12 Common Nutrient Deficiencies in the Gluten Free Diet
Celiac disease is an autoimmune disorder where consuming a protein called gluten causes damage to the small intestine. Left untreated, it can lead to nutrient deficiencies and other long-term health complications. More than 2 million Americans are undiagnosed and at risk.
Nutrient deficiencies due to celiac disease are largely due to malaborption – when nutrients are unable to be absorbed into the bloodstream through the intestinal wall. This may be related to diarrhea as well as damage to and inflammation of the small intestine. Nutrient deficiencies could also be diet-related. Some newbies to a gluten free diet may not be planning meals appropriately and missing out on some very important vitamins and minerals.
The most common nutrient deficiencies experienced by celiac disease patients at diagnosis include the B Vitamins (B12, folate, thiamine, riboflavin and niacin) as well as the fat-soluble vitamins A, D, E, and K. Minerals at risk for deficiency include iron, zinc, copper, magnesium, and calcium. One is more likely to develop a nutritional deficiencies if they have a long delay before diagnosis (and therefore have been consuming gluten, contributing to damage.) Nutritional deficiencies are also related to the amount and location of damage in the small intestine and one’s own personal nutrient needs based on age, growth, etc.
Calcium: Calcium builds and maintains bones and teeth, aids in blood clotting, and is essential for nerve function and muscle contraction. Celiac patients are more likely to be deficient in calcium if they are also experiencing lactose intolerance (a common symptom related to intestinal damage) and are avoiding dairy products. The recommended intake for adults is between 1,000 and 1,300 mg per day. Nondairy sources of calcium include vegetables, such as Chinese cabbage, kale, and broccoli.
Folate: Folate works with vitamin B12 to make red and white blood cells and is needed for protein metabolism. Adults need 400 mcg per day. Consumer wheat products, such as pasta, are known for being fortified with folate due to its important role in preventing birth defects. However, those with celiac disease must find folate from other food sources. Spinach, liver, asparagus, and Brussels sprouts are among the foods with the highest levels of folate.
Iron: Iron is needed to produce red blood cells. It is also necessary for protection against damage to cell membranes and is essential for the immune system. Heme iron (which is best absorbed by the body) is found in animal foods such as red meats, fish and poultry. Non-heme sources include lentils and beans.
Magnesium: Magnesium is needed for normal muscle and nerve function and plays a role in a steady heart rhythm. Magnesium is found in green leafy vegetables, legumes, nuts and seeds.
Vitamin A: A is needed for vision, growth and maintenance of healthy tissue, and proper immune function. Vitamin A is found naturally in many foods such as some types of fish (such as salmon), green leafy vegetables, orange and yellow vegetables (carrots, squash), fruits (cantaloupe, apricots, mangoes) and in dairy products. Fortified (gluten free) cereals are also available.
Vitamin B6: B6 is needed for healthy brain neurotransmitters as well as energy production. Adults need between 1.3 and 1.7 mg per day. Vitamin B6 is found in fish, organ meats, potatoes and other starchy vegetables, and in non-citrus fruit.
Vitamin B12: B12 is used to produced red blood cells and DNA. It is also used in energy production and digestion. Vitamin B12 is found primarily in animal products such as fish, meat, eggs and poultry (liver and clams are the best sources). Some vegetarian food products may be fortified with B12.
Vitamin D: D helps maintain normal blood levels of calcium and phosphorus and is therefore important for bone health. Of course, one of the best sources of vitamin D is not through the diet, but through sun (UV light) exposure. Very few foods naturally have vitamin D, but fatty fish (salmon, tuna and mackerel) are the best sources. Dairy products in the United States are fortified with vitamin D. If you are experiencing lactose intolerance, you will be happy to know that most “alternative” milks (such as soy, rice and almond milks) are also fortified with D.
Vitamin E: E is an antioxidant, necessary for protecting cells from free radical damage. Vitamin E is found naturally in vegetable oils (sunflower and safflower oils especially) and in nuts and seeds (peanuts, hazelnuts, almonds, and sunflower seeds are best sources). Green vegetables such as spinach and broccoli also provide some E.
Vitamin K: K is necessary for normal blood clotting. Foods rich in Vitamin K include green leafy vegetables (kale, spinach, turnip and collard greens, and romaine lettuce) and cruciferous vegetables (Brussels sprouts, broccoli, cauliflower and cabbage).
Zinc: The mineral zinc is needed for more than 200 enzymatic reactions in the body including within the immune system and for brain function. The best sources of zinc include oysters, red meat, poultry, beans, nuts and dairy products. Gluten-free whole grains (such as quinoa) are also good sources.
Copper: Copper is needed for the normal functioning of enzymes responsible for normal growth and health. It is also important for maintaining healthy blood sugar levels. The best food sources of copper include seafood (oysters, lobsters and crab), kale, mushrooms, seeds (sesame, sunflower, pumpkin and flaxseeds), nuts (cashews, hazelnuts, brazil nuts, walnuts, pistachio, pecans and almonds), chickpeas, kidney beans, white beans, and dried fruit.
When diagnosed with celiac disease, it is essential to maintain a healthy gluten-free diet, well-planned to include all of the most essential vitamins and minerals for good health. However, keep in mind that you may need more of certain nutrients than another (who does not have celiac disease), so it is important to have routine health checkups and lab work done to ensure all your nutritional needs are being met with your current diet plan.
Beth Israel Deaconess Medical Center
Celiac Disease Foundation
National Institutes of Health: Office of Dietary Supplements