Monday, June 30, 2008

Celiac and Fat-Soluble Vitamins

One of the things I've been thinking about lately is the possibility that intestinal damage due to gluten grains (primarily wheat) contributes to the diseases of civilization by inhibiting the absorption of fat-soluble vitamins. If it were a contributing factor, we would expect to see a higher incidence of the common chronic diseases in newly-diagnosed celiac patients, who are often deficient in fat-soluble vitamins. We might also see a resolution of chronic disease in celiac patients who have been adhering faithfully to a long-term, gluten-free diet.

One thing that definitely associates with celiac disease is bone and tooth problems. Celiac patients often present with osteoporosis, osteopenia (thin bones), cavities or tooth enamel abnormalities (thanks Peter).

An Italian study showed that among 642 heart transplant candidates, 1.9% had anti-endomyosal antibodies (a feature of celiac), compared with 0.35% of controls. That's more than a 5-fold enrichment! The majority of those patients were presumably unaware of their celiac disease, so they were not eating a gluten-free diet.

Interestingly, celiac doesn't seem to cause obesity; to the contrary. That's one facet of modern health problems that it definitely does not cause.

The relationship between cancer and celiac disease is very interesting. The largest study I came across was conducted in Sweden using retrospective data from 12,000 celiac patients. They found that adult celiac patients have a higher overall risk of cancer, but that the extra risk disappears with age. The drop in cancer incidence may reflect dropping gluten following a celiac diagnosis. Here's another study showing that the elevated cancer risk occurs mostly in the first year after diagnosis, suggesting that eliminating gluten solves the problem. Interestingly, celiac patients have a greatly elevated risk of lymphoma, but a lower risk of breast cancer.

There's a very strong link between celiac and type I diabetes. In a large study, 1 in 8 type I diabetic children had celiac disease. This doesn't necessarily tell us much since celiac and type I diabetes are both autoimmune disorders.

One last study to add a nail to the coffin. Up to this point, all the studies I've mentioned have been purely observational, not able to establish a causal relationship. I came across a small study recently which examined the effect of a high-fiber diet on vitamin D metabolism in healthy (presumably non-celiac) adults. They broke the cohort up into two groups, and fed one group 20g of bran in addition to their normal diet. The other group got nothing extra. The bran-fed group had a vitamin D elimination half-life of 19.5 days, compared to 27.5 for the control group. In other words, for whatever reason, the group eating extra bran was burning through their vitamin D reserves 30% faster than the control group.

Unfortunately, the paper doesn't say what kind of bran it was, but it was probably wheat or oat (**Update- it's wheat bran**). This is important because it would determine if gluten was involved. Either way, it shows that something in grains can interfere with fat-soluble vitamin status, which is consistent with the staggering negative effect of refined wheat products on healthy non-industrialized cultures.

Add to this the possibility that many people may have some degree of gluten sensitivity, and you start to see a big problem. All together, the data are consistent with gluten grains interfering with fat-soluble vitamin status in a subset of people. As I discussed earlier, this could contribute to the diseases of civilization. These data don't
prove anything conclusively, but I do find them thought-provoking.

Thanks to Dudua for the CC photo


Chris said...

Really good post.

The more I am thinking about all this stuff, the more I think we need to take a "big picture" / holistic lifestyle view of things. We tend to concentrate on getting enough sunlight, fishoil, or whatever, but all that could be sabotaged by a sensitivity to gluten.

There is a whole complex of things going on - food, exercise, sleep, mental attitude etc

Hope that makes sense!

Stephan Guyenet said...


Definitely. Anything that's outside of our environmental niche is suspect!

Yuneek said...

"Unfortunately, the paper doesn't say what kind of bran it was, but it was probably wheat or oat (Allinson's Bran Plus-- anyone know?)."

The answer is yes.

Stephan Guyenet said...

Thanks yuneek. That link didn't work but I was able to find out that it's wheat bran. Is that the same thing your link said?

Yuneek said...

I got an http status 404 error attempting to return to the site which may be why the link isn't working.

The full text article specifically named Allison's Bran Plus.

Unknown said...

I feel like I've struck gold! I was diagnosed with early stages of osteoporosis at age 48, allergic to wheat (since 1987), diagnosed with neuralgia inducing cavitational osteonecrosis (dying jawbone)in 2003 and the list goes on! I refused to have most of my teeth removed and my jawbone scraped to remove the necrosis. Five different dentists had 5 different diagnosis. 1.5 years ago, I had a root canal A temporary fix. Symptoms are back and I am not going down the dental road again! Ran across "Cure Tooth Decay" by Ramiel Nagel. That led me to Nourishing Traditions (just ordered book today). Recieved my first bottle of GP Blue Ice Gold today. While searching Activator X I found your blog. I can't begin to thank you enough. I have always believed that - given the right conditions - our bodies will heal themselves. The challenge is figuring out those conditions. Back in '79 I had chronic fatigue.Went to a orthomolecular doctor (Dr. John Barons) and thru chelation therapy++, overcame CF. Since then,I've tried macrobiotics, rotation diet, NAET, liver cleanse diet, Adkins, Blood-type diet, Hallaleuah diet, and most recently, Maker's diet. All with varying degrees of success. You've helped me put some pieces of the puzzle together. Thank you for your unbiased truth about nutrition.

Stephan Guyenet said...

Hi Kim,

Glad to hear you are figuring things out. I assume you are gluten-free? I was reading an interesting paper today about the association between Celiac disease and bone problems.

CD kids had dramatically lower levels of vitamin D, and corresponding low calcium, and high parathyroid hormone levels. Many of them already had osteoporosis and osteopenia. They also speculated that systemic inflammation from CD could contribute to the bone problems. A gluten-free diet solved the vitamin D deficiency, low bone mineral density and high PTH.

I really do think gluten sensitivity is a spectrum, with Celiac disease being the most obvious manifestation. The fact that you are allergic to wheat is a big clue. I'll be posting more on that soon. Keep us filled in on your progress.

Caira said...

I'm reading through some of your old posts, and you've hit a topic that I really wish I knew more about: ideal food combinations.

I've often heard the following: Cinnamon and apples go together - from a culinary and biological point of view. The cinnamon helps to maintain blood sugar levels, which helps to balance the effects of the fruit sugars. Miso soup is another example: soy disturbs the thyroid, but the seaweed helps to stabilize it.

Maybe you've discovered a similar rule here: toast is only acceptable (for a non-celiac, of course) to eat if it has a generous amount of pastured butter on it.

Have there been any healthy cultures that ate wheat?

Ian said...

Caira: "Have there been any healthy cultures that ate wheat?"

The Sikhs, according to Dr. Robert McCarrison. Matt Stone has written several articles about McCarrison. He studied many tribes like Weston Price and his research complements Price's. The Hunzas may be another example, but I'm not sure.