How Is Anemia Treated With Iron Supplementation
Patients diagnosed with anemia caused by IBD can often benefit from taking iron supplements.1 The goal of iron supplementation is to reduce the symptoms associated with iron-deficiency anemia and improve the patients overall quality of life. Patients with anemia due to IBD will work with their healthcare provider to decide upon the best option for treatment. There are two forms of iron supplementation:
- Oral iron supplementation
- Intravenous iron therapy
Diagnosis Of Ida In Ibd
The European Crohns and Colitis Organization recommends anaemia screening for patients in remission or mild disease every 6 to 12 months. For outpatients with active disease, screening should be every 3 months . Screening should include a complete blood count, serum ferritin, and C-reactive protein . In addition, serum vitamin B12 and folic acid should be measured at least once a year for patients at risk for these deficiencies and more frequently in patients with extensive small bowel resection, ileal pouch surgery, or extensive ileal involvement.
Anaemia diagnosis in IBD follows the recommendations of the World Health Organization : in adult males, this is a haemoglobin of < 13.0 g/dL, < 12.0 g/dL in adult nonpregnant women, and < 11.0 g/dL in pregnant women . However, multiple factors such as age, ethnicity, smoking habit, or altitude can alter these thresholds .
Ferritin is low in IDA but may increase during inflammation. A serum ferritin of < 30 µg/L is generally indicative of IDA. However, if inflammation is present , the limit is raised to 100 µg/L. The cut-off for TfS is set at < 16% for iron deficiency. However, AI may also present with a low TfS . The presence of inflammation can also be detected using inflammatory cytokines such as interleukin-6. Hepcidin is decreased in response to iron deficiency however, it is increased in response to inflammation.
Table 1.
Distinguishing iron deficiency anaemia , anaemia of inflammation , and combined anaemia
Calcium And Vitamin D Keep Bones Strong
Kristi L. King, MPH, RD, a dietitian at Texas Children’s Hospital and a clinical instructor at the Baylor College of Medicine in Houston, says that low stores of calcium and vitamin D are the main vitamin and mineral deficiencies in patients with ulcerative colitis. When you have this condition, “the intestines and colon dont absorb nutrients in the same way they do for someone without the disease,” she notes, adding that many drugs commonly prescribed to treat colitis, such as prednisone, can also interfere with the absorption of calcium and vitamin D when used for prolonged periods of time. And, losing calcium and vitamin D will deplete your bone density and put you at risk of osteoporosis. Up to 60 percent of people with inflammatory bowel disease have lower-than-average bone density, according to the Crohns and Colitis Foundation.
You may not have any noticeable symptoms, but your gastroenterologist should regularly check for these deficiencies as part of ulcerative colitis treatment, King says. Over-the-counter supplements can help restore healthy levels. Making some changes to your diet will help, too.
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Diet Doesnt Always Cover Your Needs
Fantasy: You eat a well-balanced diet that gives you all the vitamins and minerals you need every day. Reality: During a UC flare, there is often nothing balanced about whats going inor coming outof your body. If youre having a lot of diarrhea, the food and nutrients you consume may not have a chance to be fully absorbed, says Javelli. Plus, many people avoid certain nutrient-dense foods such as fruit, vegetables, and whole grains because these can worsen symptoms, leaving you a day late and dollar short when it comes to nutrition.
Symptoms Of Ulcerative Colitis
Ulcerative colitis symptoms can vary, depending on the severity of inflammation and where it occurs they typically develop over time. Most people experience mild to moderate symptoms, but the course of ulcerative colitis may vary and some people have long periods of remission. The symptoms depend on the location of the disease-causing inflammation. If you have ulcerative colitis, you may have the following signs and symptoms:
- Diarrhea, often with blood or pus
- Abdominal pain and cramping
- An increased risk of blood clots in veins and arteries
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Quality Of Life Questionnaires
The EuroQol EQ-5D-5 L is self-administered and is comprised of five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression . Each dimension has five levels: no problems, slight problems, moderate problems, severe problems, inability/extreme problems. An index value from 01 is generated using the Crosswalk Index Value Calculator . In addition, the questionnaire captures a self-rating of health status by a visual analogue scale which is limited at 100 and 0 .
The McMaster IBDQ is specific to inflammatory bowel disease and has been extensively validated . This questionnaire is more sensitive to changes in quality of life for patients with inflammatory bowel disease compared to general health questionnaires, and is able to display changes in disease activity for patients with ulcerative colitis or Crohns disease . The McMaster IBDQ consists of 32 questions designed to assess four different domains: emotional, bowel, social and systemic. Each question is scored on a seven point Likert scale and the final score ranges from 32 to 224. Higher scores indicate a better quality of life. The questionnaire was self-administered.
The Ulcerative Colitis Diet
1. Omega-3 Fatty Acids
Studies have found that an omega-3 fatty acid called eicosapentaenoic acid has the power to fight inflammation. It blocks certain chemicals in your body called leukotrienes. A benefit of fish oil is its a good source of EPA, and in some tests, people benefited from very high doses of it.
