Can Gluten Cause Low Platelets?

Gluten Induced Malnutrition Causes Low Platelet Counts

Yes, gluten consumption has been identified as a cause of low platelets, most convincingly through celiac disease. Research shows a higher prevalence of immune thrombocytopenia (ITP – AKA low platelets)) in people with celiac disease, and several cases document platelet recovery on a strict gluten-free diet. In addition, folate and B12 deficiencies from small-intestinal injury in celiac disease can reduce platelet production.

How gluten can lower platelets

1) Autoimmunity: ITP that coexists with celiac disease

• Multiple studies and case series report that ITP occurs more often in patients with celiac disease than in the general population.
• In documented cases, starting a gluten-free diet has coincided with normalization of platelet counts, supporting a causal link in a subset of patients.  

Practical takeaway: If you have ITP with no clear cause, screen for celiac disease. If you have celiac plus low platelets, adhere strictly to a gluten free diet and coordinate care with your hematologist.

2) Nutrient malabsorption that impairs platelet production

Celiac disease damages the small-intestinal mucosa, reducing absorption of iron, folate, and vitamin B12. Folate and B12 are required for DNA synthesis in the bone marrow. Deficiency can lead to thrombocytopenia or even pancytopenia. Platelets often recover after repleting the deficient nutrient and removing gluten.

Medical evidence:

• Reviews detail thrombocytopenia among the hematologic manifestations of celiac disease.
• Case reports show B12 deficiency presenting as isolated thrombocytopenia or pancytopenia that reverses with B12 therapy.

What To Do If Your Platelets Are Low & Gluten Might Be Involved?

Stepwise evaluation clinicians and patients can discuss:

1. Confirm thrombocytopenia with a complete blood count and peripheral smear. Consider reticulocyte count and hemolysis markers when indicated.
2. Check key micronutrients: iron, ferritin, vitamin B12, folate, copper, and zinc, deficiencies can all contribute to low platelets.  Extra Consideration: Many doctors lack nutritional expertise.  Consider working with an expert in nutrition to do a deeper evaluation.  You can also perform nutritional testing directly.
3. Screen for celiac disease following ACG 2023 guidance: tissue transglutaminase IgA (tTG-IgA) and total IgA; if IgA deficient, use IgG-based tests, with endoscopic biopsy for confirmation where recommended. Keep in mind that the accuracy of these tests is not full proof.  False negatives are not uncommon.  Additionally, these tests require the consumption of gluten for several months.  If you have already removed gluten for medically necessary reasons, HLA-DQ genetic testing may be a better option.
4. If tests are negative or not feasible to perform, but suspicion remains, consider HLA-DQ genotyping to assess genetic susceptibility and to support long term decision making for first degree relatives.
5. If you have established ITP, ask your hematologist whether celiac screening is reasonable given the documented association.

Treatment Basics Once Celiac Disease is Confirmed

• Strict, lifelong gluten-free diet with careful cross-contact control. Platelets may improve in ITP associated with celiac after gluten removal.
• Consider nutritional supplementation to replete nutritional deficiencies: folate and B12 as indicated, along with iron and other micronutrients. Monitor counts and symptoms.  Make sure any supplements used are gluten free.
• If monitoring is necessary, coordinate care between gastroenterology, hematology, and nutrition.

Who should be especially suspicious?

People with unexplained low platelets plus any of the following: iron deficiency, anemia, neuropathy, bone pain, chronic diarrhea or constipation, bloating, dermatitis herpetiformis, autoimmune thyroid disease, type 1 diabetes, or family history of celiac disease.

Related resources on GlutenFreeSociety.org

• Can Gluten Cause Anemia? Deep dive on gluten induced anemias –  mechanisms and recovery strategies.
• Gluten Sensitivity and Iron Deficiency Anemia – Deep dive on gluten induced iron deficiency and its contribution to persistent anemia.

Frequently Asked Questions (FAQ)

Does gluten itself destroy platelets?

Not directly. The strongest data implicate celiac driven autoimmunity that can present as ITP, and malabsorption related deficiencies that reduce platelet production.

Can going gluten free raise my platelet count?

It can in select cases, especially where celiac disease coexists with ITP or with folate or B12 deficiency. Several reports document platelet normalization after starting a gluten-free diet. Individual results vary and require medical supervision.

If my celiac blood test is negative, should I still consider gluten?

Yes. False negatives occur if gluten was reduced before testing or if IgA deficiency is present. Discuss biopsy, IgG-based tests, or HLA-DQ genotyping when appropriate.

Which nutrient deficiencies are most relevant to low platelets in celiac disease?

Folate and vitamin B12 are most often implicated. Correcting these can improve counts. Iron deficiency is common in celiac disease but typically affects red cells; combined deficiencies may occur.

How common is ITP in celiac disease?

Prevalence estimates vary by study, but ITP occurs more often in patients with celiac disease than in the general population, and screening is reasonable in otherwise unexplained ITP.

What else can lower platelets that I should not miss?

Infections, medications, alcohol, liver disease, bone-marrow disorders, and other autoimmune conditions. Work with your clinician to rule these out while evaluating gluten and nutrient status.

Can gluten cause other autoimmune health issues?

Yes, gluten has been linked to the development and increased risk of many forms of autoimmune disease.  Medical researchers sometimes refer to these collectively as Non Celiac Gluten Sensitivity and Extra-intestinal manifestations.