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Celiac disease takes away the body's ability to absorb calcium, and osteoporosis often follows. But celiac disease is not the only correctable problem with grains that increases the risk of brittle bones.

Celiac disease and osteoporosis often occur together. Striking both men and women of all ages, osteoporosis occurs in about 14 percent of people who have celiac disease, and osteopenia, a condition of weaker than normal bones, occurs in another 40 percent. Celiac disease is a well-known cause of bone health problems, and weak bones may occur even if the symptoms of celiac disease itself are mild.

In celiac disease, osteoporosis does not necessarily have anything to do with estrogen levels, testosterone levels, parathyroid hormone levels, or the amount of calcium in the diet. Simply taking calcium is not enough. The problem in celiac disease is the constant damage to the lining of the intestines that interferes with the body's ability to absorb calcium and other trace minerals and vitamin D. The buildup of inflammatory cytokines in the bloodstream adds to the destruction of bone, and the concurrence of other autoimmune diseases such as lupus and type 1 diabetes piles on to the effects of inadequate nutrition.

The problem in celiac disease isn't that people who develop osteoporosis are doing the wrong things. Their bodies simply have difficulty maintaining healthy bone mineral density.

It's not unusual for people with celiac disease to be short and slight. They are often unusually thin. And as women with celiac disease pass menopause, or when either men or women take up smoking or heavy drinking, the risk factors for brittle bones multiply even more.

What can be done to promote bone health in celiac disease?

The standard intervention for celiac disease is a gluten-free diet. Most people with celiac disease find sticking to a gluten-free diet a life-long challenge. Even tiny amounts of gluten from wheat, rye, or oats can trigger unpleasant digestive upsets and a general feeling of malaise, and these tiny, less-than-a-gram amounts of gluten creep into a vast array of food products. 

The critical time of life for managing celiac disease for future bone health is childhood. Children who have gluten enteropathy have to be given a strictly gluten-free diet for bones to have a chance to develop to their full, adult shape and size. Deficiencies of bone mineralization may not show up with a DXA scan in children who cannot follow a gluten-free diet, but bone problems are usually detectable with ultrasound, Fractures in children who have problems with gluten are about twice as common as they are in children who do not have celiac disease, but the risk of fracture during childhood is still low. Brittle bones usually don't become problematic until adulthood.

Avoiding gluten is not the only thing that helps:

  • Supplemental calcium and vitamin D give the digestive tract a chance to absorb enough calcium to build and maintain bones. It is important to take calcium supplements in doses of not more than 200 mg for children and 400 mg for adults, since even a healthy digestive tract can absorb only a limited amount of calcium at one time. Children under the age of eight need up to 700 mg of calcium per day, older children and teens 1000 to 1300 mg a day, and adults 1000 to 1300 per day.
  • A vitamin K2 supplement helps your body direct calcium where it is needed, away from your arteries and into your bones. If you live in Canada, where regulations keep the dose of K2 small, you may also need butter or cheese made with milk from grass-fed cows, eggs with bright orange yolks, or the Japanese fermented food (which is something of an acquired taste) natto.
  • Leafy greens on a daily basis plus magnesium supplementation help bones absorb calcium. If you take calcium supplements, take about half as much magnesium to aid in absorption. Leafy greens also provide "ash" that your kidneys can use to maintain a healthy pH without taking calcium out of bone.
  • White spots on the nails indicate a zinc deficiency. Another quick test for zinc deficiency is putting a zinc tablet on your tongue. If you don't experience a metallic taste, you are probably zinc-deficient. Take up to 30 mg of zinc per day, preferably in the form of zinc gluconate (although any form of zinc does some good), but be sure to take 1 to 3 mg of copper when you take zinc.
  • It's important to get enough protein. Low-protein diets interfere with calcium supplementation. You don't necessarily need a "high" protein diet, but you probably need more than the minimum of approximately 50 grams of protein every day that is recommended as a minimum.
It is not hard to tell whether you are getting diet right if you have celiac disease. When you are avoiding gluten and eating the right foods, you will have less bloating, gas, and irritation on the lips and at the corners of the mouth. If you manage to stick to a healthy diet for a year or more, your bone resorption markers (NTX) and inflammation markers (C-RP) will fall, too. But some people need some fine tuning.

Celiac disease isn't the only wheat sensitivity condition

Celiac disease is relatively rare. It affects only about one in 350 people. Far more than one in 350 people, however, seem to have problems with wheat. One explanation is that only a few genes control celiac disease, but over 70 genes control varying degrees of inflammation after eating wheat, potatoes, or oats. You can have variations in all of these genes so that wheat, potatoes, and oats give you a little trouble or a lot. You can have celiac disease, or not have celiac disease, and still have issues with these 70-plus genes.

There is good news regarding this "wheat sensitvity" disease. Unlike celiac disease, the inflammatory genes that are "turned on" by wheat are "turned off" by rye. You may not need to avoid wheat, potatoes, or oats completely, if you add rye to your diet. This reduction in the inflammatory load in your body indirectly helps to heal your bones. There have not yet been any studies that conclusively link this phenomenon to osteoporosis or osteopenia, but if you have "not quite celiac disease," switching rye for wheat is worth a try.

  • Ganji R, Moghbeli M, Sadeghi R, Bayat G, Ganji A. Prevalence of osteoporosis and osteopenia in men and premenopausal women with celiac disease: a systematic review. Nutr J. 2019 Feb 7.18(1):9. doi: 10.1186/s12937-019-0434-6. Review. PMID: 30732599.
  • Hernandez L, Green PH. Extraintestinal manifestations of celiac disease. Curr Gastroenterol Rep. 2006.8(5):383–9.
  • Kalayci AG, et al. Bone mineral density and importance of a gluten-free diet in patients with celiac disease in childhood. Pediatrics. 2001.108(5):E89.
  • Kallio P, Kolehmainen M, Laaksonen DE, Kekäläinen J, Salopuro T, Sivenius K, Pulkkinen L, Mykkänen HM, Niskanen L, Uusitupa M, Poutanen KS. Dietary carbohydrate modification induces alterations in gene expression in abdominal subcutaneous adipose tissue in persons with the metabolic syndrome: the FUNGENUT Study. Am J Clin Nutr. 2007 May.85(5):1417-27.
  • Photo courtesy of SteadyHealth

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