Disclaimer: I am not a medical professional. Please consult your doctor before making any changes to your diet, medication or supplement routine!
Well, fam…. after about two months’ reprieve, I am officially back on the gluten-free bandwagon.
When I first found out I most likely had endometriosis — not, as previously diagnosed, IBS — I quit my low-FODMAP diet and started eating whatever I wanted. For the first few weeks, it was great. Then, I quickly learned that I could not, in fact, eat whatever I want with endometriosis if I wanted to minimize my symptoms and maximize my well-being.
Don’t get me wrong: I don’t have celiac disease and I will not harm my long-term health if I indulge in a slice of pizza or a bowl of cookie dough ice cream from time to time. (And I am happy to do so, even now.) But in terms of managing my symptoms on a day-to-day basis, I discovered that a gluten-free and now (mostly) dairy-free diet helps me feel my best the most consistently.
My doctor recommended the gluten-free diet to me because she has found a link between endometriosis and non-celiac gluten sensitivity in her patients. As for the dairy, I’ve long known I was lactose-intolerant, but my love for macaroni and cheese surpassed my disdain for bloating. Until very recently, I was content to keep eating dairy despite my gluten-free lifestyle — but after a bad flare-up, I decided to give ditching dairy another go , if only for my uterus’s sake.
The trial run of my gluten-free, dairy-free diet has gone well so far, so I’ve decided to make it a quasi-permanent lifestyle change — at least until we see how my laparascopy improves my endometriosis symptoms. However, adopting a gluten-free, dairy-free lifestyle has raised some concerns that I may not be getting all the nutrients I need. For example, while I drink coffee with almond milk creamer and have coconut milk yogurt once a day, in addition to the occasional feta, Parmesan or goat cheese garnish, I still suspect I’m only getting about half the calcium I need for strong, healthy bones.
That being said, I know a lot of women with endometriosis are in the same boat. Many of us follow the endo diet, which suggests you limit gluten and dairy, or have co-occurring food intolerances that lead us to swear off gluten and dairy. If you’re on a gluten-free, dairy-free diet, you may — like me — be wondering what supplements, if any, you need to take to maintain optimum levels of vitamins and minerals. So, I did my research, and now I’m here to share what I’ve learned with you all!
Vitamin and Mineral Deficiencies on a Gluten-Free, Dairy-Free Diet
Unfortunately, my research suggests that vitamin and mineral deficiencies on a gluten-free, dairy-free diet may be fairly common. The odds of deficiency largely depend on what you eat (especially the variety of your diet) as well as the reasons for being on a gluten-free, dairy-free diet.
Gluten-free diet and nutrient deficiencies: People adopt a gluten-free diet because they have a sensitivity to gluten, such as celiac disease or irritable bowel syndrome.The likelihood of nutrient deficiencies on a gluten-free diet depend on the cause of your intolerance to gluten.
The first type of gluten sensitivity is celiac disease, which is an autoimmune disorder in which gluten causes the small intestines to attack themselves. People who have celiac disease and don’t know it have been consuming gluten for years. This exposure to gluten damages the intestines, resulting in the uncomfortable symptoms of celiac disease (although some patients show no symptoms at all). The more damaged the intestines, the fewer vitamins they can absorb from your food, leading to deficiencies. After being on a gluten-free diet for a while, your intestines will eventually heal, reversing the damage and therefore the deficiencies. However, you may need to supplement your diet in the meantime to help your body absorb more nutrients than it is receiving from your food.
Non-celiac gluten sensitivity (NCGS) is the second type of gluten sensitivity. It is not an autoimmune disorder and does not compromise the absorption of vitamins and minerals through the intestines. Irritable bowel syndrome (IBS) is similar, in that it can cause an intolerance to gluten that does not result in malabsorption or damage to the intestines. Therefore, if a person with NCGS or IBS suffers from vitamin and mineral deficiencies, the cause is probably poor diet. Unfortunately, few gluten-free foods are enriched with the vitamins and minerals found in gluten-containing products, so anyone on a gluten-free diet can be at risk, whether they have celiac disease or NCGS.
