GFG: Let’s start with the basics. What is celiac disease?
Sherry Torkos: Celiac disease is an autoimmune disease triggered by consumption of gluten. In people with celiac disease, consumption of gluten stimulates the immune system to produce antibodies that attack the small intestine and many other body tissues, causing widespread inflammation and damage. This results in digestive problems, impaired nutrient absorption, a variety of physical and emotional symptoms and serious health risks. In most cases, the damage is reversible once gluten is excluded from the diet.
Who is at risk and why?
Celiac disease affects nearly 1% of Canadians. Genetics plays a role in who will develop celiac disease. Studies have shown that the familial occurrence of the disease ranges from 10% to 22%. There are 3 things required for a person to develop celiac disease:
1. Genetic disposition – carrying the genes associated with the disease
2. Trigger – exposure to an environmental, emotional or physical event, such as adolescence, pregnancy, childbirth, infection, surgery, an accident or stressful situation
3. Diet – eating foods that contain gluten, such as wheat, rye and barley or their derivatives
What kinds of food contain gluten?
Gluten is present in many foods, including breads, pasta, cereals, cookies, cakes and pie. These are the obvious sources, but it is also “hidden” and not so obviously found in many sauces, marinades, spices, coatings and thickeners. It is also present as an additive in some drugs and vitamin supplements.
Speaking of vitamins, is it important for people with celiac disease to take vitamins or nutritional supplements?
As a pharmacist I am often asked this question. The answer depends on many factors: state of health, age, lifestyle, diet, use of medications and other factors that can impact nutritional status (such as stress, smoking, drug use).
For many people, nutritional supplements can play an important role in optimizing health. The majority of people with celiac disease suffer for a long time prior to diagnosis. The intestinal damage caused by years of ingesting gluten can be quite significant. Since nutrient absorption occurs through the intestine, undiagnosed celiac disease can result in malnutrition and signs of nutrient deficiency, such as anemia, skin rash, fatigue, poor cognitive function and stunted growth of hair and nails. It may take several months for the intestines to heal on a strict gluten-free diet. Despite even the best efforts to follow the diet strictly, inadvertent ingestion of gluten can occur and this can compromise the health of the intestines and the ability to absorb nutrients. Lastly, the gluten-free diet, while healthy, can be lacking in certain nutrients. Gluten-free flours are typically lower in fibre and not enriched with iron and B vitamins. Nutritional supplements can help facilitate healing of the body, aid digestion and compensate for possible dietary deficiencies.
Click “more” to see what supplements people with celiac disease should consider taking…
What supplements should people with celiac disease consider taking?
A MULTIVITAMIN AND MINERAL COMPLEX can complement your diet and ensure that your body is getting all essential nutrients required for good health. Capsules are easier to digest and absorb. Hard-coated tablets may have coatings and dyes that impair absorption or cause allergic reactions. Take your multi with or just after a meal.
It is important to make sure that your vitamin is gluten free. Some companies add gluten as a binder. My top pick for women is femMED’s Multi + Antioxidants.
ESSENTIAL FATTY ACIDS (EFAs) are good fats that are essential for health throughout life. They are required for the health of our brain, nervous system, adrenal glands, sex organs and eyes. They also maintain the health of cell membranes, produce hormones and brain chemicals, and regulate various cell processes. Those with celiac disease may be at particular risk of EFA deficiency, especially prior to following a gluten-free diet, due to malabsorption of fat from the damaged intestine.
The body cannot make EFAs, so they must be obtained through diet or supplementation. The two main classes of EFAs are omega-3s and omega-6s. Omega-6s are found abundantly in vegetable and seed oils, so most people get adequate amounts from diet. Omega-3s are present in fish and, to a lesser extent, in some plants (chia seed, flaxseed and leafy green vegetables). Omega-3 deficiency is thought to be quite common and supplementing with omega-3s has shown to offer a number of health benefits, such as reducing the risk of heart attack and improving brain function and skin health. Omega-3 supplements are also recommended for women who are pregnant or trying to get pregnant, as these good fats are essential to the growing brain, eyes and nervous system of the baby.
