Zinc- Zinc is considered an essential mineral, meaning it is required for vital bodily functions. In some people with gluten intolerance, blood levels of zinc have been found to be low (1). The likely reason for low zinc levels is malabsorption of nutrients, including zinc, due to a compromised intestinal lining, which is responsible for transport of vitamins and minerals into the blood. Low levels of zinc may further aggravate this condition (2).
One of the main recommendations for gluten intolerant people is to follow a gluten-free diet, which is often low in B vitamins, calcium, vitamin D, iron, magnesium, fiber and zinc (3). This type of diet can deplete zinc levels even further. A clinical study of zinc supplementation for eight weeks showed improved function of intestinal enzymes that break down sugars (4). For these reasons, people who are gluten intolerant should receive zinc supplementation to address nutritional imbalances.
Glutamine- The preferred fuel for cells of the GI tract, glutamine is an amino acid that also exerts a protective effect on the intestinal lining. It is abundant in many foods but is easily broken down in the cooking process. People who are gluten intolerant may experience a leaky intestinal tract, due to a compromised lining.
A recently published article suggests that administration of glutamine can maintain the physiologic intestinal barrier (5). Similarly, glutamine supplemented formulas given to children with low nutrient levels helped maintain the intestinal barrier (6). Glutamine has also demonstrated efficacy in the digestive tracts natural healing and anti-inflammatory processes (7-9).
DGL- Deglycyrrhizinated licorice (DGL) is licorice with the glycyrrhetinic acid removed for safety reasons. Licorice has potent anti-inflammatory activity making it a useful adjunct to the treatment of people who are gluten intolerant (10). Extracts of licorice have also shown the ability to promote the gastrointestinal tract's natural healing process possibly due to its antioxidant effect (11,12).
Artichoke leaf- Artichoke has classically been used to address gastrointestinal disturbances. Recent evidence supports this use, elucidating a possible mechanism by which artichoke can alleviate abdominal complaints such as minor cramping, bloating, and flatulence associated with conditions such as gluten intolerance.
It appears the main active constituent is a potent antispasmodic agent, reducing muscular spasms of the digestive tract that result in discomfort (13). Ninety-six percent of patients noted positive results without adverse effects. Artichoke also has fructose-containing oligosaccharides which function as prebioitcs, fuel for the good bacteria in the digestive tract, contributing to gastrointestinal health (15,16).
B complex- As mentioned, a gluten-free diet tends to be low in B vitamins. As well, malabsoption of nutrients due to compromised intestines causes low levels of B vitamins. In one study involving 41 subjects, 41% had low levels of vitamin B12 (17). Other clinical studies (even those following a gluten-free diet) demonstrated low levels of vitamins B6 and B12 (18-20). This underscores the importance of supplementation with B vitamins to prevent poor nutrient status which can contribute to cardiovascular health.
1. Fisgin T et al. Hematologic manifestation. Acta Haematol 2004;111(4):211-4.
2. Roth EB, Sjoberg K, Stenberg P. Biochemical and immuno-pathological aspects of tissue transglutaminase. Autoimmunity 2003 Jun;36(4):221-6.
3. Kupper C. Dietary guidelines and implementation. Gastroeneterology 2005 Apr;128(4 Suppl 1):S121-7.
4. Jones PE, Peters TJ. Oral zinc supplements in non-responsive effect on jejunal morphology, enterocyte production, and brush border disaccharidase activities. Gut 1981 Mar;22(3):194-8.
5. De-Souza DA, Intestinal permeability and systemic infections: effect of glutamine.Greene LJ. Crit Care Med 2005 May;33(5):1125-35.
6. Lima AA et al. Intestinal barrier function and weight gain in malnourished children taking glutamine supplemented enteral formula. J Pediatric Gastroenterol Nutr 2005 Jan;40(1):28-35.
7. Anderson PM, Ramsay NK, Shu XO, et al. Effect of low-dose oral glutamine. Bone Marrow Transplant 1998;22:339-44.
8. Israeli E et al. Prophylactic administration of topical glutamine enhances the capability of the rat colon to resist inflammatory damage. Dig Dis Sci 2004 Oct;49(10):1705-12.
9. Mellis GC et al. Glutamine: recent developments in research on the clinical significance of glutamine. Curr Opin Clin Nutr Metab Care 2004 Jan;7(1):59-70.
10. Aly AM, Al-Alousi L, Salem HA. Licorice: a possible anti-inflammatory. AAPS PharmSciTech 2005 Sep 20;6(1):E74-82.
11. Turpie AG, Runcie J, Thomson TJ. Clinical trial of deglycyrrhizinized liquorice in gastric ulcer. Gut 1969;10:299-302.
12. Bafna PA, Balaraman R. Anti-ulcer and anti-oxidant activity of pepticare, a herbomineral formulation. Phytomedicine 2005 Apr;12(4):264-70
13. Emendorfer F et al. Antispasmodic activity of fractions and cynaropicrin from Cynara scolymus on guinea-pig ileum. Biol Pharm Bull 2005 May;28(5):902-4
14. Walker AF, Middleton RW, Petrowicz O. Artichoke leaf extract in a post-marketing surveillance study. Phytother Res 2001;15:58-61.
15. Gibson GR. fructose-containing oligosaccharides. Br J Nutr 1998 Oct;80(4):S209-12.
16. Kaur N, Gupta AK. Applications of insulin and oligofructose in health and nutrition. J Biosci 2002 Dec;27(7):703-14.
17. Dahele A, Ghosh S. Vitamin B12 deficiency. Am J Gastroenterol 2001 Mar;96(3):745-50.
18. Haller C et al. Evidence of poor vitamin status on a gluten-free diet for 10 years. Ailment Pharmacol Ther 2002 Jul;16(7):1333-9.
19. Dickey W. Low serum vitamin B12 is common and is not due to autoimmune gastritis. Eur J Gastroenterol Hepatol 2002 Apr;14(4):425-7.
20. Reinken L, Zieglauer H, Berger H. Vitamin B6 nutriture of children, and of children with normal duodenal mucosa. Am J Clin Nutr 1976 Jul;29(7):750-3.