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What Is Muscle Wasting?
Muscle wasting, or atrophy, is a muscle disorder resulting from the loss of muscle tissue which is characterized by thin muscles that have reduced strength and endurance.
What Is Muscle Wasting In Celiac Disease and/or Gluten Sensitivity?
- Muscle wasting is a classic symptom of celiac disease and a well-recognized feature of multiple vitamin deficiencies.1
How Prevalent Is Muscle Wasting In Celiac Disease and/or Gluten Sensitivity?
Muscle wasting is common in untreated celiac disease.2
What Are The Symptoms Of Muscle Wasting?
Muscle wasting is marked by the following symptoms:
- Decrease in muscle size.
- Fatigue on using muscles.
- Loss of power.
- Difficulty walking and performing usual work.
How Does Muscle Wasting Develop in Celiac Disease?
- Muscle wasting results from deficiencies of vitamin C, thiamin, and protein due to malabsorption in celiac disease because of these metabolic functions that are impaired:
- Vitamin C is required for the growth and repair of all tissues in the body. Deficiency causes loss of muscles.
- Thiamin (vitamin B1) is required for carbohydrate metabolism. Deficiency causes muscular weakness with wasting leading to loss of calf and thigh muscle.
- Protein is required for the production and repair of muscle cells. Deficiency causes failure to make and replace muscle. In particular, the amino acid leucine is required for muscle production and inhibits the destruction of muscle proteins with consequent increased balance over time. Leucine is a branched amino acid that works best when the other branched amino acids, isoleucine and valine, are optimally present.3 Very good sources of leucine are hemp, beef, peanuts, pork, fish, eggs, chicken, almonds, and beans.
Does Muscle Wasting Respond To Gluten-Free Diet?
Yes. Celiac disease-related muscle wasting responds to a gluten free diet that contains adequate amounts of thiamin, protein, vitamin C, and protein.
Whey obtained from milk is an ideal food source to build muscle because it contains all the amino acids required to effectively stimulate muscle protein synthesis, particularly having a high leucine amino acid content.3
6 Steps To Improve Muscle Wasting In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery of Intestinal Lining. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.4
- The intestinal lining may take up to a year to heal.
Recovery of Muscle Tissue.
Muscle regeneration can take 6 weeks or more for improvement after eliminating all gluten and will depend on what is causing the loss of muscle.
- Thiamin (B1) and vitamin C can easily be supplied with supplements in the short run and by including important sources in your diet. Please see these posts.
- Protein is a different matter because it can be hard to digest. Right off you need to consider:
1) Do you eat adequate protein to supply your body’s needs?
2) Do you thoroughly chew your food to improve the ability of your stomach to digest protein foods? This is a consideration for people who eat hurriedly or have missing or misaligned teeth. A blender can help here. Also, eating pineapple (fresh, canned, or juice) with meals definitely will help to digest protein because it contains the enzyme bromalien. Pineapple has the wonderful added effect of killing cancer cells.
3) Do you have low stomach acid? There must be adequate hydrochloric acid available to dissolve meat and other protein foods such as chicken, milk, eggs, and fish. The solution is to take lemon juice, vinegar or some other source of acid, which may mean taking HCL supplements with ALL protein foods. Please see post on low stomach acid.
4) Do you have a stomach infection which inflames the stomach lining, produces low stomach acid, and depletes vitamin C? See post on h. pylori.
5) Do you have chronic candida (yeast) infections? See post on candida.
6) Are you allergic to cow’s milk (dairy products included)? The solution is to consume milk from sheep, goat or water buffalo because these animal milks all contain whey protein for muscle building and are easier to digest than cow milk anyway. So called “milk” from plants do not contain whey, but almond and hemp milk do contain leucine protein. Please note: Children must have animal milk products to grow their bones and muscles properly.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.5
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.5
- Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.5.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.5
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.5
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.5
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
- Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy.
- Protective Herbs and Spices. See below #6 below for examples.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain medications deplete thiamin, protein, and vitamin C that cause muscle wasting. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
ANTACIDS / ULCER MEDICATIONS
- Alka Seltzer®, Baking Soda deplete Proteins.
ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.
- Gentomycin, Neomycin, Streptomycin, Cephalosporins, Penicillins deplete Vitamin C.
ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.
- Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Vitamin C.
- Aspirin and Salicylates deplete Vitamin C.
ANTICONVULSANTS
- Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Vitamin B1.
