{"id":3306,"date":"2015-08-21T02:07:33","date_gmt":"2015-08-21T06:07:33","guid":{"rendered":"http:\/\/health.glutenfreeworks.com\/2013\/03\/28\/iron-deficiency-3\/"},"modified":"2020-07-11T10:38:44","modified_gmt":"2020-07-11T14:38:44","slug":"iron-deficiency-3","status":"publish","type":"post","link":"https:\/\/glutenfreeworks.com\/health\/iron-deficiency-3\/","title":{"rendered":"Iron Deficiency"},"content":{"rendered":"<h2 style=\"text-align: justify;\"><strong><a href=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/ferritin.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-medium wp-image-6007\" style=\"margin-left: 5px; margin-right: 5px;\" src=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/ferritin-300x240.jpg\" alt=\"ferritin\" width=\"300\" height=\"240\" srcset=\"https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/ferritin-300x240.jpg 300w, https:\/\/glutenfreeworks.com\/health\/wp-content\/uploads\/sites\/10\/ferritin.jpg 500w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/strong>What Is Iron?<\/h2>\n<p style=\"text-align: justify;\"><span class=\"dropcap\">I<\/span>ron is an essential mineral that is required for normal body function.<\/p>\n<p style=\"text-align: justify;\">Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in enzymes that assist biochemical reactions.<\/p>\n<p style=\"text-align: justify;\">Iron is also found in proteins that store iron for future needs and that transport iron in blood.<\/p>\n<p style=\"text-align: justify;\"><strong>Q<\/strong>: How are iron stores regulated?<\/p>\n<p style=\"text-align: justify;\"><strong>A<\/strong>:Iron stores are regulated by intestinal iron absorption.<a href=\"#footnote_1_3306\" id=\"identifier_1_3306\" class=\"footnote-link footnote-identifier-link\" title=\"http:\/\/ods.od.nih.gov\/factsheets\/Iron-HealthProfessional accessed 12\/11\/12\">1<\/a>That is, whenever iron is needed, more iron is absorbed than when iron is sufficient.\u00a0This mechanism prevents excess iron in the body which is harmful.<\/p>\n<p style=\"text-align: justify;\">In the brain, iron is necessary to ensure oxygenation and to produce energy in the cerebral parenchyma (via cytochrome oxid. ase), and for the synthesis of neurotransmitters and myelin.<\/p>\n<p style=\"text-align: justify;\">Iron concentrations in the umbilical artery are critical during the development of the fetus, and in relation with the IQ in the child.<a href=\"#footnote_2_3306\" id=\"identifier_2_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. J Nutr Health Aging. 2006 Sep-Oct; 10(5):377-85.\">2<\/a><\/p>\n<h2 style=\"text-align: justify;\">What Is Iron Deficiency In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p><!--more--><\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify;\">Iron deficiency is a classic symptom of celiac disease that results when the level within cells is too low to meet metabolic needs of the body for this mineral.<\/li>\n<li style=\"text-align: justify;\">Deficiency is characterized by impaired: red blood cell formation, free-radical disposal, oxygenation of cells, immune response to infection, enzyme activity, cognitive performance, digestion, nail structure, and fetal health.<a href=\"#footnote_3_3306\" id=\"identifier_3_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Kathleen Mahan and Sylvia Escott-Stump, ed. Krause&rsquo;s Food, Nutrition &amp; Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000.\">3<\/a><\/li>\n<li style=\"text-align: justify;\">Celiac disease induces malabsorption and deficiency of iron essential for fetal organogenesis (organ formation and development in a fetus).<a href=\"#footnote_4_3306\" id=\"identifier_4_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecological Endocrinology. Dec 2000; -63.\">4<\/a><\/li>\n<li style=\"text-align: justify;\">Iron deficiency has been implicated in elevated prolactin hormone characterized by altered estrogen production in women and androgen production in men.<a href=\"#footnote_5_3306\" id=\"identifier_5_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Sher KS, Jayanthi V, Probert CS, Stewart CR, Mayberry JF. Infertility, obstetric and gynecological problems in celiac disease. Digestive Diseases. May-June 1994; 12(3):186-90.\">5<\/a><\/li>\n<li style=\"text-align: justify;\">A study investigating life-long gluten-free diet in celiac disease patients shows that inadequate intake of iron is common (more than 10% of patients) and may relate to habitual poor food choices in addition to inherent deficiencies in the gluten free diet. \u201cDietary education should also address the achievement of adequate micronutrient intake.