Celiac Disease and Anemia

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Published February 24, 2022


What is Anemia?
Anemia results from a decrease in the size or number of red blood cells, or in the amount of hemoglobin, which is the red pigment in red blood cells. Think of red blood cells as ships that deliver oxygen to all the tissues in the body, and hemoglobin as the crates on the ship that hold the oxygen. If there is a shortage of red blood cells (ships) or hemoglobin (crates), oxygen cannot be adequately delivered. Oxygen is necessary for the conversion of food to energy, which is needed by all parts of the body for vital functions.

How are celiac disease and anemia connected?
Celiac disease can damage the part of the small intestine where iron, folate, and vitamin B12 are absorbed. This damage leads to reduced nutrient absorption. Reduced absorption means the body may not get enough of these nutrients, with anemia being one potential result.

The most common sign of celiac disease in adults is iron-deficiency anemia that is unresponsive to iron therapy. Iron and folate deficiencies are the more common causes of anemia in people with celiac disease because these nutrients are absorbed in the upper two parts of the intestine where damage can occur in earlier stages of celiac disease. When celiac disease progresses, the lower part of the small intestine can be damaged and cause vitamin B12 deficiency.

If you have had ongoing anemia and underlying medical conditions are ruled out, it is advisable to ask your physician about testing for celiac disease. Celiac disease testing is also recommended if you have been taking iron supplements for some time and experience no improvement in blood iron levels.

Possible Symptoms of Anemia
Fatigue, weakness, irritability, pale skin, headaches, brittle nails, decreased appetite, increased susceptibility to infections, ringing in the ears, irregular heartbeat, and a decreased attention span in kids.

The Good News
Once a person diagnosed with celiac disease has begun a gluten-free diet, the small intestine will begin to heal and allow nutrients to be absorbed. It is important to give the gluten-free diet time to have its effect – it may take between two and 18 months for nutritional deficiencies to be corrected. Discuss with your physician or dietitian the proper supplementation and diet for your anemia.


Other Things to Know about Treating Anemia


Foods High in Iron
Liver, seafood, lean meat, poultry, legumes, dark green vegetables.

Foods High in Folate
Green leafy vegetables, organ meats, lean beef, orange juice, eggs, fish, dry beans, lentils, asparagus, broccoli.

Foods High in Vitamin B12
All animal products: meat, eggs, milk, dairy products. Vegans require supplementation.


This article has been assessed and approved by a Registered Dietitian Nutritionist.

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