Inflammatory bowel disease and iron deficiency
If you have any type of inflammatory bowel disease (IBD), you are at risk of both iron deficiency and iron deficiency anemia1. The main reasons for this include:
- Long-term internal intestinal bleeding
- Decreased iron absorption caused by intestinal inflammation
- Reduced iron intake through cutting out certain iron-rich foods, for example leafy greens, if they worsen your IBD symptoms2.
What is inflammatory bowel disease?
Inflammatory bowel disease (IBD) is a term that describes disorders that involve long-standing (chronic) inflammation of your digestive tract3-5. There are two main types of IBD: ulcerative colitis (UC) and Crohn’s disease (CD).
It’s estimated that there are over one million sufferers in North America alone3,4. Once thought of as a disease of the Western world, IBD has extended to the global community in recent years, and it can greatly impact an individual’s life6.
How does iron deficiency impact those with Inflammatory bowel disease?
There are different types of iron deficiency and anemia that may impact those living with IBD. The three types are:
Anemia of chronic disease (inflammation)2 is caused by the body’s immune system7 – when iron is not available to produce hemoglobin for red blood cells7. This means that fewer red blood cells are made, and their life span can be reduced7.
Anemia from vitamin deficiencies occurs if you do not eat enough food containing vitamin B12 and folic acid, or if you have not absorbed these nutrients from your food in your intestines2. You’re at higher risk of this type of anemia if you have Crohn’s disease – the sections of the small intestine where these nutrients are usually absorbed may be inflamed or may have been surgically removed7.
IBD treatments such as sulphasalazine and azathioprine7 can suppress the production of blood cells1 and cause this type of anemia.
Do I have iron deficiency due to IBD?
Tiredness and fatigue are strong indicators of both irritable bowel disease7 and anemia. You can use our symptom checker to help assess your symptoms. The following signs could also show you have iron deficiency or iron deficiency anemia:
- Dizziness8, irritability9 and loss of concentration10
- Looking pale11
- Shortness of breath and a racing heart12
- Sore tongue or dry mouth13,14
- Cold intolerance or cold hands and feet15
- Headache16
- Restless leg syndrome (RLS)17,18
- Hair loss19
- Brittle or spoon-shaped nails20
- Increased susceptibility to infections21
How can your doctor test for iron deficiency in IBD?
A blood test can show if you have any of the signs of iron deficiency related to IBD, such as fatigue. A Complete Blood Count (CBC)7 test isregularly used in IBD cases check for anemia. If you are found to be anemic or iron deficient, regular follow-up tests are needed to check that treatment is boosting your red blood cell levels.
What are my treatment options for iron deficiency in IBD?
Upping the number of iron-rich foods in your diet, including red meat, liver, enriched (fortified) cereals and leafy greens22 is a first easy step. Try introducing these when your IBD is in remission to top up your iron levels. But if you are experiencing a flare-up of IBD, certain foods, such as beans, legumes and fibre-rich broccoli might be best avoided. Check with your doctor if you are unsure. Anemia may require a supplementary iron source, such as:
- Oral iron supplements, available over the counter or on prescription23
- Intravenous iron, where iron is delivered directly into your blood stream through a vein, for example through ‘a drip’ or an injection23
- A blood transfusion if your iron levels are extremely low24
My story: living with crohn’s disease and iron deficiency
Andy, a Crohn’s disease sufferer, has had eight major surgical procedures over 15 years. Watch his video as he shares how iron deficiency has also impacted his life.
Symptom checker
Don’t ignore or confuse the warning signs of iron deficiency. Take our quick and easy test to pinpoint any symptoms of iron deficiency.
Talk to a doctor
Dizziness, fatigue, and a shortness of breath should not be ignored. They could be symptoms of iron deficiency. Don’t waste time worrying, act now.
- Stein J, Dignass A. Management of iron deficiency anemia in inflammatory bowel disease–a practical approach. Ann Gastroenterol. 2012;26:1-10.
- Ott C, Liebold A, Takses A, Strauch UG, Obermeier F. High prevalence but insufficient treatment of iron-deficiency anemia in patients with inflammatory bowel disease: results of a population-based. Gastroenterol Res Pract. 2012;2012:595970. doi:10.1155/2012/595970.
