It can be challenging enough on gluten-free diet, but what if you eat a vegetarian or vegan diet?
It’s well established that there are health benefits to reducing the amount of meat in the diets of most Americans, and the lifestyle has appeal for some people based on ethical and/or environmental reasons. Fortunately, with extra planning, a well-rounded and delicious gluten-free vegetarian diet is possible.
The good news is that many vegetarian staples, like beans, lentils, tofu, dairy, nuts, seeds and eggs are already naturally gluten-free. And some of the best sources of vegetarian and vegan protein are gluten-free pseudo-grains, such as quinoa, buckwheat and amaranth. Also, grains, such as millet, teff and sorghum are very nutritious. In addition to protein and fiber, they all have other vital nutrients, like
When you see gluten-free fruit and nut bars in the airport newsstand, you know we’ve come a long way in our society’s awareness of food sensitivities. In my mere two years without gluten, I’ve gone from stuffing my suitcase with Larabars to ensure I don’t starve while away, to, well, still packing them, but knowing that I likely won’t be completely reliant on them the whole trip.
In addition to newsstand snack options, I recently discovered a Dallas/Fort Worth International Airport restaurant having a gluten-free menu. I was thrilled! I would sooner have expected to see a glatt kosher dining area!
The dramatic increase in gluten-free offerings makes me wonder: why the recent influx of news about gluten? Is it that so many more people are getting tested for celiac disease? Are more people questioning their ailing guts and attributing it to gluten?
Low stomach acid is common in celiac disease and dermatitis herpetiformis. It is also common in the general population, as well, affecting 50% of people age 60 years and about 80% by age 85 years. Nevertheless, low stomach acid is not generally looked for as a cause of acute and chronic disorders that rob health with far-reaching effects.
Is Low Stomach Acid New?
No. Low stomach acid (hypochlorhydria), has been well investigated much of the past century in both the general population and those with gluten sensitivity. For example, a 1985 study investigating gastric acid secretion in 116 subjects with dermatitis herpetiformis found that 41% had low stomach acid and 26% were achlorhydric (no acid). Of those older than 50 years, 47% were achlorhydric. When compared to subjects with celiac disease, the frequency of achlorhydria was significantly higher in those with dermatitis herpetiformis than in those with coeliac disease. There was no correlation between achlorhydria and small intestinal villous atrophy (damage).
Why Is Low Stomach Acid Overlooked?
Failure to understand nutrition and malabsorption…an area of science that is barely taught in medical schools is a big factor. Also,
Vitamin C, also called ascorbic acid or ascorbate, is an essential water soluble vitamin.
Fresh supplies of vitamin C are required every day to perform vital roles throughout the body among which are the production of connective tissue such as skin, blood vessels and bone, anti-inflammatory responses and anti-oxidant performance. See below for all roles.
Vitamin C fights for us! It has an anti-cancer effect stemming from its role as a potent anti-oxidant in blood plasma and within cells. It also protects nucleic acids (DNA) from oxidative damage and inhibits the formation of nitrosamines (carcinogenic compounds formed in the digestive tract).
Importantly, vitamin C can regenerate vitamin E from an oxidized state after vitamin E performs its own anti-oxidant role against free radicals and vitamin C works together with other anti-oxidants, such as beta-carotene and glutathione, to increase their overall anti-oxidant effect.
A study investigating the specific anti-inflammatory and anti-oxidant micronutrients that reduce oxidative stress found that in adolescents with metabolic syndrome (MetS) the lower the vitamin C level in blood the worse the MetS status and blood uric acid level. MetS prevalence was estimated at 7% among boys and 3% among girls.1
Vitamin C reverses osteoporosis by reducing or preventing oxidative stress that destroys living bone tissue. Osteoporosis is a disorder of bone inflammation that results in thin, weak bones that may easily fracture. In normal bone structure, vitamin C is required to form collagen, which is living bone tissue.
In humans, vitamin C reduces the duration of common cold symptoms, even if its effect is not clear.2
Vitamin C must be obtained from food daily because our bodies, unlike monkeys and other animals, cannot produce it.
