When we think about celiac disease our bone health is not usually the first thing that comes to mind, but it is an important factor that we must understand. Our bones provide us with a strong structure to help support and move our entire bodies.
Celiac disease can affect the way we absorb nutrients. Many of the nutrients necessary to keep our bones healthy are not absorbed due to damage to the gut. That’s why it’s important to understand the relationship between celiac disease and bone health and what we can do to maintain healthy bones.
Written by dietetic intern Amanda Jones and revised by Tayler Silfverduk, RDN.
Bone diseases are diseases like osteoporosis, osteopenia, and low bone density. These things cause low bone mass and weakening of the bone tissue. These factors can cause bones to be more fragile and more likely to break.
Widely thought to be a disease of older people, bone density complications can affect people at any age. A study found that low bone mineral density affects about 75% of celiac patients.
This impact on bone health is likely due to small intestinal damage. This damage to the small intestine from gluten can impair absorption of essential bone nutrients and may play a role in the high bone disease prevalence found in celiacs.
Widely thought to be a disease of older people, osteoporosis can affect people at any age. In fact a study found that low bone mineral density affects about 75% of celiac patients.
Gluten itself doesn’t affect bone density, but for people with celiac disease, it can impact their ability to absorb the necessary nutrients that do affect bone density.
When a person with celiac disease consumes gluten, their immune system responds by attacking and destroying the lining of the small intestine. The small intestine is the area of the intestines that absorb the most nutrients from the foods we consume.
This absorption happens through the lining of the small intestine. When this lining becomes damaged, the small intestines lose their ability to absorb nutrients, including the ones we need to support healthy bones.
Celiac disease can impact your bone heath. Bone health is linked to celiac disease due to vitamin D deficiency, calcium malabsorption, magnesium malabsorption, and chronic inflammation related to small intestinal damage from gluten.
Vitamin D, calcium, and magnesium are all essential nutrients in bone health. If we don’t have the proper nutrients to support bone health then it can start to deplete our current stores. Meaning, it can start to affect our bone density.
This happens because many of those minerals are essential to life. For example, we need a certain level of calcium circulating in our blood to maintain life. Our body pulls this calcium from our bones and if we aren’t getting enough calcium in our diet to replace what’s been pulled for circulation, then our bones start to lose mass.
Calcium is essential for bone health with celiac disease. It’s vital for building and rebuilding bones. Low levels of calcium can be common in people with celiac because of intestinal damage.
More specifically, the duodenum of the small intestine is damaged, a primary site for calcium absorption in the body. If the duodenum continues to face damage from gluten,it can lead to the inability to absorb enough calcium.
Therefore, people with celiac disease who consume an adequate amount of calcium can still be deficient in calcium because their small intestines are not absorbing the calcium.
Additionally, calcium absorption also depends on vitamin D and magnesium, yet the absorption of these is also affected by damage to the lining of the small intestine.
It’s a vicious cycle and is why nutrition is such a vital part of celiac treatment to make sure you’re healing and replenishing nutrient stores.
Vitamin D is essential to maintaining bone health with celiac disease. It helps with bone mineralization and calcium absorption, both of which are associated with a healthy bone mineral density.
A research study Vitamin D is built up over time and our bones reach a peak mass around the third decade of life. Although the bones reach a peak bone mass, maintenance, and continued vitamin D intake to support them is still necessary to maintain healthy bones and prevent the development of bone diseases later on in life.
Research has shown that prolonged periods of inadequate vitamin D levels can lead to bone demineralization. This happens when vitamin D levels are so low that the bones release stored calcium to restore the calcium concentration that circulates throughout our systems.
The prolonged-release of stored calcium in the bones weakens them and increases the chances of fractures, osteomalacia, osteopenia, and osteoporosis.
To prevent vitamin D deficiency with celiac disease, consider vitamin D-rich foods, discuss supplements with your doctor, and consider exposing your wrists to the sun for at least 15 minutes a day (bonus points if it’s at peak sun hours).
Magnesium is a key nutrient in celiac disease bone health. Magnesium helps absorb calcium and convert vitamin D into its active form which helps to absorb calcium.
A study found that about 20% of untreated celiac disease patients had a magnesium deficiency. Just like with calcium and vitamin D, the absorption of magnesium is also affected. The destruction of gluten on the lining of the small intestine interferes with the absorption of this important nutrient.
Diet can play a major role in bone health with celiac disease. Following a gluten-free diet can prevent further destruction of the small intestinal lining and can give the small intestine a chance to heal.
This prevention and healing of small intestinal damage can support the absorption of key nutrients that keep your bones strong.
On top of staying gluten-free to support your bone health, it is important to consume foods that are rich in calcium, magnesium, and vitamin D.
Sources of gluten-free calcium-rich foods include low fat dairy products, calcium-fortified foods like gluten-free cereals and orange juice, and leafy greens such as kale, okra, and collard greens. Figs, papayas and oranges are also high in calcium.
Fortified dairy products are high in vitamin D. Another way to consume more vitamin D is to eat fatty fish like salmon.
Gluten-free foods high in magnesium are nuts and seeds, and dark leafy vegetables like spinach, chard, and broccoli. Beans and whole grains are also good sources of magnesium. Anecdotally, I have noticed an increased need for magnesium in people with celiac. In those cases, a supplement that’s easy on the gut (like this one) may be needed.
The damage to the small intestine in celiac disease often leads to many patients with celiac disease with lactose intolerance. Out of respect for how common lactose intolerance is with celiac, below are some delicious gluten-free and dairy-free recipes to support bone health:
For more recipes high in calcium, check out my blog post on Calcium Rich Breakfast Recipes.
There are ways people living with celiac disease can support their bones, just because nutrient levels get low, doesn’t mean they have to stay low.
First, eliminate all gluten from your diet, to heal your gut so you can actually absorb nutrients essential to bone health.
Then eat plenty of foods that are rich sources of calcium, vitamin D, and calcium.
Supplements may also help increase nutrient levels, but be sure to check with your doctor first. Additionally, routine visits and tests with your doctor can also help maintain healthy bones. This includes routine bone density scans as needed, learn more about celiac follow-up testing here.
Additionally, physical movement like walking, dancing, or lifting weight has been shown to help support bone density. Find something that you enjoy doing and try to work it into your life.
Lastly, consider spending more time outside to soak up vitamin D.
Want more guidance on supporting your bones and other nutrient stores with celiac disease? Afraid of food and worried you’re not getting the right nutrients in?