Osteoporosis and Celiac Disease
Several years ago, at a gluten-free holiday dinner, I met Bill, a then-78-year-old with celiac disease.
As we chatted about gluten-free living and got to know one another, I learned that Bill had been diagnosed later in life, at age 70.
I was astonished, thinking of the suffering he must have endured before finally figuring out that celiac disease was the reason for all his maladies.
Except, Bill had not lived with any mysterious, undiagnosed illness or symptoms of celiac disease. In fact, he had always been the picture of health. Until he had a perfunctory bone scan at, you guessed it, age 70.
Bill had severe osteoporosis. He, and his doctors, were stunned.
With no known history of osteoporosis in his family, he wanted to find the root cause of the condition. After all, it was clear that something was wrong in his body.
After several months, Bill was tested for celiac disease as a “last resort” to determine the cause of his osteoporosis. Bingo! An endoscopy followed his positive blood test and Bill had a diagnosis and an answer about what caused his osteoporosis.
Osteoporosis leads to Diagnosis
As a result of small intestine damage in individuals with celiac disease, complications related to poor nutrient absorption often occur. For example, the inability to develop optimal bone mass in children and bone loss in adults. These factors can lead to osteoporosis. This is exactly what happened in Bill’s case.
Unfortunately, Bill was one of many with “silent celiac”, that is, celiac disease with no obvious outward symptoms. In his case, osteoporosis occurred due to untreated celiac disease, and subsequently led to his diagnosis. This is not uncommon.
Some studies reveal as many as 45% of newly diagnosed celiac patients also have osteoporosis at the time of their celiac diagnosis. While there is conflicting evidence in the research on that percentage, health care professionals generally agree that testing nutrient levels, including vitamin D and calcium, as well as performing a bone density test are advised in newly diagnosed CD patients. Further, in the elderly who fail to respond to treatment for osteoporosis, celiac testing is recommended.
Understanding the Importance of Nutrients for Bone Health
I believe a basic understanding of how our bodies function goes a long way in helping us appreciate the importance of nutrition. When it comes to our bones, they are quite exciting! Bones aren’t mere rock-solid supports like we tend to think. Our bones are living structures with a superhighway of nerves and blood vessels coursing through them to nourish them and keep them alive and strong.
Bones consist of several layers, too. Each layer has a different density.
Compact bone is the outer solid layer. Just beneath that lies a layer of spongy bone. It’s name is a bit deceiving – it really isn’t soft like a sponge – it is a less solid, porous layer with holes like a sponge.
And there’s even a fascinating network of cells – some breaking down and reabsorbing bone, others helping to form new bone.
Too bad all that is going on inside where we can’t see, isn’t it??
Of course, doctors can “see” our bones using a special x-ray that evaluates bone mineral density. This is the test Bill had.
This so-called bone density test doesn’t measure the true density of our bones (that would be a mass per volume measurement). Instead, this test uses x-rays to measure the amount of vital minerals in our bones.
If we have low mineral density in our bones that means our bones are more fragile and have a higher-than-average risk of breaking. It could also mean a diagnosis of osteoporosis, like in my friend, Bill.
Between those individuals already diagnosed with osteoporosis and those at high risk for the disease due to low bone mass, osteoporosis affects about 40 million people. Genetics certainly play a role in the osteoporosis equation, but there are other contributing factors, too, like celiac disease.
The Connection between Osteoporosis and Celiac Disease
Any disorder that reduces the body’s ability to absorb calcium, vitamin D, and other nutrients can cause osteoporosis. Because CD damages the small intestine, nutrient absorption is inhibited. That means the nutrients we eat don’t make it into our bloodstream and on to the places in our bodies where they are needed (like our bones).
Depending on how long an individual has CD before diagnosis (and before going on a gluten-free diet), they could be quite deficient in a variety of nutrients, including those that affect bone health.
Even after going on a gluten-free diet, it can take quite some time for the small intestine to heal and properly absorb the nutrients we consume.
