Celiac Disease: Micronutrient Therapy

As part of micronutrient therapy (vital nutrients) for gluten-induced enteropathy, particular attention should be paid to the substitution of critical vital nutrients (micronutrients). Critical nutrients and vital substances (macro- and micronutrients)

Fat-soluble vitamins vitamins A, D, E, K
Fat-soluble carotenoid beta-carotene
Vitamin B9 folic acid
Vitamin B12
Vitamin C
Calcium
Magnesium
Sodium
Potassium
Chloride
Iron
Copper
Selenium
Zinc
Essential fatty acids omega-3 and 6 compounds
Protein as well as valuable amino acids

Secondary lactase deficiency

Gluten-induced enteropathy is often accompanied by secondary lactase deficiency due to the primary disease of the small intestine. Depending on the severity of damage to the intestinal villi, many sprue sufferers have decreased lactase activity. In this case, the lactose supplied by milk and milk products cannot be broken down and consequently not absorbed. In this case, lactose should be largely avoided at the beginning of gluten-free dietary treatment in order to avoid the typical symptoms of lactose intolerance, such as flatulence, meteorism and diarrhea. Accordingly, low-lactose milk and dairy products must be integrated into the gluten-free diet to ensure the absorption of valuable nutrients and vital substances (macro- and micronutrients) from milk, including vitamins A, D, E, K, calcium and biologically high-quality protein.With increasing regeneration of the intestinal villi during dietary therapy, the activity of the enzyme lactase normalizes and milk and dairy products are again tolerated normally.

Casein intolerance

Some people who cannot tolerate gluten have a similar intolerance related to the milk protein casein. Affected individuals have a deficiency or functional impairment of the enzyme dipeptidyl peptidase. As a result, the degradation product casein cannot be broken down further. The remaining undigested peptides bind to the opioid receptors in the brain and thus exert an opioid-like effect. Opioids, which include drugs such as morphine and heroin, are a chemically dissimilar subgroup of pain-relieving drugs. As a result, there is often listlessness, fatigue, depression, and decreased pain perception. The incomplete digestion of milk protein also leads to nausea, loss of appetite and developmental disorders in childhood, as well as digestive problems such as chronic constipation, flatulence and abdominal pain.Under these circumstances, sufferers should strictly avoid not only foods containing gluten, but also milk and milk products rich in casein – one liter of whole milk contains 3.2 to 3.5% casein. Regeneration of the intestinal mucosa and villi is only guaranteed if the diet is strictly adhered to. Gluten-induced enteropathy Vital substance (micronutrient) deficiency as a result of damage to the mucosa and villi of the small intestine and absorption disorders.