Urinary excretion of vitamin C cannot be detected when vitamin intake is below the required levels. On the other hand, when intake exceeds saturation in the body, the vitamin and/or its metabolites are actively excreted into urine to prevent excessive toxicity of the vitamins.3
What Is Vitamin C Deficiency In Celiac Disease and/or Gluten Sensitivity?
Sources:
TGBeydoun MA, Canas JA, Beydoun HA, Chen X, Shroff MR, Zonderman AB. Serum antioxidant concentrations and metabolic syndrome are associated among U.S. adolescents in recent national surveys. J Nutr. 2012 Sep;142(9):1693-704. doi: 10.3945/jn.112.160416. [↩]
Shaik-Dasthagirisaheb YB, Varvara G, Murmura G, Saggini A, Caraffa A, Antinolfi P, Tete’ S, Tripodi D, Conti F, Cianchetti E, Toniato E, Rosati M, Speranza L,Pantalone A, Saggini R, Tei M, Speziali A, Conti P, Theoharides TC, Pandolfi F. Role of vitamins D, E and C in immunity and inflammation. J Biol Regul Homeost Agents. 2013 Apr-Jun;27(2):291-5. [↩]
Shibata K, Hirose J, Fukuwatari T. Relationship Between Urinary Concentrations of Nine Water-soluble Vitamins and their Vitamin Intakes in Japanese Adult Males. Nutr Metab Insights. 2014 Aug 5;7:61-75. doi: 10.4137/NMI.S17245. eCollection 2014. [↩]
Osteoporosis, or brittle bones, is a generalized bone disorder involving the slow loss of bone mass throughout the skeleton that results in diminished bone mineral density (BMD). Thinning, fragile bones maintain normal cell appearance but have a rapid turnover so that more bone is taken up and removed than is laid down. The result is bone weakness that predisposes people with osteoporosis to fractures.
Osteopenia refers to the progression of bone tissue loss in the range between normal to osteoporosis.
What are Bones?
Bones are dynamic structures made up of living connective tissue and certain minerals. Connective tissue provides the shape of bones and holds calcium phosphate mineral for hardness and
Inflammation is our body’s necessary self-defense response and repair mechanism for these assaults:
1) injuries such as cuts, scrapes, sprains, broken bones, burns, insect bites, toxins; 2) invading organisms such as bacteria; and 3) allergens and food sensitivities such as gluten.
Inflammation can be immediate (acute) or persistent (chronic).
Acute inflammation is marked by increased blood flow, migration of white blood cells, and release of defensive proteins and chemicals to the site of injured tissue. Among these chemicals are free radicals in the immune response to injury that are beneficial yet require the activity of anti-oxidants such as vitamin E and vitamin C to control.
Free radicals are chemical particles containing one or more unpaired electrons, which may be part of the molecule. They cause the molecule to become highly reactive.1
The majority of this response takes place in the first 12 to 24 hours after the assault. The inflammatory process continues until all the damaged tissue or invading germs are removed (usually about 5 days).2
Chronic inflammation is marked by persistence weeks to months or longer after tissue damage. Note: high concentrations of free radicals generated in chronic inflammation may be important causes of damage to cell structures. The defensive activity of anti-oxidants such as vitamin E and vitamin C are required to remove free radicals.
Chronic inflammation increases the risk for systemic diseases such as type II diabetes, obesity, heart disease, high blood pressure, arthritis, osteoporosis, chronic fatigue, migraine, autoimmune disease, and vasculitis which may cause stroke, heart attack or deep vein thrombosis (DVT).
Importantly, chronic inflammation is a risk factor for the onset of cancer.3
Q: Are there blood tests available for detecting inflammation?
A: Yes. Your medical health practitioner can order either or both of the following blood tests that measure the amount of inflammation present although not the source of inflammation. Abnormal is an elevation in blood levels.
C-reactive protein (CRP). This test measure C-reactive proteins that are released into the bloodstream within a few hours of tissue injury or infection. CRPs are cytokines called ‘acute phase reactants,’ meaning first on the scene. The CRP test is also useful to monitor treatment response and flare-ups of chronic inflammatory disease such as vasculitis, systemic lupus, and inflammatory bowel disease.
