Professional Advisory Council “Meet and Greet” Notes

From the 2018 National Conference – Ottawa – June 8th

The 2018 National Conference started with a panel discussion including members of the CCA Professional Advisory Council answering questions from the CCA Chapter executives. Members of the panel included:

  • Dr. Don Duerksen
  • Shelley Case RD
  • Dr. Jenny Zelin

Discussion regarding gluten-free flours
There are many myths about flours and a lot of discussion regarding arsenic in flour. The provides credible information regarding this. The bottom line is that you should not base your diet on rice, especially brown rice which has more arsenic. Alternate your grains so that you get a variety of grains in your diet.

Soy – There is a theoretical concern regarding hormones and soy. Again variety is important so you do not overload on any one grain. Soy in itself is not harmful.

Oats – Newly diagnosed should wait up to 18 months when the tTG normalizes to include gluten-free oats in the diet. The gluten-free certified oats should be introduced slowly due to the increase in fibre in the diet. The Health Canada website provides good information on gluten-free oats.

Nima Gluten Detection
The Nima device is used to detect gluten in food. Third party validation data is lacking on the Nima device, therefore it is suggested that “buyer beware”. This type of technology is where this industry is heading, however, testing must be done by experts to ensure it does what it
says it will do.

What information should I give my doctor when first diagnosed?
Direct the doctor to and give them handouts of position papers that are available there. tTG follow-up is helpful but not 100% accurate as to what is going on. The Celiac Follow Up Care Resource brochure will assist the doctor in what testing should be done on an on-going basis to manage celiac disease. Panel members stated that dietitians and dentists are very helpful in diagnosing celiac disease (CD).

What percentage of the general population are affected by celiac disease?
Canada borrows the data from the US which indicates approximately 1% of the population has CD. Test for CD before testing for anything else Canada is developing a registry for Registered Dietitians for CD. Training for undergrads is also a priority. Handouts are on the national website that Dietitians can download.

How long does one have to eat gluten before testing?
There are many different answers quoted to patients. Generally, 4-6 weeks of a slice of bread per day is adequate. If a patient has been gluten-free for a long time, more time on gluten may be required.

What symptoms affect the brain/body when eating gluten?
Symptoms vary from person to person. You must always beware that the cause “might be something else”. The longer an individual is off of gluten, usually the more sensitive they are to gluten exposure.

Please comment on tTG remaining high for an abnormally long time?

It takes different people different times to come within the normal tTG range. The number one reason for not normalizing is they are unaware of gluten exposure. Refractory celiac disease is rare. This is when the individual does not respond to a gluten-free diet.

Best to do your research before you go. Find out what the food safety standards are in the country that you are going to and it is often useful to contact the local Celiac Association and check out their website.

Wheat Starch
The inclusion of wheat starch in food is allowed in Europe. In Canada, today, this does not meet our standards. Additional processing is required to remove the gluten. Canadian law requires that anything that contains a gluten source is not allowed.

If a mother is celiac, there are no known adverse effects to the baby, however, the fertility of the mother may be an issue in those with undiagnosed celiac disease. Current research indicates that gluten should be introduced to babies’ diets at approximately 6 months of age.

Is it possible to have elevated tTG and not be celiac?
Yes, there are other conditions that may cause an elevation. It is important that the biopsy provides 4-5 samples to ensure proper diagnosis.

How long does gluten stay in your system?
Gluten is found in the stool for approximately 24 hours and in the urine for 6 hours.

Celiac Disease in the News – December 2018

by Val Vaartnou

The following are summaries of research in progress or completed from credible medical journals and medical sites. Links are provided where further information can be found.

Celiac disease and eosinophilic esophagitis linked A large analysis of more than 35 million patients found an intriguing connection between celiac disease and eosinophilic esophagitis (EoE). Out of the 15,000 patients in a database pulled from 360 U.S. hospitals who had been diagnosed with EoE, 2 percent also had celiac disease.

The numbers translate into a likelihood nine times larger of finding celiac disease in a patient with EoE compared to a patient in the normal population.

For more information:

Prebiotics can help celiac symptoms Research published in the Journal of Clinical Gastroenterology found that a 6-week probiotic treatment is effective in improving the severity of IBS-type symptoms in celiac disease patients on strict GFD, and is associated
with a modification of gut microbiota, characterized by an increase of bifidobacteria.