For this reason, it’s recommended you NOT go on a gluten-free diet to lose weight or improve your health, despite what “wellness gurus” like Gwyneth Paltrow may say. If you do not have a true sensitivity to gluten, you’re placing yourself at risk of vitamin and mineral deficiencies for no reason, meaning you’re actually harming your overall health. However, there is a huge link between the gluten-free lifestyle and patients with endometriosis: endo patients are more likely to have autoimmune diseases like celiac disease, as well as to be diagnosed with intestinal disorders like food intolerances or IBS. It’s also thought by some that gluten is inflammatory, though there is very little clinical research to support the link between diet and endometriosis. As a result, a gluten-free diet may be appropriate for some patients with endometriosis.
Dairy-free diet and nutrient deficiencies: People adopt a dairy-free diet for many reasons. Some people do not consume any animal products because they are vegan. Others ditch dairy due to an allergy, due to lactose intolerance or due to a medical condition like acne or endometriosis.
Lactose intolerance is a deficiency in the enzyme lactase, which digests lactose, the main sugar found in milk and its byproducts. It can be genetic (especially in Asian-Americans) or can develop when we stop eating dairy for long periods of time. The body only produces lactase in order to digest our mother’s milk as infants. As a result, it will only continue to produce lactase if we continue to consume dairy. If we stop eating dairy for an extended period of time, our body may stop producing lactase — and may not produce it again, even if you choose to eat dairy in the future. This is how I became lactose-intolerant; I developed lactose intolerance after going vegan for six months.
Some people believe that dairy consumption contributes to other medical conditions, and may choose not to eat dairy even though they can digest it. This is especially true of patients with hormonal conditions like polycystic ovarian syndrome, infertility, acne and endometriosis. Many factory-farmed cows are fed hormones to help them grow faster, which are excreted in their milk. As a result, when we consume dairy products, we may be consuming excess hormones from our environment that contribute to symptoms like pain and acne. Other people believe that, like gluten, dairy may be an inflammatory food that contributes to the pain of endometriosis. They may also choose to avoid dairy in their diet.
In any case, the primary cause of vitamin and mineral deficiencies in a patient on a dairy-free diet is, well, diet. American law requires manufacturers to enrich dairy products with vitamin D. As you probably know from the “Got Milk?” campaigns you saw as a kid, dairy is also a good source of calcium, which is important for preventing osteoporosis in old age (especially in people assigned female at birth). Thus, if you choose not to eat these foods, whatever the reason, you may not get enough of the nutrients your body needs to stay happy and healthy.
The only way to know for sure if you are deficient in something is to get tested at your doctor’s office. This usually takes the form of some simple bloodwork. Still, you may be wondering what you can do to enrich your diet and prevent vitamin and mineral deficiencies before they can happen, Just for you, I’ve compiled a list of some of the more common deficiencies found in people on gluten-free, dairy-free diets. I’ll also include information about food and supplement sources of these nutrients to help you feel your healthiest on a gluten-free, dairy-free diet!
There are so many types of B vitamins that it can be difficult to keep track of them all. You’ve probably heard of vitamin B12, which is found primarily in animal products. It’s a common deficiency in people who don’t consume meat, eggs or dairy, such as vegans. But did you know that the vitamins that go by thiamin, riboflavin, niacin and folate are also versions of vitamin B?
Bread and cereal products in the United States are enriched with B vitamins as required by law, but many of their gluten-free counterparts are not. This is especially problematic in the case of folate, which women require a steady intake of as young adults in order to sustain a healthy pregnancy later in life.
Thankfully, there are many food sources of B-vitamins that contain neither gluten or dairy. Some gluten-free cereals like Rice Chex and Cheerios are enriched with vitamins and minerals, as are dairy-free products such as almond milk. If you eat meat on your gluten-free, dairy-free diet you shouldn’t need to worry about vitamin B12. (If you are vegan, it’s recommended that you take a supplement to meet your B12 needs.) Other forms of vitamin B, however, may be harder to find in nature. Here are some food sources of the various types of vitamin B:
- Thiamin (B1): sunflower seeds, black beans, tuna, lentils
- Riboflavin (B2): mushrooms, spinach, soybeans
- Niacin (B3): mushrooms, avocado, broccoli, tuna, salmon, chicken breast
- Pantothenic acid (B5): avocado, broccoli, kale, eggs, animal products
- Biotin (B7): eggs, amonds, mushrooms, sweet potato, spinach
- Folate (B9): green leafy vegetables, asparagus, beets, broccoli, lentils
If you are eating a variety of these foods and still don’t feel like you’re getting enough B-vitamins, if you have been told you are deficient or if you have another medical condition (such as depression) that could benefit from B-vitamin supplementation, you may want to try taking an over-the-counter B-vitamin complex. Nature Made products are affordable and gluten-free. For a more luxurious product, try Nordic Naturals.
