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Search Health Information    Celiac Disease (Holistic)

Celiac Disease (Holistic)

About This Condition

The gluten found in grain may trigger celiac disease in some people. By keeping a close eye on your diet, you can remedy many of the symptoms. According to research or other evidence, the following self-care steps may be helpful.
  • Mix in a multi

    Take a daily high potency multivitamin that will supply your body with all the essential micronutrients, especially iron, vitamin D, vitamin K, calcium, magnesium, folic acid, and zinc

  • Breast-feed your baby

    Reduce your newborn’s risk of developing celiac disease by breast-feeding for more than a month

  • Go gluten-free

    Work with a knowledgeable health professional to find out which gluten-filled foods should be avoided

  • Get routine checkups

    Have your doctor monitor your bone health, check for anemia, and make sure you are not developing nutritional deficiencies

About

About This Condition

Celiac disease (also called gluten enteropathy) is an intestinal disorder that results from an abnormal immunological reaction to gluten, a protein found in wheat, barley, rye, and, to a lesser extent, oats .

In addition to damaging the lining of the small intestine, celiac disease can sometimes affect other parts of the body, such as the pancreas (increasing the risk of diabetes), the thyroid gland (increasing the risk of thyroid disease), and the nervous system (increasing the risk of peripheral neuropathies and other neurological disorders). Occasionally, such damage occurs only in one or more of these parts of the body in the absence of damage to the intestines.

Symptoms

Celiac disease may not cause symptoms in some people. However, others may have a history of frequent diarrhea ; pale, foul-smelling, bulky stools; abdominal pain, gas, and bloating; weight loss; fatigue; canker sores ; muscle cramps; delayed growth or short stature; bone and joint pain; seizures; painful skin rash; or infertility. Microscopic examination of the small-intestinal lining reveals severe damage, especially in the jejunum (the central portion of the small intestines). People with untreated celiac disease may eventually experience malaise and weight loss and have an increased risk of developing anemia , osteoporosis , osteomalacia , and certain types of cancer. In addition to physical symptoms, some people may experience emotional disturbances, including feelings of anxiety and depression .

Healthy Lifestyle Tips

In one study, children who were breast-fed for less than 30 days were four times more likely to develop celiac disease, compared with children who were breast-fed for more than 30 days.1 Although this study does not prove that breast-feeding prevents the development of celiac disease, it is consistent with other research showing that breast-feeding promotes a healthier gastrointestinal tract than does formula-feeding.2

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why
Go gluten-free
Work with a knowledgeable health professional to find out which foods with gluten should be avoided.

All doctors agree that consumption of the gluten-containing grains wheat, barley, and rye must be avoided in all celiac patients. Less consensus exists regarding the advisability of eating or restricting oats and oat products. While oats contain a substance similar to gluten, modern research suggests that eating moderate amounts of oats does not cause problems for most people with celiac disease.3 , 4 In one of these reports, approximately 95% of people with celiac disease tolerated 50 grams (almost two ounces) of oats per day for up to 12 months.5

Strict avoidance of wheat, barley, and rye, and of foods containing ingredients derived from these grains, usually results in an improvement in gastrointestinal symptoms within a few weeks, although in some cases the improvement may take many months. Tests of absorptive function usually improve after a few months on a gluten-free diet.6

Many people with celiac disease become symptom-free when following gluten-free diets. Others, however, continue to experience symptoms, often resulting from the presence of trace amounts of gluten either permitted in some gluten-free diets or consumed by mistake. Such mistakes are easy to make because many processed foods contain small amounts of gluten. For people with residual symptoms, a diet that truly eliminates all gluten, followed by open and double-blind challenges, resulted in symptomatic improvement in 77% of those studied.7 A careful dietary analysis should ensure that all trace amounts of gluten are removed from the diet. If this fails to relieve symptoms after three months, then other food intolerances should be ruled out using an elimination diet.

