Iron

In untreated coeliac diseaseA condition where a person is unable to eat gluten as it makes their body attack itself. , the lining of the gut is damaged by eating glutenA protein that is found in the cereals wheat, barley and rye. . Damage to the gut lining can reduce the absorption of nutrients such as iron.

What is iron deficiency?

Iron is an essential part of haemoglobin, the red pigment in blood which is needed to transport oxygen around the body. Iron deficiency occurs when the body’s stores of iron are low. It is estimated that around a quarter of adults are anaemic due to iron deficiency when they are first diagnosed with coeliac disease.

Why is there a link between undiagnosed coeliac disease and iron deficiency?

Iron deficiency is common in people with undiagnosed coeliac disease because for a long time you may not have been absorbing iron very well. This is because the area of the gut that is damaged in coeliac disease is the main place where iron is absorbed. Iron deficiency is diagnosed by a simple blood testBlood is taken from someone who is being tested for coeliac disease. which measures your blood haemoglobin levels.

Symptoms of iron deficiency:

• fatigue – feeling tired all the time
• shortness of breath
• pale skin
• reduced concentration
• headaches.

How much iron do I need?

The amount of iron that you need if you have coeliac disease is no different to people who don’t have coeliac disease.

*women have higher requirements for iron due to menstrual losses

Sources of iron

There are two types of iron:

• haem iron from animal sources
• non-haem iron from plant sources.

Animal sources of iron are better absorbed than iron from plant sources. Good sources of haem iron suitable for a gluten-freeWhen a food has less than 20 parts per million (ppm) of gluten so it is safe for people with coeliac disease to eat. diet include:

• red meat
• liver (due to high vitamin A content, women who are pregnant should avoid liver and liver products).

Good sources of non-haem iron suitable for a gluten-free diet include:

• leafy green vegetables
• pulses (peas, beans and lentils)
• dried fruit, such as raisins, apricots, figs
• nuts / seeds.

The foods and drinks below can reduce the absorption of non-haem iron:

• tannins (found in tea)
• polyphenols (found in coffee / cocoa)
• oxalates (found in spinach). 

Try to avoid having a cup of tea, coffee or cocoa with your meals and instead choose to drink these in-between meals.

To improve absorption food and drink rich in vitamin C such as fruit juice, fresh leafy green vegetables, potatoes and fruit (especially citrus fruits) should be included with meals.

Foods rich in iron and suitable for a gluten-free diet

What about iron supplements?

If you’re diagnosed with iron deficiency, iron supplements may be recommended by your GPGeneral Practitioner, or local doctor or dietitianAn expert in food and nutrition. . Side effects of iron supplements can include nausea, constipation and stomach pain. Taking supplements with meals may reduce side effects, if you’re concerned talk to your GP.

Once you have been following the gluten-free diet for some time, your gut will begin to heal and your haemoglobin levels should increase as your iron absorption improves. If you’re concerned that you aren’t eating enough iron or you have symptoms of anaemia, talk to your Dietitian or GP for individual advice about your diet and supplementation.