Avoiding Nutritional Pitfalls in a Gluten-Free Diet: All About Calcium

Osteoporosis and Celiac Disease

Osteoporosis, as well as other, less severe forms of bone disease, may be a complication of long-term untreated celiac disease, because the body cannot properly absorb calcium and vitamin D. (Vitamin D enhances the absorption of calcium and is necessary for the proper formation of bone.) Osteoporosis is a bone disease characterized by low bone mass and structural changes within the bone that weaken it and increase the risk of fracture. There are several risk factors for osteoporosis, including inadequate calcium intake and poor absorption of calcium. Before diagnosis, people with celiac disease often experience malabsorption as a result of damage to the lining of the small intestine. Consequently, their bone mineral density or peak bone mass may not be optimal. Once you are diagnosed with celiac disease and your issues with malabsorption have been resolved on a gluten-free diet, it is important that you consume recommended amounts of calcium to help improve your bone mineral density.

Calcium and the Gluten-Free Diet

The good news is that, while people with untreated celiac disease may not absorb enough calcium, there is nothing about a gluten-free diet that should limit calcium intake. The primary sources of calcium in the American diet—milk and cheese—are readily available to persons following a gluten-free diet. However, as mentioned earlier, many people with celiac disease have a usually temporary secondary form of lactose intolerance and cannot digest the sugar in milk products. If this describes you, there are still plenty of foods you can eat that contain calcium.

In addition, many people with celiac disease also are on other special diets, including low fat and vegetarian. If you are on such a diet, it is still possible to get all the calcium you need. The next section will help you do just that.

Adding Calcium to Your Diet

You can get enough calcium in your diet even if you follow a vegetarian or vegan diet, are lactose intolerant, follow a low-fat diet, or just don't eat dairy products. A combination of the foods listed in this section will enable you to get enough calcium in your diet while suiting your particular needs.

Milk Products

Dietary Guidelines for Americans, 2005 recommends that adults drink 3 cups of fat-free or low-fat milk or consume the equivalent each day. One cup of milk is equivalent to 1 cup of yogurt, 1½ ounces of hard natural cheese, 2 cups of cottage cheese, 1 cup of frozen yogurt, or 1½ cups of ice cream.

Consuming three servings of milk products each day does not have to add a lot of calories and fat to your diet if you choose low-fat products most often. For example, consuming 1 cup of 1 percent milk, 1 cup of low-fat plain yogurt, and 1½ ounces of low-fat cheddar cheese provides you with 914 milligrams of calcium (and only 330 calories).

Calcium-Fortified Foods

If you do not consume milk products, it is recommended that you consume foods fortified with calcium, such as calcium-fortified orange juice, calcium-fortified energy bars, calcium-fortified soy products, and other calcium-fortified nonmilk beverages, such as those made from rice and nuts. Some gluten-free grain foods (including breads, bagels, and granola cereals) also are fortified with calcium. Products include those made by Enjoy Life Foods and Glutino.

As you can see from the following table, calcium-fortified versions of soy milk and orange juice are comparable in calcium content to milk products.

Other Nonmilk Foods That Are Sources of Calcium

If you do not consume milk products or calcium-fortified foods, it is especially important to eat other food sources of calcium.

If You Are Lactose Intolerant

If you are lactose intolerant and are following a lactose-free or lactose-reduced diet, there may be several milk products that you can consume:

• Lactose-free milk: As the name suggests, lactose-free milk contains little to no lactose. Available brands include Lactaid and Land O Lakes Dairy Ease. These products provide 300 milligrams of calcium per 1-cup serving and are available in fat-free, low-fat, and reduced-fat versions.

• Hard cheese: Cheddar and Swiss cheese contain very low amounts of lactose and may be well tolerated.

• Yogurt with active, live cultures: This product also may be tolerated, because it contains an enzyme that may help digest lactose.

If you are unable to consume enough calcium from food, you may want to talk to your dietitian or physician about taking a gluten-free calcium supplement.