Nutritional Deficiencies in Celiac Disease

One of the most important, but lesser talked about problems of living with celiac disease is nutritional deficiencies. Nutrients maintain functions in our bodies and are responsible for the growth and regeneration we are constantly going through. 

Our bodies need a steady supply of nutrients like vitamins and minerals to stay healthy and keep us feeling our best. When we become deficient in these nutrients, not only do we feel the symptoms of our body not working at its best, but we risk irreversible health problems in the future. 

Nutrient Deficiencies in Celiac Disease are Common

When you have celiac disease, it causes damage to the villi in your small intestine. Villi are small finger-shaped projections in the small intestine that absorb nutrients from food into your body. 

When damaged, these finger-shaped villi become flat, and you cannot absorb the nutrients. Instead, they move through the colon and leave the body like they were never there. 

If you have celiac disease and follow a gluten-free diet, it’s vital to be very aware of your nutritional intake. 

People with celiac disease are very prone to nutrient deficiencies and often need to stay vigilant with their diets. 

Many regular gluten-containing products like bread, cereals, and pasta products use enriched flour to increase the nutrient intake in our diets. Most gluten-free alternative foods are not enriched in this way. People with celiac disease must find alternative sources for many common vitamins and minerals. 

Supplementing vitamins and minerals in addition to good dietary intake, can help to keep the body in a healthy condition. 

Lack Of Fiber

Not getting enough fiber can cause constipation, which makes it more difficult for the body to absorb vitamins as they flow through the intestine. 

When we eat plenty of fiber or take fiber supplements, we keep our intestines clear, and we can get all the goodness from our food. 

Getting plenty of fiber has been shown to help reduce cholesterol. It also reduces the risk of heart disease and certain cancers. Fiber bulks our stool, preventing constipation and unpleasant complications like hemorrhoids and painful fissures. 

We can take supplements to get the benefit of more fiber. It is much more beneficial to our body to get fiber from foods like vegetables, fruits, and whole grains. Foods rich in fiber are often very high in other vital vitamins and minerals that we need. A benefit fiber supplements do not have. 

People with celiac disease are prone to both constipation and reduced nutrient absorption. To stay healthy with celiac disease your food must be rich in fiber, vitamins, and minerals. 

Finding and Preventing Celiac Disease Vitamin Deficiency

Vitamin D

Vitamin D, sometimes called “the sunshine vitamin”, is responsible for many jobs in our bodies. As well as helping to absorb calcium and keeping bones and muscles healthy, it supports our immune system, nervous system, muscles, and metabolism. 

Just as vital, vitamin D helps to support our mental health and wellbeing. 

When vitamin D deficiency is undetected, not only can it cause a variety of symptoms, but it can lead to the onset of osteoporosis. Osteoporosis causes irreversible changes in our bones. It must be treated as soon as possible to avoid deterioration. 

How Celiac Disease Impacts Vitamin D Absorption

Vitamin D is a fat-soluble vitamin, which means it is absorbed into the body along with fats in the gut. When celiac disease damages the walls of the intestine, malabsorption happens. Then the vitamin D in the fats we eat cannot be absorbed. 

Signs of Vitamin D Deficiency in Celiac Disease

Vitamin D deficiency has a wide variety of symptoms. It can often be mistaken for other problems. Some of the symptoms of vitamin D deficiency include: 

• Fatigue
• Bone pain or aching
• Hair loss or thinning
• Depression
• Lack of immunity (getting sick often)
• Sleeping problems

In children, a mild vitamin D deficiency can cause weakness, fatigue, and muscle pains. Severe vitamin D deficiency in children can cause bone deformities and growth problems. 

This can lead to issues with bent and malformed bones. Fortunately, severe vitamin D deficiency in children is uncommon. But it is an example of why damage from celiac disease should be addressed quickly and taken seriously. 

Calcium

In childhood, calcium is crucial for creating strong, healthy bones. In adulthood, the goal is to keep them strong and healthy to prevent osteoporosis in older age. People with celiac disease often develop lower bone density, leaving them at a higher risk of osteoporosis. 