Avoiding gluten may also reduce cancer risk. In one trial, 210 people with celiac disease were observed for 11 years. Those who followed a gluten-free diet had an incidence of cancer similar to that in the general population. However, those eating only a gluten-reduced diet or consuming a normal diet had an increased risk of developing cancer (mainly lymphomas and cancers of the mouth, pharynx, and esophagus).8

Children with untreated celiac disease have been reported to have abnormally low bone mineral density. However, after approximately one year on a gluten-free diet, bone mineral density increased rapidly and approximated the level seen in healthy children.9 Long-term adherence to a gluten-free diet ensures normal bone density and is an important preventive measure in young people with celiac disease.10

Adults with celiac disease also have significantly lower bone mineral density than do healthy adults. After consumption of a gluten-free diet for one year, bone mineral density of the hip and lumbar spine has been reported to increase by an average of more than 15%.11

Infertility, which is common among people with celiac disease, has been reportedly reversed in both men and women after commencement of a gluten-free diet.12

Try an elimination diet
Some people with celiac disease may be intolerant to other food components in addition to gluten. An elimination diet can help rule out other food intolerances.

Some people with celiac disease may be intolerant to other foods, in addition to gluten. Foods that have been reported to trigger symptoms include cows’milk13 and soy.14 , 15 , 16

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
2 Stars
B6, B12, and Folic Acid
3 mg vitamin B6, 0.8 mg folic acid, and 0.5 mg vitamin B12
Daily supplementation with a combination of vitamin B6 (3 mg), folic acid (0.8 mg), and vitamin B12 (0.5 mg) have been shown to help relieve depression in people with celiac disease.
In one trial, 11 people with celiac disease suffered from persistent depression despite being on a gluten-free diet for more than two years. However, after supplementation with vitamin B6 (80 mg per day) for six months, the depression disappeared.17 Daily supplementation with a combination of vitamin B6 (3 mg), folic acid (0.8 mg), and vitamin B12 (0.5 mg) for 6 months also improved psychological well-being in people with long-standing celiac disease who had poor psychological well-being despite being on a strict gluten-free diet.18
2 Stars
Calcium
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with calcium may correct a deficiency.

Caution: Calcium supplements should be avoided by prostate cancer patients.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .19 Zinc malabsorption also occurs frequently in celiac disease20 and may result in zinc deficiency, even in people who are otherwise in remission.21 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.22

2 Stars
Digestive Enzymes
Consult a qualified healthcare practitioner
Some evidence suggests that enzyme supplements may be useful at the beginning of dietary treatment for this disease.

People with celiac disease often do not produce adequate digestive secretions from the pancreas, including lipase enzymes 23 In a double-blind trial, children with celiac disease who received a pancreatic enzyme supplement along with a gluten-free diet gained significantly more weight in the first month than those treated with only a gluten-free diet.24 However, this benefit disappeared in the second month, suggesting enzyme supplements may only be useful at the beginning of dietary treatment.

2 Stars
Folic Acid
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with folic acid may correct a deficiency.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .25 Zinc malabsorption also occurs frequently in celiac disease26 and may result in zinc deficiency, even in people who are otherwise in remission.27 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.28

2 Stars
Iron (Iron-Deficiency Anemia)
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with iron may correct a deficiency.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .29 Zinc malabsorption also occurs frequently in celiac disease30 and may result in zinc deficiency, even in people who are otherwise in remission.31 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.32

2 Stars
Magnesium
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with magnesium may correct a deficiency.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .33 Zinc malabsorption also occurs frequently in celiac disease34 and may result in zinc deficiency, even in people who are otherwise in remission.35 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.36

2 Stars
Multivitamin
Select a high potency formula and follow label directions
Some doctors recommend taking a high-potency multivitamin-mineral supplement to reduce the risk of nutrient deficiencies caused by the malabsorption that occurs in celiac disease.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .37 Zinc malabsorption also occurs frequently in celiac disease38 and may result in zinc deficiency, even in people who are otherwise in remission.39 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

It is possible that subtle deficiencies of other nutrients may exist in people with celiac disease who are on a gluten-free diet and are in remission. People who are not strictly avoiding gluten are likely to have more severe deficiencies. Because of the complexity of this condition and the multiple nutritional factors involved, people with celiac disease should be under the care of a doctor. Some doctors may recommend use of nutritional supplements, including a high-potency multivitamin-mineral supplement, to reduce the risk of future deficiencies. No controlled trials have investigated the value of supplements in the minority of celiac disease patients who do not go into remission in response to a gluten-free diet.40

2 Stars
Vitamin A
Consult a qualified healthcare practitioner
Vitamin A deficiency may occur as a result of celiac disease, in which case vitamin A supplements or injections can be beneficial.

