From the Guidelines
Celiac disease patients should strictly follow a gluten-free diet and address common deficiencies, including iron, vitamin B12, folate, vitamin D, calcium, zinc, and magnesium, to minimize morbidity, mortality, and improve quality of life. According to the most recent study 1, a dietetic evaluation is recommended to monitor the nutritional balance of the gluten-free diet (GFD) during follow-up. The study suggests that patients with celiac disease often have a reduction in the intake of fiber, iron, calcium, magnesium, and B vitamins, and may have a higher consumption of fatty foods, sugary foods, and drinks.
Key Nutritional Considerations
- A gluten-free diet should be individualized, reflecting the patient's relevant medical history, food preferences, socioeconomic status, and risk of food insecurity.
- The inclusion of alternative gluten-free grains such as buckwheat, amaranth, quinoa, millet, and sorghum can increase the nutritional profile of the GFD.
- Foods that should be consumed every day include home-made, natural, gluten-free preparations, such as extra-virgin olive oil, milk, yoghurt, plant foods, and fish rich in omega 3.
- Patients following plant-based diets may require additional support and should be encouraged to include legumes, nuts, meat alternatives, gluten-free fortified non-dairy milk, and appropriate micronutrient supplementation.
Supplementation Recommendations
- Supplementation is typically necessary during the healing phase, with specific recommendations including ferrous sulfate 325mg daily for iron deficiency, vitamin B12 1000mcg daily, folate 1mg daily, vitamin D3 1000-2000 IU daily, calcium 1000-1200mg daily, zinc 25-50mg daily, and magnesium 300-400mg daily.
- These supplements should be taken for at least 6-12 months while intestinal healing occurs, with dosages adjusted based on blood test results.
- Working with a dietitian who specializes in celiac disease can help create a balanced gluten-free diet that maximizes nutrient intake from food sources while supplementing as needed, as supported by earlier studies 1.
From the Research
Nutrient Deficiencies in Celiac Disease
- Celiac disease (CD) patients often experience reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium due to malabsorption 2.
- The most common extra-intestinal sign of CD is iron deficiency anemia, which usually resolves with adherence to a gluten-free diet 2.
- Deficiencies of folate and vitamin B12 may persist in some patients on a gluten-free diet, requiring vitamin supplementation to improve subjective health status 2.
Gluten-Free Diet and Nutrient Deficiencies
- A gluten-free diet (GFD) can lead to possible nutrient unbalance, resulting in improper nutritional quality of diet 3.
- GFD is often poor in alimentary fiber, micronutrients (e.g., Vit. D, Vit. B12, and folate), and minerals (e.g., iron, zinc, magnesium, and calcium) 3.
- Macronutrient intake can be inadequate, with a higher content of saturated and hydrogenated fatty acids, and an increased glycemic index and glycemic load of meals 3.
Nutritional Imbalances in Adult Celiac Patients
- Adult celiac patients following a GFD may experience nutritional imbalances, including low complex carbohydrate and fiber intakes, and high fat and sugar intakes 4.
- The most notable deficiencies in micronutrients are usually those of iron, calcium, and magnesium, and vitamins D, E, and some of group B 4.
- Regular follow-up and nutritional education are necessary to promote a balanced diet and prevent nutritional imbalances in celiac patients 4.
Importance of Nutritional Education
- Nutritional education is crucial for celiac patients to achieve a gluten-free and balanced diet 5, 6, 4.
- A trained nutritionist can help patients make informed food choices and prevent nutrient deficiencies and excesses 5.
- Educational strategies based on the relationship between nutrients and food and human health can optimize the therapeutic approach in celiac patients 3.