McCall McPhersonFounder, Modern Thyroid Clinic.

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10 Aug 2026 · 2 min

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2:27

In this short conversational video, McCall McPherson and a co‑speaker discuss a speculative evolutionary link between celiac disease, chronic iron deficiency, and the high‑iron condition hemochromatosis. They explain that celiac disease damages intestinal villi, reducing iron absorption and leading to iron‑deficiency anemia, while hemochromatosis does the opposite by increasing iron uptake. Both conditions are noted to be unusually common in people of Irish descent. The speakers attribute this prevalence to a founder effect and historical inbreeding on the island, amplified by the Great Irish Famine (1845‑1852). They argue that during the famine, individuals with better iron‑absorption capacity (hemochromatosis carriers) were more likely to survive, while those with celiac‑related low iron were at a disadvantage. Conversely, the later recognition of celiac disease may have been spurred by the same famine conditions. The dialogue frames these observations as an evolutionary trade‑off: the celiac gene may have conferred some infection‑resistance benefits, but in a modern gluten‑rich environment it becomes harmful, whereas the hemochromatosis gene offers protection against iron deficiency. The speakers treat the hypothesis as intriguing but acknowledge it remains speculative.

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So one way in medicine that celiac is often potentially flagged for a workup is chronic iron deficiency. So why? Because they're not able to absorb iron because the little hairs on our intestine get eroded away that are responsible for largely our nutrient absorption. So it decreases that surface area, minimizing and reducing our access to absorbing nutrients that we need to function every day. But I almost wonder if in the evolution of us and our genes, if that was a compensatory mechanism. So celiac people have low iron genetically. Now let's layer into high iron because they're— they center and origin from the same population. So celiacs originated in Ireland. It sounds the same for hemochromatosis, which is wild.
That's really interesting. I've thought about that. I think there's something to that. And I don't know that they both originated in Ireland, but they both became very common in Ireland because they came there early. Those genes came there early, and then it's an island, and so they It's very inbred. And then the Great Famine in Ireland caused a large number of people to die. Like 8 million people lived in Ireland before the Great Famine, and then also known as the Potato Famine. And then a million people died from the famine. And then 1.5 million people left. And most of them came to America. After the Great Famine, there was this explosion of hemochromatosis because the people who survived were the people who could absorb iron better. Because when you're going through a famine, you don't have food. Period. So interestingly enough, it was also a famine that led to the diagnosis of the celiac disease, but we'll save that for another day. But so I think you're right about them living in the same population and like the celiac gene. So celiac is also a genetic disease. 99% of people with celiac have a celiac gene and the celiac gene, it causes you to have an overactive immune system and to go after gluten, but it also prevents you from dying of infections. So yes, like there's this balance. Okay. May not die of an infection, but if I live I live in a world with too much gluten, then I could die of celiac disease or develop celiac disease, but it's not that big of a deal because now I have the hemochromatosis gene to help me absorb more iron. So I'm less likely to die of iron deficient anemia. This is the evolutionary questions that definitely this happened in some people at some point in time.
So interesting. It really is.