For more information:

Viruses can lead to activated celiac disease A growing body of research suggests that viral DNA or proteins introduced into the body can contribute toward the development of serious diseases long after the initial viral infection has passed. And now, research by a team from
the Cincinnati Children’s Hospital shows that exposure to the Epstein-Barr virus (EBV), best known for causing mononucleosis, appears to boost the risk of developing seven other diseases in individuals who inherited predisposing gene variants – including celiac disease.

For more information:

Questioning the link between antibiotics and celiac In contrast with existing research, a recent study published in the journal Jama Pediatrics found that antibiotics taken during a child’s first four years of life were not associated with the development of celiac disease or type 1 diabetes, even if the child was genetically predisposed to the development of either condition.

For more information:

Celiac disease can indeed strike anytime in life From childhood to late life, diagnosis of celiac disease is critical and should not be ignored. That’s the message for patients and healthcare providers from two recent studies.

In the first, researchers from Italy concluded that the number of patients with celiac disease worldwide is increasing, “thanks to better environmental conditions that allow children with celiac disease to survive longer.” In the second, scientists from Finland and the United Kingdom found that one in four celiac disease diagnoses is made in people 60 years or older. Still, 60 percent of patients remain undiagnosed because their symptoms, including tiredness, indigestion and reduced appetite, are blamed on older age itself.

For more information:–106300/

Gluten-free food not so gluten free in Melbourne

A first of its kind study led by Institute researchers and City of Melbourne environmental health officers has detected potentially harmful levels of gluten in foods sold and served as ‘gluten-free’ across Melbourne, Australia. The undercover study revealed one in 11 samples of ‘gluten free’ food tested were contaminated with gluten at levels that could prove harmful to people with celiac disease.

For more information:

US study finds restaurant gluten-free food not always gluten-free

Based on more than 5,600 gluten tests over 18 months, the investigators determined that 27 percent of gluten-free breakfast meals contained gluten. At dinner time, this figure hit 34 percent. The rise could reflect a steady increase in gluten contamination risk as the day unfolds, the researchers said.

For more information:

Ensuring dietary compliance among children and teenagers

New research on children and adolescents with celiac disease examined their dietary habits to determine the factors responsible for non-adherence to a gluten-free diet.

Compliance with the diet is difficult at all ages but particularly for teenagers due to social, cultural, economic, and practical pressures.

For more information:

CCA Survey On Long-Term Care Facilities


The Canadian Celiac Association (CCA) is conducting a survey of the Canadian celiac community to gain perspective on positive experiences or challenges facing people with celiac disease currently living in a long-term care facility or those feeling anxious about moving themselves or family into one.

  • The survey takes approximately 6 minutes to complete
  • Information provided on the survey will be anonymous and confidential
  • Findings will be used by CCA to identify gaps, suggest recommendations and/or tools to improve the quality of care for community members living or heading into a long-term care facility.

To complete the survey, click on the following link

For more information or if you have any questions about the survey, please contact Zaynab Al-Nuaimi at [email protected].

Gluten Concerns in Home Renovation Projects

By Jo Anne Murray

There have been a number of concerns expressed by members of the CCA Facebook page about the presence of gluten in drywall joint compound. Because I was having a few repairs done in my own home, I decided to research some of the industry standard products to determine their safety from the gluten perspective.

I’ll talk about the restoration products first. The major suppliers of many of the products currently on the market claim that there are no gluten-containing ingredients in any of their products. I included standard products marketed by Home Depot, Lowe’s, Rona and spoke to and/or exchanged emails with sales reps and other company spokespeople. Some of the products available are produced in Canada exclusively, others share some cross-border exchange. DAP was the only company that indicated that wheat starch is still used in a couple of their USA plants and that the wheat starch is actually tested for gluten content and the gluten content measures at a level well below 20 ppm. It is likely safe to say that the current drywall joint compounds should pose little to no concern to members of the celiac community.

Most of the information that I received from these spokespeople also encouraged that the products they have available that have the reduced dust properties are likely more desirable for projects where any health issues are of concern as the remnants from sanding these particular joint compounds fall directly to the floor with very little circulating in the air.

Now I’ll cover a few concerns for the demolition phases of any renovation projects. There is little information available about products that were used in previous decades and the potential for gluten content in these products. The only way to be certain of their safety would be to  have samples tested for gluten content before any major demolition took place. However, a more significant concern is that of asbestos in the drywall joint compound and the plaster used in lath and plaster finishing as well as texturing paint and stippling products.