Vitamin D deficiencies are not uncommon in the U.S. population, even if you are consuming a diet rich in wheat and dairy products. In fact, Mercy Medical Center reports that as much as 42 percent of the American population may be vitamin D deficient.
There are very few food sources of vitamin D, making it difficult to get enough of this important fat-soluble micronutrient, even on a healthy and balanced diet. Fatty fish, such as salmon and sardines, contain some vitamin D. However, the best source of vitamin D is thought to be sunshine.
Sunshine helps the body produce its own vitamin D. When your body is exposed to sunlight, the sun’s UV-B rays trigger a process that converts cholesterol into vitamin D. Doctors suggest that 10 to 30 minutes of midday sunshine exposure (sans sunscreen) is enough to help the body synthesize vitamin D without elevating your skin cancer risk.
Certain factors put you at higher risk of a vitamin D deficiency. Americans who live in a northern climate — think New England, the Great Lakes region and the Pacific Northwest — may not be able to get enough vitamin D due to lower levels of sunlight in those regions. People on a gluten-free and/or dairy-free diet are also at higher risk of deficiencies, as many wheat and dairy products are enriched with vitamin D.
Lack of consumption, as this is called, is a common cause of vitamin D deficiency. However, patients with celiac disease may also experience malabsorption of vitamin D because their intestines are too damaged from gluten exposure to function properly.
A simple blood test is enough for your doctor to tell you if you are vitamin D deficient. Still, some medical professionals say that every adult should take a vitamin D supplement in the autumn and winter, when sunlight levels reach a natural low. Those with darker skin and/or those at risk of low vitamin D levels (such as people on a gluten-free, dairy-free diet) are recommended to take a vitamin D supplement year-round.
If a blood test finds you are deficient in vitamin D, your doctor may prescribe a megadose of vitamin D to be taken once per week for a defined period (for me, this was six months). After that time, you can take an over-the-counter supplement. Look for vitamin D3, which is most readily absorbed by the body in supplement form. I take Nature Made, but I’m also a fan of HUM Nutrition.
Growing up in the United States, I was exposed to the “Got Milk?” campaign often as a kid, making it impossible to neglect the importance of calcium. Dairy is the most well-known food source of calcium — so if you’re on a dairy-free diet, you may worry about how to get enough of it. But contrary to those notorious milk-mustache ads, dairy is not the only food source of calcium.
Many bread products are enriched with calcium, including some gluten-free alternatives, as are many non-dairy milks and fruit juices. Soy products (which, I will note, aren’t ideal for patients with endometriosis due to their phytoestrogenic effects) like tofu, tempeh and edamame contain calcium, too, as do some dark leafy greens — think kale and bok choy.
Calcium is incredibly important for bone health, especially in women (who are at higher risk of osteoporosis as they age). Women under 50 need 1,000 mg of calcium per day, which can be difficult to get on a gluten-free and dairy-free diet, even by consuming all the food sources of calcium listed above. If you are a serious athlete, or don’t eat dairy, Mayo Clinic suggests monitoring calcium levels more closely than the average person.
Food sources of calcium are better absorbed than supplement forms, according to Johns Hopkins. Still, Harvard reports that there are few negative side effects associated with calcium supplements — and those that do exist are minor, such as heartburn and constipation. Hypercalcemia (a medical term for too much calcium in the bloodstream) is rare, even with calcium supplementation, but can cause more serious side effects, such as nausea, vomiting and neurological symptoms.
It’s up to you to weigh the pros and cons of taking calcium supplements on a gluten-free, dairy-free diet to determine if they are right for you. I recommend either having your calcium levels tested by a doctor or tracking your diet for a few days to see how much calcium you’re consuming on average before splurging on a supplement.
Caltrate gummies are an inexpensive and tasty way to get both vitamin D and calcium; they’re both gluten-free and dairy-free, but do contain some added sugar. If you are diabetic or prefer to avoid added sugar, you may want to opt for a pill or tablet instead — as you already know, I love the brand Nature Made!