Though not everyone will have the same set or level of nutrient deficiencies, if you have been diagnosed with Celiac Disease or are following a gluten free lifestyle, you may want to check with your practitioner to see which if any, areas of nutrition need your focused attention.
Malabsorption of nutrients, stemming from intestinal villi atrophy and the inherent lack of certain nutrients in a specifically gluten-free diet both can lead to a need for certain nutritional supplements to help guard against common deficiencies. The length of time you had Celiac disease before you were diagnosed, the extent to which your small intestine was damaged, leading to the degree of malabsorption of nutrients, and any medication that may block nutrient absorption all affect nutrient levels in any one person.
Most commonly, iron, zinc, vitamin D, and several B vitamins, along with fiber, calcium and magnesium are lacking in a gluten-free diet or are poorly absorbed in a person suffering from Celiac disease. This is in part due to many gluten-free foods not being fortified or enriched with these nutrients that would exist in a diet allowing gluten.
Calcium & Magnesium – Bone issues are common in celiac patients with osteoporosis in over 25% of all cases at the time of diagnosis, and even higher at 40% with osteopenia, making risk of fractures 30% higher than normal.
Vitamin D – Supports the immune system, and common decrease in the function of small intestine absorption seen often in Celiac patients, can compromise vitamin D activity and function. In turn, absorption of adequate calcium is also impaired.
Iron – Before taking an Iron supplement, always get tested first. Iron deficiency anemia is the most common extra-intestinal symptom of Celiac disease, however, it may be corrected after adhering to a gluten free diet.
Folic Acid – Important in the formation and maintenance of all cells, folate works with B12 to make and keep cells healthy. Gluten-free products are lower in folate than their gluten-containing counterparts.
Vitamin B12 – Vitamin B12 becomes harder for our bodies to absorb as we age. Add the complication of absorption in someone with celiac disease and the correlation to deficiency gets much higher.
Vitamin B6 - Damaged intestinal villi for those with Celiac cause issues with B6 absorption as well. B6 is involved in over 100 enzyme reactions in the body, mostly related to protein metabolism.
Fiber – If your gluten-free diet happens to be completely grain-free as well, a lack of fiber could be a health concern. A prebiotic fiber source may be helpful for providing added dietary fiber and for promoting the growth of good intestinal bacteria.
The best possible course of action to make sure you’re getting the right nutrients at the right amounts and how many, if any, nutrients you may need to supplement is to rely on your gastroenterologist for testing, and develop a program with your gastroenterologist and dietitian to cover nutrient gaps with diet and supplementation.
Should your doctor and/or dietitian recommend a vitamin/mineral regimen to bolster your health and raise levels of key nutrients, be absolutely sure that the supplements you are taking are Certified Gluten Free, as many tablets and pills contain small amounts of fillers which could contain gluten. A liquid supplement is less likely to have those fillers and is more bioavailable, since it does not need to be broken down in the stomach first. This will help improve your overall health and may help reverse nutrient deficiencies developed over course of undiagnosed Celiac disease.
Doherty C, Dennis M. Nutritional Supplements For Celiac Disease: What you need to know. New England Celiac Conference 2011.
Malterre, Tom, MS, CN. Digestive and Nutritional Considerations in Celiac Disease: Could Supplementation Help? Alternative Medicine Review Vol. 14, No. 3, 2009.