Because of the insidious nature of lung injury from asbestos particles, it is recommended that existing materials be tested before any demolition takes place and if asbestos is present that abatement should be undertaken by companies qualified in the safe removal of
the asbestos-contaminated materials.

Needless to say, proper management of asbestos removal would assure that any potential gluten content would also be safely removed.

So what construction years are of greatest concern for asbestos? Asbestos has been extensively used in the construction industry for more than a century. It was banned for use in Canada in textured paint and drywall joint compound in 1979 – but – it still made its way into many of these products until the early 1990s.

If you are inclined to disregard the asbestos concerns and undertake the DIY projects anyway, there are a number of steps you can take to limit exposure to asbestos and gluten if it is present. There is personal safety equipment available to protect your health.

There are also many ways to limit the dust exposure escaping to areas outside the actual renovation area.

  • Seal off the renovation area, including sealing off the hot and cold air returns to your furnace.
  • Choose a time of year when the furnace is not likely to be running.
  • Cleanup must be managed to prevent contamination of equipment and the remainder of the building.
  • Talk to the renovation professionals so you fully understand the methods to prevent asbestos contamination. By managing the risks for asbestos exposure, you automatically manage the risks for any potential gluten exposure.

Another consideration for gluten lurking about in a renovation project is wallpaper. The commercial glues used in most pre-pasted modern wall coverings are developed from the same types of glues that are used on envelopes. However, prior to ~1970, wallpaper was applied using wallpaper paste that was made at home from wheat flour.

There are still many homes that have layers upon layers of wallpaper, and many of those layers will have wheat based wallpaper paste holding them in place. Care must be taken in their removal to contain the dust from these projects to the area of restoration and minimize the potential for its being circulated through the furnace ducts and other air movement equipment (fans, dryers, dehumidifiers).

Gluten might be a consideration in any renovation project but will be overshadowed by the asbestos concerns in most renovations. When asbestos is addressed in your project, any gluten exposure would be included in the prevention of general contamination concerns.

Please protect your health when you undertake your DIY projects.

2018 National Conference Recap

Courtesy Calgary Chapter

The CCA’s Ottawa Chapter hosted the 2018 National Conference and it was a tremendous success! Not only did we have nearly 300 delegates (more than we’ve seen in years), but we also were able to break new ground by having a presentation on neurological issues and celiac – a rapidly developing but lesser-known area of celiac disease research.

Held at the majestic Shaw Centre in downtown Ottawa, the location was great for tourism – right by Parliament Hill, the Rideau Centre, the Byward Market and more. The conference received rave reviews from attendees and we thank the Ottawa Chapter for all the work put into this event. If you weren’t able to make it, we’re pleased to provide some of the key points from three featured speakers.

Dr. Marios Hadjivassiliou gave us a thrilling presentation on the neurological manifestations of celiac disease.

  • “Classic” celiac disease is no longer the norm. More and more we are seeing neurological issues. It’s possible to have no digestive issues, just neurological issues, and be celiac. Going gluten-free is critical to help alleviate these symptoms.
  • Early diagnosis when gluten ataxia is present can help save the patient from much hardship.
  • Balance issues and vertigo are red flags. Celiac can also interfere with speech, coordination, strength.
  • Gluten neuropathy – loss of sensation/tingling, can be numbness and pain. Accounts for 26% of all neuropathies.
  • Gluten ataxia equally common between men and women, study shows. Only 50% of them will be celiac.
  • With gluten ataxia, we can see damage to the cerebellum – damage that is often permanent.
  • Gluten ataxia in some cases linked to refractory celiac disease, which can be very difficult to treat.
  • There is a strong connection between headaches and patients with celiac disease. Some ataxia  patients get horrific headaches. You wouldn’t automatically assume that’s celiac!
  • Antibodies from gluten exposure can cross-react with neural tissue. The cerebellum is what’s primarily impacted for ataxia in these cases, but other areas of the brain can be impacted as well.
  • Some neurological patients show a poor response to the gluten-free diet. Reason most often is poor diet adherence, but there could be other issues as well.
  • Some patients say they feel like there’s a big cloud over your head, things are hazy, as if you’re just going through the motions of life.
  • Physiotherapy has been found to be able to help when there has been gluten ataxia damage to the cerebellum. Easier for younger people.
  • We know that depression and anxiety levels are higher in those with celiac disease.
  • Studies in our clinic found that half of people with ataxia showed enteropathy.
  • Ataxia patients get MR spectroscopy scans, show great improvement for celiacs once the gluten-free diet is adopted.
  • Age of diagnosis for a classical-symptomed celiac is 44, versus 53 for those with the neurological presentation.
  • Even if you’re on a strict gluten-free diet, gluten ataxia can persist. Depends on the patient and antibody profile.
  • Seizures can be associated with celiac. Specific type of epilepsy, seems to be more common in Italy and Argentina.
  • Since screening programs implemented in Finland, fewer cases of dermatitis herpetiformis have been reported.
  • If a celiac still has neurological symptoms on the gluten-free diet, he or she should repeat the blood work and the endoscopy. If everything looks healed/compliant, there may be a need to use immunosuppressants.
  • Some patients with schizophrenia showed improvement on the gluten-free diet, but we can’t say that there is a clear link. More research is needed.