&#8221;<a href=\"#footnote_6_3306\" id=\"identifier_6_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Shepherd SJ1, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111\/jhn.12018.\">6<\/a><\/li>\n<\/ul>\n<h2 style=\"text-align: justify;\">How Prevalent Is Iron Deficiency In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<ul class=\"cp_bullet black\">\n<li style=\"text-align: justify;\">Iron deficiency is common in patients with untreated celiac disease.<a href=\"#footnote_7_3306\" id=\"identifier_7_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999;69(3):354-365.\">7<\/a><\/li>\n<li style=\"text-align: justify;\">Of the general population, it is the most common nutritional deficiency in the world,<a href=\"#footnote_8_3306\" id=\"identifier_8_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Mark Beers and Robert Berkow. The Merck Manual, 17th Edition. Whitehouse Station, NL. USA: Merck Research Laboratories, 1999\">8<\/a> but it does not respond to treatment in persons with untreated celiac disease.<\/li>\n<li style=\"text-align: justify;\">Research showed that 69% of 49 patients had iron deficiency at initial presentation of celiac disease.<a href=\"#footnote_9_3306\" id=\"identifier_9_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Harmanci O, Kav T, Sivri B. Red cell distribution width can predict intestinal atrophy in selected patients with celiac disease. J Clin Lab Anal. 2012 Nov; 26(6):497-502. doi: 10.1002\/jcla.21553.\">9<\/a><\/li>\n<li style=\"text-align: justify;\">A prospective Dutch study in 80 newly diagnosed adult patients with celiac disease found 46% had decreased iron storage.<a href=\"#footnote_10_3306\" id=\"identifier_10_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.&nbsp;Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390\/nu5103975.\">10<\/a><\/li>\n<li style=\"text-align: justify;\">A study analyzing the charts of 405 patients at diagnosis of celiac disease, showed that iron deficiency was common, occurring in 33% of men and 19% of women.\u00a0Anemia was present in approximately 20% of the cohort. Among the anemic patients, ferritin was less than the 10th percentile in 45%, between the 10th and 50th percentile in 39% and greater than the 50th percentile in 13%.<a href=\"#footnote_11_3306\" id=\"identifier_11_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007 Nov; 82(11):996-1000.\">11<\/a><\/li>\n<li style=\"text-align: justify;\">A prospective study investigating the association of cervical esophageal web (Plummer-Vinson syndrome) with celiac disease found that all patients with Plummer-Vinson syndrome and celiac disease\u00a0had evidence of iron deficiency.<a href=\"#footnote_12_3306\" id=\"identifier_12_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Sinha SK, Nain CK, Udawat HP, Prasad KK, Das R, Nagi B, Singh K. Cervical esophageal web and celiac disease.&nbsp;J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 1):1149-52. doi: 10.1111\/j.1440-1746.2008.05452.x. Epub 2008 Jun 28.\">12<\/a><\/li>\n<\/ul>\n<h2 style=\"text-align: justify;\">What Are The Symptoms Of Iron Deficiency?<\/h2>\n<p style=\"text-align: justify;\">Iron deficiency is marked by this wide variety of symptoms showing the essential need for adequate supplies:<\/p>\n<ul class=\"cp_bullet red\">\n<li>Pallor (pale skin color).<\/li>\n<li>Fatigue.<\/li>\n<li>Headache.<\/li>\n<li>Lightheadedness.<\/li>\n<li>Shortness of breath.<\/li>\n<li>Rapid heartbeat.<\/li>\n<li>Blurry vision.<\/li>\n<li>Angina.<\/li>\n<li>Increased susceptibility to bacterial infection.<\/li>\n<li>Reduced learning.<\/li>\n<li>Inattention.<\/li>\n<li>Reduced memory.<\/li>\n<li>Sensorimotor incompetence.<\/li>\n<li>Anorexia (loss of appetite).<\/li>\n<li>Dysphagia (difficult swallowing).<\/li>\n<li>Pale, smooth, and sore tongue.<\/li>\n<li>Koilonychia.<\/li>\n<li>Loss of vitality.<\/li>\n<li>Infertility.<\/li>\n<li>Alopecia (hair loss\/thin hair).<\/li>\n<li>Restless leg syndrome.<\/li>\n<li>Defects in fetal development.<\/li>\n<\/ul>\n<h2 style=\"text-align: justify;\">How Does The Body Get Iron?<\/h2>\n<p style=\"text-align: justify;\">Iron must be obtained from the diet since the body cannot make it. Iron absorption depends on the ionization (gaining a positive electrical charge) in the acidic environment of stomach juice. Ionized iron is absorbed in the duodenum, the first part of the small intestine.<\/p>\n<p style=\"text-align: justify;\">Heme iron, obtained from animal food, is absorbed across the brush border of the intestinal lining then by active transport into the blood. Nonheme iron, obtained from plants, binds with apoprotein after entering the enterocyte (surface mucosa cell) to be ferried to the basolateral membrane (beneath the enterocytes) and exited by active transport into the bloodstream. Vitamin C and intestinal acidity in the duodenum are needed for absorption.