Celiac disease, commonly confused with gluten intolerance, affects about one in 141 people in the United States. Because of the 200+ associated symptoms, many common to other conditions, 83% of sufferers remain undiagnosed or misdiagnosed.
Gluten is a protein found in barley, wheat, rye or spelt grains and products, including any cross-contaminated foods, such as oats.
Foods that contain gluten can cause an adverse immune response that attacks the lining of the small intestine in some people. Different degrees of nutritional malabsorption in the body compound the condition. Symptoms are accompanied by deficiencies of minerals, vitamins, and metals:
- Vitamins D and B12
- Folate and iron.
Iron-Deficiency Anemia and Celiac Disease
Anemia and celiac disease very often go hand-in-hand. Anemia or iron-deficiency anemia is caused by a decreased amount of red blood cells in the body due to a lack of iron, from blood loss or absorption issues.
Hemoglobin, a protein in red blood cells carries oxygen throughout the body. Reduced hemoglobin levels due to anemia prevent the distribution of adequate oxygen to cells for optimal functioning.
Celiac disease impairs nutrient absorption and can aggravate this lack, and trigger symptoms linked to anemia:
- Chest pain
A recent study published in “Nutrients,” states that up to 46% of celiac patients have decreased bodily iron storage, and 32% have an iron deficiency.
Celiac disease causes Iron deficiency anemia because the part of the intestine (the upper intestine) that is damaged by gluten is also responsible for iron absorption.
Causes of Anemia
Iron-deficiency anemia is usually due to blood loss – from obvious trauma or heavy menstrual bleeding, or invisible causes such as bleeding ulcers. A diet that’s low in iron can cause iron-deficiency anemia, as can pregnancy.
If iron-deficiency anemia is not due to one of these issues, the presence of celiac disease may be indicated. Up to 9% of people with iron-deficiency anemia but no digestive symptoms test positive for celiac disease.
If digestive symptoms are present, the likelihood of celiac is even greater. People who exhibit anemia as their main symptom may have a more severe celiac disease.
Anemia of Chronic Disease
Iron-deficiency anemia is a well-known consequence of celiac disease. However, anemia of chronic disease is also associated with celiac. A 2006 study found that about 12% of newly diagnosed celiac patients had a form known as “anemia of chronic disease.”
This type of anemia also called “anemia of chronic inflammation” is present in people who have been ill long-term. Their immune system’s response to the inflammation interferes with the body’s production of red blood cells.
Celiac disease sufferers who eat gluten have an extreme inflammatory response in their intestines that contributes to anemia of chronic disease. Both these forms of anemia may exist at the same time.
Diagnosis and Treatment
Improved diagnostic methods are increasingly able to identify celiac patients who do not manifest the classical symptoms – diarrhea, malabsorption, steatorrhea and digestive complaints. Anemia is usually the main symptom in these cases.
Anemia shows up in test results of a complete blood count or CBC, which measures the hemoglobin along with the numbers and proportions of different blood cells.
If blood tests show anemia, your doctor may recommend additional tests, examining red blood cells under a microscope and testing iron levels.
A physician can test to determine if a celiac disease patient has iron deficiency anemia if the patient is consistently not responsive to iron therapy.
Although there is no cure for celiac disease, once diagnosed, the regimen is quite simple. A gluten-free diet and eating the right foods will begin to heal the lining of the small intestine and allow it to absorb nutrients again.
Doctors may recommend iron supplements to build up iron stores and to eat foods that are rich in iron.
Studies on Link between Anemia and Celiac Disease
According to “Haematologica.org”:
“Anemia without other clinical clues of intestinal malabsorption is one of the most common extraintestinal manifestations of celiac disease. Although folate and cobalamin deficiency are known complications of celiac disease, the most common nutritional anemia associated with celiac disease is iron deficiency:”
- One study of 34 children with celiac disease concluded that nearly 15% had mild to moderate iron-deficiency anemia.
- A study of 84 adults with iron-deficiency anemia of an unknown origin found that 7% had celiac disease.
- A study of 727 celiac patients reported that 23% were anemic. Additionally, those with anemia were twice as likely to have severe damage to the small intestine, as well as a low bone mass caused by celiac disease.
In all cases, a gluten-free diet with iron supplements resulted in significantly increased serum iron levels.
Conclusion: Celiac disease impairs nutrient absorption, which leads to iron-deficiency anemia. These study results conclude that anemia is common (between 30 – 50%!) in patients with celiac disease.
If you suspect you may have celiac disease, or need help with a food sensitivity or allergy, contact Austin Gastroenterology at (513) 579-3200. We can help you take care of your digestive system, allowing you to enjoy a happy, healthy life.