pumping iron

September 5, 2008 6:33 PM

Looking for suggestions on how to treat iron deficiency anemia secondary to Crohn's Disease. Problem: Iron supplements make me constipated, and last time it got so bad I wound up in hospital. Any suggestions on how to get iron without getting 'blocked up'? I need to take in a lot of iron -fast-

I'm a 24 year old female with Crohn's Disease, and in the last two months my hemoglobin dropped from ten grams to nine. If this keeps up they'll have to give me transfusions by November, and I'd really like to avoid that.

I've tried over the counter iron supplements, and find that those cause an upset stomach and constipation. I was prescribed Repliva, which I hear is supposed to be easier, but after a month on that my intestines stopped moving anything at all and I wound up in the hospital for four days. Because I'm constipated already in general, and taking Miralax (a laxative) every other day to keep regular enough, I'm afraid that adding iron will make things even worse.

Side note: I do eat a fair bit of meat, as well as spinach in an effort to up my iron levels, and I absolutely cannot eat beans, even if they are full of iron (texture is too wrong). While I'm up for dietary suggestions, I'm afraid a steady diet of hamburgers is not the solution.

I'd really love to hear about any liquid supplements, pills or creative solutions that people have found that work, especially if you've had similar problems in the past. Thanks for your suggestions!

posted by gilsonal to health & fitness (19 comments total)

When my mother had anemia, she ate liver (beef) every day. Beef liver and chicken livers are just loaded with iron. Fry it up with bacon, onion, slap some mustard on it. Wonderful stuff!! Won't be a complete solution, but it's a start.
posted by pushing paper and bottoming chairs at 6:44 PM on September 5, 2008

Can take the iron and you supplement with natural fiber, with something like psyllium husks? It is a pretty incredible source of fiber that helps keep things moving. It is very different than chemical laxitives.
posted by procrastination at 7:05 PM on September 5, 2008 [1 favorite has favorites]

What kind of iron supplements were you taking, and how much?

I ask because when you take iron supplements, more is not better. If you are not taking the proper vitamins and whatnot that help aid the absorption of the iron, you will end up needing to take an awful lot more iron than is necessary and this can lead to the constipation issue.

If you are up for it, I would heartily recommend trying Hemaplex. It is a multivitamin that has a moderate amount of iron in it, but craploads of Vitamin C and B-vitamins and other stuff that aids comfortable absorption of the iron. When I had low iron levels I tried loads and loads of plain iron supplements, and took three times the amount of iron that's in those Hemaplex tablets and got nowhere. A Red Cross nurse recommended I try Hemaplex, and after a week I was back to normal levels. I sound like a shill, but man, these things work and I didn't get any of the side-effects I got from plain iron tablets.
posted by schroedinger at 7:17 PM on September 5, 2008

Sherry at What Did You Eat posted a regrettably brief series of iron-rich dishes. The series was sadly cut short by her recent death (from causes apparently unrelated to her anemia, by the way). Admittedly, the top recipe is for a burger, but there are several inventive and delicious dishes there to start with.

I'll chip in with my own iron-rich recipe for a slapdash open-faced sandwich (call it a tartine if you wanna be fancy): The Iron Maiden, chicken liver mousse and watercress on flatbread. (self-link).

In that entry I mention that (as far as I've been able to find out) watercress contains a good dose of iron but also contains much less of the oxalic acid than a similar serving of spinach or chard. Oxalic acid (also as far as I've been able to find out) prevents your body from properly absorbing the iron. I'm no nutritionist, and perhaps one will come along to correct me.

Have you considered Floradix, a liquid iron supplement? Like you, I cannot tolerate the side effects of iron supplements in tablet form, but I found Floradix easy to tolerate. Obviously, you'd want to research it yourself and speak to your doctor. Some people find the taste dreadful, so they ice it or mix it with orange juice; I didn't mind it straight.
posted by Elsa at 7:19 PM on September 5, 2008

Ahem. This may not result in anything you can implement before November, but have you talked with your doctor (primary care, gynecologist, or anyone else) about your period and the heaviness thereof? I have CFS and a couple of years ago I had very low iron and like you, had to take supplements to avoid transfusions (sorry, this was in Switzerland, otherwise I'd try and track down the name). Around the same time I had my usual gyno check-up, and it came out that I had reaaaally heavy flow, which my doctor thought might be contributing to the iron deficiency - menstruation is a major loss of iron for women, because of the haemoglobin. Anyway, the solution for me was to tweak my birth control from something that wasn't helping with blood flow to something that encouraged lighter flow, and once my iron was back up to normal levels, I didn't have any more problems and could stop taking supplements.

