The Science Behind CeliVites Gluten Free Vitamin Supplements
NUTRITIONAL DEFICIENCIES IN CELIAC DISEASE
Behind each bottle of CeliVites are countless choices and thoughtful decisions… each of which is based on and backed by robust nutritional science. If you’re interested in reading some of the studies that Gluten Free Therapeutics used to develop CeliVites gluten free vitamin supplements, they are provided below.
Nutritional Deficiencies in Celiac Disease
Celiac disease is manifested as an autoimmune attack of the small intestinal mucosa, causing physical destruction of the cells lining the intestinal villi, the absorptive enterocytes. This leads to malabsorption, and contributes to the secondary manifestations of celiac disease, those associated with malnutrition. In fact, despite the recent trend toward earlier diagnosis, in a 2013 study published in the journal Nutrients, researchers found that almost 90% of newly diagnosed celiac patients were deficient in at least one nutrient, and half the patients were deficient in more than one nutrient1. Deficiencies in the recently diagnosed patients included vitamins A, B6, folic acid, B12, and D and minerals zinc, and iron. Deficiencies in iron and folic acid and/or B12 lead to microcytic and macrocytic anemia, respectively.
Research shows that 87% of those newly diagnosed with celiac disease have at least one deficiency:
- 7.5 – 14% deficient in Vitamin A
- 14.5% deficient in Vitamin B6
- 20% deficient in folic acid
- 5 – 41% deficient in Vitamin B12
- 5 – 55% deficient in Vitamin D
- 67% deficient in Zinc
- 46% decreased iron stores
- 20 – 41% experience microcytic or macrocytic anemia
S.H. Barton, D. K. (2007). Nutritional Deficiencies in Celiac Disease. Gastroenterol Clin N Am, 93-108.
PMID:17472877
Deficiencies of iron, calcium, zinc, copper, vitamin B-12, folic acid and vitamins A, E, D and K, are common. In more severely affected patients, deficiencies of the following nutrients also occur: thiamine, vitamin B6, selenium and magnesium.
Shepherd S.J. and P.R. Gibson (2013) Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. Journal of Human Nutrition and Dietetics
26:349-358.
The study aimed to determine the nutritional adequacy of the ‘no detectable gluten’ diet. The study concluded that dietary inadequacies are common and may relate to habitual poor food choices in addition to inherent deficiencies in the Gluten Free Diet. In addition, it was concluded that dietary education should also address the achievement of adequate micro-nutrient intake, and that fortification of Gluten Free foods also need to be considered.
Hallert C. et al. (2002) Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Alimentary Pharmacology & Therapeutics
16: 1333–1339.
In a study of celiac patients on long term (10 years) gluten free diet, half had elevated plasma homocysteine levels, indicative of deficiencies in folate, vitamin B6 and B12 and the dietary intakes of folate and vitamin B12 were also deficient in these patients.
Hallert C. et al. (2009) Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Alimentary Pharmacology & Therapeutics
29: 811–816.
In a double blinded, placebo-controlled study in which patients with long-standing (>8 years) celiac disease were given B vitamin supplementation for 6 months, plasma homocysteine levels were normalized and scores of depression and anxiety improved.
Wierdsma et. al. (2013) Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients. Nutrients
5:3975-3992.
Intestine Recovery in Adults with Celiac
A. Rublo-Tapia, M. R. (2010). Mucosal Recovery and Mortality in Adults with Celiac Disease After Treatment with a Gluten-Free Diet. The American Journal of Gastroenterology(105), 1412-1420.
PMID:20145607
As the intestine recovers from chronic injury inflicted by years of inflammation, the body regains its ability to absorb nutrients. Unfortunately, it can take years after a diagnosis with celiac disease for a patient to fully recover. In a study from the Mayo Clinic in Rochester, MN, only 66% of patients regained normal intestinal mucosal anatomy 5 years after their initial diagnosis. A patient’s ability to avoid accidental exposure to gluten while following the diet may affect the time required for recovery. The most severe cases at diagnosis were negatively correlated with the ability to regain a normal mucosa.
Vitamin B2
McNulty, H. et al. (2002) Impaired functioning of thermolabile methylenetetrahydrofolate reductase is dependent on riboflavin status: implications for riboflavin requirements. Am J Clin Nutr 76:436-41.
PMID: 12145019
100% of vitamin B2 is provided as riboflavin 5’-phosphate, the active coenzyme form. Riboflavin, or vitamin B2, is required for metabolism of homocysteine; specifically, it is required as an enzymatic cofactor for methylenetetrahydrofolate reductase (MTHFR). Approximately 12% of healthy white people have a genetic variant of MTHFR (677C-T, thermoliable or TT genotype) that is less active. Evidence from in vitro studies suggests that reduced activity of MTHFR is due to instability of the interaction with its riboflavin cofactor. In a clinical study, among those with the 677C-T genotype, those in the lowest tertile of riboflavin had higher levels of plasma homocysteine, a risk factor for development of coronary artery disease. The authors conclude that in addition to folate, riboflavin requirements should be considered by government sponsored food fortification programs to prevent hyperhomocysteinemia*. Currently there are no governmental requirements for fortification of gluten free cereal and grain products.