Dr. Joseph Murray provided an overview of the latest research from the world of celiac disease.

  • There are drugs that can damage the intestine to make it appear like celiac. There are other conditions that can also mimic the damage. Beware.
  • People with celiac disease should test their thyroid function every 4-5 years, as there is a strong link between celiac disease and thyroid disease. Both are autoimmune.
  • Cannabis is soon to be legal in Canada. Cannabis is better than over-indulging in alcohol and better than smoking cigarettes, but there are still negative impacts to watch out for. There has been no research on whether cannabis could help people with celiac disease.
  • Whether global warming is impacting celiac, who knows. It may be changing how wheat grows, how it adapts, etc.
  • In northern climates, we see more multiple sclerosis, just like we see more celiac disease.
  • Perhaps related to vitamin D? More research is needed.
  • If you’re a mother who is diagnosed with celiac, test your children NOW. Before you turn your house totally or partially gluten-free.
  • Being “very positive” on the celiac tTG blood test doesn’t really impact the level/severity of symptoms. Positive is positive.
  • Celiac was considered a rare disease in the past. We found 0.2% in testing in the 1950s. Definitely far higher now  1%, or 5x what it was.


Dr. Justine Dowd presented her research, partially funded by the CCA, on evidence-based holistic approaches to celiac disease management.

  • Many people with celiac disease are misdiagnosed with IBS first. Or some, like me, are “lucky” enough to have both.
  • I struggled for a long time with infertility and was misdiagnosed. Getting finally diagnosed as celiac led to huge improvement.
  • Those who adhere the best to the gluten-free diet are those who were in dire straits when diagnosed, awful symptoms. They do not want to take any chances at going back to how things were.
  • We need to retrain our nerves so that we can feel well. Brings in the idea of self-compassion.
  • There is a strong connection between gut health and mental health. Lots of research in that area. More incidence of depression, anxiety and other mental health issues among those with celiac disease.
  • Research shows that people are more likely to be kind to others than to themselves. Self-compassion is needed, giving ourselves the same kindness. Mindfulness over overidentification, common humanity over isolation.
  • We’re looking at exercise and effect on microbiome. Does being active make a difference?
  • Vagus nerve is key – connects gut and brain, promotes rest and digestion. Also need to reduce stress as much as possible – and cope with it, where elimination is not possible.
  • We have over 1,000 different bacteria species in our gut. Strong link between exercise and gut health.
  • Can be higher risk of excess abdominal fat, high blood pressure, high blood sugar with celiac patients. May be due to excess consumption of processed GF foods. Can lead to metabolic syndrome.
  • The app @myhealthygut is free to get started, and has additional features available ($). The dietary tracker and journal can help to figure out why you may still have symptoms. Then you can email it to your health care provider.
  • For newly diagnosed, we need to teach them self-regulatory skills. That’s what she is researching at the University of Calgary.

In addition, the conference included presentations on nutrition, gluten-free lentils and grains, and baking GF and vegan, as well as updates from Health Canada and the CFIA.

Next year’s conference will be in the Toronto area, likely in late May. Stay tuned for more details!

If a Product Does Not Contain Gluten Ingredients, Why Isn’t It Labelled Gluten-Free?

The Canadian Celiac Association Answers the Facebook Question of the Month

Why doesn’t procduct X have a “gluten-free” claim on it? There are no gluten ingredients listed.

CCA LogoIn Canada, not having gluten ingredients is just one of three criteria for a gluten-free claim. The other requirements are that the food must meet the criteria of a food for special dietary use and it must not contain gluten from uncontrolled contamination in the ingredients or manufacturing process.

