Important Supplements for Celiac Disease and Gluten Intolerance

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Important Supplements for Celiac Disease and Gluten Intolerance provides insight and practical tips for those living with celiac disease or non-celiac gluten sensitivity. In many Celiac and Gluten Intolerant Patients, the risk of vitamin deficiency and malabsorption is all too common, and many have no idea what supplements to take. This article, written by dietitian Tiffany Torok MA, RDN, provides common-sense solutions.

Woman taking a supplement

Common Vitamin Deficiencies in Celiac Patients

For celiac disease patients, several nutritional deficiencies are commonly seen. The most common nutritional deficiencies found in adults with celiac disease are:

  • Iron,
  • B12,
  • Vitamin D,
  • Zinc
  • Folic acid (Rondanelli, et, al, 2019)

Children who have celiac disease also commonly find the same deficiencies as adults, plus calcium and magnesium (Kreutz, Heynen, and Vreugdenhil, 2023).

There aren’t conclusive studies for magnesium deficiencies in adults.

Up to 40% of individuals with celiac disease continue to have persistent deficits even after following a strict gluten-free diet. Often, this results from no longer consuming vitamin-fortified grain products or foods.

  1. For Newly Diagnosed: I usually recommend a multivitamin with minerals for at least a year or longer for most newly diagnosed individuals with celiac disease or gluten intolerance. Pure Encapsulations One a Day Multivitamin is a gluten-free brand we recommend.
  2. For Children: I recommend Flintstones Chewables for Children and Toddlers; because gummy vitamins are not as easily absorbed as chewable or swallowable vitamins.
  3. For Adults, I recommend Pure Encapsulations One a Day
  4. Omega 3: I recommend Nature Made Krill Oil or Pure Encapsulations EPA/DHA with Omega 3 to supplement Omega 3’s.
  5. Probiotics: Many newly diagnosed celiacs also have gut microflora imbalances due to the breakdown and inflammation of their intestinal tract. Taking a daily probiotic for a month or so can also help to repopulate the gut while it is healing. While many strains are available and even more different brands on the market, the most well-researched probiotic is Culturelle LGG (lactobacillus).

Gluten-Free Products Often Are Not Fortified

In the United States, cereal grain products have been fortified with B vitamins and iron since the 1940s. However, gluten-free grain products often do not contain these added nutrients, ultimately contributing to ongoing nutrient deficiencies.

Is Celiac Disease an Autoimmune Disease?

Celiac disease, also called coeliac disease or celiac sprue, is a genetic, chronic autoimmune disease resulting in chronic enteritis(inflammation of the small intestine) and villous atrophy (flattening of small intestine villi causing malabsorption) secondary to gluten ingestion that causes malabsorption and malnutrition, which lead to nutritional deficiencies.

*Villous Atrophy: This means that the villi in your small intestine can no longer absorb nutrients from the food you eat. Healing the villi is critical to recovery.

Beach

What is the Treatment for Celiac Disease?

The only treatment available to individuals with celiac disease is a strict gluten-free diet, avoiding cross-contamination. Celiac disease affects less than 1% of the American population, or approximately 1 in 133 people. In the US, this equates to about 2-3 million people who suffer from this disease. It’s thought that about 1% of the world’s population has celiac.

Celiac disease is commonly under-diagnosed and is more common in women than men, first-degree relatives of individuals with celiac disease, and individuals with other autoimmune diseases or related conditions (Caio, et al., 2019).

Symptoms of Celiac Disease

These are the most common symptoms of Celiac Disease and are also sometimes present in gluten intolerance.

  • Abdominal pain
  • Anemia
  • Vomiting
  • Diarrhea
  • Constipation
  • Gas
  • Anorexia
  • Weight Gain or Loss
  • Abdominal Distension
  • Failure to Thrive
  • Irritability
  • Fatigue
  • Headache and more

Did You Know That Celiac Can Have ‘No Symptoms’?

However, celiac disease can also be asymptomatic or latent, presenting with no symptoms or symptoms not gastrointestinal related.

Also, the accompaniment of another autoimmune disease occurs in approximately 30% of people with celiac disease, whereas the prevalence of autoimmune disease in the general population is only 3% (Posner and Haseeb, 2023).

Celiac is also an Autoimmune Condition.

Due to celiac disease being an autoimmune condition that causes both malabsorption and malnutrition, there are often numerous associated medical conditions that accompany the diagnosis.

Risks of Untreated Celiac Disease

  • Celiac patients are at a higher risk of developing osteoporosis,
  • infertility issues,
  • cancers of the blood,
  • intestinal cancer,
  • additional autoimmune diseases,
  • anemia,
  • lactose intolerance,
  • impaired splenic function,
  • neurologic disorders,
  • ulcerative jejunoileitis,
  • and other health conditions (Fasano and Catassi, 2012).

