Interesting question.

I would look at exercise protocols only, as celiac disease itself is not a risk of being malnurished, neither the fact that the disease caused the low bone density affects to the protocol once a celiac diet has been prescribed.

In other words, I would concentrate on an exercise protocol for low bone density, as is assumed that celiac disease is already in treatment , bowel is restored and there is no lack of nutrients

In the US only recently have high risk individuals been screened for celiac disease. So many of the adults who are diagnosed have had the disease many years before diagnosis and treatment. In the US the physical activity levels of adults are much lower than in the EU. A significant number of people with CD have hypercalciuria which responds to a balanced diet and bisphosphonates. Rarely is physical activity mentioned as part of treatment in the literature and it is well known that disuse atrophy is an important factor. Individuals with osteoporosis are ten times more likely than others to have CD. Besides the malabsorption theory, there is a growing support for chronic inflammation being an important factor in bone mineral loss. Exercise reduces inflammation. It is difficult to determine how much and what frequency impact or non-impact exercise should be recommended. Marques,Mota & Carvalho (Age, 2012) review of studies on older adults show a benefit of exercise on BMD. Yet, a subject with CD would have been eliminated from these trials.

I believe a diet adequate in all vitamins and minerals associated with building and maintaining bone structure is step one.  As you know research is now pointing to  adding vitamin K2 via fermented soy, some cheeses (Gouda is an example) or grass fed animal products is becoming an important entity in this dietary process. I also suggest low salt, low sugar and 8 glasses of water per day to flush out toxins and improve elimination.

Step two: A good fitness program. It depends on the health and fitness level of the individual.  Thus it is recommended to first complete a physical exam and analysis of flexibility, muscle strength, and stamina. There may be cardiovascular health issues in older patients who have osteopenia or osteoporosis and celiac disease.  Individuals on the lower end of the health spectrum should begin with a solid walking program and light weight bearing exercise such as using stretch bands and water exercises.  This level of exercise can evolve by adding weight, more intense cardiovascular exercise, and weight bearing/flexibility programs such as yoga and Pilates. The amount of time dedicated to fitness is also very important.  Frequent walks interspersed throughout the day in addition to more rigorous cardio and weight bearing exercise is incredibly important and helps the digestive process if done after every meal.   A word of caution:  If a patient already has osteopenia or osteoporosis is it not recommended to do deep twisting exercises, contact sports or sports that at are high risk of falling. 

I have been developing a program for better bone health for those allergic to or who choose to avoid dairy products.  It is interesting to hear about your program that surrounds patients with celiac and absorption problems.  I would like to talk further and discuss this with you sometime.

Julie, How do you work with individuals with chronic fatigue. This has been identified as a problem with individuals with celiac as a problem?

Sorry for the delay in response.  You pointed out a problem that is also associated with aging and age related diseases.  I would suggest gentle Yin based yoga to stretch the fascia and provide a relaxed passive work out.  The result, in time, is flexibility and some strength plus invigorating the internal organs to work more symbiotically thus add energy.  Short bursts of exercise are perfect for these populations.  I would suggest 10 to 20 minutes of exercise every 2 to 3 hours depending on their schedule.  Besides the yoga you can suggest walking, stationary bicycling, dancing (any style and speed), and easy swimming.  I am not sure if your have your individuals on increased vitamins such as the B's and C's but I believe these two vitamins help with energy.  Lastly, on a nutrition standpoint I would have them detox from caffeine.  In their condition the caffeine may exacerbate and prolong extreme fatigue. I am guessing coffee or tea is a common beverage for those with chronic fatigue but it is worsening it.  Also, coffee has a protein structure similar to gluten so if they have celiac they should avoid coffee in any form.  I know I went deeper into the question and hope you don't mind.  Thank you for reaching out.

When celiac disease is already known by the patient and treated properly with the necessary supplements, the person can do almost the same exercises that a normal person does. In my experience, I not only prescribe activities involving high energy expenditure in short time, as the races for high intensity, for example. The exercises should be prescribed taking into consideration aspects of the disease and who is the patient (who may have age or not, may have cardiorespiratory or metabolic diseases, etc.)

I am interested in bone mineral density. The one study I could find reported that lumbar and femoral bone mineral density were affected by symptom severity, physical activity, and gender, with a significant correlation (r= .50 for PA and BMD). Yet, the clinical practice guidelines rarely mention physical activity as a primary treatment. Is it a problem of awareness, or is it due to the complex nature of these patients that we do not treat it as a lifestyle disorder?

Di Stefano, M., Veneto, G., Corrao, G., & Corazza, G. R. (2000). Role of lifestyle factors in the pathogenesis of osteopenia in adult coeliac disease: a multivariate analysis. Eur J Gastroenterol Hepatol, 12(11), 1195-1199.

Hi,

Check our paper: A meta-analysis of brief high-impact exercises for enhancing bone health in premenopausal women. http://www.ncbi.nlm.nih.gov/pubmed/21953474

Hope that helps

Fascinating paper. Thank you, Dr. Babatunde. Zhao et al. (2014) http://www.ncbi.nlm.nih.gov/pubmed/24981245 came to similar conclusions. They also published another meta-analysis on the effect of antiresorptive agents and exercise on lumbar spine http://www.ncbi.nlm.nih.gov/pubmed/24566585 . So, if there is a positive effect of exercise on the femoral neck and trochanteric BMD, but not on the lumbar spine, it would appear that exercise and medication management are important in healthy individuals. But we are still left wondering whether exercise and standard treatment would increase BMD in adults with CD and other metabolic bone diseases.

Yoga asanas will be good for them.

I also think if they shift to more nutritious gluten-free vegetarian balanced diet, it will improve their calcium metabolism.