Celiac Disease Program
Why does celiac disease mean malnutrition?
Many children with newly diagnosed celiac disease have malnutrition as well as vitamin and mineral deficiencies. The major reason for this is damage to the small intestine caused by an immune response to gliadin, a protein in gluten.
The damaged villi of the small intestine become shorted and flattened. This reduces the surface area of the bowel, resulting in poor absorption of nutrients leaving the body malnourished.
What can untreated celiac disease do?
Untreated celiac disease may cause growth failure and weight loss because of malabsorption of vitamins and minerals as well as carbohydrates, protein and fat—all of which are crucial for growing children.
Can it be corrected?
The deficiencies related to late diagnosis of celiac disease may be corrected withspecialized diet and supplementation.
Sources of vitamins
Vitamins A, D, E and K are fat-soluble vitamins that may be deficient in a child with celiac disease due to the malabsorption of fat. Gluten-free sources of the vitamins include:
- Vitamin A can be found in fortified milk, eggs, and dark green, orange and yellow fruits and vegetables.
- Vitamin D is found in milk products as well as milk alternatives, soy and rice beverages.
- Vitamin E comes from vegetable oils, margarine, nuts and seeds.
- Vitamin K is in leafy green vegetables such as spinach, broccoli and kale.
Sources of calcium
Calcium is an essential mineral for bone growth and is often malabsorbed in all degrees of celiac disease. Dairy foods are the best sources of calcium. However, many rice and soy beverages, as well as fruit juices, are now fortified with calcium.
Correcting calcium deficiencies can be quite challenging in the newly diagnosed celiac patient because many newly diagnosed patients are also lactose intolerant. This is because lactase, the enzyme that digests lactose, is located on the tip of the villi in the intestine. If these villi are damaged the lactase enzyme is lost. Therefore, supplementing with the fortified alternatives as well as a gluten-free calcium supplement may be recommended.
Sources of minerals
Magnesium, zinc and iron may be malabsorbed in newly diagnosed celiac patients. Gluten-free foods high in magnesium include: legumes, tofu, nuts and dark green and leafy vegetables.
Zinc is lost through diarrhea that may accompany untreated celiac disease. Foods that are good sources of zinc include: meat, liver and seafood. Children with celiac disease may have iron deficiency anemia. Foods high in iron include: meat, poultry, fish as well as dark green and leafy vegetables.
Malabsorption of B vitamins may also occur in newly diagnosed celiac patients, specifically B12 and folate. Foods that are rich sources of vitamin B12 are derived from animal products: meat, poultry, seafood, eggs and dairy. Foods from a plant base are high in folate: dark green leafy vegetables, oranges, strawberries and legumes.
Children with celiac disease may experience a deficiency of electrolytes, potassium, sodium and chloride because of excessive vomiting and diarrhea, which are common symptoms of celiac disease. Fruits and vegetables such as bananas, apricots, cantaloupe, tomatoes, and potatoes are all excellent sources of potassium. Sodium and chloride are found in table salt and processed foods that contain table salt.
Sources of carbohydrates, protein and fat
Sources of carbohydrates, protein and fat
Carbohydrates, protein and fat are the energy nutrients and are necessary for proper growth and development. When certain portions of the small intestine are damaged from untreated celiac disease, these essential body-building components are malabsorbed.
- Carbohydrates are found in fruits, vegetables and grains like breads, cereals, rice and pasta.
- Protein is found in animal products: meat, fish and dairy.
- Fats can be found in oils, butter, margarine, nuts and seeds.
If a child has been living with undiagnosed celiac disease for several years, in addition to following a balanced diet, it may be necessary to provide them with vitamin and mineral supplements. Nutritional deficiencies may be corrected by providing the child with a multiple vitamin and mineral supplements, which provide 100 percent of the RDA for age.
Children with celiac disease and suspected vitamin or mineral deficiencies should follow-up with a registered dietitian.
References: Korn, D. Kids with Celiac Disease, A Family Guide to Raising Happy, Healthy, Gluten-Free Children. Woodbine House; 2001. Mahan, LK. Escott-Stump, S. Krause's Food, Nutrition and Diet Therapy, 9th Edition. W.B. Saunders Company; 1996. Samour, PQ, Helm, KK, Lang, CE. Handbook of Pediatric Nutrition, 2nd Edition. Aspen Publishers, Inc; 1999. DISCLAIMER: ALL NUTRITIONAL INFORMATION PROVIDED IN THIS ARTICLE IS GLUTEN FREE AT THE TIME OF PUBLICATION. IT'S SUGGESTED TO CHECK WITH THE MANUFACTURER.