Dr. Vikki Peterson* is a clinical nutritionist specializing in digestive problems and gluten disorders at the HealthNOW Medical Center ("The Gluten Doctors" ), and coauthor of the best selling book, The Gluten Effect . For much more information about gluten-related illness and research, see her Youtube site .
Too often patients come to us with health complaints intact despite removing gluten successfully from their diet. Engaging in a meticulous search for any “hidden” gluten is definitely a first step but if symptoms persist, there’s much that can be done.
Let’s look at the various secondary effects that having celiac disease or gluten sensitivity can create and how to treat them.
The first thing to realize is that consuming gluten for many years has resulted in intestinal damage. And, while removing gluten is a very good thing, the deficiencies created don’t “turn around” overnight.
Sometimes, without some assistance, they don’t turn around at all.
I am reminded of the person who wrote to me on my blog concerned that her vitamin D levels were not rising despite taking daily supplements for over a year. She was religious about her gluten-free diet and was perplexed at the lack of response on her blood re-test, as her vitamin D levels remained undetectable.
Vitamin D  is critical for bone and immune health, and a deficiency has been associated with increased risk for osteoporosis, certain cancers, heart disease, arthritis, multiple sclerosis and diabetes.
The problem with vitamin D is that the deficiency can be so great that daily supplementation isn’t adequate to raise levels.
Here at our clinic, HealthNOW Medical Center, when a patient has extremely low levels of vitamin D, we follow the recommended protocol of prescribing very high doses of vitamin D  taken weekly for several weeks. This has shown to be very successful and, once ideal levels are restored, a daily dose of a high quality vitamin D3 is usually sufficient to keep the levels stable.
Vitamin B-12 is another nutrient that is frequently deficient in the gluten sensitive patient.
A deficiency creates fatigue, decreased concentration, irritability and depression.
When present, such symptoms can mask the very benefits that removing gluten has created. Unfortunately, vitamin B-12 is a large molecule and difficult to absorb, making oral administration not the best means of supplementation. [Note: studies suggest that new sublingual B-12  delivery technology supports direct absorption into the blood stream on a level similar to injection. See "The Vitamin B-12 – ME/CFS/FM Connection." ] Vitamin B-12 shots given several times per week are very successful. We deliver them at the clinic and, for our patients that travel long distances, a self-administered injection can be arranged.
Patients initially notice a big surge of energy when starting the shots. As the tissues normalize, injections typically are no longer needed.
Secondary Infections are another area to address in the gluten sensitive patient.
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A life-long attack of gluten by your immune system renders it weakened. In this weakened state, your immune system is no longer able to perform all of the functions for which it is designed.
It is estimated that the small intestine is exposed to a pathogenic (disease-causing) organism every ten minutes. A healthy immune system destroys such organisms easily. However, a suboptimal immune system is unequipped to “catch” all such organisms and, as a result, some gain a foothold. Parasites, bacteria, amoeba and yeast can all infiltrate the small intestine resulting in malabsorption, destruction of the villi and a leaky gut.
Note that the very problems such organisms cause are nearly identical to that of gluten: namely villous atrophy, decreased absorption of nutrients and a leaky gut.
No wonder removing gluten is inadequate for many people. In the presence of such infections, regaining optimal health is all but impossible!
Diagnosing and removing these inhospitable organisms is, therefore, mandatory. A stool test by a reputable laboratory that identifies a wide variety of organisms is essential. A thorough lab uses several stool samples, checks for many varieties of parasites, bacteria, amoeba and yeast and is also able to detect the ova (eggs) of certain organisms.
While it may not be nice to think about, the adults lay eggs before they die. If you do a test while the adults are no longer viable but before the eggs hatch, you’ll get a false negative test. A good lab can diagnose from the presence of ova, as well as live adults.
Once an organism has been identified, a course of specific antibiotics is typically recommended. I’ve had patients ask me if they couldn’t just skip the test and take the antibiotic!
If only there were a universal antibiotic for all possible pathogenic organisms. Unfortunately, there isn’t.
Plus, once the treatment is completed, it’s important to retest to ensure that the organisms has been eradicated. A course of probiotics  is similarly critical to recolonize the good bacteria that need to be present in the small intestine to ward off future infections. Depending on the patient, probiotics may be recommended for 1 to 2 months or longer.
Lastly, the leaky gut created by the gluten sensitivity and/or infection sometimes doesn’t resolve on its own despite eliminating the causative agents.
Some patients need to augment their diet with the amino acid glutamine , nutrients such as quercetin and bromelain , or herbs such as turmeric (curcumin ), ginger, and rosemary to help to soothe the inflammation and, thereby, allow healing.
You’ve come a long way. You’ve identified gluten as a toxin to your body and are diligent about keeping it out of your diet. A few more steps in the right direction and you’ll soon be enjoying the optimal health you deserve.
To your good health,
Dr. Vikki Petersen, DC, CCN
Founder of HealthNOW Medical Center
* This article, published Aug 28, 2009 by the National Foundation for Celiac Awareness , is reproduced with kind permission of Dr. Vikki Peterson  – a noted clinical nutritionist, author/speaker, and cofounder of HealthNOW Medical Center ("The Gluten Doctors" ) in Sunnyvale, California.
Note: The information provided here has not been evaluated by the FDA. It is not intended to prevent, diagnose, treat, or cure any condition, illness, or disease. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it with your professional healthcare team.