A 2010 case report published in the Journal of the Royal Society of Medicine evaluated a 38-year-old woman who had ulcerative colitis and used omega-3 fatty acids as part of her treatment. In 1998, at the age of 27, she went to the emergency department after 10 days of bloody diarrhea and lower abdominal cramping pain. She described up to 15 bowel motions daily with urgency, and she lost approximately six pounds. She was also clinically dehydrated.
After weeks of various treatments that only led to short-term results, the patient turned to omega-3 fatty acid treatments. The EPA and DHA doses were well-tolerated and had no side effects. Her bowel frequency slowly decreased, and within a week all rectal bleeding had resolved. The woman continued to take one gram of omega-3s and 2.4 grams of mesalazine, an anti-inflammatory medication that did not have the same reactions when given alone. The patient went into remission after adding omega-3s into her diet.
2. Probiotics
3. Iron-Rich Foods
4. Folate-Rich Foods
5. Turmeric
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What Are The Signs Of Iron Deficiency With Ulcerative Colitis
Low iron levels from colitis can make simply getting out of bed a struggle. Find out how to increase your energy and treat iron deficiency.
Feeling tired and fatigued may be more than just the result of another long day if you have ulcerative colitis. It could be a warning sign of iron deficiency.
The blood loss and internal damage to the intestine associated with ulcerative colitis can frequently lead to iron deficiency, when your body is not getting enough iron to function properly. In fact, anemia is the most common complication associated with inflammatory bowel diseases, according to a review published in May 2019 in the Swiss medical journal Acta Haematologica.
But its not as simple as taking iron supplements. Some iron-deficiency treatments, especially oral supplements, may actually make your ulcerative colitis symptoms worse. Thats why its important to know what’s causing iron deficiency issues before starting treatment.
Once iron deficiency is treated properly, energy levels can improve dramatically, as can overall health and disease status.
When To Consider A Folic Acid Supplement
Folate and folic acid help your body produce and maintain new cells. The nutrient plays a role in preventing anemia, so its important to keep your levels high. Because some UC medications, including Azulfidine and Rasuvo and others , may impede your bodys ability to absorb folate, if youre taking these meds, your doctor will likely prescribe folic acid supplements.
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Accelerate Healing With Aloe
Aloe vera gel and liquid chlorophyll, have been shown to be quite effective in speeding the healing of ulcerative colitis. When considering aloe vera gel, look for whole aloe vera gel, not products with aloe juice in them. I suggest taking about 2 ounces, six to eight times a day, on an empty stomach. Stick with this regimen for several weeks, even if your ulcerative colitis symptoms stop before then.
To make the aloe vera even more effective, add a teaspoon of liquid chlorophyll every time you take the aloe vera.
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Iron Helps Fight Fatigue
Iron deficiency is extremely prevalent in people with inflammatory bowel disease. Roughly 20 percent of patients suffer from anemia. Another 37 percent experience iron deficiency that falls short of anemia, according to a study published in February 2021 in the journal Nutrients. This deficiency may be due to blood loss from bloody diarrhea or internal ulcerations of the colon, or it could be caused by some drugs used to treat ulcerative colitis, such as cholestyramine.
All patients with IBD should be screened for anemia every 6 to 12 months for patients in remission and at least every 3 months for patients with active inflammation, according to guidelines established by the European Crohns and Colitis Organization in January 2015.
Symptoms of iron deficiency include fatigue, pale skin, and a profound craving for ice or mud , says David T. Rubin, MD, the Joseph B. Kirsner Professor of Medicine and the codirector of the digestive diseases center at the University of Chicago Medical Center in Illinois.
Only very rarely are blood transfusions used, Rubin says. Once your iron stores are back to normal, eating an iron-rich diet with foods like lean meats and cooked leafy greens can help keep your iron at a healthy level.
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What Causes Ulcerative Colitis
Because ulcerative colitis is an autoimmune condition, it results from the immune system turning against itself and attacking its own tissues.
There is a genetic predisposition to ulcerative colitis, meaning that if a family member has ulcerative colitis, there is an increased risk for a close relative to also develop the disease.
There has been a potential connection associated with oral use of a strong vitamin A derivative used to treat acne and development of ulcerative colitis.
Aggravating factors that may contribute to the onset of flare-ups include diet and chronic stress.
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How Can Supplements And Vitamins Help
Many practitioners recommend vitamins and supplements for ulcerative colitis to help the body get the nutrition that it needs. Those with UC often dont eat enough food through a loss of appetite or simply in trying to avoid a flare-up of symptoms. This increases the risk of malnourishment and stops your body from getting the calories, vitamins, and minerals it needs to heal.
Some prescribed medicines for ulcerative colitis can also have an effect on how the body absorbs minerals including calcium, vitamin D, zinc and B vitamins.
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What Are The Different Types Of Ferrous Sulfate
There are many different types of oral iron supplements. Ferrous sulfate comes in tablet or liquid form:
- Tablets: The most common tablet size is ferrous sulfate 325 milligrams . Tablets come in standard or delayed release formats.
