Hypocalcemia and Celiac Disease: What to Watch and What to Do

If you have celiac disease and feel tired, numb, or get muscle cramps, low calcium may be part of the problem. This May post explains how a damaged gut can lead to calcium and vitamin D loss, which raises fracture risk, and gives practical steps you can take now to check and improve your levels.

How celiac disease leads to low calcium

Celiac damages the lining of the small intestine where calcium and vitamin D are absorbed. When that lining is inflamed, fewer nutrients pass into your blood. Low vitamin D makes calcium absorption worse, and the body can pull calcium from bones to keep blood levels steady. Over time that increases fracture risk and causes symptoms like muscle cramps, tingling around the mouth, weak nails, and fatigue.

Practical steps to check and improve calcium

Ask your doctor for blood tests: serum calcium with albumin, parathyroid hormone (PTH), and 25‑hydroxy vitamin D. If levels are low, a DEXA scan may be recommended to check bone density. Start a strict gluten‑free diet — healing the gut is the most effective long‑term fix. For supplements, calcium citrate is easier to absorb if you have low stomach acid; calcium carbonate works well if taken with food. Split your total daily calcium into two doses — smaller amounts absorb better.

Choose foods that help: dairy (if tolerated), fortified plant milks, canned salmon or sardines with bones, firm tofu set with calcium, and leafy greens like kale. If lactose intolerance or dairy avoidance is an issue, pick fortified non‑dairy milks and check labels for calcium content.

Watch for interactions: calcium can reduce absorption of iron, levothyroxine, and some antibiotics, so take those medications at least two hours apart from calcium supplements. Vitamin D rises slowly — expect retesting after 8–12 weeks of treatment. If PTH stays high despite supplements, ask about an endocrinology referral; that can point to parathyroid or kidney causes.

Target numbers and dosing: aim for 25‑hydroxy vitamin D above 30 ng/mL. Many adults do well on 1,000–2,000 IU vitamin D daily; if levels are low, doctors sometimes prescribe 50,000 IU weekly for a short period. Aim for total calcium (diet plus supplements) of about 1,000–1,300 mg daily depending on age. Don’t take very high doses long‑term without lab monitoring.

Severe signs need fast care: prolonged muscle spasms, spreading tingling, confusion, or an irregular heartbeat — go to the ER. For children and people who are pregnant, check calcium early and follow up more often. Read the full May 2024 post for practical meal ideas, sample supplement plans, and a clear checklist to bring to your doctor.