Introduction
Good nutrition is always important, but it is especially important when you have inflammatory bowel disease (IBD).
Maintaining adequate nutrition is one of the ways that your body can restore itself to health.
This can be a challenge when your IBD symptoms affect both your appetite and your ability to absorb nutrients from the food you eat.
This newsletter will focus on iron, which is one of the most common nutrient deficiencies seen in people with IBD.
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Why is iron important?
Iron is an important part of hemoglobin, which is the part of the red blood cell that supplies your body with oxygen.
Too little iron can result in iron deficiency, which in turn can lead to iron deficiency anemia.
Iron deficiency anemia means that your hemoglobin level is lower than normal due to a lack of enough iron.
About 45% of people with IBD are iron deficient, and at least 18% of people with IBD have anemia, with some estimates as high as 42%.
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Why are people with IBD at increased risk of iron deficiency?
There are several reasons why you may be at increased risk for iron deficiency if you have IBD.
You may find that iron-rich foods are difficult to tolerate or are no longer palatable.
Your body may also have difficulty absorbing iron from foods, due to the inflammation and diarrhea that can accompany IBD.
Finally, you may experience iron loss due to chronic intestinal bleeding.
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What are the symptoms of iron deficiency?
Symptoms of iron deficiency can include fatigue, pale skin, hair loss, irritability, weakness, and brittle or grooved nails.
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How are anemia and iron deficiency diagnosed?
Anemia can be diagnosed using a simple blood test to check your hemoglobin level.
A hemoglobin level below 13.0 g/dL in men or below 12.0 g/dL in women with IBD typically indicates the presence of iron deficiency anemia,
which can then be further categorized as mild, moderate, or severe.
If you are have a low hemoglobin level, you will likely need more tests to determine the cause of the anemia and the most appropriate treatment.
Keep in mind that not all anemia is caused by iron deficiency - there may be other reasons for low hemoglobin.
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What can I eat to help prevent and treat iron deficiency?
The general recommended dietary allowance of iron is 18 mg per day.
General dietary guidelines are based on a normal sized adult person without significant health issues.
Recommended dietary allowances of many nutrients may be different for people with illnesses like IBD and can also vary between males and females.
Beef and meat from other animals are the best sources of dietary iron, in terms of iron content and ease of absorption.
A good rule of thumb is that the darker the meat, the higher the iron content.
For example, a serving of beef liver provides more iron than a serving of ground beef (7.5 mg. vs. 3.9 mg.),
and a serving of pork chop provides more iron than a serving of chicken breast (3.5 mg. vs. 0.9 mg.).
Other good sources of iron include egg yolks; prunes and prune juice; other dried fruits (e.g., raisins, apricots, and peaches);
beans and nuts; iron-fortified bread, cereal, or pasta; and dark, leafy green vegetables.
You can check a food’s Nutrition Facts label to see how much iron you will get in one serving.
Look for foods that provide at least 20% of the daily value (DV) for iron.
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Are there other ways I can boost my iron intake?
In addition to eating iron-rich foods, there are other things you can do to get more iron in your diet.
For example, foods that are rich in vitamin C (citrus fruits and juices, strawberries, and tomatoes)
enhance iron absorption from non-meat sources of iron, so try eating both in the same meal.
Conversely, foods that are high in calcium or fiber can make it more difficult for your body to absorb iron.
This doesn’t mean that you have to give up calcium- and fiber-rich foods, just be sure to eat them as part of meals that do not also contain iron-rich foods.
Also try limiting coffee, tea, and soda, all of which interfere with iron absorption.
Finally, if you use cast iron pots and pans, the food you cook will absorb iron from your cookware.
This works best with acidic foods, like tomatoes and tomato-based sauces.
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What about iron supplements?
Iron supplementation can be a way to increase your iron intake if you are not getting enough from the foods you eat.
Iron supplements typically come in tablet form, although if you have severe iron deficiency anemia or serious side
effects with oral iron supplements, intravenous (IV) iron replacement may be necessary.
The best oral iron supplements contain ferrous sulfate, ferrous gluconate, or ferrous fumerate, so check for those on the ingredient label.
If you find that iron supplements upset your stomach or cause constipation, try taking a slow-release form (look for “slow Fe” or “slow iron” on the label).
Dark stools can be another side effect when taking iron supplements. If you are also taking a calcium supplement,
be sure to do so at a different time of day, since calcium can interfere with iron absorption.
Always be sure to check with your health care provider before taking any new medication or supplement.
Unlike many other supplements, iron overdose is very dangerous. Never take a double dose to make up for a missed dose,
and keep your supplements out of easy reach. As few as three adult iron tablets can be fatal to a child.
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Conclusion
Even though iron deficiency can be a common complication of IBD, it is easily treatable.
The appropriate treatment can have a significant impact on your quality of life.
In fact, research has shown that treating iron deficiency anemia may improve the course of IBD.
Keep in mind that anemia can gradually progress over a long period of time and may not be noticeable until
it is relatively severe, so be sure to talk to your health care provider if you think you are at risk.
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