Iron Supplements
February 15, 2005 10:53 AM   Subscribe

My 11 yr old has iron deficient anemia related to colitis. I have been giving him a liquid iron supplement but it makes him feel nauseous. I have also tried pills - same result. I've tried administering multiple small doses - same result. Diet is as iron rich as I can make it. Does anytone have any suggestions as to how to increase his iron intake without this annoying (and uncomfortable) side effect?
posted by Neiltupper to Health & Fitness (26 answers total) 3 users marked this as a favorite
This is so obvious I kind of hate to say it, but just in case... have you tried giving him the iron supplement with food? If I take a vitamin containing iron on an empty stomach, it comes right back up.
posted by orange swan at 10:57 AM on February 15, 2005

I'm 29, and I experience a short period of intense nausea after taking any iron pill or adult multivitamin. My doctor told me to try Flintstones or any other chewable children's multi. It works for me, and the ones I take have 100% RDA for iron. If your son needs extra iron, I suppose you could ask a doctor if taking two or more would be OK.
posted by peep at 11:05 AM on February 15, 2005

Cooking in cast iron will add a small amount of dietary iron to the food. It's most effective with acidic foods though, and I'm not sure if that would do the colitis any favors. And of course, enameled cast iron won't do the trick.

You also might research what foods hinder and help iron absorption--it's possible that you could reconfigure his diet to maximize the amount of iron he's processing.
posted by padraigin at 11:06 AM on February 15, 2005

Also, you already mentioned diet, but I just wanted to comment that if he likes it, Malt-O-Meal is surprisingly high in iron - 40 to 60% RDA.
posted by peep at 11:08 AM on February 15, 2005

When I was pregnant, I had chewy iron supplement tabs. They were semi-chocolatey (but not real chocolate). Unfortunately, I don't remember the brand, but they were the only thing that kept me from hurling when taking iron. I picked them up non-prescription at the pharmacy.
posted by Gucky at 11:12 AM on February 15, 2005

Well, my doctor gives a lot of nutritional supplements intravenously, but I doubt you or your son would consider a needle in the arm to be an improvement over your current situation.

Another method would be to put the iron supplement in a clear gelatin capsule (GNC or your local health food store probably sell these). This will slow down the absorption/digestion process and might reduce the nausea.
posted by Clay201 at 11:15 AM on February 15, 2005

I also went through the iron pill regiment in high school, but dropped it quickly as the iron always made me constipated, which I couldn't deal with. I did also hear about using the cast-iron skillet to aid in iron absorption, but those skillets get awful grimy and are so antiquated.

Anyway, quick google of "iron absorption" yields on the third hit: "Consuming vitamin C along with iron-rich foods is one way to improve iron absorption."
posted by naxosaxur at 11:24 AM on February 15, 2005

Ask your doctor about Erythropoietin. Erythropoietin is given to patients suffering from anemia to stimulate the production of red blood cells.

Iron is only going to help if it is the CAUSE of the anemia.
posted by spock at 11:26 AM on February 15, 2005

See: this New England Journal of Medicine article
which states as its "Conclusions":
In patients with inflammatory bowel disease and anemia refractory to treatment with iron and vitamins, treatment with oral iron and recombinant erythropoietin can raise hemoglobin levels.

More Google search results from using the terms: iron anemia Erythropoietin colitis
posted by spock at 11:33 AM on February 15, 2005

NOTE: I'm not a doctor, but I am the Science officer on a Constitution-class starship.
<hee hee>
posted by spock at 11:38 AM on February 15, 2005 [1 favorite]

I did also hear about using the cast-iron skillet to aid in iron absorption, but those skillets get awful grimy and are so antiquated.

Not at all. They get awful seasoned, and for some types of cooking, they've yet to be improved upon.
posted by padraigin at 2:13 PM on February 15, 2005

padraigin's right. There's nothing wrong with properly seasoned cast-iron.

BTW, an old folk remedy for anemia is boiling rusty iron nails and drinking the water. I'm not sure what goes into the manufacturing process of nails these days, though.

But I think they gave bonus points if the nails were boiled in an iron kettle ;-)
posted by Shane at 2:41 PM on February 15, 2005

Er, what's wrong with also eating a lot of meat and other iron-rich foods? I had a type of hemolytic anemia in my childhood and we ended up eating steak and hamburgers for dinner something like five times a week. It's not ideal for an adult, but for a growing kid, that shouldn't be a problem.
posted by Asparagirl at 2:59 PM on February 15, 2005

Liver. Yes. Liver.
posted by zaelic at 3:09 PM on February 15, 2005

I intern at a free clinic - with kids diagnosed with low Hg levels, we (1) give iron supplements and advise patients to take the supplement with orange juice, because low pH leads to better absorption of iron. (2) See if family is giving child proper nutrition (3) check for cases of anemia caused by genetics (4) keep track of patient's case in case of blood cancers, but they are very rare.

