Ask Shelley Case: Anemia & Celiac Disease – Causes & Treatment
Question: After years of being anemic, I just found out I have celiac disease. Do you have any advice on maximizing iron absorption?
Anemia is a concern for many folks that have been diagnosed with celiac disease. Anemia is a condition that
results from a deficiency in the size or number of red blood cells or the amount of hemoglobin in these cells. There are many causes of anemia, however, the most common is due to iron, folate or vitamin B12 deficiency. In celiac disease damage to the intestinal villi in the area where iron and folate are absorbed frequently results in a deficiency of these nutrients. As the disease progresses, villous atrophy in the lower part of the small intestine (terminal ileum), resulting in vitamin B12 malabsorption, can also occur in some individuals. Other reasons for inadequate absorption of B12 may be due to small intestinal bacterial overgrowth, low stomach acid levels (caused by the long-term use of gastric acid blocking agents for the treatment of reflux or ulcers) or pernicious anemia (an autoimmune disease that produces antibodies that destroy specific cells in the stomach which contain the Intrinsic Factor (IF) that is necessary for the absorption of B12 from foods).
How Can You Treat Anemia?
Once a diagnosis of celiac disease is confirmed and the gluten-free diet is initiated, the villi begin to heal which allows for the absorption of nutrients. Response to the gluten-free diet varies from one individual to another and may take on average from 2-18 months until the nutritional deficiencies are corrected and symptoms resolve. In addition to a strict gluten-free diet, it is important to include foods high in iron, folate and vitamin B12. Nutrition supplements may be required if the deficiency is severe. In the case of pernicious anemia, life-long vitamin B12 supplementation (shots, intranasal or oral supplements) are necessary. Discuss with your physician and dietitian about supplementation.
There are two types of iron in foods, heme iron and non-heme iron:
Heme Iron:
• Is more readily absorbed by the body (approximately 23% of heme iron consumed is absorbed).
• Absorption is not changed by other foods in the diet.
• Is found only in red meat, fish and poultry.
Non-Heme Iron:
• Is not absorbed as well as heme iron (only 3-8% of non-heme iron consumed is absorbed).
• Absorption can be increased or decreased by other foods in the diet.
• Is found in fruits, vegetables, grains and eggs.
How Can You Maximize Iron Absorption?
1. Choose foods with a higher iron content
2. Eat a source of heme iron with non-heme iron at the same meal: An example is stir-fried beef, chicken, pork or fish with vegetables (e.g., broccoli) and rice and toasted almonds or sesame seeds; or Chili with meat and beans.
3. Vitamin C increases absorption of non-heme iron so combine vitamin C-rich foods with non-heme iron foods at the same meal: An example of this includes Poached egg and glass of orange juice; Casserole with rice, beans, canned tomatoes or tomato sauce; or a Spinach salad with strawberries or orange segments.
4. Avoid coffee or tea with meals rich in iron as these beverages contain tannins which interfere with iron absorption. It is better to drink these beverages between meals.
5. If taking iron supplements, consume supplement with vitamin C-rich foods.
How Much Iron Do You Need?
For more than 50 years, nutrition experts have produced a set of nutrient and energy standards known as the Recommended Dietary Allowances (RDA’s). A new set of standards has been developed called the Dietary Reference Intakes (DRl’s) which reflect collaborative efforts of American and Canadian scientists, through a review process overseen by the National Academy of Science’s Food and Nutrition Board, Institute of Medicine, National Academies.
The newly established levels for vitamins, minerals, protein, fats, cholesterol, carbohydrate, fiber, and energy levels can be found at this Board’s website (please note that iron levels are listed on page 2).
Ask Shelley Case is a feature of BeFreeForMe.com. It is published the second Tuesday of each month. Shelley Case is a Registered Dietitian, Consulting Dietitian, Speaker and Author of Gluten-Free Diet: A Comprehensive Resource Guide. Visit Shelley and get more gluten-free tips & info at: www.glutenfreediet.ca
August 10th, 2010 at 11:36 am
I also have celiac along with several other food allergies, and am border-line anemic. Even now, my system does not absorb all the nutrients it intakes so an iron supplement, in addition to other vitamin supplements, has really helped. But pills and capsules did not result in any change. Taking liquid supplements, however, made a world of difference. They’re more expensive but worth it, at least for me. Something to consider.
August 10th, 2010 at 6:34 pm
I HAVE CELIAC DISEASE FOR ALMOST 15 YEARS NOW.I WAS NOW TO 96 LBS. I WAS SERIOUSLY ANEMIC.I AM MUCH BETTER NOW.LAST YEAR I BROKE OUT IN A RASH AND IT WAS FROM MY CELIAC DISEASE.I WAS PUT ON THE MEDICATION DAPONE.THERE ARE SOME SIDE AFFECTS BUT I HAD WEEKLY BLOOD DONE FOR OVER THREE MONTHS.I AM DOING VERY WELL ON THIS MEDICATION.IF I DO NOT TAKE FOR 2 DAYS THE RASH COMES BACK AND I AM VERY ITCHY.
August 26th, 2010 at 4:10 pm
I consider myself lucky. I was deficient in many nutrients but after a year on the gluten free diet and eating very nutritiously, all my numbers are in the normal range. I do take a multivitamin with iron and calcium and vitamin D3 daily. I was sick for over 10 years before someone finally figured out what was wrong with me. I weighed 104 pounds at diagnosis.
September 28th, 2010 at 1:46 pm
It took over 7 yrs to get a diagnosis. The diagnosis has finally came from a cancer center. I do have several other health issues as well as Celiac Disease. As I was very recently diagnose (approx a month ago) I am just beginning to try to get all nutrient levels back to normal. I was down to 87 lbs. and I’m still struggling to gain weight. I gain and then loose. I am taking multivitamin as well as a healthy diet. Drs are still testing other things as well. My anemia is next door to having to get blood transfusions and I still may have too yet. Right now it seems like a very long road ahead of me.
November 2nd, 2010 at 6:52 pm
I am a celiac, and have had long term problems with iron deficiency anemia. My inability to absorb iron appears to be exacerbated by what they call “OGIB” – obscure gastro intestinal bleeding. So I have had about 8 endoscopies and colonoscopies, a video capsule endoscopy, and double balloon enterscopy, while they look for the source of the bleeding, so far unsuccessfully.
Meanwhile, I had to have transfusions of packed red blood cells, but when they said I needed to do it again, I found a doctor who would instead give me intravenous iron infusions (dexferrum), as I can then make my own blood cells. So I do this about every 2-3 weeks, and I am now feeling quite good. I plan to continue this until they can identify the source of the bleeding or until my body stabilizes.
Oral iron supplements never worked for me, I took them in megadoses, and evidently could not absorb them. I had to advocate for myself, until I found a doctor who would listen to me, rather than just assuming I was being “non-compliant” on taking oral iron. Not surprisingly, this doctor has immediate family members with celiac and related diseases as well. I would advise anyone with this issue to keep on looking for a doctor who will help them.
June 25th, 2011 at 5:13 am
I have found the best way to get every one of your b vitamins is to merely take a mutliple b vitamin every morning. they have 100% of the recommended daily amount. In addition some of the greatest sources of vitamins are always found in fruit plus vegetables, you really can’t go wrong with fruit and veg..