Research
Nutrient Repletion After Diagnosis
Iron, B12, folate, vitamin D, zinc. What to test for in the first year, and why supplementation alone rarely solves the problem.
When the villi are damaged, absorption fails first in the proximal small intestine — where iron, folate, and calcium are taken up. A newly diagnosed celiac patient is, on average, deficient in at least one micronutrient at the time of diagnosis. Many are deficient in several.
The baseline panel worth requesting
- Ferritin, iron, and total iron-binding capacity
- Vitamin B12 and folate
- 25-hydroxy vitamin D
- Magnesium and zinc
- Copper, in patients with neurological symptoms
What supplementation can and cannot do
Repletion works only when the underlying absorption improves. In the first three to six months of a strict gluten-free diet, the intestine begins to heal and supplements start to behave normally. Before then, oral iron may pass through largely unabsorbed; injectable iron is sometimes warranted.
Foods that do quiet, sustained work
Whole-food sources rarely replete a true deficiency on their own, but they support the diet long-term: lentils and beans for iron and folate, sardines and fortified plant milks for calcium and D, pumpkin seeds for zinc and magnesium, and good eggs for B12.
Recheck the panel at six and twelve months. Persistent deficiency in a compliant patient is one of the earliest signs of incomplete healing.