<a href=\"#footnote_3_3306\" id=\"identifier_13_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Kathleen Mahan and Sylvia Escott-Stump, ed. Krause&rsquo;s Food, Nutrition &amp; Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000.\">3<\/a><\/p>\n<p style=\"text-align: justify;\">Healthy adults absorb about 10% to 15% of dietary iron, but individual absorption varies.<a href=\"#footnote_1_3306\" id=\"identifier_14_3306\" class=\"footnote-link footnote-identifier-link\" title=\"http:\/\/ods.od.nih.gov\/factsheets\/Iron-HealthProfessional accessed 12\/11\/12\">1<\/a><\/p>\n<h2 style=\"text-align: justify;\">What Does Iron Do In The Body?<\/h2>\n<ul>\n<li>Required for hemoglobin production.<\/li>\n<li>Required for myoglobin activity.<\/li>\n<li>Required for production of numerous heme and nonheme enzymes.<\/li>\n<li>Required for the respiratory transport of O2 and CO2 because of its redox properties (giving and taking of oxygen molecules).<\/li>\n<li>Required as an active component of cytochromes involved in cellular respiration.<\/li>\n<li>Required in antibody production and cellular immunity for adequate concentrations of circulating T lymphocytes, mitogenic response, natural killer cell activity, and production of interleukin 1 and 2.<\/li>\n<li>Involved in the function and production of neurotransmitters and, possibly, myelin.<\/li>\n<\/ul>\n<h2 style=\"text-align: justify;\">How Does Iron Deficiency Develop In Celiac Disease and\/or Gluten Sensitivity?<\/h2>\n<p style=\"text-align: justify;\">Iron deficiency results from these mechanisms in celiac disease:<\/p>\n<ul class=\"cp_check red\">\n<li style=\"text-align: justify;\">Deficiency results primarily from malabsorption of this mineral due to inflammation of intestinal lining.<\/li>\n<li style=\"text-align: justify;\">Malabsorption can occur as a consequence of low stomach acid. Sufficient acid is required to ionize iron (receives a positive charge) which is required for absorption later in the small intestine.<\/li>\n<li style=\"text-align: justify;\">Malabsorption can occur as a consequence of insufficient carrier proteins needed to transport ionized into the bloodstream from the absorbing cells of the small intestine.<\/li>\n<li style=\"text-align: justify;\">Deficiency of necessary vitamin C impairs absorption.<\/li>\n<li style=\"text-align: justify;\">However, nutritional deficiencies alone do not explain iron deficiency anemia in all cases; inflammation appears to contribute.<a href=\"#footnote_13_3306\" id=\"identifier_15_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007 Nov;82(11):996-1000.\">13<\/a><\/li>\n<\/ul>\n<h2 style=\"text-align: justify;\">Does Iron Deficiency Respond To Gluten Free Diet?<\/h2>\n<p style=\"text-align: justify;\">Yes. Celiac disease-related iron deficiency responds to gluten free diet; iron supplementation is required if iron deficiency anemia results from celiac disease.<a href=\"#footnote_1_3306\" id=\"identifier_16_3306\" class=\"footnote-link footnote-identifier-link\" title=\"http:\/\/ods.od.nih.gov\/factsheets\/Iron-HealthProfessional accessed 12\/11\/12\">1<\/a>\u00a0A gluten-free diet resulted in increased serum ferritin in iron-deficient patients, and decreased ferritin levels in those with high ferritin.<a href=\"#footnote_13_3306\" id=\"identifier_17_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007 Nov;82(11):996-1000.\">13<\/a><\/p>\n<h2>6 Steps To Correct Iron Deficiency In Celiac Disease and\/or Gluten Sensitivity:<\/h2>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000;\"><span class=\"dropcap\"><strong>1<\/strong><\/span><\/span><strong><span style=\"color: #800000;\">Meet, or Exceed the RDA (Recommended Dietary Allowances) for Iron in milligrams (mg) per day<\/span><\/strong><\/em>:<\/li>\n<\/ul>\n<p style=\"text-align: center;\"><div class=\"box success\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p style=\"text-align: center;\">Men require 0.5 to 1 mg.<\/p>\n<p style=\"text-align: center;\">Women require 1.0 to 2.0 mg daily if menstruating, 2 to 4 mg if pregnant or lactating, and only 0.5 to 1 mg after menopause.