A food for special dietary use is “… a food that has been specially processed or formulated to meet the particular requirements of a person a) in whom a physical or physiological condition exists as a result of a disease, disorder or injury;”. In other words, a gluten-free food must be specifically made for someone with celiac disease.

A jar of jam may not contain any gluten ingredients but it cannot be labelled “glutenfree” unless the manufacturer takes specific steps to confirm that there is no gluten.  Because a product must meet all three of these requirements to make a “gluten-free” claim, there are many products on the market that are safe for someone with celiac disease, even though they do not carry a gluten-free claim.

Low Risk
Some of these products are essentially unprocessed including fresh fruit, vegetables, seafood, dairy, and meat. Others are products where no gluten ingredients are used in most or all of the products in the category including jams and jellies, butter, yogurt and cheese.

High Risk
There are some products that are at a higher risk for gluten contamination. The CCA recommends that you look for a “gluten-free” claim on those products. They include baked goods, breakfast cereals, flour and nuts. For lower risk products, we recommend that you make your decision based on the ingredient labelling information provided on the package.

Distilled Liquors: Are they Gluten-Free?

By  Val Vaartnou

I responded to an info line question requiring Grey Goose Vodka and whether it was glutenfree. I gave the standard response to the query that as vodka was a distilled alcoholic beverage like rye whiskey, scotch whiskey, gin and vodka they are distilled from a mash of fermented grains. Rum is distilled from sugar cane. Brandy is distilled from wine and bourbon is distilled from a grain mash including corn. Since the distillation process does not let the proteins enter the final product, distilled alcohols are gluten-free. (CCA Pocket Dictionary).

The individual asking the question said that after talking with a fellow celiac, he had been told this could not be true, as ingesting vodka causes significant celiac symptoms in his friend. I forwarded this to Sue Newell who provided this thoughtful response. I thought I would share it you as it may explain issues you may have with distilled alcohols.

I know I don’t have to tell you that not every reaction is due to gluten. Alcohol is rarely consumed in isolation from food, but somehow the alcohol always get the blame! In addition to alcohol, the other component that survives distillation is congeners. These are the flavouring agents and other components that are light enough to be carried in water vapour or that convert to gas at a lower temperature than the boiling point of water.

Most congeners are innocuous but some are rather nasty, including small amounts of chemicals such as methanol and other alcohols (known as fusel alcohols), acetone, acetaldehyde, esters, tannins, and aldehydes (e.g. furfural). If someone has a sensitivity to any of these items, they can show a variety of reactions and depending on the dose, can become quite ill. Usually, the first 5% of distillate is discarded to get rid of some of these substances. When you hear about alcohol that has been distilled multiple times, it is to
remove some of these compounds.

Different grains have different types and levels of congeners. As a result, it is possible for people to react to one brand but not another.  I can almost guarantee that this correspondent is not going to believe this information. That is common and is one of the reasons why so many rumors continue to exist.

Thanks Sue for your always knowledgeable response.

Best Foods to Stock in Your Kitchen

by Val Vaartnou

food-potluckSo you’ve been diagnosed with Celiac Disease and you worry that there will be nothing to eat because “everything” contains gluten. Yes, gluten does lurk everywhere, but there are great foods that you can enjoy and get the added benefits of reducing your inflammation in the body while eating for your health.

Keeping it simple is one of the first recommendations that I make to anyone diagnosed with Celiac Disease. Eating lots of fresh fruits and vegetables in as many colors as you can find and eating lots of lean meats is the best start. Your kitchen staples should include staples that are readily available to give you a varied diet.

Note: Grain, nuts, and seeds have the most risk of cross-contamination from gluten of all foods. In the field, during processing and packaging, the processes must be monitored to ensure gluten does not contaminate them. Ensure the manufacturer has marked grains, nuts, and seeds as gluten-free on the packaging.

Dairy products are fine unless you are also lactose intolerant. Aged cheeses and low sugar yogurts, especially greek yogurts are less problematic. Goat yogurts and cheeses are sometimes good alternatives.

Fresh fruits: In the winter, pomegranates, apples, pears, bananas, and in my freezer for smoothies, frozen berries (raspberries, blueberries, cherries and blackberries!). During the summer, visit the farmer’s market and enjoy the fresh fruits of the season.

Fresh herbs: like ginger, turmeric, chives, parsley, cilantro, rosemary, and basil. I cook with them and throw them in my salad, too. Cilantro and parsley are great as they help to detoxify the body.