Also, check with the doctor about the venous Hg test (as opposed to the capillary Hg test). We've had a case where a child had perfectly normal Hg levels overall, but always tested as severely anemic according to the cappilary Hg test.
posted by alex3005 at 3:29 PM on February 15, 2005

Er, what's wrong with also eating a lot of meat and other iron-rich foods?

Nothing, but the poster wants to know about strategies for when diet isn't enough. Gucky, were these the tablets you used?
posted by redfoxtail at 3:34 PM on February 15, 2005

I've lived with Crohn's Disease (an illness in the same medical family as colitis) for over a decade now and I take a multivitamin + iron tablet twice a day. That seems to do it for me. I should note that these are Shaklee brand vitamins, and although they are not cheap by any means they get the job done.
posted by Servo5678 at 3:43 PM on February 15, 2005

If you can get it, Deer meat is the one of the best sources of Iron in the diet.
Some people only have IBD symptoms when they TAKE an iron supplement (food is ok)
posted by Charles the Friend at 4:23 PM on February 15, 2005

Yep, redfoxtail. Not sure on the brand, but it sounds just like 'em.
posted by Gucky at 4:26 PM on February 15, 2005

I have ulcerative colitis and agree with servo5678 on combining the iron with other multivitamins. Also, watch out for iron toxicity, especially in children. A while ago my doctor had overcompensated a ridiculous amount for my anemia and I had only needed a third of what I was taking. Talk to your doctor and see if a lower dose is appropriate.
posted by Saucy Intruder at 4:28 PM on February 15, 2005

What formulations of iron have you tried? Ferrous sulfate is the most common and least expensive, but it's also the most prone to throw the digestive tract out of whack (which is not really ideal for someone who is already battling colitis). Ferrous fumarate is better tolerated by most people, including myself.
posted by Galvatron at 4:52 PM on February 15, 2005

Galvatron's right, ferrous fumarate is what I tend to move to when patients can't tolerate ferrous sulfate or ferrous gluconate. And all the comments about taking iron with acidic liquids are also right on the money; I've been able to peel back to half or a quarter of the total dose of elemental iron when patients make sure to take that half or quarter dose with orange juice.

Spock, I'm assuming that you know this from the article you cited, but to explain: just as iron alone doesn't always help anemia, erythropoietin alone will never work when chronic blood loss is the cause of anemia. The easiest way to think of it is that the body needs three things in order to make red blood cells: iron, protein, and erythropoietin (the hormone that stimulates the production of RBCs). Because of how important it is, the body has unbelievable ways of scavenging and recycling iron, but the one thing the body can't do is prevent the loss of iron when it's inside red blood cells that are lost. So you're right, that iron loss isn't the sole cause of the anemia (the blood loss itself is the cause of the anemia), but the iron is lost nonetheless, and it needs to be replaced somehow!

Lastly, Clay201, you're right -- IV iron (called iron dextran) is a good alternative when oral iron doesn't work or can't be tolerated. It carries with it a small but real risk of anaphylaxis, though, so it should always be done in an observed setting, and one in which there are people who are competent in running an arrest if need be. At my institution, patients need to get a miniscule test dose of iron dextran with an ACLS- or PALS-certified practitioner sitting at the bedside, and only if there aren't problems can they get the remainder of the iron.
posted by delfuego at 6:02 PM on February 15, 2005 [1 favorite]

I read about iron sprinkles in the paper a few weeks ago: Lipid-coated iron powder that you add to food. It's supposedly tasteless. It is intended for infants in the developing world, but according to the Supplefor FAQ, it is effective for older children. Unfortunately, it's not yet commercially available, but it looks like the Toronto Sick Kids Hospital will be selling it in the near future.
posted by teg at 8:55 PM on February 15, 2005

Molasses is pretty high in iron, if you can find a way to get it down the kid. Pecan pie is great, but incredibly high in calories.
posted by unrepentanthippie at 5:20 AM on February 16, 2005

I'm pregnant, so iron level is an issue for me right now.

I eat Cream of Wheat nearly every day for breakfast. One serving contains 45% RDA for an adult, which is a huge shot of iron right there.

I also take Floradix as a supplement twice a day. Don't know if this is the liquid supplement you mentioned having already had problems with. I *always* take it with meals (usually right before) because iron is notorious for nauseating on an empty stomach. The good thing about Floradix as opposed to normal, tablet-form iron supplements is that it does not constipate and is purely vegetable based.
posted by melixxa600 at 5:44 PM on February 17, 2005

The molasses sold in the typical store is not fit for humans -
it is the dregs of real molasses after all the sugar is removed.
Get foamy molasses - taste some before you buy it -
it should taste like strong honey.
Try some on the cream of wheat (instead of syrup) for even more iron.
You should probably take extra antioxidants
if you take Iron supplements. (IANAD)
posted by Charles the Friend at 10:11 PM on February 22, 2005

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