Special Diets Gluten-Free Print 8 Nutrients Gluten-Free Vegetarians Might Need More Of You need to watch your levels of iron and calcium, plus vitamins D and B12 By Jane Anderson Updated July 17, 2019 Medically reviewed by a board-certified physician More in Special Diets Gluten-Free Grains Other Foods Beverages Cooking/Dining Out Products Low-Carb As a gluten-free vegetarian, you're most likely following both diets for their beneficial health effects. But you do need to take special care with your food choices when you eat both gluten-free and vegetarian (or vegan): each diet carries the risk of certain specific nutritional deficiencies, and when the diets are combined, those deficiencies can amplify. That doesn't mean you need to abandon either diet — both potentially can improve your health, and it's certainly possible to build a gluten-free vegetarian diet that includes everything you need in terms of nutrition. But you'll need to pay more attention than usual to the nutrient content of the food you eat and possibly talk to your physician about supplements that might benefit you. Which nutrients are gluten-free vegetarians typically low in? Well, there hasn't been any research specific to that growing, but still small, group. But I took a detailed look at the lists of potential problem areas for both the gluten-free diet and the vegetarian diet to see where they overlap and found five fairly major potential nutrient deficits, plus a couple of others you should keep an eye on. Here's the list, and how you can combat any deficiencies. 1 Vitamin B12 d3sign/Moment/Getty Images It's probably no surprise to find vitamin B12 at the top of a list for potential nutritional trouble spots for vegetarians since it's found naturally only in animal products. In fact, a 2013 research study shows B12 deficiency rates for vegetarians ranging from 11% to a whopping 90%, with higher rates among vegans and among those who had followed a vegetarian diet since birth. But you may not realize that many people who follow the gluten-free diet also don't get enough B12 — there, the culprit seems to be the lack of fortified grain products (most gluten-free breads and many gluten-free cereals aren't fortified with extra vitamins and minerals, and that costs those of us who eat gluten-free). So as a gluten-free vegetarian, what can you do about your potential problem with vitamin B12? Well, if you're a lacto-ovo vegetarian — a vegetarian who eats eggs and dairy products — you're in luck: it's possible to get some B12 from those sources, although you'd have to eat 10 eggs a day or more than five cups of yogurt (or some combination of the two) to reach 100% of the recommended amount. You also can try fortified cereals—gluten-free Rice Chex, for example, contains 25% of the vitamin B12 you need each day, and both are vegan. Some soy milks and nut milks such as almond milk also are fortified with B12 (just be sure to use a safe option: Gluten-Free Soy Milk List) and Gluten-Free Almond Milk List). Finally, you can take vitamin B12 supplements. If medical testing finds you're severely deficient in vitamin B12, talk to your doctor about trying either sublingual lozenges or even injections—the body doesn't absorb B12 very efficiently, and both options could help you absorb more. 2 Vitamin D Verywell / Alexandra Shytsman Like calcium, vitamin D is essential for your bone health, and researchers continue to uncover evidence of the important role it plays in your overall immune system. Various studies have shown that people eating gluten-free because they have celiac disease commonly are vitamin D-deficient, and vitamin D deficiency also appears frequently in vegetarians and vegans, especially those who don't drink vitamin D-fortified milk. Natural food sources of vitamin D are limited since your body is designed to obtain this nutrient from sun exposure. But with many people avoiding the sun these days, food sources become much more important. Unfortunately, the bulk of these sources involves fortified cereal products and dairy—not the most gluten-free and vegetarian-friendly options. If you eat conventional cereals such as Chex (which is vegan), you can obtain some vitamin D (about 10% of your daily needs) each morning with your bowl of cereal. Add some vitamin D-fortified soy milk or nut milk and that bowl will get you about 40% of the way to your daily goal. Otherwise, you'll need to supplement to get the vitamin D you need. Just be careful: lots of websites seem to advocate taking extremely high doses of vitamin D, but if you take too much, you risk developing vitamin D toxicity. That, in turn, can lead to a condition known as hypercalcemia, which can cause osteoporosis, kidney stones, and even kidney failure. The message here: Don't go overboard with the vitamin D supplements. 3 Calcium Verywell / Alexandra Shytsman Most of us are well aware that we need calcium to build strong bones. But you may not know that calcium is another potential trouble spot for vegetarians, and research shows that people who follow the gluten-free diet also may have a calcium deficit. Those eating gluten-free due to celiac disease need to be especially aware of their calcium needs since they're predisposed to osteopenia and osteoporosis (although people who are newly diagnosed often see improvements in their bone health once they go gluten-free). If you're a lacto-ovo vegetarian, you can get enough calcium relatively easily by consuming plenty of dairy products—two cups of milk a day plus a cup of gluten-free yogurt will cover your needs. But if you're vegan or if you don't eat dairy (and of course many gluten-free vegetarians don't consume dairy products), then it will be tough to get enough calcium from your diet alone. Some soy milks and nut milks are fortified with calcium (again, just be sure to choose a gluten-free soy milk) or gluten-free nut milk). If you do eat soy, tofu made with calcium sulfate also can help you reach your goal, as can calcium-fortified orange juice (for safe choices, see what juices are gluten-free). You may have heard that leafy green vegetables contain plenty of calcium, and that's true... up to a point. Both kale and turnip greens contain some calcium, for example, but you'll need to eat about 10 cups of kale (measured raw, at least) to get enough each day. It's no wonder that most gluten-free vegetarians turn to supplements to get their calcium. 