As vitamin D and calcium work together to keep our bones healthy, we must get enough calcium in our diets alongside Vitamin D. 

Dairy products are a good source of calcium. For people following a vegan diet or with lactose intolerance or dairy allergies, supplements and other sources of calcium are available. 

Many brands of orange juice and dairy alternative milk products are now fortified with calcium. This is convenient for people with celiac disease, as many also suffer from lactose intolerance issues. 

Vitamins A, E, and K

Along with helping our organs to function, vitamin A is involved with our immune system, fertility, and vision. Some good sources of vitamin A in our diets are animal products and red, orange, and green fruits and vegetables such as:

• Liver
• Leafy green vegetables
• Carrots
• Sweet potato
• Tomatoes

Vitamin E comes in many forms, but we only use one of those in our human bodies. Alpha-tocopherol is the form of vitamin E we need to protect our cells from damage. An antioxidant, vitamin E can be found in plant oils, nuts, seeds, and leafy greens. 

Vitamin K, which can be found in green leafy vegetables, is vital in producing blood clotting factors and bone health. 

B Vitamins

Although we will take a closer look at the two best-known B Vitamins, folate and B12, there are actually 8 different B vitamins that our bodies need to function. 

Eating a healthy diet of meats, fish, fruits, vegetables, enriched gluten-free grains, eggs, and dairy should provide a healthy amount of these vitamins. 

Some people with celiac disease who are recently diagnosed or simply suffer from lower absorption may find that dietary changes aren’t quite enough to keep deficiencies at bay. 

B complex supplements are available. They cover the spectrum of these nutrients and might be a good choice if you struggle to keep your nutrients at healthy levels. 

Vitamin B12

B12 is often touted as a source of more energy in supplements. The vital role B12 actually plays in the formation of our blood cells, is often forgotten. 

When thinking about anemia, we tend to initially think about iron deficiency anemia. Aside from Iron deficiency anemias, people with celiac disease who don’t get enough B12 are at risk of other types of anemia. 

B12 is required for making our blood cells, in particular in making sure they are the correct size to deliver enough oxygen around our body. When we lack B12, we may still make blood cells, but they do not form correctly, and we are left with symptoms of B12 anemia, even if our iron levels are good. 

Some of the many symptoms of vitamin B12 deficiency include:

• Shortness of breath
• Low appetite
• Fatigue
• Palpitations
• Weakness 
• Mouth ulcers and sores
• Geographic tongue
• Memory problems
• A feeling of pins and needles 
• Heightened anxiety, depression, or dementia symptoms

B12 is found in animal products, and we can get B12 from eating meat, fish, dairy products, and eggs. 

For people who follow a vegan diet, B12 can also be found in fortified foods such as cereals.

Many people with celiac disease find that supplementing with B12 is necessary in addition to getting it through their diet to keep symptoms at bay. 

B12 Supplementation comes in many forms and doses, depending on your level of deficiency. Supplement pills, gummies, and sublingual liquids are available over the counter.

B12 injections from your doctor are also an option to correct or prevent a deficiency in people with particularly bad absorption. Your doctor can guide you to find the necessary supplement method for you. 

Folic acid

Folic acid, or vitamin B9 as it’s also known, is an essential vitamin. It helps to create healthy red blood cells and is part of protein metabolism. Especially vital during pregnancy, folate helps with the development of the fetus and prevents some serious birth defects. 

Folate is particularly abundant in dark leafy greens such as spinach, romaine lettuce, broccoli, and Brussels sprouts. It can also be found in fruits, fresh juices, and beans. Oranges are a particularly good source of folate in fruit. 

Iron deficiency in celiac disease

Iron deficiency anemia is common in people with celiac disease. We need iron to create blood. Without enough of it stored in our body, we can become anemic, or can easily be anemic after bleeding from surgery, etc. 

Our bodies are constantly creating new blood to keep us alive and healthy. Iron deficiency anemia is a particular risk for people who menstruate. This is an even bigger problem for people who suffer from heavy periods or gynecologic issues such as fibroids. 

For people who suffer from menstrual complications and celiac disease, it’s vital to keep a close eye on your iron levels and overall health with a doctor. 

