Gluten Free Works: TREATMENT GUIDE Get well and stay healthy living gluten free
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What Is Severe Iron Deficiency Anemia In Pregnancy?
Severe iron deficiency anemia in pregnancy is characterized by abnormal formation of small, pale red blood cells that impair the ability of the fetus to obtain adequate oxygen for proper growth and development and imperil its life and cause the mother extreme fatigue with increased risk of infection.
Q: Why does this anemia imperil the fetus and cause the mother extreme fatigue with increased risk of infection?
A: Severe iron deficiency anemia significantly impedes the ability of the mother’s blood to carry sufficient oxygen for both her needs and the unborn baby’s needs. In this anemia the blood cells do not have adequate hemoglobin which functions to carry oxygen from the mother’s lungs to her body. Of course, the fetus gets its oxygen only from the mother’s blood.
Red blood cell production and function are dependent on a sufficient level of iron in the body and also the ability to use iron to make hemoglobin in red blood cells.
Hemoglobin is a protein that binds oxygen in red blood cells to be carried by the bloodstream to cells throughout the body. In iron deficiency anemia, hemoglobin in females is below 12.5g/dl (normal range is 12.5g/dl to 16g/dl ).
What Is Severe Iron Deficiency Anemia In Pregnancy In Celiac Disease and/or Gluten Sensitivity?
- In celiac disease, severe iron deficiency anemia and iron depletion in pregnancy are characterized by failure of the expected response to oral iron supplementation.1
- Screening for celiac disease is recommended in patients with unexplained iron deficiency anemia,2particularly because the presence of anemia in patients with celiac disease suggests more severe disease.
- Adequate vitamin C as well as intestinal acidity in the beginning region of the duodenum is needed for absorption. Other nutritional deficiencies that promote iron deficiency anemia are copper and riboflavin (vitamin B2), and these are commonly found in untreated celiac disease.3
- A study by Singh et al. found celiac patients with anemia had significantly longer duration of symptoms, lower albumin levels, and higher anti-tissue transglutaminase fold rise, and a higher proportion had abnormal d-xylose tests and severe villous abnormalities than celiac patients without anemia. Thus, celiac patients with anemia had more severe disease than those without anemia. It is therefore important to diagnose these patients at an earlier stage of the disease even when the classical feature such as anemia is not clinically evident.4
- A national study investigating screening practices for celiac disease in patients with iron-deficiency anemia (IDA) because no screening guidelines exist in the literature found that practicing hematologists infrequently screen for celiac disease in IDA. Only 8.6% believed all patients with IDA should be screened for celiac disease. Physicians who have recently finished their fellowship and those who see a high volume of patients with IDA are more likely to screen for celiac disease.5
How Prevalent Is Severe Iron Deficiency Anemia In Pregnancy In Celiac Disease and/or Gluten Sensitivity?
Severe iron deficiency anemia in pregnancy has increased frequency in patients with celiac disease and may be the only sign of celiac disease.6
What Are The Symptoms Of Severe Iron Deficiency Anemia In Pregnancy?
Severe iron deficiency anemia in pregnancy is marked by these symptoms:
In the mother:
- Pallor or paleness of skin and mucous membranes..
- Fatigue.
- Faintness or lightheadedness.
- Dyspnea (shortness of breath) on exertion.
- Weakness.
- Headache.
- Susceptibility to infection.
- Irritability.
- Anorexia (loss of appetite).
- Headache.
- Angina.
- Dyspnea (shortness of breath).
- Tachycardia (rapid heartbeat).
- Visual impairment (blurry).
- Inability to pay attention.
- Reduced memory/learning.
- Sensory motor incompetence.
- Alopecia (loss of hair).
- Dry and dull hair.
- Systolic heart murmur may develop.
In the developing fetus:
- Intraterine growth retardation.
- Increased risk of fetal malformations.
- Increased risk of spontaneous abortion.
How Does Severe Iron Deficiency Anemia in Pregnancy Develop In Celiac Disease and/or Gluten Sensitivity?
- Severe iron deficiency anemia in pregnancy results from iron deficiency due to malabsorption in gluten sensitive enteropathy.6
- Iron deficiency results from lack of iron to make hemoglobin due to any of these mechanisms:
- Failure to inonize iron in the stomach and upper duodenum due to low stomach acid so this mineral can be absorbed.