Vital substance (micronutrients)	Deficiency symptoms
Vitamin A	Fatigue, loss of appetite Decreased production of antibodies and weakened immune system. Decreased antioxidant protection Impaired dark adaptation, night blindness Diseases of the respiratory tract, respiratory infections due to changes in the mucous membrane. Disorders of spermatogenesis Anemia Increased risk of Tumors of the lung, bladder, prostate, larynx, esophagus, stomach and intestine. Kidney stone formation Drying up to cornification of mucous membranes Attrition of cell and tissue mass of salivary glands and larynx, regression of organs. Dry, brittle nails and hair Dry, rough, itchy skin with rashes Decreased sense of smell, touch, hearing disorders. Deficiency symptoms in children Growth disorders of the long bones Dentin disorders (formation disorders of dental tissue). Malformations of the auditory organ, digestive and genitourinary tract
Beta-carotene	Decreased antioxidant protection, increased risk for lipid peroxidation as well as oxidative DNA damage. Weakened immune system Increased risk of skin, lung, prostate, cervical, breast, esophageal, stomach, and colon cancers Reduced skin and eye protection
Vitamin D	Loss of minerals from bones spine, pelvis, extremities leads to Hypocalcemia Decreased bone density Deformities Muscle weakness, especially at the hips and pelvis Increased risk of later osteoporosis Formation of osteomalacia Symptoms of osteomalacia Bone pain shoulder, spine, pelvis, legs. Spontaneous fractures, often in the pelvic ring. Funnel chest Map heart shape of the female pelvis Loss of hearing, ringing in the ears Disturbed immune system with repeated infections. Increased risk of colon and breast cancer Deficiency symptoms in children Impairment of the development of bones and teeth. Formation of rickets decreased mineralization of bones with a tendency to spontaneous fractures and bone bending. Symptoms of rickets Disturbances in the longitudinal growth of bones Deformed skeleton skull, spine, legs. Atypical heart-shaped pelvis Delayed retention of deciduous teeth, jaw deformity, malocclusion
Vitamin E	Lack of protection against radical attack and lipid peroxidation. Decreases the immune response High susceptibility to infection Myopathies disease of the muscle cells Shrinkage as well as weakening of the muscles Disease of the peripheral nervous system, neurological disorders, disorders in neuromuscular information transmission (neuropathies). Reduced number and lifetime of red blood cells. Deficiency symptoms in children Anemia (anemia) Impairment of blood vessels leads to bleeding Disturbances in neuromuscular information transmission. Neonatal retinopathy disease of the retina with visual disturbances. Bronchopulmonary dysplasia chronic lung disease, respiratory distress. Cerebral hemorrhage
Vitamin K	Blood coagulation disorders leading to Hemorrhage into tissues and organs. Bleeding from body orifices Small amounts of blood in the stool can cause Decreased activity of osteoblasts leads to. Increased urinary calcium excretion. Severe bone deformities
Folic acid	Mucosal changes in the mouth, intestines, and urogenital tract lead to Indigestion with diarrhea Reduced absorption of macro- and micronutrients (nutrients, vital substances). Weight loss Blood count disorders Anemia leads to rapid fatigue, shortness of breath, decreased ability to concentrate, general weakness. Impaired formation of white blood cells leads to. Reduction of the immune response to infections. Decreased antibody formation Risk of bleeding due to decreased production of platelets Elevated homocysteine levels increase the risk for Atherosclerosis (arteriosclerosis, hardening of the arteries). Coronary heart disease Neurological and psychiatric disorders, such as. Memory impairment Depression Aggressiveness Irritability Deficiency symptoms in children Disturbances in DNA synthesis impaired replication and decreased cell proliferation increase the risk for Malformations, developmental disorders Growth retardation Maturation disorders of the central nervous system. Bone marrow alteration Deficiency of white blood cells as well as platelets. Anemia Injuries to the mucosa of the small intestine Disorders of protein biosynthesis and cell division
Vitamin B12	Decreased vision and blind spots Functional folic acid deficiency Weakened antioxidant protective system Blood count Anemia reduces the ability to concentrate, leads to fatigue, weakness and shortness of breath. Reduction of red blood cells, larger than average and rich in hemoglobin. Impaired growth of white blood cells weakens the immune system Risk of bleeding due to reduced production of platelets. Gastrointestinal tract Tissue atrophy and inflammation of the mucous membranes. Rough, burning tongue Reduced absorption of macro- and micronutrients (nutrients, vital substances). Loss of appetite, weight loss Neurological disorders Numbness and tingling of extremities, loss of sensation of touch, vibration and pain. Poor coordination of the muscles, muscle atrophy. Unsteady gait Spinal cord damage Psychiatric disorders Memory disorders, confusion, depression Aggressiveness, agitation, psychosis
