Fox Valley Celiacs - CSA Chapter 26
                                                                    "Celiacs Helping Celiacs"

Vitamins & Minerals

B-Vitamins
Thiamin, Riboflavin, Niacin

• B-Vitamins aid in metabolism, maintain a healthy nervous system.
• Malabsorption of B-vitamins may occur when newly diagnosed, especially B-12 and Folate.
• Many gluten-free products are not enriched with added vitamins.
• Gluten-free grains that are good sources of B-vitamins.
  • Buckwheat, Indian rice grass, sorghum, teff, quinoa

Daily Recommendations of B-Vitamins

• Thiamin
  • RDA 1.1-1.5 milligrams
  • Good sources include sunflower seeds, pork, whole grains, dried beans, peas and brewer’s yeast.
• Riboflavin
  • RDA 1.2-1.7 milligrams
  • Good sources include milk, mushrooms, spinach, liver
• Niacin
  • RDA 15-19 milligrams
  • Good sources include mushrooms, tuna, salmon, chicken, beef, liver and peanuts

Vitamin B-6 and Folate

• Vitamin B-6
  • RDA 1.8-2 milligrams
  • Animal protein foods, spinach, broccoli, bananas, salmon and sunflower seeds.
• Vitamin B-12
  • RDA 2 micrograms
  • Sources are meat, poultry, seafood, eggs and dairy.
•   Folate (Folic Acid)
  • Needed for DNA synthesis and cell turnover.
  • RDA 180-200 micrograms
  • Formation of red blood cells and reduces birth defects.
  • Sources are green leafy vegetables, oranges, strawberries, legumes, organ meats, sprouts, and sunflower seeds

Vitamin D

• RDA 5-10 micrograms
• A healthy body can make this amount of vitamin D in 15 minutes of sun exposure. Not in WI.
• Vitamin D – helps maintain proper levels of calcium and phosphorus, helping to build and maintain bones.
• Vitamin D3 – Cholecalciferol, is the preferred vitamin D supplement; natural, and stays in the system longer.
• Sources include fish oils, egg yolks and fortified milk.
• Vitamin D deficiency can develop rickets.
•  Children with rickets will develop bowing of the extremities due to weak bones.
• In adults, vitamin D deficiency can lead to osteoporosis and osteomalacia.

Calcium

• RDA
  • 800 mg/day for children ages 1 to 10
  • 1000 mg/day for men, premenopausal women, and postmenopausal women  taking estrogen
  • 1200 mg/day for teenagers and young adults ages 11 to 24
  • 1500 mg/day for post menopausal women not taking estrogen
  • 1200mg to 1500 mg/day for pregnant women and nursing mothers
• Essential mineral for building and maintaining bone growth.
  • May protect against osteoporosis, prevent some cancers, help with weight loss.
  • Often malabsorbed in celiac disease.

• The total daily intake of calcium should not exceed 2000 mg/day to avoid toxicity.

• An average woman in the US consumes less than 500 mgs of calcium per day.

• Alcohol intake can inhibit calcium absorption.

• Hormones can cause bones to be broken down more rapidly, steroids and thyroid hormones.

• Lactase intolerant common in newly diagnosed celiac patients.

• Supplementation may be necessary.

Calcium Content of Foods

Milk, whole, low fat or skim                   288mg/cup
NFDM                                                     288mg/1/3 c.
Yogurt                                                    250mg/cup
Cheese, American process                      198mg/1 oz.
Salmon, pink, canned (bones)                167mg/3 oz.
Collards, cooked                                     145mg/1/2 c.
Ice cream                                                87mg/1/2 c.
Cottage cheese,                                       77mg/3 oz.
Broccoli, cooked                                      66mg/1/2 c.  Orange                                                     54mg/each    Sweet Potato                                            47mg/1-med

Increasing Calcium

• Best source is dairy products; good sources canned fish (with bones), deep green leafy vegetables, tofu and orange juice. Found in gluten free grains, amaranth, Indian rice grass, teff, quinoa.
• Vitamin D3 is preferred to aid in absorption of calcium.
• Take 500 mg calcium per meal.  Cannot absorb more at a time.
• Potassium from fruits & vegetables, taken with calcium can help absorption.
• Consume 3-4 dairy servings/day.
• Increasing weight-bearing exercise, can increase bone density.

• Use milk instead of water in recipes as pancakes, mashed potatoes, pudding and cereals.

Increasing Calcium in your Diet

• Use milk instead of water in recipes as pancakes, mashed potatoes, pudding and cereals.
• Fruit smoothie made with yogurt.
• Sprinkle cheese on salad, soup or pasta.
• Choose milk instead of carbonated soft drinks.
• Serve raw fruits and vegetables with a yogurt dip.
• Create a vegetable stir-fry with diced tofu.
• Enjoy a parfait with fruit and yogurt.
• Use calcium-fortified foods as gluten-free cereals, orange juice and soy beverages.