I realize that doesn't solve your immediate problem, and given the Crohn's it may not be relevant; I just thought I'd mention it!
posted by bettafish at 7:27 PM on September 5, 2008

Incidentally, if you do try to increase the iron in your diet, keep in mind that mollusks are remarkably high in iron. If you eat shellfish, this is a happy fact, since there are so many healthy ways to prepare them. Don't miss this thread that suggests some simple changes for a leftover batch of simple moules mariniere.
posted by Elsa at 7:33 PM on September 5, 2008

I have struggled with simple iron deficiency anemia due to excessive blood loss for several years, so I don't know if my experience will apply to your situation, but I hope I can help.

Because of the constipation from iron supplements, I started searching the web for alternatives and found a forum where Proferrin ES from Colorado Biolabs was recommended by kidney dialysis patients. They said their doctors were skeptical or worse about Proferrin ES, but eventually they had to admit that it worked. For me, it works better than other iron supplements I've tried and with zero side effects.

Virtually all iron supplements are non-HEME, which means they come from non-animal sources. In other words, they're processed from the metal or the ore. But Proferrin ES are HEME iron - they come from animals. That form of iron is supposed to be much more readily absorbed. You can get more information from the company (http://proferrin.com/).

I've been using these supplements for a couple of years.
posted by onemorething at 7:34 PM on September 5, 2008

Oxalic acid (also as far as I've been able to find out) prevents your body from properly absorbing the iron.

I'm not a nutritionaist but a physiologist/biochemist who has studied both iron absorption and IBD (not at the same time) and you are correct. Oxalic acid (and tannins, phytates and other divalent metals) block iron absorption.

If you are up for it, I would heartily recommend trying Hemaplex. It is a multivitamin that has a moderate amount of iron in it, but craploads of Vitamin C and B-vitamins and other stuff that aids comfortable absorption of the iron.

Vitamin C definitely does increase iron absorption and is necessary. B vitamins, however, don't do anything either way and Calcium and Manganese both definitely block iron absorption and are included in this mixture. I often see iron supplements containing things specifically counter-indicated in iron absorption and it boggles my mind. In general simple is better for an iron supplement.

However you (the OP) have Crohn's Disease. "In general" isn't really relevant here as it's a messy individualised disease that will be affecting both your iron absorption and overall digestion in lots of ways. I don't think any of us can predict how you're going to be affected by different supplements or other dietary changes, and doing things like adding soluble fibre to your diet can be potentially dangerous for a CD patient. onemorething is correct in that heme iron is better absorbed and less likely to cause constipation etc than non-heme and this is why it's generally better to get iron from your natural diet rather than supplements. But this would mean finding iron rich meats which you can tolerate in fairly high quantities, and I know that can be difficult.

I really think you should be talking with an actual nutritionist who has experience with IBD and knows your case. They will be able to help you with overall nutritional support as well as this specific ongoing problem, and should be able to help with supplements and other diet changes as well as just advising you how to get more iron in your food. Another thing to ask your doctor about are intramuscular iron injections, I know they're possible in some circumstances but not which circumstances (or if it's even a good idea). If you can get your levels back up then hopefully changes in diet etc may be enough. Either way, this is too complicated for unqualified strangers, you should be working with a medical professional.
posted by shelleycat at 9:10 PM on September 5, 2008

I can't help much with what to do in the short term since I have always believed that it may be dangerous to self-prescribe too much iron as a supplement. If it was me, I would consult a naturopath just to be sure. If I feel slightly anemic, I supplement with synergy powder.
In terms of long term eating habits, though, one way I sneak iron into my diet is via roasted pumpkin seeds or seaweed, or both. I'm addicted to Korean 'snack' seaweed. You can usually find it in Chinese, Asian, or import stores sold in individually wrapped packages of three. I like just salty, but sometimes you can find flavoured as well. You can sprinkle either seaweed or roasted pumpkin seeds on a dish to boost the iron content considerably. I believe that either clams or mussels are also huge sources of iron. Hope that helps.
posted by OlivesAndTurkishCoffee at 9:21 PM on September 5, 2008

