Nutritional deficiencies in celiac disease and non-celiac gluten sensitivity
Nutritional deficiencies can occur in individuals with celiac disease because of both low intake and poor absorption. Once the intestine has had a chance to heal, nutrient absorption improves, but intake may remain a problem. In the case of non-celiac gluten sensitivity, nutrient absorption is not compromised, but again foods consumed may be low in nutrients. Nutrient deficiencies which are common in gluten-related disorders and their gluten-free food sources are listed in the table below.
Low intake: Very few gluten-free grain products are enriched with the vitamins and minerals that gluten-containing grain products are. As a result, deficiencies can occur in these vitamins and minerals. Some people with celiac disease also have lactose intolerance during the early stages of their treatment on a gluten-free diet, so there may also be low intake of many of the nutrients provided by dairy foods (such as calcium, magnesium, and Vitamin D).
Gluten-free and dairy-free food sources of these vitamins and minerals include:
Thiamin: Sunflower seeds, black beans, tuna, green peas, lentils
Riboflavin: Mushrooms, cooked spinach, venison, soybeans
Niacin: Mushrooms, avocados, broccoli, tuna, salmon, chicken breast
Folate: Green leafy vegetables (spinach, romaine lettuce, turnip greens), asparagus, lentils, beets, broccoli
Iron: All types of meat, lentils, soybeans, tofu
Calcium: Green leafy vegetables (spinach, turnip greens, collard greens), sardines, almonds, sesame seeds, seaweed (nori, kelp)
Vitamin D*: Salmon, sardines, tofu, calcium fortified soya or rice milk, egg yolks, sunshine
Magnesium: Green leafy vegetables (spinach, Swiss chard), pumpkin seeds, sunflower seeds, black beans
*There are only a few food sources of Vitamin D. If you live in a northern climate, a supplement may be needed.
Poor absorption: When there is damage in the small intestine, the absorption of certain nutrients may be impaired. Vitamins and minerals which may be poorly absorbed include iron, calcium, folate, Vitamin B12, and all of the fat-soluble vitamins (Vitamin A*, Vitamin D, Vitamin E*, and Vitamin K*).
Gluten-free and dairy-free food sources of the nutrients not listed above include:
Vitamin B12: All types of meat and fish, eggs
Vitamin A*: Green leafy vegetables (spinach, turnip greens), sweet potato, carrots, red bell peppers
Vitamin E*: Green leafy vegetables (spinach, mustard greens, turnip greens), sunflower seeds, almonds, hazelnuts
Vitamin K*: Green leafy vegetables (kale, spinach, Swiss chard, collard greens), broccoli, Brussels sprouts
*An increased risk of these deficiencies only occurs when there is fat malabsorption.
Increasing Fiber on a Gluten-Free Diet
Eating enough fiber when following a gluten-free diet can sometimes be a challenge. However, there are many ways to increase your fiber intake because fiber is found in virtually all plant foods. Examples of gluten-free sources of fiber include:
Fruits: apples, pears, oranges, figs, plums, prunes, berries
Gluten-Free Whole Grains: amaranth, quinoa, buckwheat, quinoa, brown rice, teff, millet, corn
Legumes: lentils, split peas, black beans, pinto beans, kidney beans, lima beans, garbanzo beans
Nuts & Seeds: almonds, pistachios, pecans, flax seeds, sunflower seeds, chia seeds
Vegetables: squash, broccoli, artichokes, peas, green leafy vegetables, carrots
Getting the Most Nutrients Out of Your Food
The nutrients in foods can vary a great deal. Here are some tips for making sure you’re getting the most out of your food:
Eat Foods as “Whole” as Possible: Whole, unprocessed foods have nutrients that processed foods may no longer contain. Look for groceries around the perimeter of the store, because this is where most whole foods are located.
Cook Vegetables Lightly: Nutrients are lost when a food is fried or boiled in water for an extended time. Lightly sauté, steam, or bake vegetables rather than frying them or boiling them in water.
Be Colorful: Choose foods that are naturally bright in color. In general, each color represents a different nutrient. For example, while red tomatoes and pink watermelon have a nutrient called lycopene, orange sweet potatoes and pumpkin have a nutrient called beta-carotene. For a nutrient-rich and appetizing meal, try to include several different colors of fruits and vegetables.