Osteoporosis and Coeliac Disease

When we think about coeliac disease, we automatically think about the gut.  So many people have had all the (not) fun of bloating, tummy upsets, going too often or not often enough, and everything in between.  Although not everyone gets the gut symptoms, coeliac disease is really seen as a disease of digestion.   

But, although coeliac disease may start in your gut, it doesn’t end there.  Long-term problems of coeliac disease can include issues with fertility, anaemia and, most importantly, bone health. 

Did you know that people with coeliac disease are much more likely to develop osteoporosis?  Osteoporosis is when your bones become weaker and are more likely to break or fracture.  Good nutrition along with weight-bearing exercise are essential to having strong, healthy bones.  A brisk walk and a healthy diet are an amazing combination. 

Why do people with coeliac disease get more osteoporosis? 

Coeliac disease can make it harder for your body to absorb essential bone nutrients like calcium and vitamin D.  If it took a long time for you to be diagnosed, your bones may have been without the right building blocks for years.  After diagnosis, following a strict gluten-free diet makes it much easier for your body to start absorbing your food again and this is brilliant for your bones.   

The second reason is that eating gluten doesn’t just damage the lining of the gut.  Gluten also triggers your body to make other substances that we know attack your bones as well. So you need to make sure you are strictly gluten free AND eating lots of bone-friendly nutrients to keep your bones strong and healthy. 

Who is most at risk of getting osteoporosis? 

It looks like people who would describe themselves as being “mild coeliacs” or “slightly” coeliac are at higher risk of developing osteoporosis than people who get a more severe reaction not gluten.  Why? 

Some people will have a quick and severe reaction to gluten whereas other people may not feel anything.  Unfortunately, the damage to the gut is exactly the same.  So people with a severe rection strictly avoid gluten and that protects their bones.  Whereas people who get a milder reaction can be a bit more relaxed with their gluten (i.e. they “chance it” a bit more often).  This means they can have higher levels of gut damage and calcium malabsorption. Bottom line? There’s no such thing as “slightly” coeliac… 

What are the nutrients my bones need? 

Calcium 

We all know that we need calcium for strong, healthy bones but where is the best place to get it? 

The calcium in milk, yoghurt and cheese is easily absorbed by your body and is the best place to get the calcium you need.  You will also get calcium from plant-based milk alternativex that have calcium added.  Check the label to make sure that soya, almond or other plant-based drinks have calcium added in the ingredient list.  Tinned sardines (eaten with the bones) are a great source of calcium as well. 

You need to get 3 to 4 servings of calcium-rich foods everyday.   

1 serving is: 

• 200mls of milk (1 glass) 
• 200mls of calcium fortified soya milk (1 glass) 
• 1 pot of yoghurt (125g) 
• 30g of hard cheese like cheddar (this is the size of your two thumbs) 
• ½ tin of sardines 

Aim to have 3-4 foods from this list everyday – you can have a glass of milk with meals, pour milk over your breakfast cereal and have a milky coffee like a cappuccino.  Yoghurt makes a great snack or dessert – and don’t worry about the sugar – the sugar in plain yoghurt is the natural milk sugar that we don’t need to limit and even fruit yoghurts are safe to have.  If you do go for the caramel-toffee-crisp-crunch dessert-type yoghurt there will be a lot of sugar but ordinary yoghurts are no problem at all. 

Green Vegetables are not great for calcium… 

Although green vegetables do have calcium, they do not have enough in a serving to cover you for what you need.  You would have to eat 16 servings of broccoli per day to get the calcium you need or around 7 bags of rocket per day!  You can certainly add these foods in but don’t count them for calcium – make sure you get your milk or fortified soya milk as well. 

Vitamin D 

Vitamin D helps you to absorb the calcium that you need.  Without vitamin D it is very difficult for calcium to get into your body.  We are supposed to get vitamin D from the sun but Ireland is not famous for its sunny weather!  

Foods that are sources of vitamin D are oily fish like salmon and mackerel as well as eggs.  However, unless you are eating a LOT of these foods, you will still not get enough. Children over 13 and adults with Coeliac Disease do need to take a vitamin D supplement of 15 micrograms per day. Children aged 5-12 need 10 micrograms per day; children aged 1-4 need 5 micrograms per day.  Ask your dietitian if you are not sure what you need. 

What about exercise? 

Weight-bearing exercise encourages your body to build and maintain healthy bones.  Carrying weight helps to build bone as well as muscle.  Any exercise that carries weight will help: 

• Brisk walking is great for your hip bones and it’s free! 
• Pilates & yoga help build spine and wrists as well as balance 
• Lifting weights, going to the gym, and rowing are all great exercises that will help strengthen muscles and maintain bones 
• Gardening – digging, lifting, etc. can all help. 

Remember: if you only walk, it will not help your wrists and spine as much – do try to add in some exercise that works your upper body too.