ability to produce the lactase enzyme will return. For others, however, this intolerance is permanent. It's worth being retested after one year on a strict gluten-free diet to see if the ability to eat lactose has returned.

Lactose intolerance is diagnosed with a hydrogen breath test. Generally, it's more pleasant than most other tests a celiac will undertake. It involves drinking a very sweet solution of pure lactose and breathing regularly into a device. The room is always very near a toilet, because ingesting that amount of lactose tends to have a rather unfortunate effect on lactose intolerant individuals. Based on the amount of times you experience diarrhoea during the test, you may be able to accurately predict whether or not you are lactose intolerant before you officially receive the results.

Although being lactose intolerant means you have to avoid all foods with high levels of lactose, an intolerance is not an allergy. You don't have to avoid all lactose-containing products. This is very good to know, as products that contain lactose are often also very high in calcium.

You will have to avoid milk, soft cheeses and ice creams that contain lactose. However, many hard cheeses, yoghurts, butters and margarines have very low levels of lactose and may be safely eaten by many lactose intolerant individuals. That's good to know, because 30g of cheddar cheese contains a whopping 220mg of lactose. That's more than one-sixth of your recommended allowance.

READ Could You Be Lactose Intolerant?

Lactose intolerance can still cause problems for your bones. Because most of the products that contain the most lactose also contain the highest levels of calcium, it may be difficult to consume enough calcium to avoid the risk of osteoporosis. If you are lactose intolerant, make sure you watch out for milk-substitutes that are enriched with calcium (not all of them are).

If your doctor has found that you're lactose intolerant, you should take a calcium supplement. It's recommended that celiacs take 1200mg daily, to ward off dangerous osteoporosis.

Celiac Disease, Osteoporosis And Vitamin D Deficiency

Osteoporosis

Untreated Celiac Disease is a common cause of osteoporosis, a condition where low bone density leaves the individual prone to fractures. The gluten clogs the villi (the small, finger-like growths that line the intestine), preventing the digestion of nutrients, including lactose. This prevents the digestion of calcium, leading to low bone-density. Low bone-density is common in untreated and newly-diagnosed celiacs.

However, as mentioned before, even treated celiacs can still experience lactose intolerance, leading to low bone-density. Even once treated, celiacs without lactose intolerance may take up to two years to restore lost bone-density. A proportion of celiacs never recover the lost bone-density.

Low bone-density is usually diagnosed with a Bone Mineral Density test (usually a DXA scan). A DXA is a painless x-ray scan which measures your bone-density in your lower-spine and hip joint. A DXA scan can tell you whether you have normal bone-density, osteopenia (thinning bones, often a precursor to osteoporosis), or osteoporosis.

If you discover you have osteopenia or osteoporosis, you'll need to take care of your nutrition. A well-balanced diet should include lots of green, leafy vegetables and calcium-fortified foods. If you are lactose intolerant, you should also take a daily calcium supplement of 1200mg a day, fortified with Vitamin D of 800IU. And be sure to take regular weight-bearing exercise, such as walking, weight-training, and dancing.

Vitamin D Deficiency

Vitamin D is vital for supporting calcium-absorption and the development of strong, healthy bones. Celiacs often lack the ability to digest vitamin D from the food they eat (due to a digestive tract that may be permanently-damaged), or even to synthesise it from the sun.

Symptoms of vitamin D deficiency include muscle weakness and bone pain, which may include a specific and debilitating condition called "Osteomalacia". Osteomalacia, or "soft bones", occurs when the mineralisation of the bones fails to occur properly. It can cause severe bone pain, tiny fractures in the bone, muscle weakness, and back pain. These pains can be very severe and will last until the deficiency is diagnosed and treated. Occasionally, the partial fractures in the bone can lead to a complete fracture of the bone.

READ Vitamin D - How Much Do We Need And How Do We Get It?

Vitamin D deficiency is diagnosed by blood test and can be treated efficiently with tablets, an oral liquid, or (in extreme cases) by high-dose injection. You will usually take doses of 20-50mcg at a time, on a daily, weekly or monthly basis, depending on the extent of the deficiency.

If you have been diagnosed with vitamin D deficiency, you should be monitored when active treatment has finished, and retested to make sure you are not becoming deficient again. If your doctor finds that you're routinely becoming deficient, you may be prescribed a lower-dose of regular vitamin D to maintain your levels.

Strong bones for Celiacs

Celiacs can struggle to have the strong, healthy bones other people take for granted. However, by practicing good nutrition, taking weight-bearing exercise, and adding supplements to your diet as necessary, it is possible to make your bones stronger into the future.