Vitamin B6
Hallert C. et al. (2002) Evidence of poor vitamin status in coelic patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther 16:1333-1339.
PMID:12144584
Involved in over 100 enzymatic reactions, mostly concerning protein metabolism. Provided as 100% daily value in the active coenzyme form Pyridoxal 5′ phosphate. Among 30 people with celiac disease who had been adhering to a strict gluten free diet for over 10 years, 47% had decreased plasma levels of either Vitamin B-6, Folate, or both. The men within this study had elevated serum levels of homocysteine, an independent risk factor for development of coronary artery disease. Homocysteine is metabolized using Vitamins B-6, B-12 and Folate. Within this study, 33% of the variation in plasma homocysteine could be explained by low plasma Vitamin B-6 and/or Folate.
Folate
Lamers Y. et al. (2006) Red blood cell folate concentrations increase more after supplementation with [6S]-5-methyltetrahydrofolate than with folic acid in women of childbearing age. Amer J Clin Nutr 84:156-61.
PMID:16825690
Folate is important for red blood cell development and in the regulation of homocysteine. Adequate folate supports healthy fetal development and during lactation it supports the developing infant. 100% of the daily value for folic acid is provided as [6S]-5-methyltetrahydrofolate (Quatrefolic®) or 5-MTHF. This is the coenzyme form of folic acid bypassing the necessity of metabolism by the body. In a clinical study with 144 women, the change in plasma and red blood cell folate concentration over time was greater when administered 5-MTHF than folic acid. Due to genetic variation, some people cannot convert folic acid into 5-MTHF.
Vitamin B12
Leishear K. et al. (2012) Relationship between vitamin B12 and sensory and motor peripheral nerve function in older adults. J Am Geriatr Soc 60:1057-63.
PMID: 22690982
Vitamin B12 is necessary for red blood cell formation and neurological function. Those suffering from malabsorption due to celiac or other intestinal diseases may be deficient in Vitamin B12. Body Health by CeliVites gluten free vitamins for celiac disease patients provides 200% of the daily value as the active, coenzyme form, methylcobalamin.
Piperine
Badmaev V., et al. (1999) Piperine, an alkaloid derived from black pepper increases serum response of beta-carotene during 14-days of oral beta-carotene supplementation.
Nut. Res. 19:381-388.
A patented standardized extract from Piper Nigrum L. (black pepper) or Piper longum L. (long pepper), as BioPerine®. Body Health by CeliVites gluten free vitamins contains 5mg of BioPerine®, the same dose that was effective at enhancing the bioavailability of beta-carotene. In a prospective study using 12 adult male volunteers, 5mg Bioperine® along with 15mg beta-carotene resulted in higher serum levels of beta-carotene than those given 5mg Bioperine® with a placebo.
Hesperidin
Garg A. et al. (2001) Chemistry and pharmacology of the citrus bioflavonoid hesperidin. Phytother Res 15(8):655-69.
PMID:11746857
An antioxidant for protection against free radicals. Body Health by CeliVites gluten free vitamins contains the same amount of hesperitin as found in one orange.
Quercitin
Zhang M. et al. (2011) Antioxidant properties of quercetin. Adv Exp Med Biol 701:283-9.
PMID:21445799
An antioxidant for protection against free radicals. Body Health by CeliVites gluten free vitamins contains the same amount of quercetin as found in 5 apples.
Betaine Hydrochloride
Ratriyanto A. et al. (2010) Effect of graded levels of dietary betaine on ileal and total tract nutrient digestibilities and intestinal bacterial metabolites in piglets. J Anim Physiol Anim Nutr (Berl). 94(6):788-96.
PMID:20455968
Supports healthy digestion
Iron
Giorgini E. et al. (2001) The use of sweet rolls fortified with iron bis-glycinate chelate in the prevention of iron deficiency anemia in preschool children. Arch Latinoam Nutr 51(1 Suppl 1):48-53. PMID:11688082
Pineda O. and Ashmeda H.D. (2001) Effectiveness of treatment of iron-deficiency anemia in infants and young children with ferrous bis-glycinate chelate. Nutrition 17(5):381-384. PMID:11377130
Pineda O. et al. (1994) Effectiveness of iron amino acid chelate on the treatment of iron deficiency anemia in adolescents. J Applied Nutr 46:2-13.
