Vegetarianism and Celiac Disease

Embracing vegetarianism when our gluten-free diet already limits food choices? Risky? The gluten-free diet and vegetarianism are compatible. In this article, I will introduce you to the nutrients to be more concerned about when you have celiac disease and want to eat a vegetarian diet.

More and more people are turning to vegetarian or vegan foods for environmental, economic, health, rights or animal respect reasons. By eliminating several foods from your diet, you may be at risk to not have enough of certain micronutrients and macronutrients. In the context of celiac disease, where the absorption of certain nutrients can be more difficult, the risks of suffering from nutrient deficiencies are accentuated. Obtaining gluten-free meat alternatives can also be a problem. Many are therefore inclined to believe that it is impossible to be a vegetarian while following a gluten free-diet.

Calcium and vitamin D

The best sources of calcium and vitamin D are dairy products and their alternatives. Since calcium is the main component of bones, we must consume enough of this mineral in our diet to have healthy bones. With celiac disease, calcium needs are higher than the general population, so there is a higher risk of suffering from osteoporosis. This risk can be accentuated if the person is vegan and stops consuming cow's milk products without replacing them adequately.

On the other hand, vitamin D helps in the absorption of calcium. Likewise, it helps the activity of our muscles, our nerves and to have a good immune system. Thanks to scientific research, it has been discovered that this vitamin may be linked to a reduced risk of certain cancers and certain diseases.

Iron, folic acid and vitamin B12

With celiac disease, the risks of suffering from iron, folic acid and vitamin B12 deficiencies are higher than the general population since the risk of malabsorption is accentuated. This can eventually lead to anemia, which often manifests as a feeling of weakness, paleness, shortness of breath, heart palpitations and this complication can become very severe. Many people believe that it is difficult to meet their nutritional needs for these nutrients with a vegetarian diet. In fact, it is quite possible to meet our nutritional needs with a vegetarian diet if we consume enough varied foods rich in these vitamins and iron. In certain situations, however, the help of a dietitian is crucial, particularly in pregnant women, who have even higher nutritional needs.

There are 2 types of iron, namely heme iron (animal source) and non-heme iron (plant source). It is true that iron from plants is harder to absorb by our body, so we must consume more of it to meet our needs. In addition, products containing caffeine (coffee and tea) decrease the absorption of iron. That's why it's important to take these products one to two hours before or after iron-rich foods. In addition, consuming a food rich in vitamin C when taking our iron-rich foods increases the absorption of the latter.

Sources of iron: tofu, legumes (red, green or brown lentils, black beans, navy beans, soy beans, pinto beans, split peas, chickpeas, hummus, etc.), eggs, soy products, nuts and butters nuts, seeds and seed butters, certain vegetables (beets, beet greens, turnip greens, cooked asparagus and spinach), etc.

On the other hand, folic acid (vitamin B9) can be more difficult to absorb when suffering from celiac disease. In Canada, this vitamin is added to wheat flour since it is consumed in large quantities and helps prevent neural tube defects in newborns. Unfortunately, when suffering from celiac disease, this source of folic acid cannot be consumed and folic acid is not added to other types of flour. It is therefore important to meet our needs for this vitamin with foods rich in this nutrient.

Sources of folic acid: Vegetables (spinach, asparagus, Brussels sprouts, romaine lettuce, broccoli), legumes (black beans, green peas), rice, GLUTEN-FREE cereals, avocados, wheat germ, tomato juice, juice orange, etc

Folic acid needs increase for a pregnant woman and it is recommended by Health Canada to take a supplement.

Then, vitamin B12 (cobalamin) helps in the formation of red blood cells and also in nerve function.

Sources of cobalamin: milk, fortified vegetable drinks (soy, nuts, etc.), eggs, nutritional yeast, etc.

Proteins

A protein is a macronutrient that provides energy and serves to maintain and develop our tissues. Proteins also help the chemical reactions in our body to occur, participate in the formation of antibodies to fight infections and much more. The quality of plant protein varies, but someone following a vegetarian diet can easily meet their protein needs with an adequate amount of calories and a variety of protein-rich plant foods. If we only consume plant-based proteins during a day, it is important to vary our sources in order to meet our nutritional needs.

