Children and adults with celiac disease are at risk for iron deficiency or iron deficiency anemia (IDA), a particularly severe form of iron deficiency. Iron from food is absorbed mainly in the upper intestines, the same part of the intestines damaged by gluten. Iron deficiency is the most common nutrient deficiency in the world and children, and women of child-bearing age are at the highest risk of iron deficiency. Iron deficiency anemia occurs when the body doesn't have enough iron to make healthy red blood cells.
Why We Need Iron
Iron is a part of "hemoglobin," a protein that carries oxygen in the blood. It's necessary to transport oxygen to cells, for energy metabolism, normal human growth, reproduction, and immune system health. Children and adults who are iron deficient suffer from fatigue, the risk for chronic infections, weakness, get chilled easily, have a tendency to be pale, and have difficulty concentrating which can lead to learning disabilities.
In the United States and Europe, wheat flour is fortified (enriched) with iron to make up for the loss of iron when wheat is refined to flour. But very few gluten-free flours and starches are fortified with iron.
Absorption of Iron
There are two forms of iron in foods. "Heme" iron is found in animal sources and "non-heme" iron is found in plant sources. Heme iron is better absorbed than non-heme iron, and the absorption of both forms is enhanced by foods that are high in vitamin C.
Foods high in vitamin C include green and red peppers, citrus fruits and juices, strawberries, raspberries, blueberries, cranberries, tomatoes, broccoli, Brussels sprouts, cauliflower, cabbage, winter squash, leafy greens and parsley, sweet potatoes, cantaloupe, papaya, mango, watermelon, and pineapples.
Good Food Sources of Iron:
The following foods provide a good source of iron and are gluten-free:
- Meats: beef, pork, lamb, liver, and other organ meats
- Poultry: chicken, duck, turkey, liver (especially dark meat)
- Fish: shellfish, including clams, mussels, oysters, sardines, anchovies
- Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards
- Legumes like lima beans, green peas, dry beans and peas including pinto beans, black-eyed peas, and canned baked beans
- Yeast-leavened gluten-free whole grain bread and rolls
Iron Content of Gluten-Free Grains and Pseudo Grains
Within 1 cup of raw grain, there is iron at the following levels:
- Amaranth: 14.7 mg
- Teff: 14.7 mg
- Sorghum: 6.5 mg
- Quinoa: 7.8 mg
- Gluten-Free Oats: 4.2 mg
- Millet: 6 mg
- Buckwheat: 3.6 mg
- Brown Rice: 2.4 mg
- White Rice: 1.6 mg
Dietary Reference Intakes / Recommended Dietary Allowance for Iron (RDA)
Use this guide for yourself and your family:
- Infants 7-12 months: 11 mg
- Children 1-3 years: 7 mg
- Children 4-8 years: 10 mg
- Children 9-13 years: 8 mg
- Adolescents 14-18: Males 11 mg/Females 15 mg
- Adults 19-50: Males 8 mg / Females 18 mg
- Adults 51+: Males 8 mg/Females 8 mg
- Pregnant women all ages: 27 mg
- Breastfeeding women 18 and younger: 10 mg
- Breastfeeding women 19 and older: 9 mg
Freeman HJ. Iron deficiency anemia in celiac disease. World J Gastroenterol. 2015;21(31):9233–9238. doi:10.3748/wjg.v21.i31.9233
Cleveland Clinic. Anemia. Updated April 6, 2020.
Harvard T. H. Chan School of Public Health. Vitamin C.
US Department of Agriculture. FoodData Central.
U.S. Department of Health and Human Services. National Institutes of Health. Iron. Fact sheet for health professionals. Updated March 30, 2021.