Erythrocyte sedimentation rate (ESR or sed rate). This test measures the rate of fall of blood cells in a sample tube of blood. An increase in the rate of fall shows inflammation due to an increase of C-reactive proteins in the blood specimen. Alone or with the CRP test, the ESR is especially useful for monitoring inflammation of veins and arteries.
In regards to celiac disease, disappearance of blood antibody levels of tissue transglutaminase IgA (tTG-IgA) indicate that inflammation has also subsided. These antibodies should be checked at 3 months, 6 months if indicated, and one year after diagnosis to monitor healing. On the other hand, raised antibodies indicate that there is definitely ongoing inflammation in the small intestine.
In regards to non-celiac gluten sensitivity, disappearance of blood antibody levels of anti-gliadin IgA and IgG at 3 months, 6 months if indicated, and one year after diagnosis indicate that inflammation has also subsided. On the other hand, raised antibodies indicate that there is definitely ongoing inflammation caused by gluten within the body.
What Is Inflammation In Celiac Disease and/or Gluten Sensitivity?
Sources:
Ruttkay-Nedecky B, Nejdl L , Gumulec J. The Role of Metallothionein in Oxidative Stress. Int. J. Mol. Sci. 2013, 14(3), 6044-6066; doi:10.3390/ijms14036044. [↩]
Taber’s Cyclopedic Medical Dictionary. 19th ed. F A Davis Company. Philadelphia, PA. [↩]
Brighenti E, Giannone FA, Fornari F, Onofrillo C, Govoni M, Montanaro L, Treré D, Derenzini M. Therapeutic dosages of aspirin counteract the IL-6 induced pro-tumorigenic effects by slowing-down the ribosome biogenesis rate. Oncotarget. 2016 Aug 20. doi: 10.18632/oncotarget.11441. [↩]
What Is Intestinal Dysbiosis? Intestinal dysbiosis is an imbalance of the composition and quantity of microbe populations (called the microbiota), that naturally inhabit our human gut. Dysbiosis causes altered gut immunity, abnormal fermentation of undigested foodstuffs,…
Calcium is the most abundant mineral in the body, with 99% residing in teeth and bones where it constitutes 40% of skeletal bone weight along with 45% phosphorus.
As a component of hard tissues, calcium fulfills a structural role to maintain body size and acts as attachments for musculoskeletal tissues.
Q: What does the non-skeleton calcium do in the body?
A: The remaining 1% of calcium is present in blood and soft tissues. Calcium levels in the blood are maintained within very strict limits by dietary intake, hormonal regulation and a rapidly exchangeable pool in bone tissue. The many important functions are described below.
What Is Calcium Deficiency In Celiac Disease and/or Gluten Sensitivity?
Woman with long standing osteoporosis. Courtesy of Wikimedia.
What Is Osteoporosis?
Osteoporosis is a metabolic bone disorder characterized by diminished bone mass (density) with normal cell appearance but fragile bone strength that prediposes to broken bones, and with high bone turnover.
This condition usually goes undetected until late when loss of height or a bone fracture occurs. In fact, each year 1.5 million fractures mainly of the hip, spine and wrist are attributed to osteoporosis. Compression fractures of vertebrae bones are the most common, accounting for 700,000 cases.
Bone is composed of specialized connective tissue called osseous tissue. Osseous tissue is made up of living bone cells (osteocytes) that are embedded in a hard matrix (framework) of calcified substance.
Bone matrix contains collagen fibers and the minerals calcium phosphate and calcium carbonate, which provide strength to bone. The copper enzyme, lysyl oxidase, is involved in the cross-linking of collagen in forming the framework for depositing calcium and other minerals to build and repair bone.
Q: How do osteocytes function in bone?
A: Osteocytes maintain the health of bone by their metabolic activity in regulating normal bone turnover. Bone turnover is the breaking down and removal of old or damaged bone and rebuilding or remodeling of healthy bone that is ongoing throughout life. The bone formation process takes about 3 months to complete.