Vitamin C	Antioxidant deficiency Weakness of blood vessels leads to Abnormal bleeding Mucosal bleeding Hemorrhage into the muscles associated with weakness in heavily used muscles Inflamed as well as bleeding gums (gingivitis). Joint stiffness and pain Poor wound healing Carnitine deficit leads to Symptoms of exhaustion, fatigue, indifference, irritability, depression. Increased need for sleep, decreased performance. Weakness of the immune system with increased risk of infection Decreased oxidation protection increases the risk of heart disease, stroke (apoplexy) Deficiency symptoms in children Weakened immune system Recurrent infections of the respiratory tract, urinary bladder, and the auditory tube, which is connected to the nasopharynx via the tympanic cavity of the middle ear Increased risk of vitamin C deficiency disease Möller-Barlow disease in infancy with symptoms such as. Hematomas bruises Pathological bone fractures associated with severe pain Jumping jack phenomenon wincing after every slightest touch Stagnation of growth
Calcium	Demineralization of the skeletal system increases the risk of Decreased bone density Osteoporosis, especially in women with estrogen deficiency. Osteomalacia bone softening as well as bone deformities. Tendency to stress fractures of the skeletal system. Muscle cramps, tendency to spasm, increased muscle contraction. Cardiac arrhythmias Blood clotting disorders with increased bleeding tendency Increased excitability of the nervous system, depression. Increased risk of Hypertension Deficiency symptoms in children Impaired development of bones and teeth Decreased bone density in the newborn. Formation of rickets Decreased mineralization of bones with tendency to spontaneous fractures and bone bending. Symptoms of rickets Disturbances in the longitudinal growth of bones Deformed skeleton skull, spine, legs. Atypical heart-shaped pelvis Delayed retention of deciduous teeth, jaw deformity, malocclusion of teeth. Additional vitamin D deficiency leads to Hyperparathyroidism Hyperfunction of the parathyroid gland with increased production of parathyroid hormones The increased parathyroid hormone level leads to increased bone loss and thus increased calcium concentration in the blood Hypercalcemic coma
Magnesium	Increased excitability of muscles and nerves leads to Insomnia, difficulty concentrating Muscle and vascular spasms Numbness as well as tingling in the extremities. Heart palpitations and arrhythmias, feeling of anxiety. Increased risk of Decreased immune response Heart attack (myocardial infarction) Acute hearing loss Deficiency symptoms in children Growth retardation Hyperactivity Insomnia, difficulty concentrating Muscle tremors, cramps Heart palpitations and arrhythmias Decreased immune response
Sodium	Fatigability, possible unconsciousness, apathy, confusion, lack of drive, decreased performance; impaired short-term memory. Nausea, vomiting, loss of appetite, lack of thirst. Hypertension, tendency to collapse, hyperexcitability of the heart muscle resulting in tachycardia (heart rate > 100 heartbeats/minute) and reduction in cardiac output. Muscle spasms Decreased urination
Potassium	Muscle weakness, muscle paralysis Fatigue, apathy Nausea and vomiting, loss of appetite, constipation, decreased bowel activity to intestinal obstruction. Decreased tendon reflexes Cardiac arrhythmias, cardiac enlargement, tachycardia, dyspnea
Chloride	Acid-base balance disorders Development of metabolic alkalosis Severe vomiting with high salt losses
Iron	Chronic fatigue syndrome Loss of appetite Disorders of thermoregulation High susceptibility to infection of the upper respiratory tract Dry skin with itching Decreased concentration and retentiveness Increased lactic acid formation during physical exertion associated with muscle cramps. Increased absorption of environmental toxins Body temperature regulation may be disturbed Anemia (anemia Deficiency symptoms in children Disturbance of physical, mental and motor development. Behavioral disorders Lack of concentration, learning disorders Disturbances in the child’s intelligence development Loss of appetite High susceptibility to infection of the upper respiratory tract Body temperature regulation may be disturbed
