After the implementation of a gluten-free diet there can be many persisting deficiencies, which can be “due to slow or incomplete healing of the small intestine, failure to eat foods rich in needed nutrients, eating too much fiber with meals, thus binding nutrients, H. pylori infection, small bowel bacterial overgrowth, giardia, or other infections and parasites”. Many gluten-free made products are not fortified, enriched, or have all the nutrients that the natural sources contain, thus these products are especially low in folate, iron, and fiber. Also, due to the fact that gluten-free products are not always available, many Gluten-Sensitive Enteropathy (GSE) patients do not consume the recommended amount of grain servings per day. The standard gluten-free diet does not meet the recommended intake for fiber, thiamine, riboflavin, niacin, folate, iron, or calcium. People that change their standard gluten-free diet to implement gluten-free oats at breakfast, high fiber brown rice bread at lunch, and quinoa as a side at dinner have been found to have significant increases in protein (20.6g versus 11g), iron (18.4mg versus 1.4mg), calcium (182mg verses 0mg), and fiber (12.7g verses 5g). The B vitamin group did not have significant increases, but were still found to have improved values of thiamine, riboflavin, niacin, and folate. These dietary changes can greatly reduce a GSE patient’s risk for anemia (especially Iron Deficiency Anemia) and low blood calcium levels or poor bone health. Not only is it important to avoid gluten, but also finding more nutrient-dense, gluten-free food sources to prevent patients from other diseases due to deficiencies.
[edit] Supplements
It is also important for GSE patients to consume a variety of fruits and vegetables (all which are gluten-free) to ensure consumption of recommended dietary intake of all nutrients. While avoiding gluten and eating enriched gluten-free sources can be stressful and overwhelming, supplements can be a good choice to include in order to avoid common deficiencies and help with intestinal restoration. Dr. Lieberman suggests using a wide-range of multivitamin/mineral supplementation, which can be found in multi-nutrient formation in a daily dose of 4 to 6 capsules.
| Vitamin D | 400 IU (if low take 2,000–4,000 IU to increase bone health) |
| B-complex (thiamin, riboflavin, niacin, pyridoxine, pantothenic acid, para-aminobenzoic acid, choline, and inositol) 25 mg of each | 25 mg of each |
| Folic acid | 400 mcg |
| Calcium | 500 mg (aim for 500–1,000 mg extra in diet) |
| Iron | Only take in case of iron deficiency or anemia |
| Magnesium | 15 mg (aim for 500–750 mg total) |
| Phosphorous and potassium | Found in most foods |
Along with these nutrients, there are other nutrients used to heal the digestive tract and prevent malabsorption. Fish oil (omega-3 and omega-6 fatty acids) can help to heal the inflammation of the digestive tract because chronic inflammation in the small intestine can cause tissue damage and stress on GSE patient’s organs stressing the immune system. Dr. Lieberman recommends taking 1500–4000 mg (4–6 capsules) a day of fish oil. Acidophilius and other beneficial microorganisms are important to help break down food and even protect the gastrointestinal tract from bacteria and viral infections. Lactobacillus casei GG is recommended for patients with gluten intolerance. Glutamine, an important amino acid in the GI tract, helps to heal inflammation and repair damaged tissues. This is made in our body, but supplementing 500 to 3,000 mg of L-glutamine may be taken under professional advice to nourish and restore the intestinal villi. Phosphatidylcholine can be supplemented to help heal the intestinal mucosa at a dose of 100 to 300 mg. Lastly, fiber supplementation is healthy in those patients experiencing constipation and should not be taken unless needed, due to a major side effect of excessive gas if the digestive tract is inflamed (highly likely in GSE patients).