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  • Jefferson Adams
    Jefferson Adams

    What's the Role of Nutrients in Non-Responsive Celiac Disease?

    Reviewed and edited by a celiac disease expert.

    While most people with celiac disease see a major improvement in symptoms once eating a gluten-free diet, nearly one-in-three continue to show symptoms, including ongoing gut inflammation.

    What's the Role of Nutrients in Non-Responsive Celiac Disease? - Image: CC BY-SA 2.0--Salim Virji
    Caption: Image: CC BY-SA 2.0--Salim Virji

    Celiac.com 02/19/2020 - What role, if any, do nutrients play in non-responsive celiac disease?

    A team of researchers recently set out to compile an overview of the causes of non-responsive celiac disease (NRCD) in adults, highlight a systematic approach to investigate these patients, and assess the latest approaches to managing this subset of celiac disease. 

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    The team included Hugo A. Penny, Elisabeth M. R. Baggus, Anupam Rej, John A. Snowden, and David S. Sanders. They are variously associated with the Academic Unit of Gastroenterology, University of Sheffield, Sheffield, UK; the Lydia Becker Institute of Inflammation and Immunology, University of Manchester in Manchester, UK; and the Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.  

    Celiac disease is a common autoimmune condition of the gut which results from gluten consumption by genetically susceptible individuals. A lifelong gluten-free diet is still the only currently recognized treatment for celiac disease. 

    While most people with celiac disease see a major improvement in symptoms once eating a gluten-free diet, nearly one-in-three continue to show symptoms, including ongoing gut inflammation. 

    Patients who continue to suffer symptoms on a gluten-free diet are said to have "non-responsive celiac disease". This may be due to ongoing gluten ingestion, witting or unwitting, slow healing, refractory celiac disease, and/or some other condition. 

    The team recently published their review of the causes of non-responsive celiac disease in adults. In their paper, they also delineate a process for investigating these patients, and gauge the latest approaches to managing this type of celiac disease.

    The main causes of non-responsive celiac disease:

    • An Alternative Primary Diagnosis
    • An Associated Condition
    • Dietary Indiscretion
    • Gluten Super-Sensitivity
    • Refractory Celiac Disease

    The researchers conclude:

    Quote

    Up to a third of individuals with CD develop NRCD. Dietary indiscretion is the commonest cause of NRCD, yet currently there is no reliable objective assessment of ongoing gluten ingestion in these patients. The diagnosis and management of RCD is challenging, and patients should be referred to a specialist center with multi-disciplinary experience in RCD for assessment, diagnostics, treatment, and follow-up. Novel therapeutic strategies are required to provide realistic treatment options in RCD2 to impact the dismal mortality in this condition.

    Read their full report in Nutrients



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    Posterboy

    To All,

    Here is a nice study of nutrient levels of Celiac's on a long term gluten free diet with good compliance.

    Open Original Shared Link

    I was kind of surprised that a Zinc deficiency is fairly common in Celiac's ....the same as Iron at 40pct and I usually don't see this discussed.  I had to take Zinc lozenges to help catch up on mine.  Pumpkin seeds are also a good source of Zinc.

    I also meant to include this link on appropriate aftercare for Celiac's....nutrient status after a year and/or annually should be checked but doctor's are not doing this (at least) my doctor doesn't.

    Open Original Shared Link

    I hope it is helpful medical advise.

    Posterboy,

    EDTA: See Table 1 which summarizes studied Vitamin deficiencies in a long term gluten free diet for a quick review scan of the study in the Results Section 3 Area.

