Your client is a 25-year-old female referred to you by her physician. She was previously diagnosed with celiac disease as a young teen and you saw her with her mother at that time for this reason. Today, she is very reluctant to discuss her symptoms, but admits to “cheating” and then having to “pay for it later with gastrointestinal discomfort”. She said her doctor feels she needs a refresher about what to eat.
You refer to your previous notes and you noted that at the time of discharge you recorded that her and her mother had a good understanding of your teaching and they both attended all sessions and were keen to learn. Her main concern at this time as noted on her intake form, is finding interesting food options in the supermarket.
At her next follow-up appointment, your patient asks you what vitamin and mineral supplement she should consider?
Competency: 1 Food and Nutrition Expertise 1.06 Integrate nutrition care c. Demonstrate understanding of nutrition-related disease management strategies
Correct Answer: D. A gluten free vitamin and mineral supplement appropriate for her age.
Rationale
Many people on the gluten-free (GF) diet are recommended to take a GF multivitamin. A dietitian can recommend a suitable multivitamin, or specific vitamins or minerals based on lab information if available. Ideally, you want nutrients to come from foods first, but that is not always possible, especially for those with malabsorption and deficiencies. In those cases, taking a multivitamin or other vitamin and mineral supplements can be a good option. The most common nutrient deficiencies associated with celiac disease are B6, B12, folate, vitamin D, calcium, magnesium, iron, and zinc. In addition, the gluten-free diet tends to be low in certain vitamin and minerals such as:
- B vitamins
- Calcium
- Magnesium
- Iron
- Zinc
Also, many GF foods are not fortified or enriched with iron, folate, or other vitamins like their gluten-containing counterparts.
Important Notes:
- Make sure the multivitamin is labeled GF! Gluten/gluten ingredients are sometimes used as binders or fillers in supplements, so always check the label and choose those that are labeled GF. Products labeled GF are required to contain less than 20 parts per million of gluten per FDA regulations, which has been deemed a safe concentration for those with celiac disease.
- Choose a multivitamin based on age and gender. For instance, women of childbearing age have a higher need for iron and folate.
- Be careful with multivitamins that contain nutrients much higher than 100% Daily Value. Some vitamins, like B6 can be toxic in high amounts.
- Keep in mind that gummy vitamins usually do not contain any iron.
- Also, most multivitamin and minerals do not contain enough calcium and magnesium.
- Always check with your healthcare professional if it is ok for you to take a supplement.
- A general recommendation is to have a varied diet that focuses on whole foods such as vegetables, fruits, dairy or dairy alternatives, meat, fish, eggs, GF whole grains, legumes, nuts, and seeds and healthy oils such as avocado and olive oil. Choose fortified or enriched GF products for those times you have processed GF baked goods and pasta.