But even if genetics aren’t in your favor when it comes to osteoporosis and/or if you have CD, there are steps you can take to help prevent bone loss through diet.
To understand how, it’s important to look at some facts about calcium and its role in bone health.
The Calcium Myth
When it comes to eating for bone health, getting the right nutrients is essential.
Because of what we were told for decades, most of us believe downing loads of calcium is super-protective for our bones and can prevent low mineral density and subsequent fractures.
According to leading research from Harvard University School of Medicine that’s just not so.
The breaking news in this area of research occurred in 2005 when two British studies hit the press. They both indicated calcium (even when taken along with vitamin D, which aids calcium absorption) did not prevent bone fractures.
This was a shocking revelation!
American researchers followed with a 2006 revealing results from a large long-term study called the Women’s Health Initiative. This study showed that calcium (again, taken along with vitamin D) did no more to prevent broken bones than a placebo (biologically inert substance).
One year later, researchers from Switzerland and America teamed up (including several from Harvard’s medical school) to conduct a huge analysis of more than one dozen studies of calcium as it is related to bone fracture (specifically to hip fractures).
Absolutely no connection between high calcium intake (from food or supplements) and lowered risk of hip fracture was found.
In fact, in four clinical trials, these scientists discovered extra calcium actually increased the risk of hip fracture! How could this be?
Calcium Plays a Backseat Role in Bone Health
Bone is made mostly of collagen, a protein found in various body tissues that is woven into a strong, yet flexible framework.
It is the combination of calcium and collagen that makes our bones so strong and resilient.
So, calcium IS important, just not the “end all be all” for strong bones as was once believed.
Extra calcium is not beneficial. That’s because too much calcium can interfere with the absorption of other key nutrients like phosphorus, also important for strong bones. This is a particular concern with diets low in high-quality protein.
Another reason calcium may not have such an impact on reducing fractures may be related to vitamin D deficiency.
As I mentioned earlier, vitamin D increases the body’s ability to absorb calcium. Many Americans, particularly those with CD, have low levels of vitamin D in their blood, again, due to poor nutrient absorption.
How Much Calcium Do We Need?
The current recommendation for adults 19-50 years old is about 1,000 mg of calcium each day. For adults over 50, that amount increases to 1200 mg per day.
We should note; however, that the well-respected chair of Harvard’s School of Public Health nutrition department, Dr. W. C. Willett, says most Americans get more calcium than needed.
He recommends 600 mg per day to keep fracture risk low, but does acknowledge the extra calcium (up to a total of 1000-1200 mg per day) may protect against certain cancers (like colon cancer).
Willett also points out the negative health effects of overdoing calcium when it comes from dairy foods, based on studies that link high consumption of dairy products to ovarian and prostate cancer.
Other Vital Nutrients in Bone Health
Again, keep in mind it is not only calcium that is needed for optimal bone health. Supporting nutrients like Vitamin D, vitamin K and minerals like potassium, magnesium and zinc – in the proper proportions – help the body absorb more calcium.
For example, Vitamin D, taken in conjunction with calcium, is known to prevent bone loss. Our bodies make vitamin D when exposed to sunlight and from certain foods. Learn more about vitamin D, its sources and daily recommended intake here.
Magnesium is vital to strong teeth and bones, as it helps regulate calcium levels (and levels of other vital nutrients and vitamins in the body, such as copper, zinc, potassium and vitamin D).
Getting our nutrients through diet is important; however, there are times when supplements may be necessary to enhance nutrition and support healing, especially in the case of poor nutrient absorption in celiac disease.
Keep in mind, in your search for a supplement for bone health, not all products are created equal. For a trusted source of gluten-free, readily bioavailable nutrients properly formulated to support strong, healthy bones I recommend Celi-Vites for Bone Health. I encourage you to read about the passion- and purpose-driven company, Gluten Free Therapeutics, makers of Celi-Vites supplements. You will quickly understand why I trust these products so.
Whether you supplement or not, always remember to garner optimal nutrition from fresh fruits and vegetables by eating them in season, and avoiding over-consumption of processed foods.