<\/p>\n<p style=\"text-align: center;\">Because only a fraction of the iron in food is absorbed, it is necessary to eat 15 to 30 mg in food, preferably meat sources. \n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000;\"><span class=\"dropcap\"><strong>2<\/strong><\/span><\/span><strong><span style=\"color: #800000;\">Diet &#8211; Include Food Sources Richest in Iron:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"padding-left: 30px;\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p>Food Sources of Iron ranked by milligrams of iron per standard amount; also calories in the standard amount. (All are \u2265 10% of RDA for teen and adult females, which is 18 mg\/day.)<\/p>\n<table width=\"90%\">\n<tbody>\n<tr>\n<td><strong>Food, Standard Amount<\/strong><\/td>\n<td><strong>Iron (mg)<\/strong><\/td>\n<td><strong>Calories<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Clams, canned, drained, 3 oz<\/td>\n<td>23.8<\/td>\n<td>126<\/td>\n<\/tr>\n<tr>\n<td>GF Fortified ready-to-eat cereals (various), ~ 1 oz<\/td>\n<td>1.8 -21.1<\/td>\n<td>\u00a0 54-127<\/td>\n<\/tr>\n<tr>\n<td>Oysters, eastern, wild, cooked, moist heat, 3 oz<\/td>\n<td>10.2<\/td>\n<td>116<\/td>\n<\/tr>\n<tr>\n<td>Organ meats (liver, giblets), various, cooked, 3 oz <sup><a href=\"http:\/\/www.health.gov\/Dietaryguidelines\/dga2005\/document\/html\/AppendixB.htm#foota3\">a<\/a><\/sup><\/td>\n<td>5.2-9.9<\/td>\n<td>134-235<\/td>\n<\/tr>\n<tr>\n<td>GF Fortified instant cooked cereals (various), 1 packet<\/td>\n<td>4.9-8.1<\/td>\n<td>Varies<\/td>\n<\/tr>\n<tr>\n<td>Soybeans, mature, cooked, \u00bd cup<\/td>\n<td>4.4<\/td>\n<td>149<\/td>\n<\/tr>\n<tr>\n<td>Pumpkin and squash seed kernels, roasted, 1 oz<\/td>\n<td>4.2<\/td>\n<td>148<\/td>\n<\/tr>\n<tr>\n<td>White beans, canned, \u00bd cup<\/td>\n<td>3.9<\/td>\n<td>153<\/td>\n<\/tr>\n<tr>\n<td>Blackstrap molasses, 1 Tbsp<\/td>\n<td>3.5<\/td>\n<td>47<\/td>\n<\/tr>\n<tr>\n<td>Lentils, cooked, \u00bd cup<\/td>\n<td>3.3<\/td>\n<td>115<\/td>\n<\/tr>\n<tr>\n<td>Spinach, cooked from fresh, \u00bd cup<\/td>\n<td>3.2<\/td>\n<td>21<\/td>\n<\/tr>\n<tr>\n<td>Beef, chuck, blade roast, lean, cooked, 3 oz<\/td>\n<td>3.1<\/td>\n<td>215<\/td>\n<\/tr>\n<tr>\n<td>Beef, bottom round, lean, 0&#8243; fat, all grades, cooked, 3 oz<\/td>\n<td>2.8<\/td>\n<td>182<\/td>\n<\/tr>\n<tr>\n<td>Kidney beans, cooked, \u00bd cup<\/td>\n<td>2.6<\/td>\n<td>112<\/td>\n<\/tr>\n<tr>\n<td>Sardines, canned in oil, drained, 3 oz<\/td>\n<td>2.5<\/td>\n<td>177<\/td>\n<\/tr>\n<tr>\n<td>Beef, rib, lean, \u00bc&#8221; fat, all grades, 3 oz<\/td>\n<td>2.4<\/td>\n<td>195<\/td>\n<\/tr>\n<tr>\n<td>Chickpeas, cooked, \u00bd cup<\/td>\n<td>2.4<\/td>\n<td>134<\/td>\n<\/tr>\n<tr>\n<td>Duck, meat only, roasted, 3 oz<\/td>\n<td>2.3<\/td>\n<td>171<\/td>\n<\/tr>\n<tr>\n<td>Lamb, shoulder, arm, lean, \u00bc &#8221; fat, choice, cooked, 3 oz<\/td>\n<td>2.3<\/td>\n<td>237<\/td>\n<\/tr>\n<tr>\n<td>Prune juice, \u00be cup<\/td>\n<td>2.3<\/td>\n<td>136<\/td>\n<\/tr>\n<tr>\n<td>Shrimp, canned, 3 oz<\/td>\n<td>2.3<\/td>\n<td>102<\/td>\n<\/tr>\n<tr>\n<td>Cowpeas, cooked, \u00bd cup<\/td>\n<td>2.2<\/td>\n<td>100<\/td>\n<\/tr>\n<tr>\n<td>Ground beef, 15% fat, cooked, 3 oz<\/td>\n<td>2.2<\/td>\n<td>212<\/td>\n<\/tr>\n<tr>\n<td>Tomato puree, \u00bd cup<\/td>\n<td>2.2<\/td>\n<td>48<\/td>\n<\/tr>\n<tr>\n<td>Lima beans, cooked, \u00bd cup<\/td>\n<td>2.2<\/td>\n<td>108<\/td>\n<\/tr>\n<tr>\n<td>Soybeans, green, cooked, \u00bd cup<\/td>\n<td>2.2<\/td>\n<td>127<\/td>\n<\/tr>\n<tr>\n<td>Navy beans, cooked, \u00bd cup<\/td>\n<td>2.1<\/td>\n<td>127<\/td>\n<\/tr>\n<tr>\n<td>Refried beans, \u00bd cup<\/td>\n<td>2.1<\/td>\n<td>118<\/td>\n<\/tr>\n<tr>\n<td>Beef, top sirloin, lean, 0&#8243; fat, all grades, cooked, 3 oz<\/td>\n<td>2.0<\/td>\n<td>156<\/td>\n<\/tr>\n<tr>\n<td>Tomato paste, \u00bc cup<\/td>\n<td>2.0<\/td>\n<td>54<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><sup>a<\/sup> High in cholesterol.<\/p>\n<p style=\"text-align: justify;\">Source: Nutrient values from Agricultural Research Service (ARS) Nutrient Database for Standard Reference, Release 17. Foods are from ARS single nutrient reports, sorted in descending order by nutrient content in terms of common household measures. \n\t\t\t<\/div><\/div>\n<ul class=\"cp_check green\" style=\"padding-left: 30px;\">\n<li><em><span style=\"color: #800000;\"><span class=\"dropcap\"><strong>3<\/strong><\/span><\/span><strong><span style=\"color: #800000;\">\u00a0Diet &#8211; Avoid, Limit, or Eat Separately These Foods\u00a0<strong>That Deplete or Interfere With Iron Absorption:<\/strong><\/span><\/strong><\/em><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<ul class=\"cp_bullet red\">\n<li style=\"text-align: justify;\">Refined sugar including table sugar (cane and beet), corn syrup and especially fructose.<\/li>\n<li style=\"text-align: justify;\">High phytate-containing food like whole bran grains, except when baked with yeast which inactivates phytate (eg. bread).