In one study, six people with diet-treated celiac disease had abnormal dark-adaptation tests (indicative of “night blindness”), even though some were taking a multivitamin that contained vitamin A . Some of these people showed an improvement in dark adaptation after receiving larger amounts of vitamin A, either orally or by injection.41 People with celiac disease should discuss the possibility of vitamin A deficiency with a healthcare practitioner before taking vitamin A supplements.

2 Stars
Vitamin D
Consult a qualified healthcare practitioner
Malabsorption-induced vitamin D deficiency can lead to bone weakening in people with celiac disease. Supplementing with vitamin D may help increase bone density.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .42 Zinc malabsorption also occurs frequently in celiac disease43 and may result in zinc deficiency, even in people who are otherwise in remission.44 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.45

Malabsorption-induced depletion of vitamin D can lead to osteomalacia (defective bone mineralization) in people with celiac disease.46 Although supplementation with vitamin D appears to increase bone density, the excess risk of bone fracture may not be entirely eliminated.

2 Stars
Vitamin K
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with vitamin K may correct a deficiency.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .47 Zinc malabsorption also occurs frequently in celiac disease48 and may result in zinc deficiency, even in people who are otherwise in remission.49 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.50

2 Stars
Zinc
Consult a qualified healthcare practitioner
The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. Supplementing with zinc may correct a deficiency.

The malabsorption that occurs in celiac disease can lead to multiple nutritional deficiencies. The most common nutritional problems in people with celiac disease include deficiencies of essential fatty acids, iron , vitamin D , vitamin K , calcium , magnesium , and folic acid .51 Zinc malabsorption also occurs frequently in celiac disease52 and may result in zinc deficiency, even in people who are otherwise in remission.53 People with newly diagnosed celiac disease should be assessed for nutritional deficiencies by a doctor. Celiac patients who have not yet completely recovered should supplement with a high-potency multivitamin-mineral . Some patients may require even higher amounts of some of these vitamins and minerals—an issue that should be discussed with their healthcare practitioner. Evidence of a nutrient deficiency in a celiac patient is a clear indication for supplementation with that nutrient.

After commencement of a gluten-free diet, overall nutritional status gradually improves. However, deficiencies of some nutrients may persist, even in people who are strictly avoiding gluten. For example, magnesium deficiency was found in 8 of 23 adults with celiac disease who had been following a gluten-free diet and were symptom-free. When these adults were supplemented with magnesium for two years, their bone mineral density increased significantly.54

1 Star
Lipase
Refer to label instructions
Lipase may be beneficial for people who do not produce adequate digestive secretions from the pancreas, a common occurrence with celiac disease.

People with celiac disease often do not produce adequate digestive secretions from the pancreas, including lipase enzymes 55 In a double-blind trial, children with celiac disease who received a pancreatic enzyme supplement along with a gluten-free diet gained significantly more weight in the first month than those treated with only a gluten-free diet.56 However, this benefit disappeared in the second month, suggesting enzyme supplements may only be useful at the beginning of dietary treatment.

1 Star
Vitamin B6
Refer to label instructions
For people with celiac disease who experience depression even after following a gluten-free diet, supplementing with vitamin B6 may be beneficial.
In one trial, 11 people with celiac disease suffered from persistent depression despite being on a gluten-free diet for more than two years. However, after supplementation with vitamin B6 (80 mg per day) for six months, the depression disappeared.57

References

1. Auricchio S, Follo D, de Ritis G, et al. Does breast feeding protect against the development of clinical symptoms of celiac disease in children? J Pediatr Gastroenterol Nutr 1983;2:428–33.

2. Udall JN, Colony P, Fritze L, et al. Development of gastrointestinal mucosal barrier. II. The effect of natural versus artificial feeding on intestinal permeability to macromolecules. Pediatr Res 1981;15:245–9.

3. Srinivassan U, Leonard N, Jones E, et al. Absence of oats toxicity in adult coeliac disease. BMJ 1996;313:1300–1.

4. Kemppainen TA, Heikkinen MT, Ristikankare MK, et al. Unkilned and large amounts of oats in the coeliac disease diet: a randomized, controlled study. Scand J Gastroenterol 2008;43:1094–101.

5. Jantauinen EK, Pikkarainen PH, Kemppainen TA, et al. A comparison of diets with and without oats in adults with celiac disease. N Engl J Med 1995;333:1033–7.

6. Greenberger JN, Isselbacher KJ. Disorders of absorption. In: Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison’s Principles of Internal Medicine, 14th ed. New York: McGraw-Hill, 1998, chapter 285.

