When the time comes to discuss the use of dietary supplements to prevent or treat osteoporosis, naturally calcium will be at the top of the list. But as I've mentioned in previous alerts, calcium is poorly absorbed by the body, so an additional supplement of magnesium is needed to help solve this problem. Vitamin D has also been shown to support good bone health. But what's missing from this picture? According to a recent study, some osteoporosis patients should ask their doctors for a blood test to determine if they need to make a major change in their diets - a change that could reap significant benefits in maintaining healthy bones. More than 1.5 million people in the U.S. may have celiac disease (CD), a condition in which gluten (a component of grains) reduces the small intestine's ability to absorb essential nutrients, such as calcium. Unfortunately, the symptoms of celiac disease are often so subtle that many people don't even know they have it. A study reported in the Archives of Internal Medicine last month investigated the link between celiac disease and osteoporosis. Researchers at Washington University School of Medicine recruited 840 subjects. About 260 of the subjects had been diagnosed with osteoporosis. Blood tests and other diagnostic tools revealed that CD was much more common among subjects with osteoporosis. In addition, subjects with the most severe cases of celiac disease tended to have the most severe cases of osteoporosis. Subjects who were diagnosed with CD were asked to follow a gluten-free diet for one year. Bone mineral density was measured before and after the follow up year. In these subjects who followed the non-gluten diet, gastrointestinal symptoms were relieved and bone density improved. Lead researcher, William Stenson, M.D., told Reuters Health that he and his colleagues believe that the non-gluten diet promoted intestinal healing, which resulted in better absorption of calcium and vitamin D and a reversal of bone loss. The researchers recommend that doctors should use blood tests to screen osteoporosis patients for celiac disease. To understand celiac disease, first we need to look at gluten. Gluten is a typical component of several different grains. As a primary ingredient of flour, gluten delivers protein and gives bread a higher rise. I asked panelist Allan Spreen, M.D., for his insights on gluten basics, and here's what he had to say: "The high-gluten grains are within the mnemonic BROW (Barley, Rye, Oat, Wheat). When completely unrefined, these grains in and of themselves are not the problem. It's when sensitive individuals run into them that trouble can occur (not counting the dangers of refining them into low-nutrient, low-fiber, high-starch blood sugar stressors). Most often, reactions can involve swings in blood sugar, which can manifest as irritability, headache, difficulty concentrating, fatigue, increased appetite, and subsequently weight problems. "Constant exposure to one food can cause a person to become 'sensitized.' This is most common in the case of wheat, since wheat is absolutely everywhere. If a person craves grains, cereals, breads, etc., or eats them every day, I often test them by avoiding the potential offending agent for 7 days (21 for dairy). Sometimes the results are remarkable." The problem with diagnosis of celiac disease is that the symptoms are sometimes directly related to digestion (as with abdominal cramping, unexplained weight loss, and chronic diarrhea), but sometimes not (as with osteoporosis, joint pain, and depression). If any of these symptoms occur in a patient with family history of CD, this should stand out as a red flag for any physician. The primary treatment for celiac disease is adherence to a strict non-gluten diet - but this is easier said than done. Gluten is sometimes hidden in foods such as soups, soy sauce, low-fat or non-fat products, and even in candies such as jelly beans. Some common food ingredients that may contain gluten include: modified food starch, hydrolyzed vegetable or plant protein, and some binders and fillers, as well as malt and natural flavorings. Fortunately, if diagnosed early and addressed before it has a chance to do serious damage, celiac disease is relatively easy to treat. If you believe that you may be experiencing symptoms of celiac disease (especially if the family history is there), ask your doctor or dietician to provide you with specific strategies for recognizing and avoiding hidden gluten in your diet. In addition, a number of studies have shown that a plant- based enzyme called Aspergillus oryzae may be effective in protecting the intestine from the effects of gluten. Enzyme formulas containing Aspergillus oryzae (such as Similase and Zest for Life Enzyme Boost Formula) are available from sources on the Internet. However, anyone with celiac disease or other serious digestive problems should first discuss the use of enzyme supplements with a health care provider.