How to improve symptoms of anemia

Mariah Kay Jackson
What are my options for improving my symptoms of anemia? The supplements my doctor prescribed don’t seem to be working for me. How do other people deal with it?


Anemia is a medical condition when your red blood cells cannot properly work to carry oxygen around your body, which can cause you to be tired, weak, or short of breath. Anemia may be diagnosed as a result of not absorbing key nutrients like iron, folate, or vitamin B12. Therefore, those with a new diagnosis of celiac disease (CD) or have CD with repeated exposure to gluten and lasting symptoms should be evaluated for anemia and other nutrient deficiencies (1). It is important to know what type of anemia you have to be able to treat it effectively.

Iron-deficiency anemia is one of the most common anemias seen with celiac disease. There are three main routes of increasing iron in our bodies to help our red blood cells: food sources of iron, iron supplements, and iron infusions.

Food-Iron (2): Animal sources of iron will be best absorbed by the body over plant-sources of iron. Iron-rich animal foods include red meat (beef, pork, lamb), poultry and eggs, and seafood like clams, oysters, sardines and shrimp. Plant sources of iron include beans, spinach, and iron-fortified cereals. It is best to eat iron-rich foods with a food high in vitamin C to increase absorption. Some examples are bell peppers, citrus fruit, pineapple, broccoli, or tomatoes (like beef and veggie fajitas or black bean, tomato and spinach salad).

Iron supplements (1): Unfortunately, iron supplements are not absorbed well by the body. While taking on an empty stomach increases absorption, it may cause GI side effects. To improve absorption of iron supplements, follow these tips:

  • Take on an empty stomach or 2 hours after eating
  • Take with a serving of vitamin C, like 4-6 oz of orange juice to promote absorption
  • If taking with food, avoid taking iron pills with calcium-rich meals (milk, cheese, yogurt) or fiber-rich meals, as this decreases absorption

Iron infusions: If your doctor determines that following an iron-rich diet and oral iron supplementation are not effectively improving your iron levels, iron infusions may be warranted.

Always talk with your doctor before starting supplements to determine appropriate doses and follow up care. With continued symptoms, follow up with your doctor for other causes of anemia, including folate deficiency, vitamin B12 deficiency, or anemia of chronic disease (1).

  1. Montoro-Huguet MA, Santolaria-Piedrafita S, Cañamares-Orbis P, García-Erce JA. Iron Deficiency in Celiac Disease: Prevalence, Health Impact, and Clinical Management. Nutrients. 2021;13(10):3437. Published 2021 Sep 28. doi:10.3390/nu13103437
  2. U.S. Department of Agriculture, Agricultural Research Service. FoodData Central, 2019. Food Sources of Iron. Accessed Oct 2023.

Published November 7, 2023

Note: This information is provided by NCA and Mariah Kay Jackson, MMN, RDN, LMNT. This information is meant for educational purposes only and is not intended to substitute for personalized medical advice or replace any medical advice provided directly to you by your health care provider. No liability is assumed by the NCA or Mariah Kay Jackson, MMN, RDN, LMNT by providing this information.

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