How About Them? Best Dietary Supplements For Celiac Disease

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by Kayla Robinson


Celiac disease is a chronic, inflammatory condition that can occur in individuals of any age who possess a genetic predisposition to the disorder. In individuals with celiac disease, ingestion of wheat or other gluten-containing grains triggers an immune reaction causing damage to the intestinal villi.

Villi are finger-like projections found in the small intestine that increase its overall surface area and play a significant role in the absorption of nutrients from the foods we eat. (12)(14) Damage to the villi can lead to impaired nutrient absorption, nutrient deficiencies, and several related consequences. Several forms of celiac disease exist, such as classic, atypical, and “silent”, each characterized by different signs and symptoms.

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Symptoms of celiac disease can vary widely from gastrointestinal symptoms, such as gas, bloating, constipation, and diarrhea, to skin conditions and pathologies related to nutrient deficiencies, such as osteoporosis and infertility. Celiac disease can also be present with no visible signs or symptoms, known as “silent” or asymptomatic celiac disease. (12)

To learn more about celiac disease, including its symptoms, health risks, and treatment, visit our blog.

Celiac disease treatment: the importance of supplementation

While research has identified factors contributing to the pathogenesis of celiac disease, including genetics and a number of environmental triggers, the exact cause of the condition is still unknown. (8) Currently, the only treatment available to individuals with celiac disease is strict, life-long adherence to a gluten-free diet. This involves eliminating gluten-containing grains from the diet, including all forms of wheat, barley, and rye. (12)

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While a gluten-free diet is the only way to eliminate symptoms and reverse the progression of celiac disease, nutrient supplementation plays an important role in helping individuals return to optimal health.

Addressing nutrient deficiencies

Within a few weeks of following a gluten-free diet, individuals typically experience improvement in clinical symptoms. However, the intestinal mucosa can take up to 1-2 years to completely heal. (4)

Practitioner insight

“A person’s need to use supplements should always be individualized, and celiac disease is no different. By its nature, celiac disease causes malabsorption of nutrients. The degree of malabsorption varies from person to person,” says Dr. Amy Burkhart, MD, RD.

“Supplementation should be targeted based on someone’s specific needs, which are determined by lab testing and history. Even after the initial recovery phase, some degree of malabsorption continues in certain people with celiac disease. It can be difficult to determine who will have ongoing absorption problems based on history alone. Because of this, nutrient needs should be monitored on a regular basis. The need for ongoing supplementation is determined based on those results and clinical history.”

orange, tomatoes, and blueberries next to supplement capsules, and softgels

A daily gluten-free multivitamin and mineral supplement is often recommended to address nutrient deficiencies following a diagnosis of celiac disease.

Multivitamins and multiminerals

One study found that poor nutrient status persists in approximately half of adults with celiac disease despite following a gluten-free diet for several years. (7) In these cases, supplementation is necessary to address nutrient deficiencies, where a daily gluten-free multivitamin and mineral supplement is often recommended following a diagnosis of celiac disease. (12)

Common nutrient deficiencies resulting from malabsorption include iron, zinc, magnesium, vitamin D, vitamin B12, and folate. In addition, vitamin D and calcium supplementation are often needed as bone mineral density does not always normalize following a gluten-free diet. (4)

Practitioner insight

“I don’t have a “standard protocol” for celiac disease patients. I do often recommend a multivitamin at the time of diagnosis. We may or may not continue that based on a person’s situation. I also check specific vitamin and nutrient levels prior to any supplementation.”

Dr. Burkhart also adds, “the vitamins and minerals most commonly needed are iron, vitamin B12, vitamin D, fish oil, magnesium, and zinc. Additional calorie supplementation may also be needed. Specific supplements should only be prescribed after lab evaluation. Supplementing without lab evaluation can be dangerous if levels are not low and supplementation is started. Toxic levels of vitamins/minerals may be reached and can be dangerous.”

L-carnitine

As discussed, symptoms of celiac disease are widespread and can vary significantly between individuals. Individuals with celiac disease commonly experience fatigue. Supplementation with l-carnitine, a nutrient often depleted in individuals with untreated celiac disease, may be effective in treating celiac disease-related fatigue. One randomized, double-blind study examined the effects of 2 g of l-carnitine daily over 180 days in patients with celiac disease compared to a placebo group. Results showed that individuals receiving treatment demonstrated improvements in fatigue following l-carnitine supplementation. (3)

Improving gastrointestinal health

In addition to targeting nutrient deficiencies, research is now examining the use of certain supplements to promote healing of the intestine and improved digestion. According to the Celiac Disease Foundation, almost 20% of pediatric patients diagnosed with celiac disease demonstrate persisting intestinal damage despite adhering to a strict gluten-free diet for at least one year (1). Similarly, one study noted that complete normalization of the intestinal mucosa in celiac disease patients is rare. (10)

Probiotics

Several studies have noted imbalances in the intestinal microbiota of individuals with celiac disease. (5) Microbiota composition also appears to differ between healthy individuals and those with the condition. Specifically, children with celiac disease have been found to have fewer lactobacilli and bifidobacteria. Furthermore, certain species of probiotics have been found to alter gluten polypeptides and to protect epithelial cells from gliadin-induced damage. (6)

These findings indicate that the composition of intestinal microbiota may play a role in the pathogenesis of celiac disease and have led to the hypothesis that probiotic supplementation may be effective in the management of the condition. Unfortunately, further research is needed to confirm this hypothesis as there are currently very few studies examining the effects of probiotic supplementation for celiac disease. Available studies to date are limited primarily to animal trials.