The iron in our Blood Health formula is in chelated form, ferrous bisglycinate (Ferrochel®), with remarkable bioavailability of up to 75%. This form of iron is absorbed up to three times better than ferrous sulfate. Ferrochel® is safe, as with other forms of iron, absorption is inversely correlated with hemoglobin levels (hemoglobin is a proxy for iron stores in the blood). Ferrochel® is also easy on the digestive system; When 30 mg of ferrous bisglycinate was given for 8 weeks there were zero digestive complaints.
Vitamin C
Lane D.J.R., et al. (2013) Transferrin iron uptake is stimulated by ascorbate via an intracellular reductive mechanism. Biochim Biophys Acta 1183:1527-1541.
PMID: 23481043
To increase iron absorption and utilization, 200% of the daily value of Vitamin C is provided as PureWay-C®, an advanced form. It has long been known that vitamin C facilitates uptake of iron from the diet. It has recently been reported that vitamin C increases cellular uptake of iron bound to transferrin, a protein that carries iron within the blood stream.
Vitamin D3
Schnatz P.F. et al. (2012) Response to an adequate dietary intake of vitamin D3 modulates the effect of estrogen therapy on bone density. J Women’s Health (Larchmt) 8:858-64.
PMID: 22691032
Bone Health by CeliVites gluten free iron supplement with multivitamins for celiac patients provides 1000 IU or 250% of the daily value of vitamin D. Those taking both Body Health and Bone Health by CeliVites will receive 2000 IU or 500% of the daily value for Vitamin D. In a controlled experiment using laboratory non-human primate models of postmenopausal women, those with higher serum concentrations of vitamin D and also receiving supplemental estrogen had increased bone density relative to those receiving a placebo instead of estrogen. In summary, in this study vitamin D and estrogen supplementation are synergistic in their effects on increased bone mineral density.
Vitamin K2
Knapen M.H.J., et al. (2013) Three-year low-dose meanquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporos Int. 9:2499-507.
PMID:23525894
In a clinical study, postmenopausal women taking 180mcg of Vitamin K2 as menaquinone-7, the same dose provided by Bone Health gluten free iron supplement with multivitamins for celiac patients by CeliVites, had decreased bone loss.
Geleijnse, J.M., et al. (2004) Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease: the Rotterdam Study. J Nutr. 134:3100-5. PMID: 15514282
In a prospective study of 4807 Dutch men and women over age 55, those ingesting quantities of menaquinone in the mid and upper tertiles (21.6-32.7 and >32.7 mcg respectively) had a decreased risk of dying from coronary heart disease, a decreased risk of dying from any cause, and a decreased risk of severe coronary calcification.
Calcium
Aslam M.N. et al. (2010) A Mineral-Rich Extract from the Red Marine Algae Lithothamnion calcareum Preserves Bone Structure and Function in Female Mice on a Western-Style Diet. Calcif Tissue Int 86:313-24.
PMID: 20180099
Fifty percent of the calcium in Bone Health by CeliVites is supplied as calcium citrate and 50% as Aquamin®, which is derived from Litothamnion coralliodes, a red algae from the Atlantic waters off the coast of Ireland and Iceland. Aquamin® was found to reverse bone loss associated with feeding a high-fat Western diet in female mice*. As a marine plant-derived extract, in addition to calcium, Aquamin® contains magnesium and over 70 trace and ultra-trace minerals
Magnesium Citrate
Aydin, H. et al. (2010) Short-term oral magnesium supplementation suppresses bone turnover in postmenopausal osteoporotic women. Biol Trace Elem Res 133:136-43.
PMID: 19488681
Magnesium is important for calcium homeostatis and bone health. In a prospective study of 20 postmenopausal osteoporotic women, those taking a supplement with 1830mg magnesium citrate had levels of biochemical markers indicative of less of bone turnover than those not taking the supplement.
Potassium Citrate
Jehle S. et al. (2006) Partial neutralization of the acidogenic Western diet with potassium citrate increased bone mass in postmenopausal women with osteopenia. J Am Soc Nephrol 17:3213-3222. PMID:17035614
Cogswell M.E. et al. (2012) Sodium and potassium intakes among US adults: NHANES 2003-2008. Am J Clin Nutr 96:647-57. PMID:22854410
The western diet is higher in meats and high protein grains than was the diet of our ancestors, resulting in acidification. One hypothesis is that such an increase in acid load contributes to the loss in bone mineral density observed among modern postmenopausal women. Because potassium citrate is alkalizing, it could reverse the effects of an increased acid load on bone formation or loss. In a study with 161 postmenopausal women with low bone mass, when compared with those given potassium chloride, those given potassium citrate gained bone mineral density in the lumbar spine after 12 months (L2 – L4) (P<0.001). In the U.S. 98% of adults do not ingest the recommended daily value of potassium (4700 mg).