<\/li>\n<li style=\"text-align: justify;\">Excessive fiber.<\/li>\n<li style=\"text-align: justify;\">Walnuts.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000;\"><span class=\"dropcap\"><strong>4<\/strong><\/span><\/span><strong><span style=\"color: #800000;\">Monitor Medications That Deplete or Interfere With Iron Absorption:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<p style=\"text-align: justify; padding-left: 30px;\"><div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<p>Here are common medications that deplete iron. Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below. <strong>Do not stop prescribed medications without supervision.<\/strong><\/p>\n<ul class=\"cp_bullet blue\">\n<li>Antacids (Pepcid\u00ae, Tagamet\u00ae, Zantac\u00ae).<\/li>\n<li>Magnesium and Aluminum Antacid preparations (Gaviscon\u00ae, Maalox\u00ae, Mylanta\u00ae).<\/li>\n<li>Tetracyclines.<\/li>\n<li>Aspirin and Salicylates.<\/li>\n<li>Cholesterol Drugs (Colestid\u00ae and Questran\u00ae).\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000;\"><span class=\"dropcap\"><strong>5<\/strong><\/span><strong>Manage\u00a0<\/strong><\/span><strong><span style=\"color: #800000;\">Nutritional Supplements to Obtain Iron<\/span><\/strong><\/em><em><strong>:<\/strong><\/em><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<ul class=\"cp_bullet orange\">\n<li>A blood level concentration \u00a0of iron should be obtained to determine status before supplementing.<\/li>\n<li>Iron is available in two forms: ferrous and ferric.<\/li>\n<li>Ferrous iron salts (ferrous fumarate is 33% absorbed, ferrous sulfate is 20% absorbed, and ferrous gluconate is 12% absorbed) are the best absorbed forms of iron supplements. However, ferrous sulfate and ferric chloride are poor choices because they can damage the fat soluble vitamins (A,D,E,K) and vitamin C.<\/li>\n<li>Iron is part of multivitamin\/mineral supplements that list iron.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<ul class=\"cp_check green\">\n<li><em><span style=\"color: #800000;\"><span class=\"dropcap\"><strong>6<\/strong><\/span><\/span><strong><span style=\"color: #800000;\">Other Supplements That Deplete or Interfere With Absorption:<\/span><\/strong><\/em><\/li>\n<\/ul>\n<div class=\"box shadow\"><div class=\"box-inner-block\"><i class=\"tieicon-boxicon\"><\/i>\n\t\t\t\n<ul class=\"cp_bullet red\">\n<li>High dose zinc impairs absorption of iron in the form of ferrous sulfate supplement. Check with your pharmacist. Generally, take 2 hours before or after each other.<\/li>\n<li>Phosphorus interferes with the balance of iron.\n\t\t\t<\/div><\/div><\/li>\n<\/ul>\n<h2>Medical Research Findings On Iron\u00a0Deficiency In Celiac Disease and\/or Gluten Sensitivity:<\/h2>\n<h4><strong>RESEARCH STUDY SUMMARIES<\/strong><\/h4>\n<p style=\"text-align: justify;\"><b>&#8220;Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.\u201d<\/b>\u00a0This study aiming to assess the nutritional and vitamin\/mineral status of current &#8220;early diagnosed&#8221; untreated adult celiac disease (CD)-patients in the Netherlands found that vitamin\/mineral deficiencies are still common in newly &#8220;early diagnosed&#8221; CD-patients, even though the prevalence of obesity at initial diagnosis is rising. Eighty newly diagnosed adult CD-patients were included and a comparable sample of 24 healthy Dutch subjects was added to compare vitamin concentrations.<\/p>\n<p style=\"text-align: justify;\">Nutritional status and serum concentrations of folic acid, vitamin A, vitamin B6, vitamin B12, and (25-hydroxy) vitamin D, zinc, hemoglobin (Hb) and ferritin were determined before prescribing gluten free diet. Almost all CD-patients (87%) had at least one value below the lower limit of reference. Specifically,\u00a046% had decreased iron storage and 32% had anemia.<\/p>\n<p style=\"text-align: justify;\">Vitamin\/mineral deficiencies were counter-intuitively not associated with a (higher) grade of histological intestinal damage or (impaired) nutritional status. Extensive nutritional assessments seem warranted to guide nutritional advices and follow-up in CD treatment.<a href=\"#footnote_10_3306\" id=\"identifier_18_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.&nbsp;Nutrients. 2013 Sep 30;5(10):3975-92. doi: 10.3390\/nu5103975.\">10<\/a><\/p>\n<p style=\"text-align: justify;\"><strong>&#8220;Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with celiac disease.