Iron deficiency is a common complication in people with IBD. In fact, it’s so common that a recent study has shown 50% of Crohn’s and Colitis patients develop iron deficiency, and 25% develop iron deficiency anemia as a result. Iron deficiency and anemia go hand in hand, but they are not always seen together. It is possible to have iron deficiency and not have developed anemia at that point in time. Iron deficiency is caused by lack of iron and red blood cells to carry oxygen to the body. This can cause severe fatigue, dizziness, chest pain, shortness of breath, cold fingers and toes, and strange cravings like dirt, clay, or ice. This deficiency is caused most commonly in IBD patients from loss of blood, as gastrointestinal bleeding generally marks active disease.
Iron deficiency can be identified with a simple blood test. Your physician can have a blood panel done that can test for hemoglobin, or they can have a blood test done that measures a substance known as ferritin which will show if you have iron deficiency. If you are not losing blood, but have the symptoms of iron deficiency your doctor can have a FOBT, or fecal occult blood test done. This will test for chemical evidence of blood, but may need to be done multiple times as blood may not be present in every sample given. Either way, the good news is that iron deficiency is easy to test for, and can be addressed with iron pills or iron IV drip.
When treating IBD it’s important to address the root causes while also treating the complications and symptoms that can come with it. When the intestines are constantly inflamed, absorption can be poor. This is why many doctors will opt for iron infusions done by IV rather than iron pills. This way the iron is directly entered into the bloodstream making absorption immediate. This will also depend on severity of disease activity as well as where the inflammation is in the digestive tract. Interestingly enough it also may depend on if you have CD or UC. The same study referenced earlier, done in 2018, also found that those with UC more commonly had non-anemic iron deficiency while those with CD more commonly had anemic iron deficiency.
Another study, published in the Journal of Crohn’s and Colitis in 2014, found that 78% of Crohn’s patients studied had iron deficiency with ongoing inflammation. Versus 22% with ongoing inflammation and iron deficiency but no active disease. This study did show that the use of immunosuppressant medications improved iron deficiency. This is most likely by the immunosuppressant calming inflammation, allowing iron to be more easily absorbed in food and pill form. Once inflammation has been addressed there are lots of great foods that you can add to your diet that are rich in iron. Most commonly red meat is thought of for this mineral. However, some IBD patients, especially those who have an ostomy or active disease, can have a hard time digesting this greasy protein. Other foods you can incorporate with high iron include dark leafy greens, legumes, beans, and dried fruits. Now if you follow SCD, like I do, be sure to cook your beans according to the instructions in Breaking the Vicious Cycle, and only introduce legumes after considerable improvement. You can also cook leafy greens for easier digestion while still keeping all the nutrients intact.
If you have IBD and are experiencing fatigue, weakness, dizziness, shortness of breath, cold extremities, or unusual cravings I encourage you to talk to your doctor or specialist about iron deficiency. While it is something that can and needs to be addressed, iron deficiency symptoms often overlap with IBD medication side effects, or symptoms of the disease itself so it can be hard to identify unless you’re looking for it. However, getting your iron level up to optimal range can greatly increase your quality of life. If you have got your iron in check, but are still experiencing extreme fatigue, have your vitamin D and B12 levels tested too. Vitamin D and B12 anemia are common in IBD as well and can have a big impact on energy levels. No one knows your body better than you. Be your own advocate and be honest with your doctor. This will ensure the best care for you!
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