Gluten free, not nutrient free

Tags: nutrition, dairy council, celiac disease

Gluten free, not nutrient free

By Teresa Wagner, M.S., R.D./L.D.
Director of Dairy Confidence and Medical Outreach, Dairy Max Incorporated

The prevalence of celiac disease in average healthy Americans is 1 in 133, with odds increasing to 1 in 22 for people with first-degree relatives who are celiac and to 1 in 39 for those with second-degree relatives. In the landmark prevalence study on celiac disease, investigators determined that 60 percent of children and 41 percent of adults diagnosed during the study were asymptomatic.(1)

With celiac disease affecting at least 3 million Americans, it is an important public health risk when one understands the breadth of nutritional deficiencies that can greatly impact quality of life as well as health care costs. The average length of time it takes for a symptomatic person to be diagnosed with celiac disease in the United States is four years; this type of delay dramatically increases an individual’s risk of developing autoimmune disorders, neurological problems, osteoporosis and even cancer.(2) Symptoms of celiac disease are as varied as the nutritional deficiencies caused by the lack of absorption. The most common symptoms include chronic diarrhea or constipation, pale and bulky stools, abdominal cramping, intestinal gas (flatulence), distention and bloating, anemia, fatigue, weakness, lack of energy, weight loss, depression, irritability, and growth retardation in children.

Celiac disease is a chronic digestive disorder affecting genetically susceptible individuals. It goes by many names. It is also called celiac sprue, non-tropical sprue, malabsorption syndrome, gluten sensitivity or gluten-sensitive enteropathy. Celiac disease may strike at any age, from babies who have just been introduced to foods containing gluten to the elderly. But once diagnosed, it is for life. Children cannot outgrow celiac disease. The saying “once a celiac, always a celiac” is all too true.

In celiac disease the absorptive surface of the small intestine is damaged when gluten-containing grains are eaten. So the body is unable to absorb the nutrients—protein, fat, carbohydrates, vitamins, and minerals—which are necessary for good health. The term “gluten” refers to the damaging protein involved in celiac disease, but this term is not scientifically accurate. There are actually separate proteins in each of the gluten-containing grains.

The gluten-free diet is the only treatment for celiac disease. This means that the diet of patients with celiac disease must be strict, involving complete, lifelong avoidance of all products containing gluten. Thus, the need to include adequate amounts of nutrient-rich foods to meet nutritional needs becomes imperative. Patients should work closely with a registered dietitian to help them choose fruits, vegetables, lean proteins, non-gluten containing grains and adequate dairy as a temporary lactose intolerance may occur with the inflammation of the brush border of the intestine.

With half of all Americans over age 50 facing risk of osteoporosis by 2020, it becomes even more important to find ways to include dairy during this period of temporary lactose intolerance for the unique package of bone-building nutrients milk, cheese and yogurt contain. Lactose intolerance guidelines including use of small amounts of dairy at a time with food—hard cheeses, yogurt and lactose-free or lactose-reduced products—can be helpful in assisting patients in consuming adequate dairy. Fortunately, with healing of the intestinal surface, the lactose intolerance usually goes away. At that point, it becomes important to continue consumption of at least three servings of dairy per day for adequate calcium, potassium and magnesium for strong bones and overall health. Children, in particular, have shown an ability to recover from the effects of calcium deficiency and resume normal growth. Patients may require interim vitamin and mineral supplementation as well as bone density evaluation to check for possible bone loss due to calcium malabsorption.

Overall, gluten intolerance and the related diseases can be detrimental in many areas of health care regarding nutrient deficiency. A registered dietitian is the expert in food and nutrition that can assist in ensuring that people consume nutrient rich diets to help prevent secondary disease states such as osteoporosis related to strict dietary restrictions. To refer your patients to a registered dietitian in your area, go online to or, or ask our dietitian at


  1. A multi-center study on the sero-prevalence of celiac disease in the United States among both at risk and not at risk groups. Fasano, et al., Archives of Internal Medicine, February 2003.
  2. Characteristics of adult celiac disease in the USA: results of a national survey. Green, PH, et al., American Journal of Gastroenterology, 2001, 2006.