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The Connection Between Anemia and Celiac Disease: What We Know

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The link between celiac disease (CD) and anemia is well-established, especially in older adult patients whose prevalence staggers between 60 and 80 percent. In a more comprehensive 2011 study, researchers found that anemia was a major symptom in about 32 percent of newly confirmed celiac patients.

Anemia is often considered a silent symptom of CD, unlike gastrointestinal conditions, such as diarrhea, constipation, IBD, and excessive gas, which normally show up as soon the person starts consuming gluten. Nonetheless, anemia is a very rampant feature indicative of the disorder, and it’s not difficult to understand why. When a person with celiac disease takes gluten, an autoimmune reaction attacks villi, hairlike structures lining the inner wall of the small intestine. This renders your small bowel unable to properly absorb nutrients, including vital micronutrients, causing malnutrition and a host of other health issues. Because it’s an autoimmune condition, celiac disease has also been associated with other autoimmune conditions such as type 1 diabetes, rheumatoid arthritis, autoimmune thyroid disease (ATD), and Sjögren’s syndrome. The most damage of CD happens at the duodenum, a small section of the small bowel, which is coincidentally where the vast majority of iron is absorbed from the food. Consequently, this results in iron-deficiency anemia, a malady characterized by low levels of red blood cells in the body.

This article digs deeper into the connection between celiac disease and anemia. Let’s start with the basics.

What is Anemia?

Anemia is a disease of the blood that occurs when the number of healthy red blood cells is extremely low in your body. Also, very low hemoglobin and a substantial reduction in the size of red blood cells can lead to anemia. Found within red blood cells, hemoglobin is a special type of protein that is responsible for carrying oxygen from the lungs to various parts of your body. When you are anemic, you don’t have an adequate amount of hemoglobin, which means oxygen can’t be delivered throughout your body. As a result, cells don’t receive enough oxygen to function properly.

Approximately 1.62 billion people across the globe are affected by anemia, according to the WHO. Women, preschool-age children, and persons with chronic conditions like celiac disease, cancer, IBS, etc. are at the highest risk of developing anemia.

Anemia is measured based on your red blood count or amount of hemoglobin. So, the lower your hemoglobin, the more severe your symptoms.

What Causes Anemia?

There are numerous potential causes of anemia, all of which affect the levels of the red blood cells (RBCs) in the body. Red blood cells have a relatively short lifespan of between 100 and 120 days. In fact, an average of 0.9 percent of red blood cells is naturally replaced every day in a healthy person. There exists a subtle balance between the replacement and destruction of red blood cells. Anything that interferes with this balance may reduce the number of red blood cells in the body, leading to anemia.

The factors that cause anemia can be categorized into those that negatively impact the production of red blood cells and ones that encourage the destruction of RBCs.

Factors which lead to reduced production of red blood cells include:

  • Inadequate intake of folate, vitamin B12, and iron, three micronutrients critical to hemoglobin production.
  • Hypothyroidism, a condition in which the body is unable to produce enough thyroid hormones
  • When hormone erythropoietin can’t properly stimulate the production of RBCs.

Factors which encourage the destruction of red blood cells, causing anemia, include:

  • Excessive bleeding during childbirth
  • Excessive menstruation
  • Surgery
  • Spleen or liver disorders
  • Genetic conditions
  • Cirrhosis

In any disorder, condition or complication that destroys RBCs at a higher pace than they are produced will lead to anemia. Celiac disease is known to cause one of the most common types of anemia: iron-deficiency anemia. This is characterized by the body’s lack of capacity to absorb enough iron. Celiac patients may also develop anemia of chronic disease. This is a type of anemia that is associated with extensive damage to the digestive system when one eats gluten-containing foods.

Symptoms of Anemia

Symptoms of anemia vary depending on the cause and the type. The most common symptoms are:

  • Dizziness
  • A rapidly beating heart
  • Weakness
  • Fatigue
  • Shortness of breath
  • Chest pain
  • Headache
  • Heart palpitations
  • Frequent bouts of colds

5 Types of Anemia Linked to Celiac Disease

Celiac disease has been linked with at least five forms of anemia related to malabsorption of nutrients and autoimmune response.

