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Calcium, Vitamin D Level and OsteoporosisMany people with celiac disease have osteoporosis. If they have had symptoms for a long time without a diagnosis they may even have advanced osteoporosis. If they were fortunate enough to be diagnosed fairly early in the disease process they might only have osteopenia. Why is osteoporosis so common among celiacs? Malnutrition seems like an obvious answer. Yet even with calcium supplementation the osteoporosis continues to get worse. For many, more bone density is lost each year. If you've been diagnosed with celiac diseae, gone on a gluten free diet, and followed it strictly and faithfully, shouldn't you stop losing bone mass? Why do so many with celiac disease continue to drop in bone density even after they have healed and are getting adequate nutrition? Vitamin D Level and Calcium Absorption What many patients or even doctors fail to recognize is that there is more to this equation than the amount of calcium in the diet. There are other factors that most likely contributed to the osteoporosis. Unless these other factors are recognized and treated, the osteoporosis will continue to get worse. One of the missing parts of this equation is your vitamin D level. If you are very low in D, then your body cannot absorb and use most of the calcium in your diet. Even supplements will not be absorbed well. Why? Vitamin D is essential to the absorption of calcium. In order for your body to absorb and make use of the calcium you take, whether in food or supplements, there has to be an adequate supply. If you don't have enough, you will only absorb less than 1/3 of the calcium you take in. Calcium is mainly absorbed in the small intestine, about 90% of the absorption takes place there. The major part is absorbed in the ileum, the lower portion of the small intestine. There are recent studies showing that those with adequate levels absorbed over 3 times as much calcium from an identical meal as those with a low vitamin D level. These were people who had not been diagnosed with celiac disease. Imagine how little is absorbed if your intestines are damaged as well. The recommended daily allowance you see listed on the back of your multivitamin is probably not enough to keep your body's level of D adequate. If you have any symptoms of fat malabsorption, like being deficient in other fat soluble vitamins (A,E,K) or if you have steatorrhea(floating stools), or very low cholesterol levels then you are even more likely to be vitamin D deficient.
Vitamin D3 is made by the body when you are out in the sun. The best time of day for this production is between 10 AM and 3 PM. This will provide about 10,000-20,000 IU of D after 20-30 minutes in the sun. 
In order for this to happen however, you can't be wearing sunscreen. Your skin must be exposed to the sun directly, not through a car window or other glass. Your body also needs to have an adequate supply of cholesterol. It is a form of cholesterol(7-dehydrocholesterol) in the skin that sunshine converts to D3, the active form of vitamin D. Girl Sunbathing by Petr Kratochvil Depending on your geographic location, the sunshine may be too weak to produce much if any D. For example, in the U.S., most northern states do not have enough of the necessary kind of UVB light during the winter to enable vitamin D production. This is especially true north of California in the west and Boston in the east. This means that unless you get enough sunshine during the summer months, so that your body will store any extra D produced, you will run out during the winter and be unable to make any. This will lead to a low vitamin D level. Very few foods contain high amounts of vitamin D. Cod liver oil is one of the highest, but it is also very high in vitamin A, and could produce a toxicity from excess levels. There is also some controversy about whether high levels of A can inhibit the action or absorption of vitamin D. This is in regard to retinol, the actual vitamin. (beta-carotene does not produce the same effect as it is a pre-vitamin). Other foods that contain good levels of vitamin D are salmon, mackerel, and tuna. Egg yolks and beef liver also contain small amounts. Milk and some fruit juices have been fortified with vitamin D, along with cereal grains. (The gluten containing ones.) Lack of vitamin D can lead to depression, bone loss, poor immune function, increased cancer risks, and many other problems. The good news is that you can take a supplement during the winter months to help your body. See Vitamin D and Calcium at
gluten free vitamins and supplements
Lack of vitamin D can lead to depression, bone loss, poor immune function, increased cancer risks, and many other problems. The good news is that you can take a supplement during the winter months to help your body. So How Much Vitamin D Do You Need? Lab tests show a range of 30-100 ng/ml to be normal. New research however is showing that a healthy vitamin D level, one at which calcium is absorbed, the immune system functions well, and there is good health, is closer to 50 ng/ml. Once you get over 50, the body can begin storing the extra D for later. Dr. Cannell of the Vitamin D research council has said that most of us, that is Amercian citizens, are deficient in vitamin D. According to him, if your level is less than 50ng/ml your body will be using it as fast as it can make it, so there won't be any extra to store. He believes the body uses up about 4000 IU per day. You should try to get enough sunshine to boost your vitamin D level first. By the time your skin begins to turn pink, the body has made all it can use. Once it gets to a certain amount it will begin destroying any additional that is produced. This is a natural self-regulating function in the body. A lab test that measures your current status will tell you if you have a vitamin D deficiency. If so, a combination of sunshine and perhaps supplementation is the ideal approach. Because it is stored in the body, you want to be sure of your status before taking any supplements. The correct test to measure your vitamin D status is the 25-OH-D. For many, just getting their vitamin D levels up to the proper amount will be the answer to help them retain their bone mass. For some, there is another element that is just as important as the vitamin D. The other very important element is the function of the parathyroid gland. This is discussed in detail on the next two pages.
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