This is a common scenario among my patients with celiac disease and non-celiac gluten sensitivity. Melinda Dennis, MS, RDN, is a registered dietitian specializing in celiac disease and gluten-related disorders, author, nationally acclaimed speaker, and the Nutrition Coordinator of the Celiac Center at Beth Israel Deaconess Medical Center in Boston. She offers gluten-free consulting through her private firm, Delete the Wheat, LLC.
Symptoms can include (but are not limited to) gas, bloating, cramping, abdominal pain, loose stool, diarrhea, constipation, abnormal stool patterns, fatigue, headaches, nausea, and the list goes on. So, let’s explore what might be causing these persistent symptoms.
If you were undiagnosed with celiac disease for years, chances are good that one or more of your vitamin and mineral levels are low due to malabsorption over a long period of time. Nutrient deficiencies can also be seen in non-celiac gluten sensitivity. These deficiencies can lead to symptoms that can be extensive and hard to pin down. Here are just a few:
- Poor health of skin, hair and nails? Check your zinc level.
- Twitching, spasms and muscle cramps? Likely low magnesium.
- Fatigue can be blamed on low vitamin D, iron, magnesium, folate, B6 or B12, for example.
- (The symptoms above can be related to other deficiencies or conditions, as well, which are not listed here.) The list goes on and on.
Fortunately, lab testing can help identify vitamin and mineral deficiencies and your health care practitioner can recommend foods and supplements to help you restore them. At diagnosis, the typical celiac blood panel includes:
- Complete blood count (hemoglobin, hematocrit, etc.)
- 25 OHD (Vitamin D)
- Vitamin B12
- Folate (often depends on the region)
- Iron and/or ferritin
- IgA-tTG; DGP (deamidated gliadin peptide) may also be tested
- TSH (thyroid stimulating hormone)
￼(Courtesy Beth Israel Deaconess Medical Center, Celiac Center, 2015)
This is an enormous topic, like all the others in this article, and I will address it in more detail in a later article. References and further reading:
Common Nutritional Deficiencies in Patients with Celiac Disease
http://www.bidmc.org/Centers-and-Departments/Departments/Digestive-Disease- Center/Celiac- Center/CeliacNow/NUTRAGFD/NUTRCNSDRGFD/CMMNNUTRPTNTS/Level3. aspx
http://theceliacmd.com/the-celiac-md-articles/top-5-reasons-for-persistent-symptoms-after-going-gluten-free/ Amy Burkhart MD, RD
Other Reasons: Less common causes of continued symptoms on the gluten-free diet include, but are not limited to, microscopic colitis, pancreatic enzyme insufficiency, and refractory celiac disease (very uncommon) and can be discussed with your doctor.
Bottom line: Don’t assume it’s normal to be feeling unwell. I hear many patients say “I just assumed everyone had diarrhea twice a day and I got used to living with it.” If you are still experiencing symptoms, talk to your doctor and ask for testing. You deserve to be in excellent health.
Disclaimer: As Nutrition Coordinator of the Celiac Center at Beth Israel Deaconess Medical Center, I am the lead writer and editor of the website www.celiacnow.org and co-author of the book Real Life with Celiac Disease. Otherwise, I have no business/financial stake in the resources listed in my article above.
Melinda Dennis, MS, RDN, is a registered dietitian specializing in celiac disease and gluten-related disorders, author, nationally acclaimed speaker, and the Nutrition Coordinator of the Celiac Center at Beth Israel Deaconess Medical Center in Boston. She offers gluten-free consulting through her private firm, Delete the Wheat, LLC.
Note: The References and Further Reading resources above represent only a portion of the excellent information available on these topics. I recommend PubMed, in particular, for the multiple peer-reviewed journal articles you will find.
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