Anemia and IBD

***If you're anemic, then you should see your doctor for treatment. It's serious.***

   Anemia is a common problem in people with IBD. Intestinal inflammation leads to bleeding. If you have active IBD, chances are you're bleeding. For six years I never thought I was bleeding because I couldn't see it. It wasn't until I finally submitted a stool sample that I learned I was indeed bleeding, albeit on a small scale.

   The two main causes of anemia in IBD patients (--that I know of. Your doctor might know more) are iron deficiency caused by bleeding in the intestine (simply, loss of red blood cells through leakage), and anemia caused by vitamin deficiency (poor absorption in the intestine).

There is also a B12 specific, pernicious anemia, caused when the body cannot adequately absorb vitamin B12. (All the more important to take a B-complex supplement, especially those with Crohn's, as B vitamin activity is mostly related to the small intestine.)

   I don't know this for sure, because it varies widely from person to person, but my sense is that anemia in IBD patients with active symptoms is a result of both, leakage and vitamin deficiency. So that's the first question for your Dr.:

      Which is the most likely cause of my anemia, and does the treatment I'm on account for one or the other or both?

Your Dr. may say that as the [IBD treatment] takes hold, and the inflammation decreases, vitamin absorption will increase too. That's true, but you will likely have to wait 6-ish weeks to find out if the [allopathic IBD treatment] will be effective enough to get a hold on the inflammation. Naturopathic IBD treatments take time to, and you'll want to treat anemia concurrently with your other symptoms.

   Regardless of the quality of your diet, you should consider a good multivitamin (there's advice on vitamin supplementation from my reading list-- here and here). When you have active IBD symptoms, the combination of inflammation and increased transit time (not to mention fluid loss from diarrhea) will lead to vitamin deficiency. Freeda makes an SCD friendly multivitamin. I take that and the SCD friendly B complex too.

   There is some evidence that IBD patients could benefit from a calcium supplement. From what I've read it's mostly due to two things. (1) Some of the [allopathic IBD] drugs encourage the leaching of calcium from the bones, or frustrate it's absorption, and (2) chronic inflammation and IBD symptoms deplete the body, leading to nutritional deficiencies, calcium being one of these.

   I found this below that might be helpful. It comes from the National Anemia Action Council FAQ site:

I have been diagnosed with anemia and my doctor has started treatment; how long will it take for my symptoms to improve?

[snip]

Without receiving a blood transfusion, your body must manufacture new red blood cells to reduce the symptoms related to anemia. It takes about 5-7 days for your body to start making red blood cells. This can result in an increase in hemoglobin levels within 2-3 weeks of starting treatments with erythropoiesis-stimulating agents (ESAS), iron supplements, or vitamin supplements.

The NAAC focuses on allopathic medicine. Below are some natural treatments for IBD-related anemia. Remember, you still need to see your doctor.

Natural Anemia Treatments

• Eat dark green vegetables. These are high in iron and B vitamins. If you have active IBD symptoms, lightly steam them to make them more palatable.
• If your system can handle them, beets are an all-around super food. High in lots of things, including iron and B vitamins.
• Iron is better absorbed in the presence of vitamin C, so eating oranges or apples with a high iron meal assists absorption. This argues, again for a good vitamin supplement (Multi with folic acid, and B-complex).
• Salmon and Mackerel are high in B vitamins.
• Take a tablespoonful of blackstrap molasses twice daily. Molasses is a good source of iron and essential B vitamins.
• Eat Liver or take a raw liver extract. Both are high in iron.
• Some recommend 1/2 to 1 tsp. of the Tincture of Yellow Dock Root three times daily (I've not tried this).
• Take an organic form of Iron ( with amino acid chelate [more on chelated minerals]): 100 mg of elemental Iron daily (Iron aspararte, citrate or picolinate), not the poorly absorbed sulphate which may cause constipation and/or stomachache.
• Extra Vitamin C (500 mg), can be be taken with iron for better absorption.

Avoid foods that interfere with the iron absorption. Examples of foods to avoid are: beer, candy bars, dairy products, ice cream, soft drinks, coffee and tea. If you're on the SCD (which I recommend), then the first six won't be a problem for you. Cut the coffee and tea though.

Foods high in oxalic acid interfere with iron absorption (there's argument over the details). Foods such as almonds, cashews, chocolate, kale, rhubarb, sorrel, spinach, swiss chard and most nuts and beans are high in oxalic acid.

Onward to Health.