1. Iron-Deficiency Anemia

Again, iron-deficiency anemia is the most prevalent type of anemia both globally and in people with celiac disease. Traditionally, blood loss is the primary cause of the vast majority of individuals who suffer from iron-deficiency anemia. Physical injury, surgery, accidents, heavy menstrual bleeding, or trauma are some obvious ways one may lose enough blood to cause iron deficiency in the body. Hidden problems like gastrointestinal lesions, cirrhosis (scarring of the liver), and ulcers may also cause heavy blood loss that can lead to the development of iron-deficiency anemia.

When food in the gastrointestinal tract doesn’t mix well with enzymes and bile, this can also result in inadequate digestion and malabsorption of iron. This could be due to gallstones, cystic fibrosis, pancreatic cancer, chronic pancreatitis, and the inflammation of the bile duct (cholangitis).

If you are pregnant and don’t take enough iron-rich food or folate supplements, you might also develop iron-deficiency anemia. And so does a diet that is scanty in iron.

As we have mentioned earlier, small intestines bear the biggest brunt of celiac disease. If left untreated, it impairs the small intestine’s absorption of minerals, vitamins, and other nutrients.

Celiac disease impairs the ability of the bowel to absorb iron, folate and vitamin B-12, all of which are important for production or healthy development of red blood cells (or hemoglobin). If you’ve iron-deficiency anemia that isn’t related to blood loss, the odds are very high that you may also have celiac sprue. This can be the case even if you don’t show obvious signs of celiac disease. Did you know that up to 9 percent of asymptomatic (those who don’t show gastrointestinal symptoms) patients with iron-deficiency anemia also have celiac disease?

Another more extensive study carried out in 2012 corroborated this finding. However, only 7 percent of patients with iron-deficiency anemia with the cause not known had celiac disease. More importantly, these patients saw improved iron levels when they went on a gluten-free diet. In a 2014 study involving 34 celiac children, scientists found that close to 15 percent suffered from mild to moderate iron-deficiency anemia.

Note, however, that iron-deficiency anemia can also be caused by long-standing abuse of painkillers, poor diet, and peptic ulcers.

It is for these reasons that experts recommend that you take a celiac disease test before you embrace a gluten-free lifestyle or start getting treatment for iron deficiency.

2. Folate Deficiency Anemia

Duodenum takes the most hit from celiac disease. Unfortunately, this is the region of the gastrointestinal tract that helps absorb folate from food and supplements you consume. When your small bowel is unable to absorb folate, this will create a shortage in the body, leading to anemia.

Like iron, folate is a vital micronutrient that is used to make hemoglobin, a protein that binds oxygen in the red blood cells.

Anemia as a result of folate deficiency depicts several symptoms, including irregular heartbeat (arrhythmia), sore tongue, cracked lips, and ringing in the ears, just to mention a few.

3. Vitamin B-12 Deficiency Anemia

Your body needs vitamin B-12, and most people get plenty of it through diet. However, celiac disease leaves your small intestine vulnerable and without the capacity to absorb enough vitamin B12. This versatile vitamin is critical for not only the formation but also the development and healthy growth of red blood cells. Most celiac patients suffer from vitamin B12 deficiency, which hampers the production of red blood cells, causing anemia.

4. Pernicious Anemia

Whereas it is rare, pernicious anemia is also associated with people with celiac disease. The precursor factor is also a vitamin B12 deficiency.It so happens that the inner lining needs a glycoprotein called gastric intrinsic factor (GIF) in order to properly absorb vitamin B12. In celiac disease, GIF cannot function properly, leading to pernicious anemia.

5. Anemia of Chronic Disease

Besides Iron-deficiency, anemia of chronic disease is a well-documented consequence of having a chronic disease. In a study published in 2008, researchers discovered that 12 percent of newly confirmed celiac patients had anemia of chronic disease. Otherwise known as anemia of chronic inflammation, anemia of chronic disease happens when an autoimmune response to inflammation impacts the ability of your body to produce red blood cells. Celiac disease patients often experience far-reaching inflammatory response or attack when they consume gluten, which is possibly why they are highly likely to develop anemia. This may also help explain why celiac disease can affect your gums and teeth.

More often than not, anemia of chronic disease is observed in patients who have lived with untreated celiac disease for a long period. It is worth noting that a celiac patient may have both anemia of chronic inflammation and iron-deficiency anemia at the same time.

Testing for Anemia

Blood tests are often conducted to screen for anemia. Complete blood count (CBC) is a very typical test that tells how much hemoglobin you have in your blood, as well as to measure the proportions and counts of other blood cells. Do you think you have celiac disease? Check out our celiac disease screening test that can be taken in the comfort of your home.

Updated on
April 15, 2021
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