Does Celiac Disease Cause a Deficiency in Vitamins and Minerals?
Celiac disease is one of the most common autoimmune disorders affecting the functioning of the gastrointestinal tract. For those with the disease, there is a reason for concern. Those with celiac disease often have malabsorption syndrome, which leads to a deficit of various minerals and vitamins. If the disease is untreated, it can lead to villous dystrophy, which is the damage to the finger-like structures in the small intestines that play a vital role in the absorption of nutrients.
Although classical symptoms like chronic diarrhea and bloating are common in celiac, some people may only get diagnosed due to malnutrition. It is not uncommon to find the deficiency of one or more vitamins and minerals in celiac patients at the time of diagnosis, and can make patients also experience symptoms of anemia. It is estimated that as many as 90% of celiac patients have a deficit of one or more micronutrients at any given time. Moreover, these nutritional deficiencies are not much related to the severity of symptoms and nutritional status.
Although women are more likely to take supplements, nonetheless, deficiency of vitamins and minerals is equally present in both genders with celiac disease, which makes diagnosis critical for a number of different patients.
What are the common deficiencies in celiac disease?
Folic acid deficiency is quite common in celiac disease, which may lead to anemia, mood disorders, poor nerve health, infertility, and much more. It is estimated that at least one-fifth of those living with celiac have folate deficiency. Macrocytic anemia is one of the most common signs of folate deficiency in celiac disease. It is estimated that at least one-third of those living with celiac disease also have anemia. In fact, anemia due to folate and iron deficiency is commonly present at the time of diagnosis of celiac disease.
Similarly, deficiency of water-soluble vitamins (B6 and B12) are also common in celiac and found in at least 20% of the cases, despite the fact that many of them are taking a multivitamin or B-complex containing supplements. At present, researchers are finding it difficult to explain the cause of this deficit, since vitamin B12 is mainly absorbed in the terminal ileum. While in celiac disease, the distal part of small intestine is more commonly affected. Further, studies have shown that in many people with vitamin B12 deficiency symptoms gastric dystrophy was absent. It has led researchers to think that vitamin deficiency in celiac disease may be caused due to a shortage of some other factors in the disease.
Whatever be the cause, it is not easy to diagnose the deficiency of vitamin B12, until the deficiency becomes too severe. A little deficiency of vitamin B12 would not show any signs in most people. Thus it may take really long to know the vitamin B12 deficit. Some of the common symptoms of severe vitamin B12 deficiency are fatigue, pale skin, the sensation of pins and needles (especially in the feet), mouth ulcers, glossitis, the difficulty of movement, altered vision, dizziness, and, in rare cases, high body temperature.
Apart from a deficiency of various water-soluble vitamins, deficiencies of fat-soluble vitamins are also prevalent in celiac disease. So, in celiac disease, there may be a deficit of vitamin A, E, and D. Deficiency of vitamin D would result in the weakening of bones and nails. Therefore, many clinicians recommend the higher intake of vitamin D in those living with celiac disease. Vitamin A is essential for ocular health; problems of night vision are a common symptom of its deficit. Our body has vast stores of vitamin A. So, its deficit develops only if a person has been living with celiac disease for years.
Among mineral deficiency, zinc is commonly found in celiac disease, though research does not know much about this yet. Diagnosis of zinc deficiency is considered to be extremely difficult in clinical conditions. It is thought that zinc deficiency is a result of the increased loss of minerals, rather than due to absorption defects. Lack of zinc may play a role in anemia; it may also cause skin lesions. Zinc is also known to play a vital role in cell-mediated immunity and is also a powerful antioxidant.
Why vitamins and the nutrient deficit is so prevalent in celiac?
It is thought that the deficit of various minerals and vitamins occur much before a person is diagnosed with celiac. These are often the people with an inadequate nutritional intake. It is estimated that malnutrition is present in almost one-fifth of all cases with celiac disease, with more than 10% reporting unintentional weight loss before being diagnosed with celiac, while around 7.5% are thought to have BMI below 18.5 kg/m2.
Further research indicates that most of those living with malnutrition in celiac disease did not report any changes in their diet before the diagnosis, suggesting that the loss of nutrition through feces and malabsorption are the primary reasons for malnutrition.
Most of the specialists of celiac disease think that malnutrition in the disease is perhaps due to a combination of factors, like malabsorption, poor digestion, increases loss through fecal mass, and inadequate intake of nutrients.
Another reason for the presence of malnutrition at the time of diagnosis is the delay in the diagnosis itself. In many cases, it may take up to 10 or more years to be diagnosed from the appearance of the first symptoms. It actually takes a long period of time to cause such needless harm to the body, which make it no surprise that even individuals with signs of mild celiac show the signs of nutritional deficiency and weight loss.
In fact, one clinical trial in Italy concluded that celiac disease should never be considered as mild based on its clinical presentation since the mildness of gastrointestinal symptoms does not provide a clear picture. In the research, it was found that those suffering from a mild form of enteropathy demonstrated an equal level of the nutritional deficit when compared to those displaying severe enteropathy. So, even in milder cases, there were alterations in bone density an indicator of severe nutritional deficit.
Based on the analysis of massive data and clinical trials, it could be said that those living with celiac should regularly monitor their body weight, and more often have blood tests to find out their levels of certain vitamins and minerals. These checkups should not depend on the severity of symptoms, as just anyone with celiac disease is at risk of developing vitamin and mineral deficiencies. Moreover, deficiencies of vitamins and minerals evolve over the years, and in most cases, symptoms are either absent or vague before the deficit becomes severe enough.
Everyone living with celiac disease must pay particular attention to micronutrients and their supplementation. There is also a need for higher intake of vitamins and minerals then recommended in RDA as those recommendations are for healthy individuals and not for those with the compromised functioning of their gastrointestinal tract. At the same time, there is need to avoid hypervitaminosis, overconsumption of pyridoxine and iron could be harmful too. In general, supplementation can reverse the symptoms of various deficiencies, and may significantly improve the quality of life in celiac disease.
References
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