7. Faulkner-Hogg KB, Selby WS, Loblay RH. Dietary analysis in symptomatic patients with coeliac disease on a gluten-free diet: the role of trace amounts of gluten and non-gluten food intolerances. Scand J Gastroenterol 1999;34:784–9.

8. Holmes GKT, Prior P, Lane MR, et al. Malignancy in coeliac disease—effect of a gluten free diet. Gut 1989;30:333–8.

9. Mora S, Barera G, Ricotti A, et al. Reversal of low bone density with a gluten-free diet in children and adolescents with celiac disease. Am J Clin Nutr 1998;67:477–81.

10. Mora S, Barera G, Beccio S, et al. Bone density and bone metabolism are normal after long-term gluten-free diet in young celiac patients. Am J Gastroenterol 1999;94:398–403.

11. McFarlane XA, Bhalla AK, Robertson DAF. Effect of a gluten free diet on osteopenia in adults with newly diagnosed coeliac disease. Gut 1996;39:180–4.

12. Baker PG, Read AE. Reversible infertility in male coeliac patients. BMJ 1975;2:316–7.

13. Sewell P, Cooke WT, Cox EV, Meynell MJ. Milk intolerance in gastrointestinal disorders. Lancet 1963;2:1132–5.

14. Haeney MR, Goodwin BJF, Barratt MEJ, et al. Soya protein antibodies in man: their occurrence and possible relevance in coeliac disease. J Clin Pathol 1982;35:319–22.

15. Mike N, Haeney M, Asquith P. Soya protein hypersensitivity in coeliac disease: evidence for cell mediated immunity. Gut 1983;24:A990.

16. Ament ME, Rubin CE. Soy protein—another cause of the flat intestinal lesion. Gastroenterology 1972;62:227–34.

17. Hallert C, Astrom J, Walan A. Reversal of psychopathology in adult celiac disease with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol 1983;18:299–304.

18. Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther 2009;29:811–6.

19. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

20. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

21. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

22. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

23. Patel RS, Johlin FC Jr, Murray JA. Celiac disease and recurrent pancreatitis. Gastrointest Endosc 1999;50:823–7.

24. Carroccio A, Iacono G, Montalto G, et al. Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study. Dig Dis Sci 1995;40:2555–60.

25. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

26. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

27. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

28. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

29. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

30. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

31. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

32. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

33. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

34. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

35. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

36. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

37. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

38. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

39. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

40. O’Mahony S, Howdle PD, Losowsky MS. Review article: management of patients with non-responsive coeliac disease. Aliment Pharmacol Ther 1996;10:671–80 [review].

41. Russell RM, Smith VC, Multak R, et al. Dark-adaptation testing for diagnosis of subclinical vitamin-A deficiency and evaluation of therapy. Lancet 1973;2:1161–4.

42. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

43. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

44. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

45. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

46. Basha B, Rao S, Han ZH, Parfitt, AM. Osteomalacia due to vitamin D depletion: neglected consequence of intestinal malabsorption. Am J Med 2000;108(4):296–300.

47. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

48. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

49. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

50. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

51. Connon JJ. Celiac disease. In: Shils ME, Olson JA, Shike M, eds. Modern Nutrition in Health and Disease, 8th ed. Philadelphia: Lea & Febiger, 1994, 1062.

52. Crofton RW, Glover SC, Ewen SWB, et al. Zinc absorption in celiac disease and dermatitis herpetiformis: a test of small intestinal function. Am J Clin Nutr 1983;38:706–12.

53. Solomons NW, Rosenberg IH, Sandstead HH. Zinc nutrition in celiac sprue. Am J Clin Nutr 1976;29:371–5.

54. Rude RK, Olerich M. Magnesium deficiency: possible role in osteoporosis associated with gluten-sensitive enteropathy. Osteoporos Int 1996;6:453–61.

55. Patel RS, Johlin FC Jr, Murray JA. Celiac disease and recurrent pancreatitis. Gastrointest Endosc 1999;50:823–7.

56. Carroccio A, Iacono G, Montalto G, et al. Pancreatic enzyme therapy in childhood celiac disease. A double-blind prospective randomized study. Dig Dis Sci 1995;40:2555–60.

57. Hallert C, Astrom J, Walan A. Reversal of psychopathology in adult celiac disease with the aid of pyridoxine (vitamin B6). Scand J Gastroenterol 1983;18:299–304.

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