4 Iron Verywell / Alexandra Shytsman Iron helps us build the proteins we need to transport oxygen through our bloodstream to our waiting cells. Studies show vegetarians frequently have lower iron stores than omnivores, and people with celiac disease (especially those newly diagnosed) often suffer from iron-deficiency anemia due to the damage in their small intestines. So where does iron usually come from in our diets? Well, people who follow a conventional diet may get some or even most of their iron from burgers and the vitamin-fortified wheat buns that surround them. But that won't work out so well if you're gluten-free and vegetarian or vegan, and therefore don't eat the burger or the bun. Fortunately, iron is easier to get through natural vegetarian foods than nutrients such as vitamin D and vitamin B12, even if you avoid dairy (which generally isn't a source of significant iron anyway). Half a cup of amaranth, for example, will provide more than one-third of your daily iron requirements, and legumes (especially soybeans, if you eat soy) also are a rich source of iron. Mainstream gluten-free breakfast cereals also provide lots of iron—as much as half your daily needs in a serving. And if you're a big eater of dark leafy greens such as spinach, half a cup a day will get you nearly halfway to your goal. Since as a gluten-free vegetarian you'll be relying on what are called non-heme iron sources (sources that don't come from animal foods), you need to be aware that non-heme iron isn't absorbed as easily as heme iron. In addition, coffee, tea, calcium, and fiber can inhibit the absorption of non-heme iron. The lesson here: Be sure to get enough iron, and if you suffer from any symptoms of iron-deficiency anemia—which can include fatigue, weakness, a rapid pulse, dizziness and feeling cold—talk to your doctor about getting your hemoglobin tested. 5 Vitamin B6 Verywell / Alexandra Shytsman Vitamin B6 (actually the generic name for six related compounds) is critical to your body's ability to metabolize protein, build up your immune system and form hemoglobin to transport oxygen to your cells. Unfortunately, studies show that people who have celiac disease and who follow the gluten-free diet tend to be deficient in B6. And although a plant-based diet tends to be high in the nutrient, several studies nonetheless also have found a high vitamin B6 deficiency rate in vegetarians and especially in vegans. So what can you do if you're both gluten-free and vegetarian or vegan? Well, you can eat chickpeas. The large round legumes (also known as garbanzo beans) turn out to be an excellent source of vitamin B6 — one cup of canned chickpeas gives you more than half of a day's needs. Fortified cereal also can help; one serving of gluten-free Rice Krispies, for example, is fortified with 25% of the vitamin B6 you need each day. Other good sources include potatoes, bananas and winter squash ... all gluten-free vegetarian-friendly foods. 6 Zinc, Fiber and Folate Jonelle Weaver/Getty Images Gluten-free vegetarians and vegans also have two or three other potential nutritional pitfalls. Vegetarians and vegans tend to have low zinc, studies show, in part because zinc absorption is helped by animal protein and hindered by phytates, which are antioxidant compounds found in abundance in grains, legumes, and nuts. We need zinc for a variety of processes related to cell metabolism. Therefore, if you're following a gluten-free vegetarian or vegan diet, you should try to boost your zinc intake—fortified breakfast cereals, yogurt, and cheese (if you consume dairy), cashews and chickpeas all represent good sources. In addition, fiber intake often is less than ideal on the gluten-free diet, since few gluten-free grain products are made with whole grains. The gluten-free fiber situation has improved in recent years with the introduction of new whole-grain gluten-free breads and other products. But if you're a gluten-free vegetarian, you probably don't need to worry that much anyway, since people following a vegetarian diet usually get plenty of fiber. When you can, though, reach for whole-grain products instead of more refined options. Lastly, those eating gluten-free tend to be low in folate, also known as folic acid, although vegetarians and vegans generally consume plenty of folate. You probably know how important folate is if you're pregnant, but it's also crucial for the formation of red blood cells and DNA. To make sure you get enough folate on a gluten-free vegetarian diet, you'll need to load your shopping cart with spinach, rice, black-eyed peas, asparagus, and Brussels sprouts. If you possibly could become pregnant, you also should consider taking a regular folic acid supplement—by the time you know for sure that you're pregnant, the neural tube defects that result from folate deficiency already may have developed. Gluten-free vegetarians tend to be particularly health-conscious, and so it's likely you're already following a diet that's packed with fresh fruits, vegetables, and other nutrient-rich foods. But it helps to know exactly where you might be deficient so that you can plan your meals — and any possible supplements — to compensate before it becomes an issue. Was this page helpful? Thanks for your feedback! Following a gluten-free diet can be challenging. We're here to help. Sign up and receive our free recipe guide for delicious gluten-free meals! Email Address Sign Up There was an error. Please try again. Thank you, , for signing up. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Ball M.J. et al. Dietary intake and iron status of Australian vegetarian women. American Journal of Clinical Nutrition. 1999 Sep;70(3):353-8. Foster M. et al. Effect of vegetarian diets on zinc status: a systematic review and meta-analysis of studies in humans. Journal of the Science of Food and Agriculture. 2013 Aug 15;93(10):2362-71. doi: 10.1002/jsfa.6179. Epub 2013 May 29. Parrish C. The Gluten-Free Vegetarian. Practical Gastroenterology, May 2007. Waldmann A. et al. Dietary intake of vitamin B6 and concentration of vitamin B6 in blood samples of German vegans. Public Health Nutrition. 2006 Sep;9(6):779-84. Weaver C.M. et al. Choices for achieving adequate dietary calcium with a vegetarian diet. American Journal of Clinical Nutrition. 1999 Sep;70(3 Suppl):543S-548S.