If you have weak, porous bones, you might want to eliminate gluten from your diet even if you do not mount an immune response to this food. A significant portion of our society is plagued by this silent disability. The first painful hint of a problem is often a broken bone. There are several ways that gluten can interfere with maintaining strong, healthy bones. In this chapter, we explain how gluten can cause this crippling and painful malady.
According to the National Osteoporosis Foundation, osteoporosis is a major public health threat for more than 28 million Americans, 80 percent of whom are women. In the United States today, 8 million women and 2 million men already have osteoporosis, and 18 million more have low bone density, placing them at increased risk for osteoporosis; hip, back, and wrist fractures; and premature death.
Approximately 250,000 Americans die annually from the complications associated with hip fractures. Co-author James Braly's father was one such osteoporotic hip fracture victim.
Cases of bone degeneration are increasing at an epidemic rate. Much of it is due to our aging population, of course, with women now living well beyond eighty and men following closely behind. But that is only part of the explanation. Current dietary recommendations are shortsighted and out of date, reflecting a simplistic view of the many factors that contribute to building and maintaining strong, healthy bones.
The source of much of this poor advice is the infamous USDA food guide pyramid. Its proponents have failed to keep pace with current research. Despite exploding numbers of cases of osteoporosis and the well documented, negative impact of gluten consumption on bone density, daily consumption of six to eleven servings of cereal is still recommended Such recommendations are akin to urging a drowning man to drink more water. These recommendations are a clear denial of much of what we now know about bones, how they grow, and what makes them strong.
GLUTEN CAN ALSO CAUSE OSTEOPOROSIS IN THE NON-GLUTEN SENSITIVE
Further, grain consumption often displaces fruits and vegetables that are good sources of some important vitamins needed to keep our bones healthy. Vitamin C contributes to bone maintenance by aiding in the production of collagen. Production of this connective tissue is needed not only for the repair of bone breaks but also for the replacement of aging collagen that is destroyed by osteoclasts in the normal turnover of bone tissues.
Vitamin K chlorophyll liquid or capsules) is deficient in the diets of many women, many celiacs, and most people suffering from osteoporosis. At one time, vitamin K, an essential vitamin derived from food and the action of intestinal bacteria, was thought to be involved solely with the clotting of blood. As it turns out, vitamin K is needed in other key processes, including the production of osteocalcin by osteoblasts. Osteocalcin is a bone protein important in bone metabolism and bone formation. When excessive levels are found in the blood, it is associated with bone disorders such as Paget's disease and postmenopausal osteoporosis.
The January 1999 issue of the American Journal of Clinical Nutrition reported on more than seventy-two thousand women who were divided on the basis of their consumption of vitamin K. Those who consumed the most vitamin K were only 70 percent as likely to have broken a hip as women in the group that took in the least amount of this important vitamin. More impressive was the observation of lettuce consumption. Women who ate vitamin K-rich lettuce at least once a day were 45 percent less likely to have a hip fracture than those who ate the same food once a week or less. Consuming less than 109 micrograms of vitamin K resulted in bone thinning, but more than 109 micrograms did not add any more protection against hip fracture.
For women ages fifteen and older, federal guidelines recommend consuming 180 micrograms of vitamin K each day, probably an excessive amount. On the other hand, the RDA for vitamin K is 65 micrograms for women and 80 micrograms for men, which is probably too low.
The research findings clearly demonstrate that other nutrients besides calcium are
important for maintaining healthy bones. Instead of the current narrow focus on calcium, women ought to be sure to eat a well-balanced diet containing enough
protein and vitamin K. In addition to broccoli, lettuce, and other leafy vegetables, foods rich in vitamin K include pork, liver, and vegetable oils.
BONES ARE VERY MUCH ALIVE
A related paradox of osteoporosis and celiac disease is that calcium supplementation does not help to remineralize celiac patients' bones as much as magnesium supplementation. There is comparatively much less magnesium in our bones, so this information provides an important clue to the fascinating puzzle of the impact that gluten can have on bone density.
Not only is magnesium important to the activation of bone-building osteoblasts that deposit calcium and add collagen to our bones but is also a factor that aids in repairing the parathyroid gland. This is a gland that produces the hormones (PTH) that regulate most of the body's calcium metabolism. These hormones signal the kidneys to recover calcium from the urine, to elevate blood levels of calcium, and to activate vitamin D (calcitrol), which signals the intestine to absorb calcium from the food we eat. Clearly, adequate dietary calcium is of little value if we are not getting enough magnesium for the parathyroid gland to function properly.