Gluten-degrading enzymes

While gluten-degrading enzymes have been previously suggested as a method of addressing celiac disease, limitations exist as most enzymes are deactivated by pepsin and the acidic pH in the stomach rendering them ineffective. A new enzyme, Aspergillus Niger Prolyl EndoProtease (AN-PEP), has shown some promise as it remains stable as a lower pH and is resistant to pepsin. (15) However, more research is needed as only in-vitro studies have demonstrated the ability of AN-PEP to accelerate the degradation of gluten. (11)

bowl with chicken and spinach and other vegetables

Chicken and spinach contain high levels of l-glutamine, a nutrient that may help improve intestinal permeability. .

L-glutamine

It has been well-established that individuals with celiac disease exhibit damage to the intestinal villi as a result of the immune response caused by exposure to gluten. However, recent evidence suggests that the pathophysiology of celiac disease may also involve alterations in the epithelial barrier and tight junction-mediated permeability. (13) Intestinal inflammatory disorders, including celiac disease, have been associated with increased epithelial cell death. (9) These findings could provide an opportunity for new treatment options targeting epithelial cells and improved intestinal permeability. (13)

L-glutamine supplementation may enhance tight junction protein expression and therefore, improve intestinal permeability. Rat and human in-vitro studies have also suggested that glutamine may suppress cell death, known as apoptosis. (9) While the use of l-glutamine in celiac disease appears promising, further understanding of the mechanism and effects of l-glutamine in human trials is necessary.

Important considerations for supplementation

When purchasing supplements, a few important considerations can help minimize the chances of gluten exposure. Vitamins and supplements may contain trace amounts of gluten, especially those found in tablet or capsule form. If you’re looking at a product label, you’ll see that supplements are generally made up of active or therapeutic ingredients and “additional” ingredients. These “additional” ingredients are also known as excipients.

Excipients, used during the manufacturing process and in the finished product, can contribute to product attributes, such as enhancing stability, bioavailability, and patient acceptability. They may also contain wheat-derived ingredients. For example, starch, a common excipient, is most often derived from corn but may come from other sources, including wheat. Individuals should also be aware of potential cross-contamination, particularly if other products are manufactured using gluten in the same facility. (2)

To minimize the risk of contamination, look for products marked with a gluten-free third-party certification. Gluten-free certifications indicate that a product has been extensively tested by a third party to ensure gluten content does not exceed a safe amount.

Practitioner insight

Dr. Amy Burkhart, MD, RD shares her expertise and adds, “since the Gluten-free labeling act went into effect in 2014, any supplement labeled “gluten-free” must contain < 20ppm of gluten. This is the level deemed safe for most people with celiac disease.

I recommended people try to find products labeled “gluten-free” or certified “gluten-free” due to this fact. It is not mandatory to label a product gluten-free, so many supplements are not labeled. If a supplement is needed and not labeled gluten-free I recommend the person, or their health care provider, call the company to discuss manufacturing practices and assess safety. Even very small amounts of gluten in supplements can create symptoms and be dangerous for someone with celiac disease. For this reason, determining the safety of products is crucial.”

Gluten-free certifications indicate that a product has been extensively tested by a third party to ensure gluten content does not exceed a safe amount.

While the gluten-free diet remains the only treatment option for celiac disease, early diagnosis to prevent complications, as well as addressing nutrient deficiencies with appropriate supplementation is imperative. A number of other nutritional therapies, such as  probiotic, enzyme, and l-glutamine supplementation, have shown some promise, however, more human trials are necessary to determine the effectiveness of these therapies for individuals with celiac disease. If you suspect you or your child may have celiac disease, be sure to consult an integrative health care practitioner.

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  1. Celiac Disease Foundation. (2016). Gluten-free diet does not heal intestinal damage in 20% of children with celiac disease. Retrieved from https://celiac.org/about-the-foundation/featured-news/2016/12/gluten-free-diet-not-heal-intestinal-damage-20-children-celiac-disease/
  2. Celiac Disease Foundation. (n.d.). Gluten in medicine, vitamins & supplements. Retrieved from https://celiac.org/gluten-free-living/gluten-in-medicine-vitamins-and-supplements/
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