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    Maverita

    By the time I was diagnosed as having celiac disease I had leaky gut syndrome and had developed multiple food allergies/sensitivities.  This was discovered slowly as I cleaned up my diet bit by bit.  My doctor accused me of not being compliant with the gluten-free diet, but she also suggested I use almond and rice milks, both of which contained just enough grain in the enzymes to set me off.  I have to be careful with cheese enzymes as well.  The WORST offender for me was the xanthum gum that they put in ALL the gluten-free flours nowadays.  Ditto citric acid -- often grain/vegetable vinegars, or even mold are sources of citric acid.  A relatively simple elimination diet can help you determine foods that might bother one.  After my gut healed I was able to add certain foods back into my diet, as long as I don't overdo them -- but some remain irritating to this day:  GMO corn, GMO soy, pork that eats mostly the previous 2, xanthum gum, chicory, and wheat/grain based anything (including amaranth and spelt), including the "gluten-free" (wheat) vinegars or grain alcohols (even the tiny bit in vanilla flavoring), which are also considered "gluten-free".   

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    Jefferson Adams
    On 2/24/2020 at 5:21 PM, Maverita said:

    By the time I was diagnosed as having celiac disease I had leaky gut syndrome and had developed multiple food allergies/sensitivities.  This was discovered slowly as I cleaned up my diet bit by bit.  My doctor accused me of not being compliant with the gluten-free diet, but she also suggested I use almond and rice milks, both of which contained just enough grain in the enzymes to set me off.  I have to be careful with cheese enzymes as well.  The WORST offender for me was the xanthum gum that they put in ALL the gluten-free flours nowadays.  Ditto citric acid -- often grain/vegetable vinegars, or even mold are sources of citric acid.  A relatively simple elimination diet can help you determine foods that might bother one.  After my gut healed I was able to add certain foods back into my diet, as long as I don't overdo them -- but some remain irritating to this day:  GMO corn, GMO soy, pork that eats mostly the previous 2, xanthum gum, chicory, and wheat/grain based anything (including amaranth and spelt), including the "gluten-free" (wheat) vinegars or grain alcohols (even the tiny bit in vanilla flavoring), which are also considered "gluten-free".   

    Many people with celiac disease have multiple sensitivities when first diagnosed. Often, as the gut begins to heal, many of these sensitivities can disappear. Also, read up on FODMAPs, which seem to cause celiac-like symptoms in many people. Btw: Grain fed meats have been shown to contain no gluten. Also, distilled alcohol or vinegar is also gluten-free, though some people claim sensitivity to these products. Definitely listen to your gut and avoid things that seem to make you feel bad.

     

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    Guest Outlier Babe

    Posted

    Re:  FODMAPs, OP has clearly had significant experience with elimination diets, and it thus seems unlikely, imo, these are the culprits.

    OP never claimed her reactions to vinegar or vanilla were gluten reactions.  She made clear a celiac's leaky gut caused many food sensitivities.

    If one of these sensitivities included corn, that would explain citric acid (grown on corn), vinegars, maltodextrin, xanthum gum (often corn-y), and a host of other food reactions.  I can have only some vinegars.  One brand of pricey vanilla, or make my own.  Though theoretically all certified as 100% olive oils should be safe, they are not.  Corn is even in most tea (bagged), including organic herbal ones, in "natural flavors".  I suspect many celiacs and non-celiac gluten-sensitive persons are sensitized to corn and unaware their bodies' immune reactions are being constantly triggered by this ubiquitous hugely water-hungry chemical-fertilizer-hungry massively-subsidized crop.

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  • About Me

    Jefferson Adams

    Jefferson Adams is Celiac.com's senior writer and Digital Content Director. He earned his B.A. and M.F.A. at Arizona State University. His articles, essays, poems, stories and book reviews have appeared in numerous magazines, journals, and websites, including North American Project, Antioch Review, Caliban, Mississippi Review, Slate, and more. He is the author of more than 2,500 articles on celiac disease. His university coursework includes studies in science, scientific methodology, biology, anatomy, physiology, medicine, logic, and advanced research. He previously devised health and medical content for Colgate, Dove, Pfizer, Sharecare, Walgreens, and more. Jefferson has spoken about celiac disease to the media, including an appearance on the KQED radio show Forum, and is the editor of numerous books, including "Cereal Killers" by Scott Adams and Ron Hoggan, Ed.D.

    >VIEW ALL ARTICLES BY JEFFERSON ADAMS

     


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