- Failure to absorb iron into the bloodstream from the duodenum due to mucosal damage to intestinal absorptive cells from gluten.
- Inadequate vitamin C needed for iron absorption.
- Interference with the usage of iron in the body for hemoglobin production.
- Deficiencies of co-factors need for normal red blood cell health: copper, which is essential for the formation of hemoglobin and red blood cell production and stimulates the absorption of iron through the copper transport protein ceruloplasmin and riboflavin (vitamin B2), which maintains the normal lifespan of red blood cells.
- If present, infection of the stomach with H. Pylori bacteria (an associated disorder of celiac disease) depletes iron in the body for its own metabolism.
Does Severe Iron Deficiency Anemia in Pregnancy Respond To Gluten-Free Diet?
Yes. Celiac disease-related iron deficiency anemia responds to a nutritious gluten free diet with adequate meat. Supplementation is advised under supervision of the doctor.
6 Steps To Improve Iron Deficiency Anemia In Celiac Disease and/or Gluten Sensitivity:
- 1Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:
- Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
- A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
- Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.
Correct Your Individual Nutritional Needs.
- Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
- Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.
Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the absorbing cells that make up the surface lining of your small intestine are better able to function.
- Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
- Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.7
- The intestinal lining may take up to a year to heal.
- 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:
Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).
- Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.8
- Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
- Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.8
- Bad Fats. Includes deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.8.
- Excessive Refined White Flours (bran layer removed). Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.8
- Refined Sugars. Includes white sugar, corn fructose and high fructose corn syrup.
- Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.8
- Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.8
- Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
- Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
- High Quality Complex Carbohydrates. Provide vitamins, minerals, phytochemicals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
- Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
- Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources include tuna, salmon, cod, and others. Plant sources include flax, chia seeds, canola oil, and others.
- Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
- Prebiotics/ High Fiber Foods. Food with fiber keeps our population of colonic microbes healthy.
- Protective Herbs and Spices. See below #6 for examples such as ginger.
- 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:
- 4 Manage Your Medications Safely:
Certain medications deplete nutrients that promote iron deficiency anemia. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. Do not stop prescribed medications without supervision.
This is not a complete listing.
CHOLESTEROL DRUGS
- Colestid® and Questran® deplete Iron.
ANTI-INFLAMMATORIES disrupt intestinal permeability.
- Aspirin and Salicylates deplete Iron.
ANTACIDS / ULCER MEDICATIONS
- 5Nutritional Supplements To Help Correct Deficiencies:
- Multivitamin/mineral as prescribed for pregnancy.
- Ferrous fumarate or gluconate as prescribed following blood test for iron status. Do not take with other supplements because of interactions with iron. Always check with your doctor when taking supplements to avoid interactions with medications.
Storage Note for Supplements: Store container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.
- 6Manage Natural Remedies:
- Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
- If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
- Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
- What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.
Carminative Food Remedies:
- Raspberry.
- Carrot is also a cleansing digestive tonic.
- Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
- Redbeets stimulate and improve digestion and are easily digested.
- Cabbage stimulates and improves digestion and is also a liver decongestant.
- Lettuce stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
- Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.
Carminative Herb Remedies:
- Chamomile (as a tea) also promotes healing and help relieve nervous tension. Drink as a tea.
- Parsley relieves colic, gas and indigestion.
- Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
- Thyme is a soothing remedy useful for stimulating digestion of rich, fatty foods.
Carminative Spice Remedies:
- Cloves are also antispasmodic.
- Ginger also supresses inflammation.
Exercise improves circulation and rids the body of toxins.
- Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
- Weight training builds muscle. Read more about Exercise and Fitness.
- Stretching improves flexibilty. Read more about Exercise and Fitness.
Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.
What Do Medical Research Studies Tell About Severe Iron Deficiency Anemia in Pregnancy In Celiac Disease and/or Gluten Sensitivity?