For these reasons, dairy products and calcium supplementation may actually have a negative impact on the density of our bones, exactly the opposite of what we were taught to expect. It also counters the simplistic advice to consume calcium supplements alone and/or dairy products that are often offered to many individuals with declining bone density. Magnesium, calcium, zinc, boron, and vitamins D and K, all reported to be deficient in many celiacs, are absorbed from the intestine by the same mechanism, called "active transport." Loading the digestive tract with calcium alone overwhelmingly invites this part of our absorptive capacity with a single mineral, albeit the most common one in the body. This approach is shortsighted and, quite frankly, harmful. It risks causing a deficiency of magnesium and other necessary minerals, which are less abundant and frequently deficient in our diets. Magnesium and phosphorous deficiencies caused by excessive calcium intake may pose a much greater risk of causing bone mineral loss. Further, the risk is largely independent of the traditional suspect in gluten-induced bone damage malabsorption. The key issue is the balance of relative quantities in which these minerals are available, either in our diets and/or the supplements we consume.
Great care should be taken in recommending calcium/supplementation, especially among those who already suffer from bone demineralization and among those at greatest risk of developing such problems. A typical, healthy intestine only absorbs a small portion of the calcium that is available from our food. At the same time, evidence suggests that excess calcium intake competes with magnesium absorption, further aggravating a poor magnesium status. Flooding our diet with more and more calcium is a dangerously simplistic approach to this complex problem.
Many hospital emergency rooms are now using large therapeutic doses of intravenous magnesium as one of the first-line therapies for cardiac patients. Such magnesium treatments have been shown to reduce the extent of damage to the heart muscles and tissues. More and more medical clinics and emergency rooms are also beginning to use IV magnesium as a first-line therapy to abort migraine headaches and asthma attacks. The effectiveness of these therapies also suggests a common condition of chronic magnesium deficiency. We view this common deficiency as a predictable result of our culture's obsession with magnesium-depleting consumption of massive quantities of dairy products and cereal grains.
THE PARATHYROID GLAND
The tragic underdiagnosis of celiac disease and gluten sensitivity certainly suggests the need for more frequent screening for these conditions among those with reduced bone density. Such testing should be conducted as early as possible to allow early and extensive gains in mineral deposition, resulting in strong, healthy bones prior to declining production of sex hormones and growth hormones later in life.
OSTEOMALACIA AND GLUTEN
In osteomalacia and its milder form, osteopenia, our bones bend and become deformed due to a deficiency of absorbed minerals, and this condition can often be halted and reversed by simple vitamin D supplementation. Unfortunately, bone deformations usually are not corrected. Those who get little exposure to unimpeded sunlight, perhaps due to their jobs, age, or medical condition, are at risk. Those who live in temperate zones of the world run a seasonal risk of developing this problem.
Impaired kidney function, where there is excessive calcium excretion, can also result in rickets, osteornalacia, and
osteopenia. There is clear evidence that gluten contributes to at least some cases of impaired kidney function.
THE IMPACT OF AGING AND SEX HORMONES ON BONE HEALTH
BACK TO THE FUTURE
As you have seen, there are many factors that affect bone health. Regular exercise, ample sunshine, a varied non-allergenic diet, and a variety of vitamins are needed, along with several important minerals and hormones. All of these factors must work in a balanced, harmonious manner to build and maintain strong bones. Any change in this balance can lead to sudden and measurable changes in a relatively short time. Substantial improvements in bone density occur within one year of diagnosing celiac disease and beginning a gluten-free diet. Excessive calcium supplementation, without a balance of other bone nutrients, may well contribute to the very problem that it is aimed at helping.
A gluten-free, dairy-free diet that includes a wide range of meats, organ meat, fish; poultry, vegetables, and fruits, with moderate quantities of non-gluten grains, is not only closer to the one we evolved to eat but also one that will give us strong, healthy bones. Given the importance of an optimally functioning parathyroid gland for bone health, the cross reaction between endomysium antibodies and the parathyrod gland also suggests that there may be autoimmune factors contributing to the bone damage caused by gluten. >
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