Protein sources: tofu, textured vegetable protein, edamame, eggs, milk, legumes, lentils, nuts, etc.

Supplements

Vitamin and mineral supplements may be needed especially if you already have nutritional deficiencies or have other health problems. To find out if you need it, it is important to speak with a health professional such as your doctor and/or dietitian.

Conclusion

With a balanced diet, it is possible to follow a vegetarian diet while having celiac disease. What is important to remember is that if you eliminate a food from your diet, you often have to substitute it for another food to have all the necessary nutrients and be healthy. For more personalized information or if you suffer from other illnesses, it would be important to consult a registered health care professional. Contact me!

Karine Drouin, registered dietitian RD.

---

References

Alleyne, M., McDonald, K.H., Miller, J.L. (2008). Individualized Treatment for Iron-deficiency Anemia in Adults.121(11), 943–948. https://doi.org/10.1016/j.amjmed.2008.07.012

Dispensaire diététique de Montréal. (Août, 2015). Le supplément d’acide folique est-il essentiel pendant la grossesse ? Retrouvé le 28 mai 2021 au https://www.dispensaire.ca/articles/acide-folique-grossesse-supplement/

Gouvernement du Canada. (Mai, 2019). Enrichissement: Exigences d'étiquetage et de composition pour les céréales et les produits de boulangerie. Retrouvé le 28 mai 2021 au https://inspection.canada.ca/exigences-en-matiere-d-etiquetage-des-aliments/etiquetage/industrie/cereales-et-les-produits-de-boulangerie/fra/1392135900214/1392135960867?chap=6

Healthline. (2018). 9 Important Functions of Protein in Your Body. Retrouvé le 24 mai 2021 au https://www.healthline.com/nutrition/functions-of-protein HealthLinkBC. (Mars, 2019). Les aliments sources de calcium et de vitamine D. Retrouvé le 26 mai 2021 au https://www.healthlinkbc.ca/hlbc/files/documents/healthfiles/hfile68e-f.pdf

Les diététistes du Canada. (2019). Ce que vous devez savoir au sujet de la vitamine D. Retrouvé le 27 mai 2021 au https://www.unlockfood.ca/fr/Articles/Elements-nutritifs-(vitamines-et-mineraux)/Ce-que-vous-devez-savoir-au-sujet-de-la-vitamine-D.aspx

Les diététistes du Canada. (Février, 2019). Comment consommer plus de fer?

Retrouvé le 24 mai 2021 au https://www.unlockfood.ca/fr/Articles/Vitamines-et-Mineraux/Comment-consommer-plus-de-fer.aspx

Les diététistes du Canada. (Mai, 2018). Ce que vous devez savoir au sujet de la vitamine B12. Retrouvé le 24 mai 2021 au

https://www.unlockfood.ca/fr/Articles/Elements-nutritifs-(vitamines-et-mineraux)/Ce-que-vous-devez-savoir-au-sujet-de-la-vitamine-B12.aspx

Les diététistes du Canada. Celiac/Coeliac Disease. Dans: Practice-based Evidence in Nutrition® [PEN]. 25 mai 2011. [cité le 24 mai 2021]. Disponible sur: https://www-pennutrition-com/KnowledgePathway.aspx?kpid=924. Accès uniquement par abonnement ou inscrivez-vous pour un essai gratuit de deux semaines.

Mendoza, N. Celiac disease: an overview of the diagnosis, treatment and management. Nutr Bulletin. 2005 [cité le 20 mai 2021];30(3):231. Disponible sur: https://www.researchgate.net/publication/230005046_Coeliac_disease_An_overview_of_the_diagn osis_treatment_and_management

National Institutes of Health (NIH). (Mars, 2021). Folate. Retrouvé le 27 mai au https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

NIH Consensus Statement on Celiac Disease. NIH Consens State Sci Statements. 2004 Jun [cité le 10 juin 2021];21(1) 1-22. Available from: http://consensus.nih.gov/2004/2004CeliacDisease1 18PDF .pdf