Micronutrients Dietary Supplementation Advices for Celiac Patients on Long-Term Gluten-Free Diet with Good Compliance: A Review

Abstract

Background and objective: Often micronutrient deficiencies cannot be detected when patient is already following a long-term gluten-free diet with good compliance (LTGFDWGC). The aim of this narrative review is to evaluate the most recent literature that considers blood micronutrient deficiencies in LTGFDWGC subjects, in order to prepare dietary supplementation advice (DSA). Materials and methods: A research strategy was planned on PubMed by defining the following keywords: celiac disease, vitamin B12, iron, folic acid, and vitamin D. Results: This review included 73 studies. The few studies on micronutrient circulating levels in long-term gluten-free diet (LTGFD) patients over 2 years with good compliance demonstrated that deficiency was detected in up to: 30% of subjects for vitamin B12 (DSA: 1000 mcg/day until level is normal, then 500 mcg), 40% for iron (325 mg/day), 20% for folic acid (1 mg/day for 3 months, followed by 400–800 mcg/day), 25% for vitamin D (1000 UI/day or more-based serum level or 50,000 UI/week if level is <20 ng/mL), 40% for zinc (25–40 mg/day), 3.6% of children for calcium (1000–1500 mg/day), 20% for magnesium (200–300 mg/day); no data is available in adults for magnesium. Conclusions: If integration with diet is not enough, starting with supplements may be the correct way, after evaluating the initial blood level to determine the right dosage of supplementation.

Edible Brown Seaweed in Gluten-Free Pasta: Technological and Nutritional Evaluation

“…Zinc deficiency affects about 50% of the celiac population and can affect protein synthesis leading to growth arrest [44]; thus, a zinc supplementation between 25-40 mg/day is recommended [60]. In the present study, Laminaria incorporation in pasta led to an increase of Zn from 4.8% to 6.3% RDA.…”

“…As mentioned earlier, the most deficient minerals in a GF diet are Ca, Fe, Mg, and Zn. In a review, Rondanelli and co-workers [60] gathered suggestions and guidelines for supplementation with several minerals and Theethira et al [55] reported a reduction in calcium intake by about 76%-88% of patients adhering to a GF diet. Although Laminaria ochroleuca is a good source of Ca, the PP pasta only contributed to 1.9% of RDA for calcium, whereas Ca supplementation in the range of 1200-1500 mg/day is recommended.…”

“…In the present study, Laminaria incorporation in pasta led to an increase of Zn from 4.8% to 6.3% RDA. As GF products are usually lower in magnesium, some celiac patients need additional magnesium supplement of 200-300 mg/day in the form of magnesium oxide or magnesium chloride, whereas others can improve magnesium levels through dietary means [60]. Laminaria incorporation in GF pasta rendered an increase from 2.5% to 4.5% RDA of Mg, promoting an additional source of Mg to the diet.…”

Genome-Wide Transcriptomic Analysis of Intestinal Mucosa in Celiac Disease Patients on a Gluten-Free Diet and Postgluten Challenge

“…This is in accordance with the clinical data, as it has been shown that patients on a GFD quite frequently suffer from micronutrient deficiencies. 25 A list of the 24 transporter genes affected by a GFD is presented in Table 1 .

Figure 5 Differential intestinal mucosal gene transcriptome between healthy control subjects and patients with celiac disease on a GFD.

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“…Our data suggest that the low expression of micronutrient transporters in the intestine explains described clinical micronutrient deficiencies (ie, iron, folate, B12, and various mineral and vitamin D deficiencies) in patients following a strict GFD. 25 , 34 , 35 , 36 The low expressions might be due to inadvertent gluten ingestion and indication of disease due to early mucosal injury. Complete elimination of dietary gluten seems impossible to maintain due to issues such as contamination of gluten-free foods, resulting in the ingestion of hundreds of milligrams of gluten per day in an attempted GFD.…”