“Biochemical individuality” - A phrase I state multiple times a day in appointment settings, speaking with the media, and colleagues alike. That phrase comes to mind again with regard to a proper understanding of the unique nutrient deficiencies that may plague the newly diagnosed celiac disease patient. I will discuss what is common in peer-reviewed literature, but that data should be a guide, not set-in stone examples of only what to test for in such a patient base.
Since celiac disease is a disease that attacks the nutrient absorption areas of the small intestine, nutrients that appear in peer-reviewed literature that are typically deficient include vitamins A (retinol), D, E, K, folic acid, B6, B12, and the minerals calcium, copper, magnesium, zinc, selenium and iron.1234 Quoting Green and Cellier, “after the diagnosis of celiac disease has been established, the patient should be assessed for deficiencies of vitamins and minerals, including folic acid, B12, fat-soluble vitamins, iron, and calcium, and any such deficiencies should be treated”.1 That quote is from one of the most important peer-reviewed publications on celiac disease at the time in 2007, from the New England Journal of Medicine, simply titled Celiac Disease. I recall reading that paper and I was excited. In my mind, fleets of medical doctors were going to read this review of this important disease and increase their understanding of some of the complexities of this disease, including the aforementioned statement on the importance of testing nutrient status, as opposed to simply asking what people eat and with what frequency. Never assume nutrient status. Unfortunately, of all the cases of celiac disease I have worked on, the only nutrients ever routinely tested have been iron, B12 and vitamin D, and certainly not in every case. Many persisting symptoms can have a deficiency causing or exacerbating the situation.
As any practitioner will tell you, the power of the n of 1 can never be ignored. What I mean by that is as a health care practitioner, the person sitting across from you is the most important person in the room, bigger than any single study, and my goal is to use my education and experience, which includes peer reviewed literature, to make informed decisions. Every individual presents differently. I have discovered some extremely interesting cases of deficiencies in the newly or just about to be diagnosed celiac disease patient. In addition to the above listed nutrients, I have discovered manganese deficiencies, B1 and B2 deficiencies (which are considered rare), low levels of omega 3 fatty acids (particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), with subsequent elevated levels of mead acid (a fatty acid that is produced in higher amounts in the presence of suboptimal EPA and DHA concentration)5, and low levels of carotenoids.
The excellent news is that once celiac disease is diagnosed and a gluten-free diet has commenced, and any deficiency is addressed, normalization transpires. A terrific example is a study back in 2014 where van Hees and colleagues looked at omega 3 fatty acids in individuals that were diagnosed with celiac disease and on a gluten free diet and compared that data to their counterparts free of the disease. Celiac disease patients on a gluten-free diet actually had better DHA levels than their non-celiac counterparts.6
The key point of this article is any nutrient can be a potential deficiency in newly diagnosed celiac disease patients. Once again, this is an example of the need to be an advocate for your own care. If you or a loved one was just diagnosed with celiac disease, print out this article and bring it to your physician. Please do the same if you or a loved one have celiac disease but never had a nutrient analysis.
1. Green PH, Cellier C. Celiac Disease. NEJM 2017;357:1731-1743.↩
2. Henri-Bhargava A, Melmed C, Glikstein R, Schipper HM. Neurologic impairment due to vitamin E and copper deficiencies in celiac disease. Neurol. 2008;71:860-861.↩
3. Jamnik, Joseph, et al. Biomarkers of Cardiometabolic Health and Nutritional Status in Individuals with Positive Celiac Disease Serology. Nutrition and Health, vol. 24, no. 1, Mar. 2018, pp. 37–45, doi:10.1177/0260106017748053.↩
4. Murray, Joseph A. MD Micronutrient Deficiencies Are Common in Adults With Newly Diagnosed Celiac Disease: 2394.[Abstract] American Journal of Gastroenterology. 110 (Supplement 2015 ACG Annual Meeting Abstracts):S994, October 2015.↩
5. National Center for Biotechnology Information. PubChem Database. Mead acid, CID=5312531, https://pubchem.ncbi.nlm.nih.gov/compound/Mead-acid (accessed on Oct. 9, 2019).↩
6. van Hees, Nathalie J M et al. “DHA serum levels were significantly higher in celiac disease patients compared to healthy controls and were unrelated to depression.” PloS one vol. 9,5 e97778. 19 May. 2014, doi:10.1371/journal.pone.0097778↩