Osteoporosis develops from failure of the body to maintain health and to provide bone tissue with adequate nutrition for proper function. Risk factors that can be modified include: low calcium intake, sedentary lifestyle, smoking, drinking alcohol excessively, eating a diet with excessive caffeine, protein, and phosphate, and taking certain medications over a long time such as steroids, thyroid preparations, the anti-convulsive drug phenytoin, aspirin, antacids, anticoagulants, some diuretics, and some chemotherapeutic drugs. See below for a fuller description.
In addition to celiac disease, osteoporosis is associated with advancing age, family history, nulliparity (no pregnancies) and post-menopause in females, certain disorders such as hyperthyroidism, hypogonadism, inflammatory bowel disease like Crohn’s disease, multiple myeloma, anorexia nervosa, and Cushing’s disease.
Bone strength is easily measured by testing bone mineral density (BMD). BMD is evaluated by DEXA scan (dual-energy X-ray absorptiometry). DEXA at the femoral neck and lumbar spine is considered the gold standard to confirm the diagnosis of osteoporosis. Results are expressed as T and Z scores. T scores compare the result with a 20 to 40 year old helathy person while Z scores compare the result with persons in the same age group. Both are measured in standard deviations (SD).
According to WHO criteria (World Health Organization), a T-score of -1 SD or greater denotes normal bone, a T-score between −1 to −2.5 SD denotes osteopenia, and a T-score of −2.5 or more denotes osteoporosis.1
Treatment is aimed to preserve and increase bone density, minimize symptoms for better quality of life and reduce risk of bone fractures.
What Is Osteoporosis In Celiac Disease and/or Gluten Sensitivity?
The cumulative effects of gluten-induced inflammation, treatment delay, and malabsorption result in lower bone density and bone fragility.2
Sources:
Pantaleoni S, Luchino M, Adriani A, Pellicano R, Stradella D, Ribaldone DG, Sapone N, Isaia GC, Di Stefano M, Astegiano M. Bone mineral density at diagnosis of celiac disease and after 1 year of gluten-free diet. ScientificWorldJournal. 2014;2014:173082. doi: 10.1155/2014/173082. [↩]
Grace-Farfaglia P. Bones of Contention: Bone Mineral Density Recovery in Celiac Disease-A Systematic Review. Nutrients. 2015 May 7;7(5):3347-3369. [↩]
Copper is an essential trace element that is required for a number of enzymes which are necessary for normal metabolic function.
In the body almost all the copper is present as a component of copper proteins which are produced and controlled by the liver.
Q: How does the liver control copper?
A: The liver maintains proper copper balance by binding free copper to proteins and by excreting excess copper as part of bile that is then emptied into the intestinal tract and excreted in stool.
Metabolic balance studies have demonstrated that daily copper losses are approximately 1.3 mg/day.1
Among its specific functions listed below, copper is essential for energy production, blood and nerve functions, blood components, immunity, and collagen tissue. The copper enzyme, lysyl oxidase, is involved in the cross-linking of collagen in forming the framework for depositing calcium and other minerals to build and repair bone.
Animal studies suggest that adequate copper levels during pregnancy are critical to development of higher brain function in the offspring.2
What Is Copper Deficiency In Celiac Disease and/or Gluten Sensitivity?
Sources:
Williams DM. Copper deficiency in humans. Semin Hematol. 1983 Apr; 20(2):118-28. [↩]
Fisgin T, Yarali N, Duru F, Usta B, Kara A. Hematologic manifestation of childhood celiac disease. Acta Haematol. 2004;111(4):211-4. [↩]
Low stomach acid is common in celiac disease and dermatitis herpetiformis. It is also common in the general population, as well, affecting 50% of people age 60 years and about 80% by age 85 years. Nevertheless, low stomach acid is not generally looked for as a cause of acute and chronic disorders that rob health with far-reaching effects.
Osteoporosis, or brittle bones, is a generalized bone disorder involving the slow loss of bone mass throughout the skeleton that results in diminished bone mineral density (BMD). Thinning, fragile bones maintain normal cell appearance but have a rapid turnover so that more bone is taken up and removed than is laid down. The result is bone weakness that predisposes people with osteoporosis to fractures.