- WGO Global Guidelines. 2015
- Ng SC et al. Lancet. 2017;390:2769–2778
- Wilhelm SM and Bryan L. Clinical Pharmacist. 2017;Vol 9(3):online. DOI: 10.1211/CP.2017.20202316
- Burisch J et al. J Crohns Colitis. 2013;7(4):322–337
- Gasche C, Lomer MCE, Cavill I, Weiss G. Iron, anaemia, and inflammatory bowel diseases. Gut. 2004;53(8):1190-7. doi:10.1136/gut.2003.035758.
- Paterson JA, Davis J, Gregory M, et al. A study on the effects of low haemoglobin on postnatal women. Midwifery. 1994;10(2):77-86.
- Radlowski EC, Johnson RW. Perinatal iron deficiency and neurocognitive development. Front Hum Neurosci. 2013;7:1-11.
- Albacar G, Sans T, Martín-Santos R, et al. An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression. J Affect Disord. 2011;131:136-42. doi:10.1016/j.jad.2010.11.006.
- Stoltzfus R, Edward-Raj A. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr. 1999;129(May):1675-1681.
- Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol. 2011;90(11):1247-53. doi:10.1007/s00277-011-1279-z.
- Baird IM, Dodge OG, Palmer FJ, Wawman RJ. The tongue and oesophagus in iron-deficiency anaemia and the effect of iron therapy. J Clin Pathol. 1961;14:603-9.
- Osaki T, Ueta E, Arisawa K, Kitamura Y, Matsugi N. The pathophysiology of glossal pain in patients with iron deficiency and anemia. Am J Med Sci. 1999;318(5):324-9.
- World Health Organization. Iron deficiency anaemia. Assessment, prevention and control: A guide for programme managers.; 2001:1-114.
- Vuković-Cvetković V, Plavec D, Lovrencić-Huzjan A, Galinović I, Serić V, Demarin V. Is iron deficiency anemia related to menstrual migraine? Post hoc analysis of an observational study evaluating clinical characteristics of patients with menstrual migraine. Acta Clin Croat. 2010;49(4):389-94. Sun ER, Chen CA, Ho G, Earley CJ, Allen RP. Iron and The Restless Legs Syndrome. Sleep. 1998;21(4):381-387.
- Sun ER, Chen CA, Ho G, Earley CJ, Allen RP. Iron and The Restless Legs Syndrome. Sleep. 1998;21(4):381-387.
- Wang J, O’Reilly B, Venkataraman R, Mysliwiec V, Mysliwiec A. Efficacy of oral iron in patients with restless legs syndrome and a low-normal ferritin: A randomized, double-blind, placebo-controlled study. Sleep Med. 2009;10(9):973-5. doi:10.1016/j.sleep.2008.11.003.
- Stein J, Dignass A. Management of iron deficiency anemia in inflammatory bowel disease–a practical approach. Ann Gastroenterol. 2012;26:1-10.
- Cashman MW, Sloan SB. Nutrition and nail disease. Clin Dermatol. 2010;28(4):420-5. doi:10.1016/j.clindermatol.2010.03.037.
- Dhur A, Galan P, Hercberg S. Iron status, immune capacity and resistance to infections. Comp Biochem Physiol A Comp Physiol. 1989;94(1):11-9.
- Michael Alleyne, McDonald K. Horne, MDb, and Jeffery L. Miller M. Individualized treatment for iron deficiency anemia in adults. Am J Med. 2008;121(11):943-948. doi:10.1016/j.amjmed.2008.07.012.Individualized.
- Stein J, Hartmann F, Dignass AU. Diagnosis and management of iron deficiency anemia in patients with IBD. Nat Rev Gastroenterol Hepatol. 2010;7(11):599-610. doi:10.1038/nrgastro.2010.151.
- Gomollón F, Gisbert JP. Current Management of Iron Deficiency Anemia in Inflammatory Bowel Diseases: A Practical Guide. Drugs. 2013;73(16):1761-70.