RESEARCH STUDY SUMMARIES
“How often do hematologists consider celiac disease in iron-deficiency anemia? Results of a national survey.” This study investigating screening practices for celiac disease in patients with iron-deficiency anemia (IDA), which is a common presentation of celiac disease, because no screening guidelines exist in the literature found that practicing hematologists infrequently screen for celiac disease in IDA. Physicians who have recently finished their fellowship and those who see a high volume of patients with IDA are more likely to screen for celiac disease.
A survey was e-mailed to members of the American Society of Hematology to survey hematologists to determine rates of celiac disease screening.
There were 385 complete responses from 4551 e-mails. Most respondents were practicing clinicians (74%), clinical researchers (10%), or laboratory researchers (6%). Specialists in benign hematology accounted for 45% of respondents, oncologists accounted for 33%, and specialists in malignant hematology accounted for 22%. The most common practice types were university-affiliated hospital (43%), private clinic (29%), community hospital (12%), and Veterans Affairs or military hospital (9%).
Only 8.6% believed all patients with IDA should be screened for celiac disease. Respondents who had completed their fellowship within 5 years were more likely than more experienced clinicians to believe that all patients with IDA should receive celiac disease screening. Having a higher volume of IDA patients per month also increased the likelihood of testing. In multivariate analysis, specialists in malignant hematology and oncologists were more likely than specialists in benign hematology to screen all patients for celiac disease, as were those who saw predominately pediatric patients with IDA vs adult patients.5
“Presence of anemia in patients with celiac disease suggests more severe disease.” This database study investigating what proportion of celiac disease patients had normal hemoglobin levels and if there were any differences in characteristics of those with and without anemia found that celiac disease patients with anemia had more severe disease than those without anemia.
Of 338 celiac disease patients, 14.8 % had normal hemoglobin levels at diagnosis. When compared with celiac disease patients without anemia, those with anemia had significantly longer duration of symptoms, lower albumin levels, and higher anti-tissue transglutaminase fold rise, and a higher proportion had abnormal d-xylose tests and severe villous abnormalities. Thus, celiac disease patients with anemia had more severe disease than those without anemia. “It is therefore important to diagnose these patients at an earlier stage of the disease even when the classical feature such as anemia is not clinically evident.”9
CASE REPORT SUMMARIES
“Celiac disease in pregnancy – not always a relapse.” In this case series, all of the patients in this series had typical gastrointestinal (GI) manifestations of celiac disease in infancy that had resolved despite a normal diet, but subsequently relapsed in pregnancy or the puerperium. In most patients, a previous history of GI disease or anemia cannot be elucidated, and refractory sideropenic anemia during pregnancy may be the only sign of celiac disease. Although the acute presentation of celiac disease in pregnancy or the puerperium is concerning, potentially of more concern is the risk of spontaneous abortion and intrauterine growth retardation of undiagnosed celiac disease.6
- Mitchell RMS, Robinson TJ. Celiac disease in pregnancy – not always a relapse. Acta Obstetricia Et Gynecologica Scandanavica. Aug 2003;82(8):777, 1p. [↩]
- Karnum US, Felder LR, Raskin JB. Prevalence of occult celiac disease in patients with iron deficiency anemia: a prospective study. Southern Medical Journal. Jan 2004; 97(1):30-4. [↩]
- Kathleen Mahan and Sylvia Escott-Stump, ed. Krause’s Food, Nutrition & Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000. [↩]
- Singh P, Arora S, Makharia GK. Presence of anemia in patients with celiac disease suggests more severe disease. Indian J Gastroenterol. 2013 Nov 19. [↩]
- Smukalla S, Lebwohl B, Mears JG, Leslie LA, Green PH. How often do hematologists consider celiac disease in iron-deficiency anemia? Results of a national survey. Clin Adv Hematol Oncol. 2014 Feb;12(2):100-5. [↩] [↩]
- Mitchell RMS, Robinson TJ. Celiac disease in pregnancy – not always a relapse. Acta Obstetricia Et Gynecologica Scandanavica. Aug 2003;82(8):777, 1p. [↩] [↩] [↩]
- Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. [↩]
- Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [↩] [↩] [↩] [↩] [↩] [↩]
- Singh P, Arora S, Makharia GK. Presence of anemia in patients with celiac disease suggests more severe disease. Indian J Gastroenterol. 2013 Nov 19. [↩]
