The Link Between Celiac Disease And Iron-Deficiency Anemia

By: GI Alliance


At least 3 million Americans suffer from celiac disease. However, until recent years, the exact prevalence of the disease was not always clear. An estimated 1 in 133 people have celiac, yet only 1 in 4,700 will ever receive their accurate diagnosis. Despite the dramatic growth in awareness, the symptoms that accompany celiac are still often mistaken for other ailments. Therefore, the connection is never made, and an astounding 97% of celiac sufferers go undiagnosed or misdiagnosed.

Common misdiagnoses of celiac include irritable bowel syndrome and ulcerative colitis. The symptoms of these disorders and celiac often align and may include abdominal pain and diarrhea. However, there are many other, lesser known symptoms that are associated with celiac as well. Among these symptoms is iron-deficiency anemia, which affects anywhere from 3%-6% of all celiac patients.

What Causes It?

Iron-deficiency anemia is typically a result of blood loss. Trauma, heavy menstrual bleeding, ulcers, and even pregnancy are all well-known contributors. However, for cases which cannot be directly attributed to these causes, celiac has an exceptionally high presence. In fact, for those who have iron-deficiency anemia and no other celiac symptoms, up to 9% will have positive biopsy results for the disease. So, what is responsible for this link between celiac and anemia? The answer involves improper eating habits and ultimate damage to the small intestine.

When not properly treated with a gluten-free diet, celiac disease leads to damage of the nutrient-absorbing villi in the small intestine. These finger-like protrusions are responsible for the absorption of nutrients into the bloodstream, including iron. When damaged by the intake of gluten, these villi are no longer able to absorb adequate amounts of iron, often resulting in anemia.

Additionally, research has found that many of those with celiac develop a form of anemia known as “anemia of chronic disease.” This type of anemia typically results after long bouts with inflammatory or infectious diseases. In the case of celiac, the inflammation of the intestines impairs the immune system’s ability to adequately produce red blood cells.

What Can Be Done?

A patient suffering from iron-deficiency anemia without clear medical cause should be tested for celiac disease. A simple blood test and a confirmatory test can easily diagnose the disease, and physicians can readily evaluate for the illness when there is a high index of suspicion with symptoms suggestive of celiac. If the test results are positive, immediate action should be taken by implementing a gluten-free diet. However, it is important to know that implementing this diet prior to testing may result in a misdiagnosis, and it is important to wait until after confirmation of celiac to make the switch. Over time, this diet will give the intestines the opportunity they need to heal and correct nutritional deficiencies. Other steps that may be taken in conjunction with the gluten-free diet include taking iron supplements, eating foods rich in vitamin C, and eating foods known to be high in iron, including dark leafy vegetables, seafood, and legumes.

The link between celiac and many of its symptoms is not always readily obvious. For many patients, the path to an accurate diagnosis can take several years, and in the meantime, seemingly unrelated ailments such as iron-deficiency anemia simply don’t make sense. Fortunately, as an understanding of the disease grows, so does the rate of diagnosis. Access to gluten-free foods and menus is more prevalent than ever before, making the need for a gluten-free lifestyle just a bit easier, and once properly diagnosed, the quality of life for many patients will increase drastically.

If you are concerned about the possibility of celiac disease, it may be time to see a specialist for a definitive diagnosis. The gastroenterologists with GI Alliance have many years of experience in the diagnosis and treatment of celiac. Our physicians see patients all over the United States. Find a GI Alliance location near you today.