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How Bone Health and Gluten Sensitivity are Linked

Going gluten-free is not a trend, it’s here to stay.

By 2018, the global gluten-free product market is expected to reach $6.28 billion, according to a report by MarketsandMarkets.¹

One reason for this – celiac disease is on the rise. In fact, it’s four times as common as it was 50 years ago.² And while testing methods and diagnosis has improved, they alone don’t account for all of that increase, says Joseph A. Murray, MD, professor of medicine and gastroenterologist at the Mayo Clinic in Rochester.

Even with the rise, celiac disease only affects about 1% of the total population³, but more and more people are also suffering from gluten intolerance.

Researchers speculate this increase may be due to how grains are bred these days. Another theory is that over increased hygiene and reliance on infant formula have also led to this autoimmune disease.

That’s for another time.

What we do know is that more people are following a gluten-free diet for many different health reasons. They may have celiac disease, gluten intolerance, or simply feel better cutting it out.

But what are the differences between these diagnoses? And how are they linked to bone health?

Let’s find out…

The Difference Between Celiac Disease and Gluten Intolerance

What is celiac disease?

Celiac disease is a genetic, autoimmune disorder in which the body cannot tolerate gluten.³ Gluten is a protein found in barley, rye, wheat, farina and bulgur among others. When gluten is consumed the immune system responds by attacking the lining of the small intestine, which can lead to damage. And each time gluten is consumed, more damage ensues. When the small intestine is damaged, so is its ability to absorb and distribute nutrients into the bloodstream for your body to use.

Normal small intestine vs. celiac disease

The most common blood test for celiac disease is the Tissue Transglutaminase Antibodies (tTG-IgA) test. If you do discover you suffer from celiac disease, the only treatment is to follow a gluten-free diet.

Untreated celiac disease can lead to malnourishment and therefore result in the following diseases and symptoms.

There are over 300 possible symptoms of celiac disease, including but not limited to:

  • Fatigue
  • Constipation
  • Abdominal bloating and pain
  • Behavioral changes
  • Arthritis
  • Irritability
  • Anemia
  • Bone or joint pain
  • Low bone density

If you have celiac disease, you are at a higher risk of osteoporosis and bone loss.⁴ But more on that a bit later…

What is gluten intolerance?

Gluten Intolerance also known as non-celiac gluten sensitivity (NCGS) is a condition where people suffer from similar symptoms as celiac disease or a traditional allergy, but do not have either.¹

Symptoms of gluten intolerance include, but are not limited to:

  • Headaches
  • Fatigue
  • Gas
  • Abdominal bloating and pain
  • ‘Brain Fog’ (mental fatigue)

Researchers are still trying to discover the exact biological cause of this condition. Currently, there is no clinical test to diagnose NCGS. Your doctor will therefore have to establish a clear connection between your symptoms and NCGS. They may ask you to keep a food and symptom journal in order to determine whether gluten is causing you problems.

Once that connection has been established, you may be advised to follow a gluten-free diet.

osteoporosis and gluten sensitivity - sliced bread ciabatta and extra virgin olive oil on wooden background

4 Links Between Celiac Disease, Gluten Intolerance and Bone Health

A study in The Journal of Clinical Endocrinology & Metabolism found that celiac disease was associated with a 69% increased risk of hip fracture and a 30% increased risk of any fracture.⁵

There are several reasons for the increased risk of bone loss for those with celiac disease and gluten intolerance. They are:

