Calcium, vitamin D and coeliac disease

Why is calcium important?

Calcium is a mineral needed for strong bones and healthy teeth. People with coeliac disease have higher calcium requirements than the general population, because they do not absorb calcium in their gut as efficiently due to the damage caused by coeliac disease. People with coeliac disease tend to have a lower bone mineral density (a measure of your bone strength) when coeliac disease is first diagnosed, as they may not have been absorbing calcium well for a long period of time. By following a gluten free diet, your bone mineral density can improve and adequate calcium intake is vital to support this. It should normalise within 12 months if you strictly follow the gluten free diet, meet your requirements for calcium and vitamin D intake and correct any deficiencies.

Osteoporosis is a condition where bone mineral density is low and it means that bones are more brittle and more likely to break. Your doctor may request that you have a scan of your bones (DEXA scan) to monitor your bone health either at diagnosis or after one year.

How much calcium do I need?

Your daily calcium requirement is: 1000-1500mg per day.

How can I make sure I am getting enough calcium?

The best way to make sure you are getting enough calcium is to have food and drinks rich in calcium. The most common sources of calcium in the UK diet are dairy produce and fortified plant based dairy alternatives e.g. soya milk. It is important to note that the organic versions of these products do not contain calcium. Calcium is also found in smaller quantities in a variety of other foods, for example green leafy vegetables and pulses. Some gluten free bakery products may be fortified with calcium. Hard water is also rich in calcium in some areas of the country, such as Cambridge.

The following table lists good sources of dietary calcium (dairy and non-dairy) and the amount of calcium a typical portion contains.

* Please remember to check these are gluten free using the ingredients list on the food label or the Coeliac UK gluten free food and drink directory.

What about calcium supplements?

These are usually not required unless your dietary calcium intake is inadequate or you have been advised by your doctor/ dietitian to take them.

Vitamin D

Why is vitamin D important?

Vitamin D helps to regulate the amount of calcium and phosphate in the body by increasing absorption and retention of these nutrients. It also helps to maintain and repair the gut lining. These nutrients are needed to keep bones, teeth and muscles healthy.

Vitamin D deficiency is also associated with low mood and impaired immune function.

How much vitamin D do I need?

Your daily vitamin D requirement is: 10 micrograms (mcg)/ 400IU per day for maintenance. Your doctor may prescribe you higher doses if you are deficient, as found in blood tests. Unless advised to by your clinical team, you should be cautious about routinely taking high doses as vitamin D can be harmful when too much accumulates in the body.

How can I make sure I am getting enough vitamin D?

You make vitamin D in your body by allowing sunlight exposure to your skin but you only need to have your face and hands in the sunlight for 20 mins/day during spring and summer. For elderly people and for people with darker skin tones, this synthesis is less efficient. For the general population aged four years and older, in the winter months (October to February) they may struggle to get enough vitamin D from the sun and diet, so should consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D during this time.

Vitamin D is found naturally in a small number of foods, including oily fish such as salmon, sardines, pilchards, trout, herring, kippers and eel. Egg yolk, meat, offal, and milk contain small amounts but this varies during the seasons. Margarines and some yoghurts and milkshakes have added or are ‘fortified’ with vitamin D. Mushrooms which have been exposed to sunlight also contain the vitamin.

It is important to incorporate these foods into your diet however, it is almost impossible to get enough vitamin D from food alone so you may require a supplement.

You should have your vitamin D levels and other key nutrients at risk for malabsorption checked annually if you have a diagnosis of coeliac disease.

Dietetic department number: 01223 216655