&#8221;<\/strong> This study investigating life-long gluten-free diet (GFD) in celiac disease patients aimed to determine the nutritional adequacy of the &#8216;no detectable gluten&#8217; diet. Results show that inadequate intake of iron is common (more than 10%) and may relate to habitual poor food choices in addition to inherent deficiencies in the GFD. \u201cDietary education should also address the achievement of adequate micronutrient intake.\u201d<\/p>\n<p style=\"text-align: justify;\">A seven-day prospective food intake was assessed in 55 patients who were adherent to a GFD for more than 2 years and in 50 newly-diagnosed age- and sex-matched patients (18-71 years, 24% male) studied prospectively over 12 months on GFD. Historical pre-celiac intake was also assessed in the latter group. Intake was compared with Australian Nutritional Recommendations and the Australian population data.<\/p>\n<p style=\"text-align: justify;\">RESULTS: Nutritional intake was similar between groups. Of macronutrients, only starch intake fell over 12 months (26% to 23%). Fibre intake was inadequate for all except in diet-experienced men. More than one in 10 of both newly-diagnosed and experienced women had inadequate thiamin, folate, vitamin A, magnesium, calcium and iron intakes. More than one in 10 newly-diagnosed men had inadequate thiamin, folate, magnesium, calcium and zinc intakes. Inadequate intake did not relate to nutrient density of the GFD. Inadequacies of folate, calcium, iron and zinc occurred more frequently than in the Australian population. The frequency of inadequacies was similar pre- and post-diagnosis, except for thiamin and vitamin A, where inadequacies were more common after GFD implementation. \u00a0Because dietary intake patterns at 12 months on a GFD are similar to longer-term intake, researchers stress that fortification of GF foods also need to be considered.&#8221;<a href=\"#footnote_6_3306\" id=\"identifier_19_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Shepherd SJ1, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. J Hum Nutr Diet. 2013 Aug;26(4):349-58. doi: 10.1111\/jhn.12018.\">6<\/a><\/p>\n<p style=\"text-align: justify;\"><strong>&#8220;Cervical esophageal web and celiac disease.&#8221;<\/strong> This prospective study investigating the association of cervical esophageal web (Plummer-Vinson syndrome) with celiac disease found that all patients with Plummer-Vinson syndrome and celiac disease\u00a0had evidence of iron deficiency. None of these patients gave a history of chronic diarrhea. Researchers suggest that all adult patients with cervical esophageal web and iron deficiency need screening for celiac disease even in the absence of chronic diarrhea.<\/p>\n<p style=\"text-align: justify;\">Subjects included were consecutive patients with symptomatic cervical esophageal web diagnosed over a period of 4.5 years. Tissue transglutaminase antibody was measured in serum of each patient. Patients with elevated tissue transglutaminase antibody titer were subjected to esophagogastroduodenoscopy and biopsies were obtained from the descending duodenum to look for histological changes of celiac disease. Celiac disease was diagnosed on the basis of elevated tissue transglutaminase antibody and suggestive duodenal histology.<\/p>\n<p style=\"text-align: justify;\">RESULTS: Twenty one patients were diagnosed to have cervical esophageal web. Eighteen (85.7%) had evidence of iron deficiency. Five (23.8%) patients with cervical esophageal web fulfilled criteria for diagnosis of celiac disease. All five had evidence of iron deficiency. None of these patients gave a history of chronic diarrhea. All patients were treated with bougie dilatation. Patients with celiac disease were advised of a gluten-free diet. All five celiac disease patients are free of dysphagia without recurrence after a mean follow up of 10 months (range: 3 to 16 months).<a href=\"#footnote_12_3306\" id=\"identifier_20_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Sinha SK, Nain CK, Udawat HP, Prasad KK, Das R, Nagi B, Singh K. Cervical esophageal web and celiac disease.&nbsp;J Gastroenterol Hepatol. 2008 Jul;23(7 Pt 1):1149-52. doi: 10.1111\/j.1440-1746.2008.05452.x. Epub 2008 Jun 28.\">12<\/a><\/p>\n<p style=\"text-align: justify;\"><strong>\u201cAnemia in celiac disease is multifactorial in etiology.\u201d<\/strong>\u00a0This study assessed the characteristics of anemia from a cohort of patients seen at a hospital care center for celiac disease. Hematological parameters measured within 3 months of diagnosis and degree of villous atrophy from 405 patients diagnosed after 1995 was analyzed. Ferritin (iron) levels were compared with population controls (NHANES III). Iron deficiency was common, occurring in 33% of men and 19% of women. Anemia was present in approximately 20% of the cohort. Among the anemic patients, ferritin was less than the 10th percentile in 45%, between the 10th and 50th percentile in 39% and greater than the 50th percentile in 13%. Ferritin greater than 50th percentile was more common in anemic men (24%) than in anemic women.