A deficiency in vitamin B12 is common in people with newly diagnosed or untreated celiac disease. Low levels of vitamin B12 caused by poor digestion from celiac disease can lead to anemia. If you have symptoms of anemia and celiac disease, like fatigue and chronic diarrhea, there are simple ways to test and treat the problem, restoring your energy and wellness.
Many people with untreated celiac disease have low vitamin B12 levels, which can lead to vitamin deficiency anemia and many other health challenges.
Celiac disease causes poor digestion and reduces the absorption of many vitamins and minerals along the entire small intestine.
Since anemia and celiac disease decrease one’s wellness significantly, knowing the signs and symptoms of both conditions is essential for adults and children.
If you suspect you have either condition, talk with your doctor. Testing is available, and treatment is simple for restoring your wellness for both anemia and celiac disease.
What is celiac disease?
Celiac disease is an autoimmune condition that causes injury to the small intestine's lining. A gluten protein in some grains like wheat, rye, and barley triggers the condition.
In people with celiac disease, the body sees gluten as a dangerous invader, causing the immune system to produce antibodies and start an attack against the gluten protein. This attack damages the lining of the small intestine, where nutrients are broken down and transferred to the bloodstream. This damage results in poor absorption of essential nutrients.
Signs and symptoms of celiac disease
Celiac disease can be debilitating to your overall wellness. Not only is your digestion constantly uncomfortable, but your energy levels also drop dramatically because you lack the nutrients to feel well.
If you have these symptoms, it’s time to see the doctor for diagnostic testing:
- Weight loss and pale skin
- Abdominal pain
- Chronic diarrhea
- Muscle fatigue
- Fatty, foul-smelling stools
- Brain fog
- Bone fractures
Vitamin B12 deficiency
Vitamin B12 is one of eight B vitamins. The human body can’t make it, so you need to eat foods rich in vitamin B12 to have sufficient levels.
The body absorbs vitamin B12 through the lining of the small intestine — the same area celiac disease damages. When the gut lining is impaired, the intestines can't distribute nutrients like B12 throughout the body.
Signs and symptoms of a vitamin B12 deficiency
The body uses vitamin B12 for many processes, including brain health and the production of energy and DNA. Low levels often cause:
- Tingling in hands and feet
- Gastrointestinal problems
- Difficulty concentrating
- Mood disorders
Anemia and celiac disease
Without sufficient vitamin B12, your body also can’t make enough red blood cells, which leads to vitamin deficiency anemia.
Anemia occurs when your blood doesn’t have enough red blood cells or hemoglobin to carry sufficient oxygen for your body to function well. Red blood cells deliver oxygen to every cell, while hemoglobin is a protein within red blood cells that carries the oxygen.
To make red blood cells, the body requires three nutrients, called hematinics:
- Vitamin B12
All three hematinics are commonly low in individuals with newly diagnosed or untreated celiac disease. As a result, iron and vitamin deficiency anemia from malabsorption is often one of the first signs of celiac disease.
Anemia typically causes these signs and symptoms:
- Pale skin
- Shortness of breath
- Bleeding gums
- Low blood pressure
Diagnosing anemia and celiac disease
If you suspect you have anemia, start with a visit to the doctor’s office and a simple blood test to reveal whether your iron, folate, and vitamin B12 levels are low.
If you are diagnosed with iron or vitamin deficiency anemia and have symptoms of celiac disease, too, ask your doctor whether additional testing is sensible. Your provider may test your blood for specific antibodies and genetic factors. A final diagnostic tool for celiac disease is a painless tissue biopsy from the lining of your small intestines.
Treatment of anemia related to celiac disease
Fortunately, the treatment for celiac disease and related nutrient-deficient anemia is straightforward: a strict gluten-free diet (GFD). The GFD excludes all forms of gluten but welcomes a wide variety of gluten-free grains, fruits, vegetables, dairy, nuts, and meats to power up your body's energy and wellness.
In 2001, a study at the University of Edinburgh published in The American Journal of Gastroenterology found that a gluten-free diet alone can normalize vitamin B12 levels for most celiac patients. Another 2019 review published in the Nutrients journal discussed the same results.
Both studies noted, however, that even with a GDF, some individuals with celiac disease still require supplements or injections to restore healthy levels of nutrients like vitamin B12.
Remember that to fully restore one's wellness, a gluten-free diet must do more than remove gluten. Your diet must also be dense with nutritious food to feed every system and cell for them to function well.
After a few weeks of adherence to a wholesome gluten-free diet, a doctor may retest a patient’s blood. If your hematinics are still low, the provider may recommend iron, folate, and vitamin B12 supplementation to boost your red blood cell count.
A gluten-free diet and supplementation occasionally fail to improve a patient's anemia sufficiently. When this occurs, doctors may offer genetic testing to see if you have specific genotypes that influence your body's ability to metabolize and use iron.
Celiac disease and anemia in children
If you suspect your child may also be anemic or have celiac disease, the symptoms and testing are essentially the same for children as they are for adults.
These important signs and symptoms in children may indicate anemia or celiac disease:
- Pale skin
- Poor digestion
- Bone fractures
- Poor tooth enamel
- Slow growth
- Attention deficit
- Learning disabilities
- Behavior struggles
- Mood disorders
- Poor coordination
The good news
For those who struggle to follow the diet, some insurance companies cover dietician consultations to help fully restore your wellness and encourage you along the journey. Adhering to a gluten-free diet is challenging, but it's also life-changing for an adult or child with celiac disease.
Celiac disease and vitamin deficiency anemia are often closely related. With the right testing and treatment, both conditions are manageable.
- Nutrients. Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review.
- The American Journal of Gastroenterology. Vitamin B12 Deficiency in Untreated Celiac Disease.
- European Psychiatry. Vitamin B12 deficiency induced psychosis – a case report.
- Child and Adolescent Psychiatry and Mental Health. Mood disorder with mixed, psychotic features due to vitamin b12 deficiency in an adolescent: case report.