Iron deficiency is one of the most common nutritional deficits found in patients with celiac disease and non celiac gluten sensitivity.  The most common symptom linked to iron deficiency is unwavering fatigue.  Patients will often report severe loss of energy even when sleep has been adequate.  This energy deprivation can also contribute to severe brain fog and mental clarity issues.  Iron deficiency can often times be confused with low thyroid or hypothyroidism.

Iron loss can contribute to a multitude of health problems – not just fatigue.  Some of the most common side effects of iron deficiency include:

  • shortness of breath (people often report that they cannot get enough air into their lungs)
  • irritability
  • extreme fatigue (people commonly report sleeping for 8 + hours and still waking up exhausted)
  • chronic recurrent infections (cold and flu)
  • craving ice
  • hair loss
  • headaches
  • gluten sensitivity and iron deficiencyweakened or spooned nails (see the picture on the right)
  • restless legs syndrome
  • angular stomatitis (cracking in the corner of the lips)
  • chapped lips
  • easy bruising

Research Shows Iron Deficiency Linked to Gluten Exposure

The following research study published in the Turkish Journal of Gastroenterology discusses how iron deficiency can be the first symptom associated with celiac disease.  The results of the research led to the recommendation of ruling out gluten sensitivity in all patients with iron deficiency anemia.  The study additionally recommends this screening in patients who supplement with iron, but still have persistently low levels (refractory iron deficiency).

Bottom line: if you suffer with any of the symptoms listed below for unknown reasons.  You should have your doctor do two things –

  1. Order a complete blood count with an iron panel and ferritin
  2. Rule out gluten sensitivity

What You Should Know About Gluten and Iron

Gluten sensitivity and iron deficiency are commonly found together.  Gluten can contribute toIron RBC Gluten iron deficiency in several ways.  Malabsorption of iron is often a consequence of damage to the small intestine (villous atrophy).  Additionally, gluten can damage the acid producing cells of the stomach.  Since acid is a necessary component for iron absorption, this commonly leads to anemia even in the absence of villous atrophy identification.

Anemia leads to oxygen deficiency which in turn can reduce the body’s ability to generate energy, which in turn can cause a cyclic state of healing inhibition.

Aside from gluten induced damage, iron deficiency can occur in menstruating women with heavier periods.  Iron deficiency can also occur when there is slow steady blood loss.  This can occur in a hidden manor (occult blood loss) or it can be more obvious as in the case of hemorrhoids.

Iron deficiency and gluten sensitivityLack Of Iron Causes Immune Problems

Iron is an essential element in the formation of lactoferrin, a protein used by the immune system to help fight gastrointestinal infections.  This includes viral, bacterial, fungal, and parasitic infections.  This is critical because in the presence of persistent GI infection, leaky gut syndrome is allowed to perpetuate regardless of a gluten free diet change.  Additionally, the protein lactoferrin aids in both growth and in some studies has shown cancer protective qualities.

Children with iron deficiency often exhibit lethargic behavior, and suffer with unexplainable fever spikes as well as chronic recurrent infections.

Do you have a story about gluten sensitivity and iron deficiency?  Don’t be shy and chime in below in the comments section.

Always looking out for you,
Dr. Osborne – The Gluten Free Warrior

17 thoughts on “Gluten Sensitivity and Iron Deficiency Anemia – Are They Related?

  1. Carina says:

    A year ago my new family doctor examined me simply because he didn’t have much on file about me. Then he found out I had a severe iron deficiency. The number was 3 which should be at least 40. It surprised him I felt good. However, he thought the reason for this was that I hadn’t catch up with my severe C-section, now 7 years ago. Starting a treatment with iron tablets and even an iron injection right into the muscle (for which I’m allergic we found out AFTER the injection) didn’t do much. In December I was tested for gluten sensitivity, positive! Started a gluten free diet and my iron was going up! Unfortunately I have been lazy with gluten free last few weeks and my numbers are down to 6.4 from 11.2. I feel very tired which I never did even when my numbers were less then this. Learn the hard way I’m really sensitive to gluten. I’m not sure if I ever can go back to gluten, for now I have to eliminate it from my diet!

    • Kashif says:

      Hi its kashif my wife also suffering bcz of her iron level is 3 we are from Pakistan staying in South Africa last night i took her to emergency bcz 2’oclock in the morning she was struggling of shortness of breathing and suddenly she called me and fall down
      Please help me out what should i do

  2. Rhonda says:

    I have always been anemic and had no digestive issues until a year ago when I was assaulted and left with 8 concussions and a boat load of extreme stress. Within a week of this I became severely intolerant to gluten. I cant even make a sandwich for my boyfriend without getting sick. I AM THE FIRST IN MY FAMILYS HISTORY TO HAVE GLUTEN INTOLERANCE.

