In untreated coeliac disease, the lining of the gut is damaged by eating gluten. Damage to the gut lining can reduce the absorption of nutrients such as iron.
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.
Iron deficiency is diagnosed by a simple blood test which measures your blood haemoglobin levels.
Symptoms of iron deficiency
- Fatigue – feeling tired all the time
- Shortness of breath
- Pale skin
- Reduced concentration
The amount of iron that you need if you have coeliac disease is no different to people who don’t have coeliac disease:
|Age group||Iron requirements milligrams per day|
|0 - 3 months||1.7|
|4 - 6 months||4.3|
|7 - 12 months||7.8|
|1 - 3 years||6.9|
|4 - 6 years||6.1|
|7 - 10 years||8.7|
|11 - 18 years||11.3|
|19 years +||8.7|
|11 - 50 years||14.8|
|50 years +||8.7|
*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 that are suitable for a gluten-free diet include:
- red meat
- liver (due to high vitamin A content, women who are pregnant should avoid liver and liver products)
- egg yolk.
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 and 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 of iron, 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:
|Food per serving||Amount of iron (milligrams)|
|Red meat, 90g||3|
|Dried apricots, one handful 80g||3|
|Dried figs, one handful 80g||3|
|Cashew nuts, two tablespoons (24g)||1.5|
|Sesame seeds, two tablespoons (24g)||2.5|
|Chick peas, two to three tablespoons (80g)||1|
|Lentils, two to three tablespoons (80g)||3|
|Spring greens, 95g||1|
The table below shows an example of how the iron requirements for women (14.8mg per day) could be met through a vegetarian and non vegetarian diet:
|Day one (vegetarian)||Iron (mg)||Day two (non vegetarian)||Iron (mg)|
|Breakfast||Porridge (made with gluten-free oats and semi skimmed milk) with raisins||2.6||
Fortified gluten-free cornflakes with dried apricots and semi skimmed milk
Glass of pineapple juice
|Lunch||Lentil soup||5.8||Jacket potato with tuna and sweetcorn||2.7|
|Dinner||Chickpea and spinach curry with brown rice||4.5||Cottage pie with peas||3.9|
Hummus with red pepper
Dark chocolate (25g)
Cashew nuts (30g)
If you’re diagnosed with iron deficiency, iron supplements may be recommended by your GP or dietitian. 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’ve 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 your diet doesn’t include enough iron or you have symptoms of anaemia, talk to your dietitian or GP.