Why are people with Coeliac Disease at Risk of Iron Deficiency?

Coeliac disease and iron deficiency often occur together. Having coeliac disease increases your chances of also being iron deficient1 and it’s even possible that your doctor found you to be iron deficient before they diagnosed you with coeliac disease.2

How are coeliac disease and iron deficiency related and what can coeliacs do to maintain their iron levels?

Coeliac disease is a condition where your immune system attacks your intestines when you eat gluten, which is found in wheat, barley and rye.3 This causes the lining of your small intestine to become inflamed and sometimes damaged.3 Overall it is estimated that 1% of the population has coeliac disease.1

If you have inflamed or damaged intestines because of coeliac disease, it is likely that nutrients such as iron, folic acid and vitamin B12 are not absorbed well from your food into your bloodstream.1 In the case of iron, this can lead to iron deficiency and iron deficiency anaemia (IDA). As well as the reduced uptake of iron from your diet, coeliac disease can cause internal bleeding in your gastrointestinal tract.1 This loss of blood means that more iron is lost from your body than normal, which could also lead to iron deficiency.

You are also at greater risk of iron deficiency if you have coeliac disease and are also:

  • Pregnant1, as pregnancy increases the iron demands on your body
  • Vegetarian, as iron from plant sources is more difficult for your body to absorb than meat-based iron, or
  • Have heavy periods, which increase the amount of iron lost from your body.

Once you are following a gluten free diet it is likely that your iron levels will improve but you may also need to be treated with extra iron to replenish the iron levels in your body.1 Talk to your doctor if you are concerned about your health or you are experiencing any of the warning signs of iron deficiency, such as fatigue, weakness, headaches, or irritability.

Warning signs of iron deficiency in coeliac disease

One of the main symptoms of iron deficiency is fatigue, a more extreme version of tiredness. If you are experiencing fatigue, you may feel physically and mentally exhausted and lack energy for a number of days each week, even if you have not been doing any physical activities that are particularly tiring.4 You may be too exhausted to complete normal daily tasks such as getting dressed or going shopping, and you may often feel too tired to spend time with friends or family.

Fatigue is a well known symptom of coeliac disease,3 so if you are experiencing fatigue it is important to speak to your doctor so that they can find out what is causing it.

There are also many other signs that may indicate that you have iron deficiency or iron deficiency anaemia. These include:

  • Dizziness,5 irritability6 and loss of concentration7
  • Looking pale8
  • Shortness of breath and a racing heart9
  • Sore tongue or dry mouth10
  • Cold intolerance or cold hands and feet11
  • Headache12

Use our Symptom Browser to see the complete list of symptoms that iron deficiency can cause and to understand what each of these symptoms involves.

In addition to fatigue, coeliac disease and iron deficiency have some overlapping symptoms, for example restless leg syndrome13 and hair loss.3 It is therefore important that you discuss all of your symptoms with your doctor.

Talking to Your Doctor: Coeliac Disease

It is likely that if you have been diagnosed with Coeliac disease that you will have regular follow up appointments with your doctor to check how you are feeling and to monitor the progress of your symptoms. If you have been feeling fatigued or have any of the symptoms of iron deficiency such as paleness, faintness or a racing heart, you may want to make an extra appointment or speak to your doctor about your symptoms at your next scheduled visit. To get the most out of your visit, think in advance about the information that the doctor might need in order to work out what is causing your symptoms. You should also prepare any questions that you want to ask.