There is a good chance one of your patients is one of the 3 million Americans who have been diagnosed with celiac disease.
Or they may be in the additional 2.5 million who do not have an official diagnosis of celiac disease, but may have determined that they are gluten-intolerant, but they likely have a well established routine in place for avoiding food that contains gluten.1
They are experts at preparing food that is gluten-free, nutritious and satisfying (and can even make gluten-free treats, such as cookies and cupcakes). They understand how to read food labels to search for ingredients that may contain hidden gluten.
They can handle kitchen utensils and serving items to avoid any cross-contamination from items that have come in contact with gluten. In short, your patients who must be mindful about gluten are often your most nutritionally savvy patients.
This is particularly true for those who have to maintain gluten-free not just for themselves, but also for their entire family, particularly their children.
However, even the most gluten-aware of your patients may be not know about the most dangerous places in which gluten may be lurking—their vitamins and supplements.
This can be a real problem because celiac disease or gluten intolerance can lead to nutritional deficiency if not properly treated, so vitamins and supplements are often recommended.
Are the ones your patients are taking actually gluten free supplements?
Nutritional supplements and celiac disease/gluten intolerance
Celiac disease/gluten intolerance is an autoimmune condition in which the small intestine is unable to absorb important nutrients, such as fiber, iron, calcium, magnesium, zinc, niacin, riboflavin, vitamin B12, and vitamin D.2
The trigger for this malabsorption is ingestion of gluten (a protein in wheat, rye and barley that helps bind the food together to hold its shape). This reaction to gluten damages the villi, which line the small intestine.
If left untreated, this nutritional deficiency can lead to a number of other serious conditions, including multiple sclerosis, anemia, osteoporosis and intestinal cancer.2 Standard treatment is generally a combination of a strict gluten-free diet, along with vitamins and supplements.
Hidden gluten in nutritional supplements
If the vitamins and supplements that your patients are taking are not gluten-free, their symptoms will only worsen. Unfortunately, it can be particularly difficult to determine whether or not vitamins and supplements contain gluten, as it is almost never one of the active ingredients.
Instead, it is often used as part of the excipient, or the material that helps stabilize the vitamin or supplement, making the active ingredients capable of working properly.3,4
Although some ingredient labels list what goes into excipients, others do not because excipients are considered to be a proprietary trade secret. A 2011 study from a Romanian journal tested 21 various nutritional supplements using an immunochromatographic assay to determine whether or not they were gluten free.
The researchers found that almost 24 percent of the samples they tested contained more than 20 ppm of gluten (the FDA standard below which food, drugs, and nutritional supplements can be considered gluten-free).4
In light of this, what is the best recommendation that you can make to your patients who must maintain a gluten-free lifestyle, either for themselves or for other family members? They should read ingredient labels on their vitamins and supplements just as carefully as they do for their food.
Obviously, any nutritional supplement that does not provide an ingredient list should not be considered safe. If there is a list, but it uses very vague terms, such as binding agents, coatings or preservatives, but without specifying exactly what goes into them, it’s a safe bet that those may be proprietary formulas that may contain gluten.
Instead, your patients should look for a complete list of the inactive ingredients, including the inactive ingredients.
In fact, if you find a line of nutritional supplements that is gluten-free, you may wish to consider selling it in your office. Your gluten-free patients will thank you for your efforts to help them keep healthy.
- Green PH, Stavropoulos SN, Panagi SG, et al. (2001). Characteristics of adult celiac disease in the USA: Results of a national survey. American Journal of Gastroenterology, 96(1), 126-131.
- Vitamins and supplements. Celiac Disease Foundation. Accessed 12/20/2017.
- Oancea S1, Wagner A, Cîrstea E, Sima M. (2011). Gluten screening of several dietary supplements by immunochromatographic assay. Roumanian Archives of Microbiology and Immunology, 70(4), 174-177.
- Wikipedia. Accessed Dec. 20, 2017.