Fresh veggies: Spinach, chard, kale, arugula, beets, broccoli, cauliflower and brussel sprouts. radishes, jicama, scallions, and fennel for my salad. Again the farmer’s market is great to pick up fresh local vegetables.

Healthy fats: Avocado, olives, oils (avocado, coconut, olive), ghee (check out online recipes to make your own), seeds (chia, hemp, flax, pumpkin or sunflower seed), full-fat coconut milk.

Healthy grains: Quinoa and wild rice are my favorites. Try some different grains for variety, for example, millet, teff, and sorghum. If you are very strict on your gluten-free diet and still find your symptoms continue, you may find that the elimination of all grains is required. Eliminate them all for a few weeks and then reintroduce each grain, one at a time, eating it daily for a few days. Listen to your body and your symptoms. You may find you can tolerate some grains better than others.

Healthy proteins: Turkey, chicken, salmon, sardines, mung beans, adzuki beans, lentils (again marked gluten-free by the manufacturer), hummus (chickpeas).

Healthy snacks: Whole nuts and seeds, or nut butters (cashews, almonds, Brazil, macadamia, coconut, sunflower, walnut), nori (seaweed), 70% or higher dark chocolate.

Spices and condiments: Cinnamon, cumin, curry powder, coriander, turmeric,
ginger, black pepper, sea salt and dried herbs.

Pantry staples: canned beans (chickpeas, kidney, and black), canned tuna and salmon, gluten-free minimally-processed crackers (Mary’s Gone Crackers for example), artichoke hearts, sardines.

Gluten-free processed foods are fine for treats but should not be the foundation of your diet. Unfortunately, gluten-free foods are often high in fats, sugars, and salt so reading the nutritional label is always required, not just to ensure there is no gluten, but to ensure that you are not eating empty calories.

Action Needed By Sept 14: Write Govt On New Beer Labelling Regs.


gluten-free-beerThe Government of Canada is proposing to amend the compositional standards for beer and ale, stout, porter and malt liquor. Their aim is to modernize the Food and Drug Act to recognize the new variations of beer, flavourings and preparations.

In addition to this review, the Government is also recommending to require beer manufacturers to declare allergens including gluten on their product labels.

As the voice for people adversely affected by gluten, the Canadian Celiac Association, with assistance from the Professional Advisory Council, has submitted its response in support of the proposed amendments. View our response here.

Pour on the support by September 14.

Why do we need your help?
During amendments to the regulations in 2010, the beer lobby was very effective in influencing politicians and bureaucrats to not be included in regulations requiring declarations of allergens or gluten on their labels or products. They were exempt. Now eight years later, the government is now proposing to remove this exemption.

The Government of Canada needs to hear from concerned consumers who are impacted by these regulations. The more people and groups who submit official responses, the more likely the amendments will be implemented.

Step one: Click here to download a template letter.
Step two: Add your name and address
Step three: Submit by email to: [email protected] by September 14 using the subject line: Canada Gazette, Part I, Volume 152, Number 24: Regulations Amending the Food and Drug Regulations (Beer) – June 16, 2018
Step Four: Tell us you sent a letter by emailing us at [email protected]

Step Five: Donate to CCA to allow us to continue to be your advocate in Ottawa and across the country for the right to safe gluten-free food. Donations can be made securely online, via CanadaHelps by clicking here.

Thank you for your help and support!

CCA Publishes Management of Bone Health Paper

The Professional Advisory Council of the CCA has written a paper on bone health. It’s now been published and will become one of our standard resources. It’s also 6 pages long, so here are the key points.

  • Celiac disease (CD) is a chronic disorder that affects bone structure. It requires strict lifelong adherence to a gluten-free diet (GFD), and long-term monitoring of patients with CD should include assessment of bone health.
  • Bone health assessment in CD with malabsorption requires bone mineral density (BMD) testing at diagnosis. Correction of malabsorption of calcium, phosphate, and vitamin D should be ensured. At the time of diagnosis, patients should receive counselling on a GFD and on the nutrition required to restore bone health. Intake of calcium and vitamin D should be optimized using dietary sources, whenever possible. Patients should be encouraged to participate in weight-bearing exercises, limit alcohol intake, and avoid cigarette smoking.
  • Evidence for management of low BMD and prevention of fractures in CD is limited. Strict adherence to a GFD seems to be the only effective treatment to improve BMD in adults with CD and decrease the risk of fractures.

If you would like to read the whole paper, you can find it at