- Liquid: You can also take ferrous sulfate as a liquid iron supplement. The liquid comes as an elixir or as drops.
Supplements For Ulcerative Colitis
Because ulcerative colitis may interfere with your ability to absorb nutrients, its important that you use supplements to ensure that your body gets the vitamins and minerals that are necessary. Some supplements that may be helpful when combating the symptoms of ulcerative colitis include:
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Treatment Options For Anemia
While anemia can be serious, it is also treatable.
Treatment options for anemia in people will UC will depend on the cause of the anemia and whether the UC is active.
A doctor will decide what treatment option is best, taking into account:
- whether UC is active
- whether other medical problems are present
- whether other nutritional deficiencies are present
How Much Iron Should You Take
The recommended dietary allowance includes the iron you get from both the food you eat and any supplements you take.
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Category |
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8 mg/day |
Strict vegetarians may need to take in higher levels of iron.
At high doses, iron is toxic. For adults and children ages 14 and up, the upper limit — the highest dose that can be taken safely — is 45 mg a day. Children under age 14 should not take more than 40 mg a day.
The American Academy of Pediatrics suggests that — starting at 4 months of age — full-term, breastfed infants should be supplemented with 1 mg/kg per day of oral iron. This should continue until iron-containing complementary foods, such as iron-fortified cereals, are introduced in the diet. Standard infant formula that contains 12 mg/L iron can fulfill the iron needs of an infant until age 1.
Ask your health care provider how much iron supplement you or your child should take, if any.
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Should You Take A Vitamin B12 Supplement
Vitamin B12 helps keep your bodys nerve and blood cells healthy while working to prevent certain types of anemia. Although deficiencies are more common in patients with Crohns disease, it can affect people with UC, too, Javelli says. B12 is absorbed in an area of the small intestines called the distal ileum, says Dr. Yen. This type of deficiency is common in people who have had surgery on this area of their gut, making it hard for the body to absorb the nutrient.
How Is Anemia Treated
Depending on the cause of iron-deficiency anemia, your treatment will vary. Your healthcare provider may recommend eating foods that are high in iron. They may also suggest an oral iron supplement such as ferrous sulfate. If you cant take an oral supplement, you may need to get iron through a vein .
What foods are high in iron?
You can find iron naturally in many foods. Many food products have also been fortified with iron. Iron-rich foods include:
- Lean meat and poultry.
- Green leafy vegetables such as spinach.
- Fortified bread and breakfast cereals.
Your body can absorb iron from plant foods better when you eat it with meat, poultry, seafood and foods that are high in vitamin C. Foods that contain a lot of vitamin C include fruits and vegetables such as oranges, strawberries, tomatoes and broccoli.
What is oral iron supplementation?
In addition to eating foods that are rich in iron, you may have to take an oral iron supplement. The benefit of an oral iron supplement is it treats your symptoms by increasing the levels of iron and hemoglobin in your body.
The iron in your body is called “elemental iron.” Oral iron supplements contain different amounts of elemental iron. When you choose a supplement, be sure to check the label to see how much elemental iron it contains. A greater amount of elemental iron means your body will absorb more iron.
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Phosphorus For Bloody Diarrhea With Marked Weakness
Phosphorus is a significant medicine for treating ulcerative colitis cases with bloody diarrhea attended with weakness. The stool is copious, gushing, and watery. The character of the blood is bright red. The person feels exhausted after passing stool. Cramping pain in the rectum may arise on passing stool. Phosphorus is majorly indicated in case of inflammation of rectum i.e. proctitis.
Etiology Of Anemia In Ibd
The most common causes of anemia in IBD are IDA, chronic inflammation, and anemia of mixed origins, whereas B12 deficiency and folic acid deficiency belong to the less common causes. In addition, it may also occur because of hemolysis, myelodysplastic syndrome/medication-induced aplasia, protein starvation, and liver disease .
Table 2. Ethiology of anemia in IBD.
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Symptoms And Clinical Role
Generally speaking, it should be highlighted that patients with IDA claim to have decreased QoL. In a Spanish study, conducted by García-López et al., it was found that treating IDA improves the QoL, regardless of the symptoms of IBD .
As iron plays key role in the function of many cells , cellular proteins, and enzymes , the symptoms of IDA vary over a wide range . Key symptoms, such as shortness of breath, palpitation, tachycardia, and even angina, occur because of the hypoxemia. As a result of the decreased blood oxygen level, there is a compensatory decrease in intestinal blood flow, which may cause motility disorder, malabsorption, nausea, weight loss, and abdominal pain. Central hypoxia may lead to headache, vertigo, and lethargy, as well as cognitive impairment, and several studies proved that normalizing anemia improves cognitive functions .
Table 1. Symptoms of iron deficiency anemia.
Michailidou et al. compared the risk of postoperative complications between anemic and nonanemic patients. In their study consisting of more than 15,000 people, it was found that patients with anemia were more likely to have postoperative complications .