Why does celiac disease mean malnutrition?

Many children with newly diagnosed celiac disease have malnutrition as well as vitamin and mineral deficiencies. The major reason for this is damage to the small intestine caused by an immune response to gliadin, a protein in gluten.

The damaged villi of the small intestine become shorted and flattened. This reduces the surface area of the bowel, resulting in poor absorption of nutrients.

What can untreated celiac disease do?

Untreated celiac disease may cause growth failure and weight loss, due to the malabsorption of vitamins and minerals as well as carbohydrates, protein and fat.

Can it be corrected?

The deficiencies related to late diagnosis of celiac disease may be corrected with proper diet and supplementation. The food guide pyramid can be utilized as a guideline for consuming a healthy diet.

Sources of vitamins

Vitamins A, D, E and K are fat-soluble vitamins that may be deficient in a child with celiac disease due to the malabsorption of fat.

• Vitamin A can be found in fortified milk, eggs, and dark green, orange and yellow fruits and vegetables.
• Vitamin D is found in milk products as well as milk alternatives, soy and rice beverages.
• Vitamin E comes from vegetable oils, margarine, nuts and seeds.
• Vitamin K is in leafy green vegetables such as spinach, broccoli and kale.

Calcium is an essential mineral for bone growth and is often malabsorbed in all degrees of celiac disease. Dairy foods are the best sources of calcium. However, many rice and soy beverages as well as fruit juices are now fortified with calcium.

Correcting calcium deficiencies can be quite challenging in the newly diagnosed celiac patient because many newly diagnosed patients are lactose intolerant. This is because lactase, the enzyme that digests lactose, is located on the tip of the villi in the intestine. If these villi are damaged the lactase enzyme is lost. Therefore, supplementing with the fortified alternatives as well as a gluten free calcium supplement may be indicated.

Sources of minerals

Magnesium, zinc and iron are other minerals that may be malabsorbed in the newly diagnosed celiac patient. Foods that are high in magnesium include legumes, tofu, nuts and dark green and leafy vegetables. Zinc is lost as a result of persistent diarrhea that may accompany untreated celiac disease. Children are also at risk for consuming inadequate amount of zinc. Foods that are good sources of zinc include meat, liver and seafood. Children with celiac disease may present iron deficiency anemia due to malabsorption of the mineral. Foods that are high in iron include meat, poultry, fish as well as dark green and leafy vegetables.

Malabsorption of B vitamins may also occur in newly diagnosed celiac patients, specifically B12 and folate. Foods that are rich sources of vitamin B12 are derived from animal products: meat, poultry, seafood, eggs and dairy. In contrast, foods that originate from a plant base are high in folate, for example, dark green leafy vegetables, oranges, strawberries and legumes.

Sources of carbohydrates, protein and fat

Carbohydrates, protein and fat are the energy nutrients. These nutrients are also necessary for proper growth and development. When certain portions of the small intestine are damaged from untreated celiac disease, these essential body building components are malabsorbed.

• Carbohydrates are found in the food at the base of the pyramid: fruits, vegetables and breads, cereals, rice and pasta.
• Protein is found in animal products: meat, fish and dairy.
• Fats are at the tip of the pyramid and include oils, butter, margarine, nuts and seeds.

Supplements

If a child has been living with undiagnosed celiac disease for several years, in addition to following a balanced diet, it may be necessary to provide them with vitamin and mineral supplements. Nutritional deficiencies may be corrected by providing the child with a multiple vitamin and mineral supplement, which provides 100 percent of the RDA for age. Freeda and Nature's Bounty vitamins are a gluten free supplement [(800) 777-3737 or www.freedavitamins.com]. For other gluten free vitamins, check with the manufacturers.

Children with celiac disease and suspected vitamin or mineral deficiencies should follow-up with a registered dietitian.

References: Korn, D. Kids with Celiac Disease, A Family Guide to Raising Happy, Healthy, Gluten-Free Children. Woodbine House; 2001. Mahan, LK. Escott-Stump, S. Krause's Food, Nutrition and Diet Therapy, 9th Edition. W.B. Saunders Company; 1996. Samour, PQ, Helm, KK, Lang, CE. Handbook of Pediatric Nutrition, 2nd Edition. Aspen Publishers, Inc; 1999.

DISCLAIMER: ALL NUTRITIONAL INFORMATION PROVIDED IN THIS ARTICLE IS GLUTEN FREE AT THE TIME OF PUBLICATION. IT'S SUGGESTED TO CHECK WITH THE MANUFACTURER.