<\/p>\n<p style=\"text-align: justify;\">A gluten-free diet resulted in increased serum ferritin in iron-deficient patients, and decreased ferritin levels in those with high ferritin. Although anemia is still a common presentation of celiac disease, nutritional deficiencies alone do not explain this phenomenon in all cases; inflammation appears to contribute as evidenced by the presence of anemia of chronic disease in some individuals.<a href=\"#footnote_14_3306\" id=\"identifier_21_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. Am J Hematol. 2007 Nov; 82(11):996-1000.\">14<\/a><\/p>\n<p style=\"text-align: justify;\"><strong>\u201cDo adults with high gliadin antibody concentrations have subclinical gluten intolerance?\u201d<\/strong> This study measuring IgG and IgA isotypes and IgG subclasses demonstrated significantly decreased transferrin saturation, mean corpuscular volume, and mean corpuscular hemoglobin in patients with positive IgA gliadin antibodies.<a href=\"#footnote_15_3306\" id=\"identifier_22_3306\" class=\"footnote-link footnote-identifier-link\" title=\"Arneson JA, Gudjonsson H, Freysdottir J, Valdimarsson H. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance? Gut. Feb 1992; 33(2):194-7\">15<\/a><\/p>\n<ol class=\"footnotes\"><li id=\"footnote_1_3306\" class=\"footnote\">http:\/\/ods.od.nih.gov\/factsheets\/Iron-HealthProfessional accessed 12\/11\/12<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_1_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_14_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_16_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_2_3306\" class=\"footnote\">Bourre JM. Effects of nutrients (in food) on the structure and function of the nervous system: update on dietary requirements for brain. Part 1: micronutrients. <em>J Nutr Health Aging.<\/em> 2006 Sep-Oct; 10(5):377-85.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_2_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_3_3306\" class=\"footnote\">Kathleen Mahan and Sylvia Escott-Stump, ed. Krause\u2019s Food, Nutrition &amp; Diet Therapy, 10th Edition. Philadelphia, PA. USA: W.B. Saunders Company, 2000.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_3_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_13_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_4_3306\" class=\"footnote\">Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. <em>Gynecological Endocrinology.<\/em> Dec 2000; -63.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_4_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_5_3306\" class=\"footnote\">Sher KS, Jayanthi V, Probert CS, Stewart CR, Mayberry JF. Infertility, obstetric and gynecological problems in celiac disease. <em>Digestive Diseases<\/em>. May-June 1994; 12(3):186-90.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_5_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_6_3306\" class=\"footnote\">Shepherd SJ1, Gibson PR. Nutritional inadequacies of the gluten-free diet in both recently-diagnosed and long-term patients with coeliac disease. <em>J Hum Nutr Diet<\/em>. 2013 Aug;26(4):349-58. doi: 10.1111\/jhn.12018.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_6_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_19_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_7_3306\" class=\"footnote\">Murray JA, the widening spectrum of celiac disease. American Journal of Clinical Nutrition. Mar 1999;69(3):354-365.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_7_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_8_3306\" class=\"footnote\">Mark Beers and Robert Berkow. The Merck Manual, 17th Edition. Whitehouse Station, NL. USA: Merck Research Laboratories, 1999<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_8_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_9_3306\" class=\"footnote\">Harmanci O, Kav T, Sivri B. Red cell distribution width can predict intestinal atrophy in selected patients with celiac disease. <em>J Clin Lab Anal<\/em>. 2012 Nov; 26(6):497-502. doi: 10.1002\/jcla.21553.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_9_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_10_3306\" class=\"footnote\">Wierdsma NJ, van Bokhorst-de van der Schueren MA, Berkenpas M, Mulder CJ, van Bodegraven AA. Vitamin and mineral deficiencies are highly prevalent in newly diagnosed celiac disease patients.