Fish oil provides the highest amount of omega-3s. Choose a quality fish oil supplement from a reputable manufacturer, such as Heart Health by femMED. Those who cannot tolerate fish oils can take chia seed oil or flaxseed. There are specific formulas for children with improved taste and texture.
DIGESTIVE ENZYMES are found naturally in raw foods and produced to some extent by the body. They aid in the breakdown and digestion of food and may be particularly beneficial to those with celiac disease who face impaired digestion and nutrient absorption. There are some new products designed specifically for those with celiac disease or gluten/casein sensitivity, such as Gluten Defense, which provides a wide range of plant enzymes to support complete digestion of all types of nutrients, such as carbohydrates, proteins and fats. This particular blend of enzymes has been shown to aid in the breakdown of gluten and gliadin from foods. This product is NOT intended to replace the gluten-free diet—it is to be taken to aid digestion and mitigate the impact of hidden gluten and casein. Digestive enzymes are best to take just before a meal or with the first few bites.
Also known as friendly or beneficial bacteria, PROBIOTICS, such as acidophilus, are normally present in the digestive and urinary tracts. Probiotics provide many health benefits: They protect against infection by harmful bacteria and yeast, assist in detoxification, produce B vitamins, aid digestion and support immune function. They can improve bowel function and aid both constipation and diarrhea. Those with celiac disease may be deficient in beneficial bacteria because of intestinal damage; supplementing with fermented dairy foods (live cultured yogurt) or supplements may help improve various aspects of health. Some probiotics supplements are stable at room temperature whereas others require refrigeration.
OTHER SUPPLEMENTS may be necessary depending on one’s individual health status. For example, those at risk of osteoporosis may require additional bone health supplement that contains calcium, magnesium and vitamin D. Vitamin D is not only essential for bone health but there is a growing body of evidence suggesting that it can play a role in the prevention of many other chronic diseases, including cancer and diabetes. It is important to consult with your health care provider if you have any health concerns and before you start taking any new drugs or supplements.
When someone is first diagnosed with celiac, what supplements can help heal their gut?
A MULTIVITAMIN AND MINERAL COMPLEX is absolutely essential to correct deficiencies and promote healing. The most common deficiencies include calcium, magnesium, iron, zinc, vitamins D and K and folic acid. Even those who are stable on a gluten-free diet and in remission may still have nutrient deficiencies and would benefit from a supplement. Those with severe malnutrition and deficiencies may require higher-than-typical amounts.
GLUTAMINE is an amino acid that supports the immune system and gastrointestinal health. Glutamine may help repair damage to intestinal lining. Dosage: 3 to 30 grams daily, as advised by your practitioner.
ESSENTIAL FATTY ACIDS (EFAs) are highly recommended to correct deficiencies, reduce inflammation and promote healing of intestinal cells. Look for a product that provides both omega-3 (fish) and omega-6 (borage, primrose) fatty acids. Dosage: 1 to 3 grams daily.
DIGESTIVE ENZYMES may be depleted in those with celiac. They aid proper digestion of food and are particularly important in newly diagnosed individuals. Once the intestines have healed, enzymes may not be necessary. Look for a broad-spectrum product containing lipase, amylase and protease along with DPP IV, an enzyme that has been shown to aid in the breakdown of gluten. Enzymes are not to replace a gluten-free diet but rather to aid digestion and, in the case of DPP IV, to mitigate the effects of hidden gluten in the diet. Dosage: Take as directed before meals.
As someone living with celiac disease, how do you avoid being glutened?
Despite my best efforts, I inevitably get poisoned by gluten at least once a year. I travel a lot for work and this means eating out in restaurants. I always explain my dietary restrictions in detail to the chef (rather than the server to make sure the message doesn’t get mixed up) and while most are very informed today about celiac disease and where gluten is present, there are still some who are lacking in knowledge in this area. I am very sensitive to gluten and can react to even a few breadcrumbs that make their way into my salad or to cross contamination that may occur during food preparation.
