Iron is a key mineral that helps red blood cells carry oxygen from the lungs throughout the body to all the cells and organs. This function relies on a protein called hemoglobin, of which iron is an essential element. When you have low iron, your body has trouble producing enough hemoglobin and therefore can’t maintain its red blood cell count or ability to transport oxygen and other gases. This can lead to anemia, a broad term that indicates low red blood cell levels, meaning the body will have a hard time getting enough oxygen into the bloodstream. This leads to a variety of symptoms including fatigue, shortness of breath, feeling weak, and dizziness. Anemia is even considered an extraintestinal manifestation of IBD because it is a common complication of this disease. While iron deficiency anemia is the most common anemia for IBD patients, there are many other types or causes, such as chronic inflammation, medication, or deficiencies in vitamin B12 or folate. (2)
Iron deficiency anemia comes with a host of problems for anyone, but when you have IBD, these complications can be even more worrisome. A lower quality of life and risk of increased inflammation are linked to IBD patients with iron deficiency anemia. Inflammation alone can worsen one’s ability to absorb nutrients in the gut (3), yet anemia is an often overlooked cause of this issue. With anywhere between 60% and 80% of people with IBD having iron deficiency and at least a third having anemia (4), healthy iron levels are definitely something to achieve among all patients. Iron is used up or lost everyday through menstruation and/or through the constant process of creating and repairing cells on the skin and in the gastrointestinal tract, bile ducts, and urinary tract. We maintain healthy iron levels thanks to the starting portion of the small intestine, known as the duodenum, which can absorb iron from our diet (4). However, if this region is affected by IBD, it can be difficult for iron to be absorbed. For example, if the colon is severely ulcerated (sores on the lining of the colon) from disease, blood loss can occur, which can also lead to iron deficiency (5).
Another reason for iron deficiency anemia among those with IBD is chronic blood loss due to the disease (6). Additionally, many people with IBD have surgery to remove parts of their intestines, in order to help instigate remission and reduce the amount of blood loss. However, removing parts of the intestinal tract can also affect iron absorption (7). Therefore, it’s extra important that people with IBD get enough iron to offset what they may not be absorbing or may be losing. Common ways this is done is through oral or IV iron supplementation. Oral pills are common and ideal for people with mild IBD activity, but in some cases can trigger diarrhea and abdominal pain. Importantly, inflammation can prevent proper absorption of iron from the intestines. In this case, any non-absorbed iron would go into the circulation and accumulate, which can be toxic. This can lead to worsening IBD symptoms because multiple biochemical reactions that dictate disease activity are negatively affected by high iron levels (6). This can also be toxic to the liver, so it’s critical that iron levels are tested by a health professional before starting next steps such as supplementation or a diet revamp (8).
It’s also possible that if you have iron deficiency, you’re simply not consuming enough iron. Especially with gut issues like IBD and IBS, it can be difficult to find foods that are both nutrient-dense and don’t trigger digestive symptoms. Although eating more iron-rich foods won’t be beneficial if you’re in a flare up (since inflamed intestines won’t absorb the iron well), getting enough iron on a daily basis is a must. Luckily, there’s plenty of options for food choices to help with this. For example, oysters, beans, beef and beef liver, spinach, tofu, sardines, and canned and stewed tomatoes are some great choices. There’s a myth that people who don’t eat animal products struggle with iron deficiency, but with a proper diet, you can see that foods such as beans and spinach can be part of the solution. And if you’re worried about your body’s ability to absorb iron, vitamin C is a great way to help iron be absorbed in the body, so consuming foods such as bell peppers, broccoli, berries, citrus, and tomatoes is encouraged. (8)
While there are tons of resources available to investigate iron, iron deficiency anemia, and IBD, nothing can replace seeking medical advice. If you’re concerned about your iron levels, be sure to consult a healthcare professional. To help you investigate this concern, Injoy can be used as a digital journal where you keep track of all your supplements and medications, food intake, symptoms, and more, so that your health provider has the most complete picture of your health and daily life.
You can never collect too much information in these cases, so make sure you download Injoy today!