Enough nutrients on a gluten free diet?

Dear Reader,

Wondering about whether you’re getting enough nutrients is a common question among people with celiac disease. Both untreated celiac disease and treatment with the recommended gluten-free diet can make getting those daily doses of nutrients all the more challenging. In several research studies, the most common nutrients that people on a gluten-free diet lacked were iron, zinc, calcium, and vitamin K. Also, vitamin B12, folic acid, vitamin D, magnesium, and selenium were reported, but less frequently. That being said, it’s worth noting that everyone’s nutritional needs vary, regardless of whether they have celiac disease and are on a gluten-free diet. One way to ensure you’re getting adequate nutrients through eating is to work with a health care provider or a registered dietitian to figure out your individual nutritional needs and the best ways for you to meet them.

Before delving into the nutrients people on a gluten-free diet often lack, it might be helpful to know why this diet is the universally recommended treatment for celiac disease. When people with celiac disease eat gluten, it activates an immune response in the small intestine. Over time, this can degrade the intestinal lining. This lining, known as gut mucosa, plays a central role in transmitting the nutrients from food to the rest of the body. However, when this lining is impaired, so too is nutrient absorption. When the body doesn’t absorb nutrients, it can lead to a host of short-term and long-term health challenges. Removing gluten reduces inflammation and hopefully minimizes damage to the intestines caused by celiac disease. Given the potential impact of eating gluten for those with celiac disease, health care providers advise initiating and maintaining a gluten-free diet as a lifelong treatment for those with the condition.

Going gluten-free isn’t a lifestyle choice; it's a necessary treatment for those with celiac disease, though the transition poses its own challenges. Some foods that need to be eliminated on a gluten-free diet (such as some whole grains) naturally contain or are enhanced with nutrients, which not surprisingly, coincides with the ones that people on a gluten-free diet often lack. The good news is that people can make up for this deficit by taking supplements and consuming food items that are rich in certain nutrients. It’s worth noting that some supplements may contain gluten, and there are some potential risks of consuming too much of certain vitamins. All that said, one way, and perhaps the preferred option, for increasing your intake of vitamins is through food. Some food sources of B-vitamins, calcium, fiber, folate, iron, magnesium, vitamin D, and zinc are:

• Fruits: apples, berries, figs, oranges, pears, plums, prunes
• Legumes: lentils, split peas, beans (black, garbanzo, kidney, lima, pinto)
• Meats, fish, and eggs: cod liver oil, swordfish, salmon, and tuna are especially high in vitamin D, which can be hard to find in many foods
• Nuts and seeds: almonds, chia seeds, flax seeds, pecans, pistachios, sunflower seeds
• Vegetables: artichokes, broccoli, green leafy vegetables (chard, collards, kale, spinach, etc.), squash
• Gluten-free whole grains: amaranth, quinoa, buckwheat, brown rice, teff, millet  

Before you change the menu, you might consider talking with a health care provider about how to navigate life with celiac disease, including your particular nutrient needs. Most likely, they’ll do some routine blood work, check your bones, and see how you’re doing emotionally. The blood test results in particular will give a clearer picture of your nutrient levels, which can support recommendations for your diet. In fact, your health care provider may refer you to a registered dietitian who can provide you with in-depth information and strategies for getting enough nutrients, including eating specific foods or taking vitamin supplements. They can even provide advice about how to read labels, avoiding cross contamination, and options for substituting your favorite grains. Additionally, you might be interested in exploring the Academy for Nutrition and Dietetics for ideas on what to look for at the grocery, how to decipher what’s gluten-free, and links to other helpful websites.

While eating gluten-free is essential for people with celiac disease, it doesn’t have to mean foregoing those vital nutrients. Knowing what you need is the first step to understanding how what you eat impacts your health and how to address it. Kudos to you for thinking carefully about your diet and asking questions. And here’s to noshing on nutrients in the future!