CARDIOVASCULAR DRUGS
- Antihypertensives (Catapres®, Aldomet) deplete Vitamin B1.
DIURETICS
- Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Vitamin B1, Vitamin C.
FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.
- 5Nutritional Supplements To Help Correct Deficiencies:
The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.
- Multivitamin/mineral combination once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
- Vitamin B1 as prescribed following test for status.
- Natural Vitamin C such as Ester-C as prescribed. More than 250% as a single dose is not absorbed and will deplete minerals through the urine as excess vitamin C is excreted. Larger amounts should be divided into smaller doses.
Storage Note: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets also stimulate and improve digestion and are easily digested.
- Cabbage also stimulates and improves digestion and is also a liver decongestant.
- Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa. Drink as tea or use in cooking.
- Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
- Parsley also relieves indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Nutmeg is also useful for indigestion.
- Ginger.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Muscle Wasting In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“Clinical features of celiac disease in Indian children: are they different from the West?” This prospective study investigating the clinical features of celiac disease in a large group of Indian children and to comparing them with those from the West found that the majority presents with classic symptoms of diarrhea, failure to thrive, and anemia.
Over a period of 5 years, a total of 549 children younger than 14 years with a clinical suspicion of celiac disease were evaluated. Their detailed clinical features, investigations, and follow-up data were recorded. Complete hemogram, endoscopic duodenal biopsy, andceliac serology were done in all of the cases. Celiac disease was diagnosed on the basis of modified European Society of Paediatric Gastroenterology, Hepatology and Nutrition criteria.
RESULTS: Celiac disease was diagnosed in 300 children; 39 were excluded because of lack of follow-up or poor response to gluten-free diet. The remaining 210 had normal villous architecture and served as controls. The mean age of children with celiac disease was 6.7 +/- 3 years, and the mean duration of symptoms was 3.5 +/- 2.5 years. The majority (84%) presented with diarrhea; other features were failure to thrive in 91%, anemia in 84%, muscle wasting in 87%, and stunting in 60% of cases. On follow-up (19.4 +/- 15.5 months), symptoms subsided in all cases of celiac disease with a significant weight and height gain.6
CASE REPORT SUMMARIES
“Celiac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy.” This case report describes diagnosing celiac disease in a 36-year-old gentleman who presented with 6 months of poor energy, tingling in fingers and weight loss with a change in bowel habit. He appeared cachectic and had clubbing, demineralisation of teeth, pectus carinatus, kyphosis, spinal tenderness, proximal muscle weakness and generalised muscle wasting (atrophy).
Chvostek’s and Trosseau’s signs were positive. His hemoglobin (Hb) was 8.7 g/dl, MCV 64.7 fl with low iron. Calcium corrected was 1.30 nmol/l, parathyroid hormone 440.4 ng/l, vitamin D <12.5 nmol/l; INR was 2.7 with coagulation inhibitor studies negative. Radiographs of spine and pelvis commented on osteopenia with thoracic kyphosis and mild anterior wedging of thoracic vertebrae. Antitissue transglutaminase was 145 U/ml, and antiendomysial antibodies were positive. An esophagogastroduodenoscopy was consistent with celiac disease. A diagnosis of osteomalacia and coagulopathy secondary to celiac disease was made.
The hypocalcaemia was treated with calcium gluconate infusions with symptomatic relief. Coagulopathy was treated with vitamin K intravenously with normalization of INR (international normalised ratio), a lab measurement to determine coagulation.7
- Krause’s Food, Nutrition, & Diet Therapy. 10th Edition. Kathleen Mahan, Sylvia Escott-Stump. 2000. W.B. Saunders Company. [↩]
- Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the West? J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):313-7. [↩]
- Rondanelli M, Faliva M, Monteferrario F, Peroni G, Repaci E, Allieri F, Perna S. Novel insights on nutrient management of sarcopenia in elderly. Biomed Res Int. 2015;2015:524948. doi: 10.1155/2015/524948. Epub 2015 Jan 29. [↩] [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
- Poddar U, Thapa BR, Singh K. Clinical features of celiac disease in Indian children: are they different from the West? J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):313-7. [↩]
- McNicholas BA, Bell M. Coeliac disease causing symptomatic hypocalcaemia, osteomalacia and coagulapathy. BMJ Case Rep. 2010 Dec 1;2010. pii: bcr0920092262. doi: 10.1136/bcr.09.2009.2262. [↩]