<span class=\"apple-converted-space\">\u00a0<\/span><em>Nutrients<\/em>. 2013 Sep 30;5(10):3975-92. doi: 10.3390\/nu5103975.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_10_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_18_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_11_3306\" class=\"footnote\">Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. <em>Am J Hematol<\/em>. 2007 Nov; 82(11):996-1000.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_11_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_12_3306\" class=\"footnote\">Sinha SK, Nain CK, Udawat HP, Prasad KK, Das R, Nagi B, Singh K. Cervical esophageal web and celiac disease.\u00a0<em>J Gastroenterol Hepatol<\/em>. 2008 Jul;23(7 Pt 1):1149-52. doi: 10.1111\/j.1440-1746.2008.05452.x. Epub 2008 Jun 28.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_12_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_20_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_13_3306\" class=\"footnote\">Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. <em>Am J Hematol<\/em>. 2007 Nov;82(11):996-1000.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_15_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_17_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_14_3306\" class=\"footnote\">Harper JW, Holleran SF, Ramakrishnan R, Bhagat G, Green PH. Anemia in celiac disease is multifactorial in etiology. <em>Am J Hematol.<\/em> 2007 Nov; 82(11):996-1000.<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_21_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><li id=\"footnote_15_3306\" class=\"footnote\">Arneson JA, Gudjonsson H, Freysdottir J, Valdimarsson H. Do adults with high gliadin antibody concentrations have subclinical gluten intolerance?<em> Gut.<\/em> Feb 1992; 33(2):194-7<span class=\"footnote-back-link-wrapper\"> [<a href=\"#identifier_22_3306\" class=\"footnote-link footnote-back-link\">&#8617;<\/a>]<\/span><\/li><\/ol>","protected":false},"excerpt":{"rendered":"<p>What Is Iron? Iron is an essential mineral that is required for normal body function. Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in &#8230;<\/p>\n","protected":false},"author":7,"featured_media":6007,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[4,120,155,232,177,108,209,1682,200,176,147,179,1131,24,183,157,974,48,221,55,56,70,50,212],"tags":[1884,1839,1326,1703,1216,1841,327,452,1460,916,1906,277,400,633,1029,437,1835,319,68,1727,8,1885,1019,547,1836,1837,1707,1615,1840,545,1838,299],"class_list":["post-3306","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-conditions-2","category-blood-plasma-and-cells","category-esophagus","category-fetus","category-hair","category-iron","category-lungs","category-malabsorption-disorders","category-mind","category-minerals-3","category-mouth","category-nails","category-nutrient-deficiencies","category-nutrient-deficiency-symptoms","category-skin","category-stomach","category-symptoms","category-blood","category-female","category-immune-2","category-integumentary-2","category-pulmonary-2","category-sensory-2","category-taste-buds","tag-health-conditions-2","tag-alopecia-thin-hair","tag-angina","tag-blood-system","tag-blurry-vision","tag-defects-in-fetal-development","tag-fatigue","tag-headache","tag-inattention","tag-infertility","tag-iron","tag-iron-deficiency","tag-iron-deficiency-anemia","tag-koilonychia","tag-lightheadedness","tag-loss-of-appetite","tag-low-stomach-acid-low-plasma-proteins","tag-malabsorption","tag-minerals-2","tag-nervous","tag-nutrient-deficiency","tag-nutrient-deficiency-symptoms","tag-pallor","tag-rapid-heartbeat","tag-reduced-learning","tag-reduced-memory","tag-reproductive-system","tag-restless-leg-syndrome","tag-sensorimotor-incompetence","tag-shortness-of-breath","tag-smooth-sore-tongue","tag-vitamin-c-deficiency"],"_links":{"self":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/3306","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/comments?post=3306"}],"version-history":[{"count":43,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/3306\/revisions"}],"predecessor-version":[{"id":19170,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/posts\/3306\/revisions\/19170"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media\/6007"}],"wp:attachment":[{"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/media?parent=3306"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/categories?post=3306"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/glutenfreeworks.com\/health\/wp-json\/wp\/v2\/tags?post=3306"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}