This Academy member benefit temporarily has been made public to allow all practitioners access to content that may assist in patient care during the national pandemic response. Click here for information on joining the Academy. 

Quick Links

Recommendations Summary

CD: Iron Supplementation for Iron Deficiency Anemia 2009

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

  • Recommendation(s)

    CD: Iron Supplementation for Iron Deficiency Anemia

    For individuals with iron deficiency anemia and celiac disease, the registered dietitian (RD) should advise the consumption of a daily gluten-free multivitamin with iron or additional individualized therapeutic doses of iron. Studies report that iron supplementation may be necessary to achieve normal values of hematological parameters. 

    Rating: Strong

    • Risks/Harms of Implementing This Recommendation

      Consumption of iron beyond the UL may result in hemochromatosis.

    • Conditions of Application

      • This recommendation applies to individuals with iron deficiency anemia and celiac disease
      • Refer to the recommendation on Provide Resources and Education on Label Reading available at

    • Potential Costs Associated with Application

      Although costs of medical nutrition therapy (MNT) sessions and reimbursement vary, MNT sessions are essential for improved outcomes.

    • Recommendation Narrative

      • For most children and adults with celiac disease, studies report that compliance with a gluten-free dietary pattern results in significant improvements in hematological parameters including serum hemoglobin, iron, ferritin, mean corpuscular volume, mean corpuscular hemoglobin and red cell distribution width (Rea et al, 1996; Annibale et al, 2001; Mitchell and Robinson, 2002; Kapur et al, 2003; Patwari et al, 2003; O'Leary et al, 2004; Rashid et al, 2005; Masjedizadeh et al, 2006; Poddar et al, 2006)
      • Recovery of anemia (normalization of hemoglobin concentrations) generally occurs within six months, while recovery from iron deficiency (normalization of ferritin concentrations) may take longer than one year
      • Iron supplementation in the form of a multivitamin with iron or additional therapeutic doses of iron may be necessary to achieve normal values of these hematological variables within these time periods. 

    • Recommendation Strength Rationale

      Conclusion statement received Grade II.

    • Minority Opinions

      Consensus reached.