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House CallFeb/Mar 2010 Issue

Iron Deficiency and Celiac Disease

This mighty mineral fights fatigue

Iron deficiency is the most common nutritional deficiency in the world. The World Health Organization estimates that up to 700 million people suffer from lack of this important mineral. Could you be one of them?

If you have celiac disease, you are at risk. (A common manifestation of celiac disease is iron-deficiency anemia.) Vegetarians are also at risk. (People on a strict vegetarian diet have a difficult time maintaining healthy iron levels because vegetable sources of iron are more difficult to absorb than animal sources.) Heavy menstrual periods, pregnancy, any kind of internal bleeding (like ulcers) and certain kidney conditions can also set you up for iron deficiency. Lack of vitamin K can indirectly contribute because it can lead to poor blood clotting, which causes increased bleeding and iron loss.

With its profound impact on energy and even mood, iron has a major influence in determining your quality of life. If your body lacks iron, it has too-few red blood cells and the blood cells it does have are pale and small. Depletion symptoms range from pale skin, light nail beds, brittle nails and rapid heart rate to lack of stamina, depression, cognitive confusion and overall fatigue. In cases of severe deficiency, people develop intense cravings, called pica, driving adults to crunch on ice cubes, for example, and children to eat non-food items like chalk, dirt or paint chips.

A simple blood test checks for iron deficiency, usually diagnosed as anemia. However, if you’ve been iron depleted for a long time (often the case for people with undiagnosed celiac disease), you may be suffering from very low iron levels that won’t be detected by the usual blood test. In this scenario, doctors can assess iron levels with a more sensitive blood test, called serum ferritin. Celiac patients should specifically ask for this test if they continue to have low-iron symptoms after a blood test rules out anemia.

The foods richest in iron are meat, specifically beef, dark chicken and turkey, and lamb. Molasses is a good vegetable source (one tablespoon contains more iron than a 3-ounce steak), as are teff, amaranth, pumpkin seeds, raisins and prune juice. Absorption is enhanced by eating these items along with foods that contain vitamin C, like citrus juice.

Studies reveal that many celiacs are still iron deficient up to a decade after going gluten free. If you have celiac disease, ask your health care practitioner to monitor your ferritin level. Aim for a serum ferritin of at least 45. (Many labs use 10 as a bottom range but people often continue to have symptoms at this level.) If tests reveal your numbers are low, include more iron-rich foods in your diet. You may also want to talk with your doctor about taking an iron supplement.

Supplements are often required to reverse long-standing deficiency, especially in at-risk populations. Many iron supplements contain ferrous sulfate, which can cause stomach pain, nausea and constipation, particularly if taken on an empty stomach. Look for iron bys-glycinate, which is better tolerated. In severe cases of deficiency, iron can be administered at your doctor’s office via a series of injections or IV. LW

Christine Doherty, ND, is a licensed naturopathic doctor who specializes in food allergies and celiac disease. She lives in the Boston area.

Note that iron excess increases the risk of heart disease and organ damage. Most people, particularly men and post-menopausal women, should not take iron supplements unless prescribed by their doctor. Consult your health care practitioner before taking supplements.

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