Some symptoms of iron deficiency anemia are:

• Extreme fatigue
• Pale skin
• Weakness
• Palpitations or chest pain
• Dizziness
• Tongue inflammation
• Cravings for non-food items (called pica)
• Cold hands and feet

If you suffer from symptoms of iron deficiency anemia, or any nutrient deficiency, it’s important to see your doctor. Correcting it as quickly as possible is vital to staying healthy and thriving. 

Deficiencies in pancreatic enzymes

A little-known problem many people with celiac disease encounter is a loss of enzymes in the pancreas. These enzymes are an important part of the digestive process. Without them, we can suffer chronic diarrhea and malabsorption. 

People with celiac disease are prone to pancreatic insufficiency from both nutrient deficiencies. The fact celiac disease is an autoimmune disease can also cause pancreatic issues. Sometimes these pancreatic enzymes are destroyed, leaving the diagnosed and newly gluten-free patient still stuck with diarrhea and malabsorption as their pancreas isn’t functioning as it should. 

To break this cycle, people with pancreatic insufficiency and celiac disease often require their pancreas to be supplemented with enzymes. Along with a gluten-free diet, this helps to stop the cycle of malabsorption caused by both celiac disease and pancreatic insufficiency and allows the body to start taking nutrients again. 

A study showed that 30% of people suffering from exocrine pancreatic insufficiency also had undiagnosed celiac disease. This makes it very important for people suffering from pancreatic issues to be tested. 

Gluten-free Food Sources of Vitamin D

Although vitamin D deficiency is quite common in the general population, it is especially high in people with celiac disease. The primary way we can naturally boost our vitamin D level is to get enough natural sunlight. Unfortunately, the weather and our schedules don’t always allow us to get enough vitamin D this way. 

Luckily many foods that are high in vitamin D are also gluten-free. 

• Salmon
• Tuna
• Swordfish
• Sardines

Fortunately, many foods are fortified with Vitamin D, including dairy products, cereals, and orange juice. Look out for these fortified versions of these products in the supermarket to increase your intake of vitamins. 

Gluten-Free and Vegan Sources of Vitamin D

If you follow a gluten-free and vegan diet, you might fear that vitamin D sources might be limited, but that’s not the case. The most direct way to create Vitamin D as a vegan is to enjoy some sunlight, but there are still vegan options when the sun isn’t available. 

Many producers of dairy-free milk alternatives fortify their products with Vitamin D. Realizing the nutrients found in dairy can be more difficult for vegans to Soy milk, oat milk, almond milk, and other alternatives can be found fortified with vitamin D.

Gluten-Free Recipes High in Vitamin D

Cooking with nutrients in mind is a great habit for everyone, but especially vital for a gluten-free diet. Sometimes people find getting vitamin D into their diet a challenge, especially if they don’t eat, or like to eat, fish. 

Cooking with vitamin D in mind doesn’t need to be a challenge. Vitamin D can be added to recipes to fortify them, like this Gluten-free French Toast with fortified cherry sauce. This recipe uses vitamin D fortification of ingredients at home to create a delicious meal with the added benefit of vitamin D.

For people who like to eat fish, there are so many tasty options for getting plenty of vitamin D. This selection of gluten-free fish recipes can perk up your vitamin D and your taste buds. 

In conclusion

Experiencing symptoms of nutrient deficiencies is a good reason to be tested for celiac disease. Many people wait until their deficiencies have caused a lot of problems for their bodies before seeking care or getting tested. 

When you are living with celiac disease, your relationship with food changes. Not only is a gluten-free diet necessary to keep your body and colon healthy, but you need to become much more aware of nutrient levels in the foods you take in. 

Living with celiac disease can create an ongoing battle to absorb enough nutrients. While switching to a gluten-free diet fixes deficiencies for many people, some continue to have nutrient deficiencies throughout their lives due to poor absorption rates in their intestines. 

Supplementation is often required to make sure the body has everything it needs to thrive. 

If you are suffering the symptoms of vitamin deficiency, or live gluten-free with celiac disease and are still not feeling healthy, consult your doctor sooner rather than later.