How to Maintain Proper Nutrition and Bone Health in Celiac Disease Patients

The reduced bone density of patients is sometimes devalued by people, but the reality is that reduced bone density is how celiac disease is sometimes detected by doctors. According to the director of the Celiac Disease Center at New York-Presbyterian Hospital, about 10% of the patients with celiac disease in their Celiac Disease Center were diagnosed because of bone loss.

Among the factors that contribute to bone loss in celiac disease are nutrient malabsorption, tissue transglutaminase (tTG) antibodies, and enhanced cytokines circulation that delays bone development.

Having a balanced and nutritious diet is the best way to have healthier bones. If in any case, the patient has limitations to take in food rich in vitamins and minerals, it is highly advised for them to take multivitamin supplements.

It is also important to consult an expert to fully determine what exactly the patient is missing in their diet. Their deficiency in vitamins would determine the amount of supplements that the patient would need, just so the patient would receive the proper dosage.

Causes of improper bone health

Nutrient Malabsorption

According to Pam Cureton, RD, LDN, chair of Dietitians in Gluten Intolerance Diseases, people with celiac disease have a tendency for their villi that covers the small intestine to be destroyed by gluten.[1] When this happens, the area that absorbs nutrients such as calcium, magnesium, vitamins D and K, and B vitamins is reduced, which are very important when maintaining bone health. As a result, the bones won’t get enough nutrition, causing them to be reduced and become weak over time.

Another effect of the destruction of the villi is lactose intolerance. Lactase is produced in the tip of the villi so if this is destroyed, less lactase will be produced, resulting in less dairy intake. While dairy contains two essential nutrients (calcium and vitamin D), patients should always try to look for alternatives in order to be health. This may also include looking into supplements. 

Strictly following a gluten-free diet will allow the villi to regenerate so that nutrient absorption can be improved. Experts are continuously conducting research and experiments to improve the development of destroyed villi.

Tissue Transglutaminase (tTG) Antibodies

Tissue transglutaminase or tTG can be found in every tissue inside the body. This is an enzyme responsible for joining proteins together that contributes to proper bone development. If a person has celiac disease, tTG antibodies are produced in the gut whenever a patient consumes gluten or gliadin. With gluten or gliadin present, the antibodies prevent tTG from helping the bone develop properly, and usually in this case, this would cause an autoimmune response.

Inflammation (Enhanced Cytokines Circulation)

There is another way that the body’s immune system can cause problems for bones to develop properly. According to Matthew Greenblatt, MD, Ph.D., a resident in pathology at Brigham and Women's Hospital in Boston, the body’s immune cells or T-cells are the ones responsible in the creation of specific cytokines called osteoclasts. The osteoclasts are the ones that break down bones. Once a person with celiac disease takes in gluten, the creation of these cytokines is triggered.

Normally, doctors give patients some agents that could calm the immune system to limit the production of osteoclasts and improve bone density. Doctors would also advise patients to avoid consuming gluten.