Zinc

Zinc deficiency is common in celiac disease. Intestinal damage (villous atrophy) and a restrictive gluten-free diet both reduce zinc intake/absorption, so many newly diagnosed or even treated celiac patients have low zinc. Beth Israel Deaconess Medical Center Mayo Clinic Proceedings

Biological rationale: zinc is essential for epithelial integrity, immune regulation and intestinal barrier function; correcting deficiency helps restore normal mucosal function and systemic processes (growth, taste, wound healing). This is why clinicians consider zinc when levels are low. MDPI American Journal of Clinical Nutrition

Important caveat: zinc is not a cure for celiac disease. The primary disease-directed therapy remains strict lifelong gluten avoidance. Zinc supplementation treats zinc deficiency and may help symptoms related to that deficiency, but it does not replace a gluten-free diet or immunologic/biologic therapies for celiac disease. Celiac Disease Foundation

Check first. Measure serum zinc (and consider other micronutrients) before starting supplements — many clinics only supplement when deficiency is documented. Re-check after therapy to confirm normalization. Typical clinic practice is to re-test after ~6–8 weeks. National Celiac Association Caring Sunshine

Dose & duration (typical clinical practice):

• There is no single universally accepted dose specific to celiac disease; clinicians commonly use replacement doses for zinc deficiency rather than very high pharmacologic doses. Public health guidance/RDAs: ~8 mg/day (women) and ~11 mg/day (men) is the recommended dietary intake for maintenance; the tolerable upper intake level (UL) for adults is 40 mg elemental zinc/day (to avoid toxicity). For treatment of deficiency, some guideline summaries (for acquired zinc deficiency) use roughly 0.5–1 mg/kg elemental zinc per day for several months (often 3–4 months) — but precise regimens can vary by clinic and severity. Always follow a clinician’s prescription. Linus Pauling Institute Office of Dietary Supplements Dr.Oracle
• Example used in current pilot trials: trial protocols may use a single daily zinc tablet (trial details vary — see the clinical trial entry below). This illustrates that supplement regimens differ and are usually standardized within a study. ICHGCP inclinicaltrials.com

Formulation: zinc sulfate, gluconate or acetate are commonly available; there is no clear consensus that one form is vastly superior for celiac patients — clinicians choose based on tolerance and availability. Labelled products report elemental zinc (always check the elemental-zinc amount on the supplement label). Office of Dietary Supplements Celiac Canada

Monitoring: if you treat with zinc for months, many clinicians also check copper (because prolonged high zinc can induce copper deficiency) and repeat zinc level after the course to stop supplementation once levels normalize. National Celiac Association AAFP

1. Systematic / review evidence on zinc in GI disease (includes celiac discussion).
2. A 2023 review summarized zinc deficiency in pediatric GI diseases and discussed zinc’s role in mucosal protection and inflammation; it notes zinc repletion corrects low serum zinc and can help GI mucosal function, but direct evidence in celiac mucosal healing is limited. MDPI
3. Zinc metabolism / absorption work (AJCN).
4. Studies measuring whole-body and mucosal zinc pools show altered zinc kinetics in people with celiac disease and support the biological plausibility for deficiency and need for repletion. American Journal of Clinical Nutrition ScienceDirect
5. Clinical intervention studies (mixed results / limited size):

• Oral zinc in non-responsive adult coeliac syndrome — a small study reported that oral zinc normalized plasma zinc but did not change villous morphology or produce clear clinical improvement in a few patients; there was a modest increase in brush-border enzyme activity. This shows zinc corrects biochemical deficiency but may not reverse mucosal damage by itself. Gut
• Pediatric study (Journal of Tropical Pediatrics, Rawal et al., 2010 / similar) — trials comparing gluten-free diet with or without short zinc supplementation show that supplementation raises serum zinc in deficient children; follow-up and mucosal outcomes vary by study. (Access to full text may require journal subscription.) Oxford Academic Europe PMC

1. Contemporary clinical trial activity:

• Pilot randomized trial (NCT05782257): a McMaster University pilot study is/was registered to compare a zinc-optimized gluten-free diet versus zinc supplementation to treat zinc deficiency in celiac disease — endpoints include normalizing plasma zinc and improving GI/extraintestinal symptoms at 3 and 6 months. This shows active research but not definitive published results yet. (ClinicalTrials.gov entry.) ClinicalTrials.govCDEK

1. Clinical guidance / clinic experience summaries: major celiac centers and reviews note that zinc deficiency is common and that supplementation is a part of nutrient repletion strategies — but that evidence for zinc improving celiac histology or curing symptoms beyond correcting deficiency is limited. Caring Sunshine Celiac Disease Foundation

Summary on evidence: there is good evidence that zinc deficiency occurs frequently in celiac disease and that supplements correct serum zinc. There is limited and mixed evidence that zinc supplementation alone reverses intestinal villous atrophy or resolves celiac disease symptoms — it is primarily a targeted treatment for deficiency, not a disease-modifying therapy for celiac disease itself. Beth Israel Deaconess Medical Center Gut