Zinc	Instead of zinc, the toxic cadmium is integrated into the biological processes, resulting in Inflammatory changes in the mucous membranes of the nose and throat. Cough, headache, fever Vomiting, diarrhea, cramping pain in the abdominal regions. Renal dysfunction and increased protein excretion. Osteoporosis, osteomalacia leads. Disturbances in the functioning of the immune system. Inhibition of cellular defense leads to increased susceptibility to infection Wound healing disorders and mucosal changes, as zinc is required for connective tissue synthesis Increased keratinization tendency Acne-like symptoms Progressive, circular hair loss Metabolic disorders, such as. Weight loss despite increased food intake Failure of beta cells in the pancreas high risk of developing adult-onset diabetes (type II diabetes mellitus) Blood clotting disorders, chronic anemia. Reduction of the sense of smell and taste, reduction of vision, night blindness, sensorineural hearing loss. Fatigue, depression, psychosis, schizophrenia, aggressiveness. Permanent male infertility due to hypofunction of the gonads. Deficiency symptoms in children Low zinc concentrations in plasma and white blood cells cause Malformations and deformities especially of the central nervous system. Growth disorders and retardation with delayed sexual development. Skin lesions in the extremities hands, feet, nose, chin and ear and natural body orifices Wound healing disorders Hair loss Acute and chronic infections Hyperactivity and learning disability
Selenium	Weight loss, intestinal sluggishness, indigestion. Depression, irritability, insomnia. Memory loss, difficulty concentrating, headaches Immunodeficiency Chronic fatigue syndrome (CFS syndrome) Thyroid dysfunction due to deficiency of selenium-dependent deiodases. Decreased activity of glutathione peroxidases leads to an increase in peroxides and thus to increased radical formation and increased formation of pro-inflammatory prostaglandins Joint pain due to processes that promote inflammation Increased susceptibility of the mitochondria Male infertility Increased risk of Liver damage Muscle pain and stiffness Keshan disease viral infections, cardiomyopathy (disease of the heart muscle), heart failure, cardiac arrhythmias. Kashin-Beck disease degenerative joint disease with disturbances of bone and joint metabolism, which can lead to arthrosis and severe joint deformities. Deficiency symptoms in children Immunodeficiency Thyroid dysfunction Increased radical formation Increased susceptibility of the mitochondria Increased susceptibility to infections Increases the need for vitamin E [2.2]
Copper	Neurological deficits Reduced sperm motility with fertility disorders. Elastin depletion in the vessels, vasoconstriction or occlusion, thrombosis. Anemia due to impaired blood formation Increased susceptibility to infections Increased total cholesterol and LDL cholesterol levels. Glucose intolerance Hair and pigment disorders Osteoporosis due to impaired collagen synthesis Proliferation of smooth muscle cells Weakness, fatigue Copper metabolic disorders Wilson’s disease liver damage, hepatitis, cirrhosis. Menkes syndrome (failure to thrive). Cutis laxa (skin laxity) Amyotrophic lateral sclerosis (ALS) progressive muscle weakness, insufficiency of respiratory muscles. Deficiency symptoms in children Anemia due to impaired hematopoiesis leads to maturation disorders of white blood cells and lack of defense cells in the blood Growth disorders Skeletal changes with changes in bone age. Increased susceptibility to infections, frequent respiratory infections
Essential fatty acids omega-3 and 6 compounds.	Weakened immune system, increased susceptibility to infections. Disturbed heart rhythm Disturbed vision Disturbed wound healing Disturbed blood clotting Hair loss Hypertension, dyslipidemia Kidney damage and blood in the urine Reduced functionality of the red blood cells Skin lesions scaly, cracked, thickened skin. Fertility disorders in women and men Decreased liver function Enhancement of symptoms of arthritis, allergies, atherosclerosis, thrombosis, eczema, premenstrual syndrome. Increased risk of cancer Deficiency symptoms in children Disorders in whole body growth Insufficient development of the brain Reduction in the ability to learn Neurological disorders poor concentration and performance
High quality protein	Disturbances in digestion and absorption of (micronutrients) and resulting water and electrolyte losses. Muscle atrophy Tendency to accumulate water in the tissues edema
Amino acids, such as leucine, isoleucine, valine, tyrosine, histidine, glutamine, carnitine.	Disturbances in the function of nerves and muscles Decreased performance Limited energy production and resulting fatigue and muscle weakness. Impairment of hemoglobin formation Severe joint pain and stiffness in arthritis patients. High depletion of muscle mass and protein reserves. Insufficient protection against free radicals Weakening of the immune system, since amino acids are the main sources of energy for the immune system Disturbances in the digestive system Fluctuations in blood sugar levels Increased blood lipid and cholesterol levels Cardiac arrhythmias