Nutritional Supplements

KEY POINTS:

Untreated celiac disease may cause poor absorption of nutrients, vitamins, and minerals such as calcium, vitamin D, iron, folate, zinc and B12 1,2,3,4 .

The most important action you can take is to follow the gluten-free diet very carefully.

However, the gluten-free diet by itself may not provide enough vitamins and minerals to correct low levels of vitamins and minerals in your blood. For this reason, doctors and dietitians often recommend specific supplements.

A gluten-free multivitamin/mineral supplement (MVM) that is chosen for your gender, age, diet and blood test results is a standard recommendation.5  Read below for details on other important vitamins and minerals.

A LOOK AT A FEW VITAMIN AND MINERAL BASICS:

MVM = multivitamin/mineral supplement (in this document) 

See Level 2 for formulas and dosages.

CALCIUM:

Calcium is a mineral that has many functions in the body, and is best known for its important role in keeping bones strong and healthy. There are many gluten-free foods that are good sources of calcium. Dairy foods such as milk, cheese and yogurt are high in calcium. If you are lactose intolerant, it is important that you consume low lactose or lactose-free foods that contain calcium. In this case, you may also need to take a gluten-free calcium supplement to meet your calcium needs. See Level 2 and 3 for more information on choosing a calcium supplement.

Certain calcium supplements may cause constipation. It may help to take a calcium supplement that contains magnesium, a natural laxative.

VITAMIN D

Getting enough vitamin D has many health benefits. Along with calcium, it helps to build and maintain bone health.

It is very difficult to find enough vitamin D in foods. Ask your doctor to check your blood level (25 OHD) of vitamin D to see if you need a supplement.

Most people with celiac disease need more vitamin D than what is found in a MVM. Sometimes they take a calcium supplement that contains vitamin D and/or they may take additional vitamin D. Individual needs for vitamin D vary widely, so make sure your doctor monitors your levels, especially if you live in a cold climate where people don’t get enough skin exposure to make vitamin D from the sun.

B VITAMINS

Studies show that people with celiac disease need higher amounts of folate (B9) and vitamin B12. 3They are important for energy, mood, clear thought, and preventing anemia.

Choose a MVM that offers at least 100% of the daily value (DV) of each B vitamin, unless directed otherwise. Most supplements come as a mixture of B vitamins.

If you have low energy, ask your doctor or dietitian if your B vitamin levels are low. Most MVMs include sufficient B vitamins. You should not take an additional B complex unless recommended by your doctor because it may contain too much vitamin B6 which can cause numbness and tingling in the extremities, nausea, abdominal discomfort, and headaches.

Take your MVM in the morning with food to get energy for the day. It is best to take B vitamins with food since they can cause stomach upset in some people.

MAGNESIUM

Magnesium plays over 300 roles in the body. It helps muscles relax, produces energy, and helps the body absorb calcium.

Magnesium intake is low in the diets of most Americans. Whether they are gluten-free or not, most MVMs do not contain enough magnesium. You may need a separate supplement.

Magnesium is often included in a calcium supplement to help prevent constipation and because it plays an important role in bone health.

IRON

Iron helps make red blood cells to carry oxygen to the cells.

Women’s MVMs usually contain 18mg of iron. Mens’ MVMs contain 0-8mg. Postmenopausal women’s MVM do not contain iron.

Some people need more iron than what is in a standard MVM. Iron supplements for people with celiac disease are recommended based on age, gender, diet, and blood tests, such as a complete blood cell count (CBC), iron and serum ferritin. Talk to your doctor about having your levels checked before taking iron.

People who take iron supplements often have constipation or dark stools. If this or any other side effect occurs, talk to your doctor. Taking iron with vitamin C rich foods like citrus or vitamin C supplements helps increase the absorption of iron.

ZINC

Zinc helps build protein, heals wounds, helps us grow and develop, and makes our immune system stronger.

Zinc is a trace mineral so it is needed in smaller amounts in the body than iron or calcium. Make sure to take an MVM that contains zinc.

If you have a low zinc level and/or have chronic diarrhea, your doctor may suggest zinc. If you take extra zinc, you must take a MVM which contains copper because zinc absorption needs to balance with copper absorption.

ESSENTIAL FATTY ACIDS 6

Celiac disease causes inflammation in the body. One of the key ways to calm inflammation is to eat the right fats in your diet.

Most Americans do not get enough omega-3 fatty acids. These are found in cold water fish, and in some seeds, nuts, and grains. If you do not eat fish regularly you can take a fish oil supplement. Always speak to your doctor before you start a fish oil supplement since there are several factors to consider. Learn more in Levels 2 and 3.

CHOOSING SUPPLEMENTS:

Look for supplements labeled “gluten-free.” It is best to choose labeled gluten-free supplements that have been tested for gluten contamination. This may not always be possible. 7 Read Level 2 for key labeling laws.

If you have allergies or food sensitivities, read the label carefully, including the small print, to avoid these trigger ingredients.

Check with your doctor before starting a supplement. Some need to be taken at certain times of the day, with or without food, and with or without other supplements or medications.

TAKE HOME MESSAGES:

  • Step One: follow the gluten-free diet very carefully for your best health.
  • Step Two: Ask your doctor or dietitian to help you select a gluten-free MVM that is appropriate for you. You may need extra calcium, magnesium, iron, zinc and vitamin D. Your doctor will suggest other supplements like essential fatty acids, as needed.
  • Step Three: Follow up closely with your doctor to monitor and correct any deficiencies.

References:

  1. Staun M, Jarnum S. Measurement of the 10,000-molecular weight calcium-binding protein in small-intestinal biopsy specimens from patients with malabsorption syndromes. Scand J Gastroenterol. 1988;23:827-832.
  2. See J, Murray JA. Gluten-free diet; the medical and nutritional management of celiac disease. Nutrition in Clinical Practice, 2006;21:1-15.
  3. Hallert C, Svensson M, Tholstrup J, Hultberg B. Clinical trial: B vitamins improve health in patients with coeliac disease living on a gluten-free diet. Aliment Pharmacol Ther 2009;29(8):811-16.
  4. Malterre T. Digestive and nutritional considerations in celiac disease; could supplementation help? Altern Med Rev 2009;14(3):247-57.
  5. ADA Evidence Analysis Library. Executive Summary of Recommendations.http://www.adaevidencelibrary.com/topic.cfm?cat=3726
  6. Dennis M, Doherty C. Supplements 101. In Real Life with Celiac Disease: Troubleshooting and Thriving Gluten-Free . Eds. Dennis M, Leffler D. AGA Press. Bethesda, MD. 2010.
  7. Dennis M, Kupper C, Lee AR, Sharrett MK, Thompson T. Celiac Disease Toolkit. American Dietetic Association, 2011.

Revision Date: 5-8-13 
Authors: Melinda Dennis, MS, RD, LDN, Lauren Alder Dear and Lindsey O’Regan 
Editors: Christine Doherty, ND, Suzanne Simpson, RD, Rupa Mukherjee, MD

CeliacNow Disclaimer