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Gluten-Free Blogs • Shelley Case Column

Celiac Disease and Anemia

Q: After years of battling anemia, I’ve finally been diagnosed with celiac disease. How are the two related, and what can I do to reverse the anemia?

A: Anemia is one of the most common symptoms of undiagnosed celiac disease. In the Canadian Celiac Association Health Survey*, published in 2007, 66 per cent of adults and 40 per cent of children with biopsy-proven celiac disease suffered from anemia. The study noted that it also took an average of 11.7 years for celiac to be diagnosed, so you are not alone in your long struggle with these two conditions.

In those with celiac, exposure to the gluten found in grains (wheat, rye and barley,) damages the villi – tiny, finger-like projections that line the small intestine. This interferes with the absorption of nutrients such as iron and folate (a B vitamin). These nutrients are essential for the production of healthy red blood cells and hemoglobin, which helps to carry oxygen throughout the bloodstream. Very low levels of iron and/or folate can lead to anemia, causing symptoms such as fatigue, irritability, pale skin, brittle nails, increased susceptibility to infections and difficulty with learning and concentration.

Following a strict gluten-free diet will eventually allow the v­­illi to heal. The length of time for this process varies, with the average falling between two and 18 months.

In addition to eliminating gluten, it is important to eat iron and folate-rich foods. Many gluten-free products are not enriched with iron and B vitamins like their gluten-containing counterparts, but some companies, such as Ener G Foods, Enjoy Life Foods, Glutino, Kinnikinnick and Pastato do enrich their products for better nutrition. Supplements may also be necessary for some people, so consult your health professional.
Gluten-free Sources of Iron and Folate

Meats and Alternatives

  • Iron: Beef, poultry, pork, clams, eggs, oysters, sardines, shrimp, legumes, seeds (flax, pumpkin, sesame, sunflower), almonds, peanuts
  • Folate: Liver (beef, chicken), eggs, legumes, peanuts, seeds (pumpkin, sesame, sunflower)

Fruits

  • Iron: Dried apricots, prunes, raisins
  • Folate: Avocado, banana, orange juice, pineapple juice, strawberries, melons, tomato juice

Vegetables

  • Iron: Collard greens, potato (white and sweet), green peas, spinach
  • Folate: Avocado, banana, orange juice, pineapple juice, strawberries, melons, tomato juice

Gluten-Free Grains & Flours

  • Iron: Amaranth, bean flours (garbanzo, soy), buckwheat, cornmeal (enriched), ground flax, millet, quinoa, rice (enriched), sorghum, teff
  • Folate: Amaranth, bean flours (garbanzo, soy), cornmeal (enriched), ground flax, millet, quinoa, rice (enriched), teff, wild rice

Miscellaneous

  • Iron: Blackstrap molasses
    Enriched gluten-free breads, cereals, pasta
  • Folate: Enriched gluten-free breads, cereals, pasta

Shelley Case is a consulting dietitian and author, whose revised and expanded edition of Gluten-Free Diet: A Comprehensive Resource Guide is now available. See www.glutenfreediet.ca. Shelley Case is on the advisory boards of the Canadian Celiac Association, the Celiac Disease Foundation and the Gluten-Free Intolerance Group.  The editors at Allergic Living additionally highly recommend her book Gluten-Free Diet, a vital resource for those interested in celiac disease and living gluten-free.

* Published in Digestive Disease Sciences, 2007

Allergic Living acknowledges the assistance of the OMDC Magazine Fund, an initative of the Ontario Media Development Cooperation.