  1. Malabsorption of Nutrients, such as calcium and vitamin D. Gluten damages the villi lining of the small intestine and for untreated celiac sufferers, this can inhibit nutrient absorption. So while they may be consuming adequate bone-building minerals, the small intestine cannot absorb them properly and send the nutrients to your bones.
  2. Autoimmune factors. Tissue Transglutaminase (tTG) is an enzyme that is crucial for joining proteins together, which impacts bone remodeling.6 Antibodies against tTG are formed in the small intestine when individuals with celiac disease consume gluten.
  3. Secondary hyperparathyroidism: Some people with celiac disease may also suffer from secondary hyperparathyroidism. Significant calcium malabsorption in this condition results in low blood levels of calcium. This triggers the parathyroid gland to secrete parathyroid hormone (PTH). PTH then signals the bones to release calcium in order to balance calcium blood levels again to the desired range, which contributes to bone loss.7
  4. Inflammation. Celiac disease can lead to abnormal inflammation, which includes excessive levels of pro-inflammatory compounds in the blood. “Gluten intolerance inflames the gut which then leads to a bodywide inflammation and, consequently, bone loss,” says Dr. Vikki Petersen, a Certified Clinical Nutritionist.

Untreated celiac disease and gluten intolerance can impact your bones in the above four ways.

So can your bones bounce back?

It depends on your age and the duration of your untreated condition. But the sooner and earlier in life someone switches to a gluten-free diet, the better chance they have to return to normal bone mass.

This also takes into consideration lifestyle factors such as weight-bearing exercise, avoidance of smoking, and a healthy and nutrient dense diet.

Optimal Supplementation and Diet Plan

The best approach for celiac disease and gluten intolerance sufferers is to follow a gluten-free diet.

It’s worth noting that many people who are gluten intolerant are also intolerant of other food proteins found in eggs, dairy and even coffee. (I know! I’m sorry!)AlgaeCal Plus for Bone Strength

Research has shown that about 50 percent of patients with celiac disease also show an intolerance to a protein in milk called casein.8

So focusing on a diet plan that cuts out any intolerances is crucial! Loading up on fruits, vegetables, nuts and seeds and lean proteins and fatty fish (like salmon) is the first step in reclaiming your health.

To make up for the nutrient shortfall from malabsorption, supplementation may be necessary. AlgaeCal Plus is a plant-based whole foods supplement, clinically supported to increase bone density. It provides ALL 13 known essential bone-supporting minerals (calcium, magnesium, boron, copper, manganese, silicon, nickel, selenium, strontium, phosphorus, potassium, vanadium, and zinc). Plus it contains vitamins C, D3, and K2. That’s everything you need for healthy bones. (And it’s gluten-free!)

If you are already suffering from bone loss, take it together with Strontium Boost to ensure you’re giving your bones all that you need.

You can reclaim your bone health. Find out how.


  2. Increased Prevalence and Mortality in Undiagnosed Celiac Disease. Rubio–Tapia, Alberto et al. Gastroenterology , Volume 137 , Issue 1 , 88 – 93
  4. Meyer D, Stavropolous S, Diamond B, Shane E, Green PH. Osteoporosis in a north american adult population with celiac disease. Am J Gastroenterol. 2001 Jan;96(1):112-9.
  5. Heikkilä K, Pearce J, Mäki M, Kaukinen K. Celiac disease and bone fractures: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2015;100(1):25-34.
  6. Agardh D, Björck S, Agardh CD, Lidfeldt J.Coeliac disease-specific tissue transglutaminase autoantibodies are associated with osteoporosis and related fractures in middle-aged women.Scand J Gastroenterol. 2009;44(5):571-8. doi: 10.1080/00365520902718929.
  7. Green PHR, Jones R. Celiac Disease: A Hidden Epidemic. Revised edition. New York, NY: HarperCollins; 2010.
  8. Kristjánsson G, Venge P, Hällgren R. Mucosal reactivity to cow’s milk protein in coeliac disease. Clin Exp Immunol. 2007 Mar;147(3):449-55.

Author: Monica Straith, BS

Monica is the PR and Outreach Manager and Fitness Lead at AlgaeCal. She’s an ACE Certified Personal Trainer and Nutrition Specialist, and has a B.S. and B.A. from the University of Wisconsin-Madison, where she played varsity soccer for four years. Monica pulls from her experience in athletics and health to contribute to AlgaeCal and has also been featured on myfitnesspal blog, Prevention, and Huffington Post.