  3. paula says:

    I am celiac. I had extremely low iron when I was first diagnosed. I took iron pills but could not absorb them due to intestinal damage. Finally I had to have iron transfusions.

  4. Lenie says:

    I am wheat and milk intolerant (extreme for milk), and I have had gastritis, bursitis, costochondritis, anemia, adrenal failure and candida. If iron deficiency is the root of all this, then the key to our lives may be medicinal iron supplementation. However I’ve been taking 500 mg for 2 months and still every day I feel like there is no oxygen in my arms. I’m a 27 year old woman yet my arms feel like those of a 70 year old. No muscles, just sensitive tissue, or at least that’s how it feels, because I’m actually quite strong. Breathing rarely feels satisfying. Should I take more iron? I try to eat a lot of chicken, eggs and rosbif on top of the pills to “cheat” a little and because a various diet is important, but nothing seems to be working. I’m not fatigued anymore but that’s because I take cortisol for my adrenals.

    • says:

      You need to find a good functional medicine doctor to work with. Someone with an intimate knowledge of biochemistry, lab testing, and proper follow up evaluation skills. You might also find the book, No Grain No Pain very helpful.
      All the best,
      Dr. Osborne

  5. Maegan says:

    I am hypothyroid. I bruise easily & have had labs done twice now which come back ‘normal’. I take iron supplements which help some.
    Now with food diary I’m noticing gas & bloating with gluten/wheat. Recently has first run in with hemorrhoids. I drink plenty of water & run almost daily. Will be cutting out gluten now to see if helpful!

    • Maggie says:

      I am hypothyroid and had 15 years of painful muscles and joints and fatigue. My blood tests show B5 and B12 are high but I am always anemic at the same time due to malabsorption. Recently my Dr suggested cutting gluten and put me on low dose Predisnolone. All the pain is gone, I move like I am 20 years younger and have had 6 different people comment on how different I look. I have been pretty much gluten/ wheat and oat free but slipped up a couple of times and noticed symptoms of bloating, nausea and constipation almost immediately. I never gave it much credence because I didn’t want to give up bread etc.. before but now there is no going back. Try going GF and see if it works for you.

  6. Verna Large says:

    Just wanted to mention that B12 tablets and vitamin E can help a lot, but take the iron and Vitamin E 8 hours apart for better absorbtion.

  7. David Krause says:

    is iron loss only associated with blood loss or are there other situations which cause low iron
    family members have been dealing with low iron for a while – and are at a loss for recovery
    i ask these questions because there seems no agreement from one doctor to another – both sides
    claim their opinions are the truth
    if any of your readers [or you yourself] could give some insight – it would be appreciated

  8. Alicia says:

    Interesting article. Just wanted to know if the ultra iron supplements have soy in them as I can’t have any.

  9. Faith says:

    I have been anemic for the past 15 years not knowing what caused the iron deficiency till recently when a doctor told me that I am allergic to cereal. I take iron supplements throughout to keep my blood level close to normal but without it, then few months of menses will bring it down to very low levels. On the other hand, I have acne, and another doctor said its iron deficiency related. How can I manage a gluten free life to deal with these to problems, iron deficiency and acne?

  10. Mary says:

    I was anemic, diahrea etc and endoscopy showed villi blunting. Blood test negative for ceoliac. Went gluten free, took oral iron to sort out anemia. Felt better, blood tests normalised for short while then chronic abdomen pain . 2nd endoscopy showed normal Villi but biopsy showed non specific chronic gastritis and duodenitis. Bad reaction to PPI. Felt fatigued again. Went for another blood test, deficient in iron and vitamin d but thankfully not anemic.Referred to dietician to try and sort out if l am eating gluten accidentally or another intolerance/ cause.

  11. Diana C. says:

    Three weeks ago I was diagnosed at level 4 of iron. Very low. I asked to get tested for gluten intolerance and the result was negative. I am taking supplement now and will get tested next month. I am eating gluten free. The one difference from eating gluten free is that I am not gassy nor bloated. The iron pills are helping as energy level is up. Even if the one blood test for gluten free came out negative, I could still be gluten intolerant?

    • says:

      Blood tests are notorious for false negatives as it relates to gluten sensitivity. Especially non celiac gluten sensitivity. That’s why we recommend genetic screening to identify the genes.
      Hope you get it figured out!
      Dr. O

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