When was the last time you were glutened?
The last time I got sick was eating out at a restaurant in Toronto that promotes the fact that they offer gluten-free items on their menu. It was a busy night, the chef was busy and the server assured me that he understood the severity of my diet. However, he brought me out fish that was crusted with a coating that contained gluten. About an hour or so later I was in agony.
What can you do to feel better when this happens?
There is nothing that a person with celiac disease can take to prevent getting sick or reverse the damaging effects of gluten once gluten is consumed. To ease digestion in the immediate stages after consuming gluten, I would suggest minimizing high fibre foods, spicy foods and dairy. Drink lots of water and take glutamine, probiotics and essential fatty acid supplements to promote healing.
Can you tell us a bit about your celiac diagnosis?
When I was a teenager I started to experience horrible gastrointestinal symptoms. My parents took me from doctor to doctor in search of a diagnosis. First I was told that I had irritable bowel and was put on a special diet. That didn’t help. Then I was diagnosed with colitis and put on powerful sulfa drugs and prednisone. Again, this didn’t help and my situation started to deteriorate. The next doctor told my parents that he thought that I was just an emotional teenager and that my issues were all in my head! Imagine that. I was physically ill with obvious symptoms. And despite my chronic diarrhea, I was instructed to increase my fibre intake and mix wheat bran into juice several times a day. At this point I had lost over 25 pounds, which was a lot for my five-foot frame, I had diarrhea all day long, my skin was covered with eczema, I was anemic, my hair stopped growing and I was emotionally depressed. These were all clear signs of malnutrition, yet somehow the doctors I saw missed that.
After much insistence by my parents, I was finally referred to a gastroenterologist. He was quite confident that these problems were not all in my head. In fact, during my fist visit he told me that he suspected that I had celiac disease but in order to properly diagnose it I would require a biopsy of my small bowel. This was the first time I had heard about celiac disease, so not knowing anything about it was a little scary. He told me that if I had celiac it meant that my body was reacting to gluten, a protein found in many grains. And if the test was positive I would have to give up many of my favourite foods, such as pizza, breads, pasta, cookies and other foods that contain flour. I recall thinking, what’s left?
My biopsy ended up being positive. And while I was a little afraid of what life would be like as a celiac, I was relieved to finally know what was wrong with me. It took me a while to adjust to the gluten-free diet but I soon found out that if I was strict in avoiding gluten my symptoms would disappear and I would feel better. While my symptoms resolved fairly quickly on a gluten-free diet, it took years for other aspects of my health to improve. My skin, hair, nails, energy levels and even cognitive function were still not optimal. It was through my research and training in health and medicine that I discovered how to use supplements to correct the long-standing nutritional deficiencies that were continuing to affect my physical and emotional well being. Now, more than 20 years later, great progress has been made in our understanding of celiac disease and its management. More and more restaurants and food companies are offering gluten-free products, making it easier to live without gluten.
Coping with a health problem at such a young age was a life-altering experience and filled me with a passion for health and a willingness to look “outside the box” for answers. After high school, I studied science, pharmacy and nutrition in Philadelphia and went on to build a holistic pharmacy practice in the Niagara area of Ontario. In my practice, I have worked with many people facing serious health challenges, such as heart disease, diabetes, cancer and depression. And I have seen how remarkably well the body can heal and repair when it is given the proper elements.
Sherry Torkos has been practicing holistic pharmacy in the Niagara region of Ontario since 1992. Her philosophy of practice is to integrate conventional and complementary therapies to optimize health and prevent disease. Sherry has won several national pharmacy awards for providing excellence in patient care. As a leading health expert, she is on the medical advisory board for femMED and is frequently interviewed on radio and TV talk shows throughout North America and abroad on health matters. Sherry has authored 16 books and booklets, including Saving Women’s Hearts, The Canadian Encyclopedia of Natural Medicine and The Glycemic Index Made Simple.