You might want to talk to your doctor about whether an intravenous formulation of iron might be appropriate for you. These are now increasingly used for the treatment of iron deficiency when oral supplementation is considered ineffective or inappropriate, as may be the case for you.
posted by drpynchon at 9:26 PM on September 5, 2008

I am seconding talking with a nutritionist for your particular situation.
That said, you mentioned having tried over the counter iron supplements. This might be too obvious, because I haven't seen anyone point it out yet, but OTC iron supplements are not created equal and some are easier on the digestive system. For example, ferrous iron is more easily absorbed than ferric iron, and ferrous gluconate is more easily absorbed than ferrous sulfate. I'd been walking around either uncomfortable or iron deficient for years before figuring this out the hard way.
posted by boy detective at 9:31 PM on September 5, 2008

Here is a news report about a study suggesting caution in treating anemia in individuals with inflammatory diseases:

Anemia Of Chronic Disease: An Adaptive Response?

ScienceDaily (Aug. 12, 2008) — The anemia of chronic disease may be a beneficial, adaptive response to the underlying disease, rather than a negative effect of the illness, postulates an analysis article in CMAJ.

The authors argue that anemia may be beneficial to patients with inflammatory disease, and advocate restraint in treating mild to moderate forms of anemia. ...
posted by jamjam at 10:07 PM on September 5, 2008

I was looking for a "quick" solution as well, and ended up on an 8 week iron transfusion series. Which was not to bad AFTER they got the PICC line installed. It was horrible getting it in, but I would do it again if I ever needed the transfusions again. My levels went from 9 to 98 in 8 weeks, however...about 3 months later my levels are at half of that (52) so I dont know. I have had more internal scopes than believable and they still can not find the source of the loss...so now on to more drastic measures...fun times. Its seems for something as elemental as iron, if you are unable to take the pills or the pills do nothing for you (both in my case) there is not a "quick fix", and for me, the iron transfusions only put a band-aid on the problem.
posted by Jenny is Crafty at 10:10 PM on September 5, 2008

I had the same problem. For years. I tried everything.

They finally just gave up and gave me an iron infusion. Nothin' to it, but a big bill for the insurance and a couple of hours trying to read without disconnecting the line.

They should have done it twenty years ago. So yeah, seconding drpynchon's suggestion.
posted by tejolote at 11:47 PM on September 5, 2008

Side note: I do eat a fair bit of meat, as well as spinach in an effort to up my iron levels, and I absolutely cannot eat beans, even if they are full of iron (texture is too wrong). While I'm up for dietary suggestions, I'm afraid a steady diet of hamburgers is not the solution.


Leafier, greener leafy greens have a lot more iron than spinach --- try kale especially. You can make it just as you would make spinach -- just steamed/sauteed/roasted a little longer. And drink the juice left over if you steam it. It's a fiber-rich source of iron so it can help with your constipation as well. Local and/or organic is best. A lot of the food we eat is grown in nutrient-depleted soil --- we aren't getting what we need from our food.

And definitely talk with a nutritionist as others have said.
posted by headnsouth at 3:13 AM on September 6, 2008

In my case, my GI guy has suggested that my anemia might partly due to the Crohn's not being fully under control and is therefore a slow leak. What does your GI guy say? In particular, I'd wonder what he says about managing your constipation.

Shellfish can be high residue - great source of iron, but it can wreck me.
posted by plinth at 4:49 AM on September 6, 2008

I think that eating raisins might be an easy way to increase your iron intake. Wikipedia says that raisins contain a lot of iron.
posted by taojones at 5:51 AM on September 6, 2008

Fellow Crohnie here. I really recommend talking to your GI. S/he should have run into this problem before. I know from my own experience that trying to solve a problem like this on my own can range from dangerous to just painful.
posted by acoutu at 8:45 AM on September 6, 2008

Thanks for all the great suggestions so far! I have been talking to my GI about this, and he's aware of my problems with constipation and recommended the Miralax to counteract it. He thinks it is likely due to loss from bleeding rather than malabsorption, so we were considering putting me on birth control that would put me with four rather than twelve periods.

I've been suggesting transfusions or injections since that would bypass the GI absorption, but he's concerned about possible side effects, I guess heart attacks happen rarely? I think I might need to be more assertive about the possibility of iv iron, and then look to supplements and dietary stuff in the future to keep the levels up. Can you really have an iron of 98? I've always had 12 or lower!
posted by gilsonal at 9:25 AM on September 6, 2008