Many patients who have digestive problems are also anemic due to low iron or low vitamin B12 levels. Being anemic and having IBS is not unusual and there is a logical reason for it.
What is Anemia?
Anemia is a common blood disorder, which is either a decreased number of red blood cells (RBCs) and/or poorly formed red blood cells. There are many different types of anemia, the most common types being iron deficiency, vitamin B12 deficiency, and folic acid deficiency anemias.
Iron, vitamin B12, and folic acid are each required to make red blood cells, which in turn carry oxygen throughout the body. Without adequate amounts of these, we can become anemic.
Anemia of any kind will cause fatigue and poor cognitive function. If you are anemic, then you will be tired because you are not delivering as much oxygen to your body as someone who is not anemic. And when you don’t get enough oxygen, you get tired and you can’t think straight.
IBS and Anemia: Not Absorbing Nutrients Properly
People with IBS and related digestive problems often have a problem properly absorbing nutrients, as discussed in a malabsorption study in the American Journal of Clinical Nutrition. They may not be aware of it, but not properly digesting food directly impacts the ability to access the nutrients in that food. This is particularly obvious with diarrhea, which is clearly a malabsorption issue. However, constipation and other digestive symptoms can also interfere with the absorption of nutrients.
This explains why it is not unusual for people with IBS to also suffer from chronic anemia. They are not absorbing all of the iron and/or vitamin B12 that is in their food. Thus, their digestive problem is leading to other problems, such as anemia.
Treating the cause of the IBS (not just the symptoms) allows the digestive tract to heal and will result in much better absorption of these nutrients, as noted by Dr. Zaidel in his research study Uninvited Guests: The Impact of Small Intestinal Bacterial Overgrowth on Nutritional Status. It will also result in much better absorption of other nutrients, such as vitamin D, and others that are not so commonly measured.
The end result will be that you not only solve your digestive problems, but you also solve your anemia. Ultimately, you are much healthier and happier.
Testing for Anemia
Iron deficiency anemia shows up on your complete blood count (CBC) test as a low red blood cell (RBC) count, low hematocrit (Hct), or low hemoglobin (Hgb). B12 and folic acid deficiency anemias show up as unusually large red blood cells on your CBC.
Long before your CBC is affected, however, low iron status will show up if ferritin is measured. This is a simple blood test. Ferritin is a protein complex that contains iron and is the form in which iron is stored in the tissues of the body, particularly the liver, spleen, and bone marrow.
Ferritin decreases long before iron deficiency anemia shows up on your CBC. Therefore, measuring ferritin is the optimal way to determine your actual iron status. It also takes much longer to increase your ferritin (iron stores) to a strong level than it does to correct your anemia.
A satisfactory ferritin level is generally over 50 and not much higher than 200. A ferritin level of less than 30 indicates iron deficiency, and less than 18 can indicate absent iron stores. If you do not adequately raise your ferritin level, then you are much more susceptible to repeatedly becoming anemic and may have difficulty breaking out of a cycle of frequent anemia.
On the opposite end of iron deficiency anemia, it’s also possible to have too much iron. A high ferritin level may indicate the need for further testing in order to rule out iron overload.
It is not unusual for people to report that they have been told that they are borderline anemic. In most cases, they were not told to treat it. What you should know is that borderline anemia means that something is wrong, and it can be treated. If you have been told that you are borderline anemic, then you have a less than optimal blood test and may be suffering symptoms because of it.
Correcting an iron deficiency will help you to feel much better. If you are borderline anemic and it is due to an iron deficiency, then your iron stores will be very low. Have them checked with a ferritin blood test.
Eating foods rich in iron, vitamin B12, and folic acid, and taking iron, vitamin B12, or folic acid supplements, as indicated can help treat the anemia, but it will not fix the underlying cause of the anemia. Absorption issues might be at the root of the problem.
If your digestive system is not properly processing what you eat and drink, you can still have anemia and other symptoms of poor nutrition, even if you have a good diet. This means you won’t be able to permanently address your anemia with diet or supplements.
If you have been told that you are anemic (or borderline anemic) or have been told you can’t give blood because your iron level is too low, consult a doctor. If your doctor can’t give you a definitive reason why then start to suspect that the issue may be due to the malabsorption of nutrients. You can have this problem whether or not you are at a healthy weight, are very thin, or are carrying extra weight.
If your anemia is due to a B12 deficiency, then taking vitamin B12 will correct the anemia. Your doctor may prescribe B12 injections, which will improve the treatment and vastly increase the amount of B12 getting into your body. Vitamin B12 is also stored in the body, but its stores are unfortunately not so easy to measure.
If iron deficiency is the cause of your anemia, then your doctor will probably tell you to take iron supplements. However, not all supplements are the same, and this is especially true for iron.
Many people have trouble absorbing and tolerating iron supplements. It’s common for patients to complain that iron is causing constipation, abdominal pain, nausea, or diarrhea. These patients complaints are supported by this “Tolerability of Iron” medical study.
Much of this is due to the type of iron being taken. There are many kinds of low-quality iron supplements, such as iron oxide and iron sulfate. These are more likely to cause absorption problems and the side effects already mentioned.
High-quality iron comes in the form of iron picolinate, iron glycinate, or iron citrate, which are much better absorbed and are generally tolerated much better than low-quality forms of iron. Liquid iron and time release iron capsules are also less likely to cause digestive upset.
Another way to help your body better absorb iron is to take about 200 mg of vitamin C with each dose of iron. This has been shown in many medical studies, such as ”The Role of Vitamin C in Iron Absorption” study. It is also wise to include folic acid and vitamin B12 in your iron supplement, because these nutrients are also required to form red blood cells (RBCs).
At the IBS Treatment Center, we often recommend Ferrasorb which is a highly absorb-able and well-balanced formula for the major nutrient deficiencies that cause anemia. It includes iron, folic acid, and vitamin B12. Ferrasorb contains a high-quality form of iron, and is often tolerated well by patients who do not tolerate other iron supplements.
If you have one of these types of anemia on your complete blood count (CBC) test, they will generally respond fairly rapidly (within a month) with the proper supplementation. However, it has been seen clinically that it can take 6-12 months to increase iron stores (ferritin) to an adequate level, depending upon how iron deficient you are. Therefore, it is important to continue to take iron until you have raised your ferritin level to a satisfactory level, even though your CBC may be normal.
If you are anemic and you take iron only long enough to correct the anemia, you likely have not built up your iron stores enough to last for very long. Because of that, you are much more likely to become anemic again in the near future, which of course will cause you to be fatigued. Checking your ferritin level will help you to know if you are sufficiently building up your iron stores and can help you avoid becoming anemic again.
Dangers of Iron Supplementation
Too little iron can cause fatigue, but too much iron can be toxic. Many studies have proven this, such as this “Mechanisms of Iron Loading and Toxicity” study by the American Journal of Hematology. Never take iron unless blood tests demonstrate you are iron deficient. Excess iron can cause symptoms similar to iron deficiency and can be very toxic, leading to liver damage.
It is important to monitor your iron supplementation with follow-up blood tests to check your CBC and your ferritin. This is necessary to determine that the treatment is working, that you reach an adequate ferritin level, and that you do not take excess iron.
At the IBS Treatment Center, we often see patients who are iron deficient and enjoy working with them to correct the deficiency on multiple levels. This includes working with them to find the proper supplementation, evaluating and improving their diet, and correcting underlying digestive problems that may be inhibiting the absorption of the nutrients required to form red blood cells (RBCs). If you suffer from chronic anemia, please give us a call.