Healthcare provider and patient discussing the link between celiac and anemia

The Link Between Celiac Disease and Anemia

Written on October 4, 2023 by Gillian (Gigi) Singer, MPH, Sexuality Educator & Certified Sexologist. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Understanding Celiac Disease

Celiac disease is a chronic autoimmune disorder that is triggered by the consumption of gluten, a protein found in products like wheat, wheatberries, durum, emmer, semolina, spelt, farina, farro, graham, KAMUT® Khorasan wheat, einkorn, rye, barley, and triticale.[1] Gluten-containing foods and products are often found even in items where you wouldn’t expect them to be—like sauces, drinks, and even food coloring.

A person living with celiac disease has an abnormal immune response to gluten when it is consumed. When individuals with celiac disease consume gluten, their immune system mistakenly attacks the small intestine, leading to damage to the intestinal lining and impaired nutrient absorption. These attacks lead to damage on the villi. Villi are small fingerlike projections lining the small intestine which promote nutrient absorption. When the villi get damaged, nutrients can't be absorbed into the body properly.[2]

Who Has Celiac Disease?

The Celiac Disease Foundation estimates that 1 in 100 people worldwide have celiac disease, but only about 30% are diagnosed properly.[2] The disease can develop at any age and is hereditary, meaning it is passed from parent to offspring. In fact, people with a parent, child, or sibling living with celiac disease have a 1 in 10 risk of developing it.[2]

Health Effects of Celiac Disease

Even when treated adequately, celiac disease can have long-term health effects. The Celiac Disease Foundation states that people with celiac:

  • Have two times greater risk of developing coronary artery disease
  • Have four times greater risk of developing small bowel cancers
  • May develop other autoimmune disorders like type 1 diabetes and multiple sclerosis (MS), dermatitis herpetiformis, anemia, osteoporosis, infertility and miscarriage, neurological conditions like epilepsy and migraines, short stature, heart disease, and intestinal cancers

Celiac Disease and Anemia

Anemia can be caused by many things, such as iron deficiency, folate deficiency and Vitamin B12 deficiency. These deficiencies can be attributed to the malabsorption from celiac disease. Some symptoms of anemia include tiredness, fatigue, or weakness. People with anemia may also have shortness of breath or not be able to exercise normally. Consult a medical professional to identify and treat the root cause of anemia and to monitor iron levels during treatment. Adding iron supplements is not advised without speaking to your healthcare provider first.[3]

Anemia, a decrease of red blood cells created by a lack of iron, is very common in people with undiagnosed celiac disease. When people have undiagnosed celiac disease, the part of the small intestine where iron is absorbed is also the area that gets damaged when gluten is ingested.[3] People with celiac may experience other nutritional deficiencies of calcium, vitamin D, iron, folate, vitamin B12, copper, magnesium, and zinc.[3]

People with celiac may be at a higher risk of anemia than people without.[4]

According to a study published in the Journal of Clinical Gastroenterology, approximately 6% to 20% of individuals with celiac disease have anemia, making it one of the most frequent extraintestinal complications associated with the condition.[4]

Celiac disease can also lead to various types of anemia, including iron deficiency anemia, vitamin B12 deficiency anemia, and folate deficiency anemia. Each type is associated with different mechanisms and nutritional deficiencies.

Diagnosis and Management

Given the frequent association between celiac disease and anemia, it is essential for healthcare providers to consider celiac disease as a potential underlying cause when diagnosing and treating anemia, especially when anemia does not respond to conventional treatments.

Think you might have celiac disease? Everlywell can help you get the answers you need with our Celiac Disease Screening Test.

This at-home lab test checks for antibodies that may indicate celiac disease. If your results show that you may have an increased risk of celiac disease, our patient care team will reach out to you about the next steps once you have your test results.

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  1. What is gluten? Celiac Disease Foundation. Accessed September 22, 2023.
  2. What is celiac disease? Celiac Disease Foundation. Accessed September 22, 2023.
  3. Celiac disease and anemia. Beyond Celiac. May 11, 2023. Accessed September 22, 2023.
  4. Freeman HJ. Iron deficiency anemia in celiac disease. World J Gastroenterol. 2015;21(31):9233-9238.
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