By Lauren Hoffman, Bastyr University Dietetic Intern
We know that untreated or poorly managed celiac disease can cause damage to the inside of the body, but how can it affect the outside? Often nutrient deficiencies can be detected through examining outward features like skin, hair, and nails. Normally, vitamins and minerals help keep these areas nourished and healthy, but some conditions, such as celiac disease, can inhibit nutrient absorption. When vitamin stores are compromised, nutrients like iron, folic acid, vitamin B12, biotin, and vitamin E are shuttled to the areas in the body that need them the most, leaving hair, skin, and nails left dry, flaky, and dull.
Nails– It is not uncommon to see dry and brittle nails caused by nutrient malabsorption. B12 deficiency can create ridges on the nails. In extreme cases, clubbing of the fingers can occur due to lack of oxygen in the blood. These symptoms are from a lack of iron in the body, also known as anemia. Other symptoms of anemia include fatigue, light-headedness, feeling unusually cold, shortness of breath, and pale skin. Talk to your physician if you are experiencing any of these symptoms. Your doctor may recommend a total iron binding blood count to screen for iron deficiencies.
Skin– Rosacea and dermatitis herpetiformis are conditions that sometimes occur in conjunction with celiac disease. Dermatitis herpetiformis, which is manifestation of celiac disease, is a blistering, bilateral rash caused by gluten-sensitive enteropathy, and affects approximately 5% of people with celiac disease. Milder cases of nutrient deficiency can cause dry skin and itchy, dry rashes. Biotin, a B vitamin, is an essential building block for hair, skin, and nails. Biotin deficiency can result in dry, itchy skin. Dry, cracked lips can be an indicator of folate deficiency as well, a vitamin that is also important for helping prevent neural tube defects in pregnancy and for building red blood cells.
Hair– Untreated celiac disease can lead to hair loss, dry, brittle strands and stunted hair growth due to malabsorption. In addition, risk of alopecia areata, an autoimmune disease that attacks the hair follicle, is increased in people with celiac disease. Vitamins that affect hair health are vitamins D and E. Both are important for health and regeneration of the hair follicle by increasing blood circulation.
The only way to treat and manage celiac disease is through following a strict gluten-free diet to allow the intestine to heal and begin absorbing nutrients properly again. This process can take anywhere from a few months to years, so be patient in the healing process. Nutrients that the body uses to build healthy hair, skin, and nails are iron, folate, vitamin B12, biotin, vitamin D, and vitamin E . Eating a variety of fruits, vegetables, lean meats, and gluten-free whole grains will offer the nutrients that your body needs to function optimally on the inside and look good on the outside. Sources of these essential nutrients are listed in the table below. Even with a healthy diet, help meet your nutrient requirements.
Iron: chicken, legumes, spinach, dark green vegetables
Folate: lentils, dark leafy greens, lean meats, fortified orange juice, beans, broccoli
Vitamin B12: meat, eggs, poultry, dairy, fish
Biotin: eggs, almonds, sweet potatoes, oats, salmon, peanuts
Vitamin E: sunflower seeds, almonds, spinach, Swiss chart, avocado, asparagus
Vitamin D: fortified dairy products, mushrooms, sunlight
Beauty Products: Gluten-free?
Wheat and oat derived ingredients are commonly found in lotions, cosmetics, shampoos, soaps and many other beauty products. However, since it is the ingestion of the gluten protein that causes a reaction, gluten-containing beauty products should not be problematic as long as ingestion is avoided. If you do have a reaction to gluten-containing body products, you may have a wheat allergy, which could result in a typical allergenic reaction. Products that are certified by the Gluten Intolerance Group’s Gluten-Free Certification Organization (GFCO) can be found online in the GFCO Product database. https://gluten.org/resources/find-products/
Jam Packed Green Smoothie
-2 cups packed baby spinach
-1 cup orange juice*
-2-3 ice cubes, optional
- Add all ingredients into a blender and blend until smooth. Makes 1 serving.
- *Orange juice fortified with vitamin D will increase your intake.
Nutrition Facts: 371 calories, 12g fat, 62g carbohydrates, 43g sodium, 5g protein
Vitamins: Folate 70%, Iron 14 %, Vitamin E 13% (Based on Daily Recommended Intake, DRI)
DIY Trail Mix
-1 cup raw or roasted almonds
-1/2 cup sunflower seeds
-1/2 cup raisins
-1/2 cup dark chocolate chips
-pinch of sea salt, optional
- Add ingredients to a bag or container. Shake and eat! Makes 10 ¼
Nutrition Facts: 173 calories, 12g fat, 17g carbohydrate, 3g fiber, 3.5g protein
Vitamins: Vitamin E 29 %, Folate 5 %, Iron 5% (Based on DRI)
Chunky Chili Soup
-46 oz. tomato juice
-1 lb ground beef or turkey, thawed
-1 yellow onion, chopped
-2 cloves garlic, minced
-1 can red kidney beans, drained
-1 can black beans
-1/2 cup lentils, dry
-1 Tbsp. chili powder
-Pepper to taste
-2 Tbsp. olive oil
-plain Greek yogurt for garnish
- In a large skillet, heat oil over medium-high heat. Add onion and garlic and sauté until soft, 3-5 minutes.
- While onions and garlic are cooking, pour tomato juice into a large stock pot and add beans, lentils and spices. Heat to a simmer, stir occasionally.
- Brown the ground meat with onions and garlic until cooked completely through.
- Once the meat is cooked, drain the fat from the meat while keeping the onions and garlic. Add to the tomato juice mixture.
- Simmer all ingredients together 20-30 minutes. Makes 6 servings.
Nutrition Facts: 397 calories, 20g fat, 36g carbohydrate, 9g fiber, 24g protein
Vitamins: Vitamin E 14%, folate 20%, iron 31% (Based on DRI)
Collin P, Salmi TT, Hervonen K, Kaukinen K, and Reunala T. “Dermatitis Herpetiformis: A Cutaneous Manifestation of Coeliac Disease.” PubMed. Ann Med, 8 Aug. 2016. Web. 17 Nov. 2016. <https://www.ncbi.nlm.nih.gov/pubmed/27499257>.
Egeberg, A. “Clustering of Autoimmune Diseases in Patients with Rosacea.” National Center for Biotechnology Information. U.S. National Library of Medicine, 30 Jan. 2016. Web. 18 Nov. 2016
“Celiac Disease and Anemia – The Gluten Intolerance Group of North America.” The Gluten Intolerance Group of North America. GIG, 8 Aug. 2016. Web. 18 Nov. 2016.
Robert S. Fawcett, M.D., M.S., Thomas M. Hart Family Practice Residency Program, York Hospital, York, Pennsylvania, and Sean Linford, M.D., and Daniel L. Stulberg, M.D., Utah Valley Family Practice Residency Program, Provo, Utah. “Nail Abnormalities: Clues to Systemic Disease.” Nail Abnormalities: Clues to Systemic Disease – American Family Physician. N.p., 15 Mar. 2004. Web. 18 Nov. 2016.