This is why it’s critical to be diagnosed and treated immediately. In addition, the optimal chance of recovery includes close attention to a super nutritious, strict gluten-free diet.

Family outside eating

7 Facts About Celiac and Digestion

  1. Celiac disease is a genetic autoimmune disease that can develop at any point in life. The immune response in celiac disease is elicited by the consumption of gluten, particularly the gliadin component of gluten, found in gluten-containing foods made with grains such as wheat, rye, and barley. Once ingested, gluten causes inflammation that alters the integrity of the tight junction system of the intestinal lining in celiac disease patients (Green & Cellier, 2007).
  2. In a normally functioning small intestine, the intestinal lining is responsible for the absorption of nutrients via intestinal villi and serves as protection from antigens, bacteria, or other pathogens. When the intestines are damaged during the immune response in celiac disease, macromolecules such as gluten permeate into the submucosa of the gut.
  3. People with celiac disease have a particular class of genes known as HLA-DQ2 and/or HLA-DQ8. When the gluten molecule passes through the submucosa, it binds to the HLA antigen-presenting cells of class II DQ2 or DQ8. Then, specific immune cells recognize the antigen-presenting cells as invaders and begin an autoimmune attack, causing inflammation and villous atrophy in patients with celiac disease (Tonutti & Bizzaro, 2014).
  4. Villous atrophy is measured using the Marsh scale, a tool designed to define the severity of damage to the lining of the small intestine in patients with celiac disease.
  5. A Marsh score of 1 represents mild damage to the intestinal villi, and a score of 3c means complete atrophy and blunting of the intestinal villi, which is the nutrient-absorbing site in the lining of the small intestine of celiac disease patients.
  6. As the damage progresses, symptoms become more severe, and associated comorbidities such as malnutrition and intestinal cancers may develop.
  7. When severe damage to the intestinal villi occurs, it causes malabsorption of nutrients, ultimately leading to malnutrition and micronutrient deficiencies (Tonutti & Bizzaro, 2014).
Healthy Juice with Lime

Common Vitamin Deficiencies in Celiac Patients

  • Iron– Iron is required for the body to carry oxygen through the body. Iron is found in red meat, whole grains, beans, legumes, and fortified cereal grains. Blackstrap molasses also contains a good amount of iron and mixes well into hot cereals. Iron-containing foods are best paired with vitamin C-containing foods, such as citrus.
  • Iron supplementation is recommended for individuals with microcytic anemia or when the blood cells are too small to do their job correctly. Further serum iron studies are often advised to confirm iron deficiency anemia. Since celiac disease patients also commonly present with a B12 and or folate deficiency, which causes macrocytic anemia or large red blood cells, the deficiencies can often be overlooked. This is due to their effect on blood cell size, which can cancel each other out unless blood levels for iron, folate, and B12 are checked.
  • B12 – Also known as cobalamin, B12 is an essential nutrient involved in carbohydrate metabolism. As mentioned earlier, a deficiency can cause macrocytic anemia. Long-term complications of a B12 deficiency can result in issues with the nervous system, including sensory neuropathy (Vasavada & Sanghavi, 2023). B12 is also required to turn folate into its usable form in the body, so a deficiency in this essential nutrient can also lead to a secondary nutritional deficiency in folate.
  • B12 supplementation for a severe deficiency is typically given via inter-muscular injections, the dosage and frequency of which are prescribed at the advice of your physician. B12 is naturally found in meat and meat products, as well as nutritional yeast and some seaweed.
  • Folate– Folate is another B vitamin whose absorption is affected by celiac disease. It is found naturally in dark leafy greens and other vegetables, fruits (especially citrus fruits), and animal products such as liver. Being deficient in folate can cause neural tube defects in fetuses if their mother has a deficiency. Additionally, folate deficiency can lead to issues utilizing other nutrients.
  • Folic acid is the form of folate that is available for our bodies to use. However, in recent years, evidence has found that high doses can lead to a higher risk for malignancies (Khan & Jialal, 2023).
  • Zinc – Our bodies use zinc in the production of immune cells. Typical signs and symptoms of a zinc deficiency include skin lesions, dry skin, and taste changes.
  • Vitamin D – recent studies have shown that anywhere from 8-88% of individuals are deficient in vitamin D during celiac disease diagnosis. Although vitamin D is produced in our skin, many Americans live above the latitude at which the sun’s UV rays do not activate the vitamin properly. Thus, dietary intake and or supplementation is required.
  • Calcium is necessary for bone mineralization, most of which occurs during childhood. It is also essential for the heart to function correctly. The body regulates blood calcium levels very closely. Thus, a deficiency is uncommon in adulthood because the body just raids the bone stores to prevent a full-on deficiency.
  • Magnesium – Magnesium is used in the body to make hormones and energy production. Magnesium helps the mitochondria, or the cell’s ” powerhouse, ” function properly. Magnesium also aids with the transport of Potassium and the regulation of sodium. A deficiency can result in muscle cramps, hypertension, and vasospasm. Magnesium and/or calcium deficiency is more commonly seen in children than adults with celiac disease.
Vitamins for Celiac Vitamin in the Sun

Is There A Gluten-Free Labeling Act for Supplements?