Calcium Supplement

• The calcium in a compound is called elemental calcium.
• During digestion, the calcium compound dissolves and the elemental calcium becomes available to be absorbed into the blood.
• If a tablet contains 500 milligrams of calcium carbonate, it contains only 200 milligrams of elemental calcium. This is because only 40% of the calcium compound is elemental calcium. The other 60%, or 300 milligrams, would be from the carbonate ingredient.
• Most calcium supplements list the elemental calcium content on the label. Look for labels with “USP” logo.

Calcium Citrate

• Best absorbed supplemental form of calcium.
• It does not require the presence of extra stomach acid to dissolve.
• Calcium citrate can come in a liquid form of calcium that may be less irritating to the intestinal wall.
• Citracal® and Solgar® are brand name calcium citrate products.
  • Citracal-630 mg calcium and vitamin D3
  • Solgar-250mg calcium & vitamin D3/tablet

Calcium Carbonate

• Most common type of calcium supplement on the market.
• Usually requires extra stomach acid for digestion, so should be taken with a meal.
• Tums® and Caltrate® are brand name calcium carbonate products.
  • Tums-500 mg/tablet.
  • Caltrate-600 mg/tablet

Viactiv

• Viactiv Chew
  500 mg calcium
  added Vitamin D & K.
• Viactiv Multi-Vitamin 
    200 mg calcium.

Each VIACTIV® Calcium Soft Chew contains 500 mg of
elemental calcium from 1,250 mg of calcium carbonate.
If taking more than 1/day, take at different times. Does not contain gluten

Taking Calcium Supplements

• Dolomite, Oyster shell, and Bone Meal are naturally occuring calcium carbonate sources which may contain heavy metals, including lead.
• Minimizing lead intake is important for pregnant and nursing women, and children. The FDA has set an upper limit for the amount of lead a calcium supplement may contain.
• Calcium can decrease the effects of many other medicines by binding to them or by changing the acidity of the stomach or the urine.
• Do not take calcium carbonate or antacids containing calcium without first talking to your doctor if you take other medications.

Best Sources of Calcium

• Try to consume calcium from foods or beverages.
• If you take calcium supplements, calcium citrate and calcium carbonate are the best choices because they are easy to find, contain relatively large amounts of elemental calcium, and dissolve well in the body.

Minerals
 Magnesium, Zinc and Iron

May be malabsorbed in newly dx celiac patients.

Magnesium

•   RDA 350 mgs for men, 280 mg for women
•  Helps build bones and release energy from muscles.
•  Helps absorb calcium and potassium.
•  Found in gluten-free grains – Buckwheat, Teff, Quinoa, also legumes, tofu, nuts, dark green vegetables and chocolate. 

 Zinc

• RDA 8-11 mg
• Avoids skin rashes and restores normal taste.
• Zinc is lost by persistant diarrhea.
• Good sources are meat, liver and seafood.
• Supplementation is usually with a multi-vitamin and mineral supplement.

Iron

• RDA- women 18 mg women,  and men 10 mg
• Carries oxygen in the blood and prevents iron-deficiency anemia.
• In children, a low iron can cause lower learning ability and depressed growth.
• Low iron causes less energy, fatigue, irritability, decreased appetite and infections.
• Common in newly diagnosed celiac disease to be anemic, caused by malabsorption of the small intestine.
• Adhering to a strict gluten-free diet is critical to heal the small intestine, to allow iron to be absorbed.
• Eating iron rich foods, and if anemic, an iron supplement may be prescribed.
• Take vitamin C to improve absorption of iron.
• Most gluten free products are not enriched with added minerals.
• GF grains that are high in iron -Amaranth, buckwheat, Indian rice grass, sorghum and teff
• Food sources of heme iron, best absorbed, only in red meat, fish and poultry.
• Avoid tannins in tea and coffee that interfere with absorption.

Iron Content of Foods

Liver and organ meats                  5.9-9.9 mg/3 oz.
Soybeans, cooked                         4.4 mg/½ cup 
White beans, canned                    3.9 mg/½ cup
Lentils, cooked                             3.3 mg/½ cup
Spinach, fresh-cooked                  3.2 mg/½ cup
Kidney beans, cooked                   2.6 mg/½ cup
Sardines, canned in oil                 2.5 mg/3 oz
Chickpeas, cooked                        2.4 mg/ ½ cup
Prune juice                                   2.3 mg/ ¾ cup
Navy beans, cooked                      2.1 mg/½ cup

Electrolytes   
Potassium & Sodium

May be malabsorbed with excessive vomiting and diarrhea.

• Sodium –
  RDA-500 mg, not to exceed 3000 mg per day.
  Found in table salt and processed foods.
• Potassium -
  RDA-2000 mg children, 3500 mg adult
  Helps to maintain healthy blood pressure and absorb calcium.
  • Found in gluten free grains, buckwheat, sorghum, wild rice; also leafy vegetables, bananas, apricots, oj, potatoes, tomatoes, milk, dried beans, and meats.

Supplements

• Nutritional deficiencies may be corrected by providing a gluten free multiple vitamin and mineral supplement.
• Use a supplement that provides 100% of the RDA of vitamins and minerals.
• Always check with your physician before taking any nutritional supplement.
• Should be based on your specific nutritional needs.