Although there is the gluten-free food labeling act, unfortunately, no such law exists for supplements. This leaves people with celiac disease open to exposure to gluten through cross-contamination or unclaimed gluten in the product.

Often, if a vitamin or supplement contains gluten, it is used as a filler in the form of starch. Thankfully, there is hope on the horizon for prescribed medications as a similar law to the gluten-free food labeling act is currently working its way through the government.

Eating a Nutrient Dense Diet Provides Variety

Once a nutritional deficiency is corrected, eating a nutrient-dense, whole-food diet instead of only processed gluten-free food can help your body maintain optimal nutrition by providing various vitamins and minerals, which can often be better absorbed together.

This also prevents over-supplementation of certain micronutrients, which can hinder the absorption of a different micronutrient, causing a secondary deficiency. One such example is the over-supplementation of zinc, causing a copper deficiency.

5 Commonsense Solutions

Here are five solutions to help with Celiac, Non-Celiac Gluten Sensitivity, and Vitamin Deficiencies.

  1. The best way to do this is to “eat a rainbow” of fruits and vegetables daily. This is due to different colors being associated with various vitamins and minerals.
  2. Additionally, look for minimally processed gluten-free grain products fortified with iron and B vitamins.
  3. Furthermore, don’t forget to eat a variety of proteins so you don’t miss out on omega-3 fatty acids that are most commonly found in fish and all the excellent fiber most widely found in beans.
  4. Suppose you struggled with a vitamin or mineral deficiency when you were first diagnosed. In that case, it is a good idea to have your micronutrient levels for the most common deficiencies checked each year.
  5. If you need to supplement due to a deficiency, do your best to purchase a gluten-free supplement like Pure Encapsulations or ask your doctor to prescribe the specific micronutrient you are deficient in.

How To Eat A Whole Foods Gluten-Free Diet
Focus on fresh food!

Natural ways to add lots of super nutrition to your diet!


  • Eat the Rainbow – A variety of fruits and veggies every day
  • Think Whole Gluten-Free Grains – Quinoa, Brown Rice, GF Rolled Oats, Cornmeal, Whole Grain Gluten Free Bread
  • Potatoes and Squashes – Sweet Potatoes, Potatoes, Butternut Squash, and more.
  • Nuts – Cashews, Macadamia, Almonds, Walnuts, Pecans, Pistachio Nuts
  • Seeds – Sunflower Seeds, Pumpkin Seeds, Flax, Chia etc.
  • Healthy Oils – Flax Oil, Coconut Oil, Olive Oil
  • Seafood- Omega 3 fats
  • Fresh Poultry and Leans Meats – healthy protein
  • Water – stay hydrated

I hope you enjoyed this article. For more information, check out our recent blog posts in our Gluten-Free Living Section and delicious 100% gluten-free recipes.

References:

Caio G, Volta U, Sapone A, Leffler DA, De Giorgio R, Catassi C, Fasano A. Celiac disease: a comprehensive current review. BMC Med. 2019 Jul 23;17(1):142. doi: 10.1186/s12916-019-1380-z. PMID: 31331324; PMCID: PMC6647104.

Fasano, A. &; Catassi, C. (2012). Celiac disease. The New England Journal of Medicine, 367, 2419-2426. doi: 10.1056/NEJMcp1113994

Green, P.H.R. &; Cellier, C. (2007). Celiac Disease. The New England Journal of Medicine, 357, 1731-1743. doi: 10.1056/NEJMra071600

J.M. Kreutz, L. Heynen, A.C.E. Vreugdenhil. Nutrient deficiencies in children with celiac disease during long-term follow-up. Clinical Nutrition. Volume 42, Issue 7, 2023, Pages 1175-1180, ISSN 0261-5614. https://doi.org/10.1016/j.clnu.2023.05.003.

Rondanelli M, Faliva MA, Gasparri C, Peroni G, Naso M, Picciotto G, Riva A, Nichetti M, Infantino V, Alalwan TA, Perna S. Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review. Medicina (Kaunas). 2019 Jul 3;55(7):337. doi: 10.3390/medicina55070337. PMID: 31277328; PMCID: PMC6681258.

Tonutti, E. & Bizzaro, N. (2014). Diagnosis and classification of celiac disease and gluten sensitivity. Autoimmunity Reviews, 13(4-5), 472-476. doi:10.1016/j.autrev.2014.01.043

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