Iron Deficiency Anemia 101: Everything You Need to Know About Iron for IBD

A close up image of a blood sample that is deficient in iron
Danielle Gaffen, MS, RDN, LD

Danielle Gaffen, MS, RDN, LD

Iron-deficiency anemia is unfortunately common for people with IBD to experience. My husband with Crohn’s disease has struggled with very low iron levels in the past (his Hemoglobin levels were at 7 at one point!).

 

Ever wonder why iron is so important, and what you can do to prevent and combat iron-deficiency anemia? If so, then continue reading:

 

What is iron and why do we care?

Iron is a mineral, and its main purpose is to carry oxygen (in the hemoglobin of red blood cells) throughout the body so cells can produce energy. Iron also helps remove carbon dioxide.

 

When the body’s iron stores become so low that not enough normal red blood cells can be made to carry oxygen efficiently, a condition known as iron deficiency anemia develops. When this happens, fatigue, weakness, and difficulty maintaining body temperature often result. Other symptoms may include pale skin and fingernails, dizziness, headache, rapid heartbeat, and an inflamed tongue (glossitis).

 

How do I know if my iron levels are low?

Your doctor can do a simple blood test to see where your current iron levels are and then your healthcare team can decide what the appropriate treatment should be for you!

 

Iron status has a variety of indicators. Here are the lab values that your doctor will look at when he/she checks your iron levels:

 

Serum or plasma ferritin:

This is the most sensitive indicator of iron deficiency and an indicator of the levels of your iron stores. [1] A low ferritin level usually indicates low iron stores.

 

Hemoglobin:

A low value indicates anemia.

 

Serum or plasma iron:

Indicates the amount of iron in the blood.

 

Transferrin:

Transferrin is the protein that transports iron to the bone marrow for production of hemoglobin. The plasma transferrin level is controlled by the size of the iron storage pool. When iron stores are depleted, transferrin synthesis increases. [2]

 

Total iron binding capacity:

Measures how well iron attaches to transferrin and other proteins in the blood.

 

What is Iron deficiency anemia

Interestingly, there are 4 stages of iron deficiency anemia [3]. When people think of full-blown anemia, they often think of the symptoms associated with the last stage of a chronic, long-term iron-deficiency like fatigue, lack of appetite, and even pica, especially pagophagia which is ice chewing.

 

 

Here are the 4 stages:

 

Stage 1:

Early negative iron balance.

This means that even though a person won’t necessarily feel symptoms, there’s a moderate depletion of iron stores. Basically, you’re taking away from your iron store reserves.

 

Stage 2:

Severe iron depletion.

You still won’t experience symptoms, but you’re really taking from your iron stores.

 

Stage 3:

Irony deficiency and you start to experience symptoms.

 

Stage 4:

Iron deficiency anemia, experiencing symptoms, and new red blood cells will be damaged when formed due to the lack of iron.

Your body’s red blood cells, which are the cells that need iron to function properly, have a life span of 3 months. When your body’s making new red blood cells, these may not form properly without having enough iron, so they’re damaged.

 

  

4 Common Causes of Iron Deficiency Anemia in IBD:

1. Inadequate dietary intake of iron rich foods without supplementation.

2. Inadequate absorption of iron resulting from diarrhea or drug interference

3. increased blood loss from Crohn’s disease, ulcerative colitis, or ulcers, as well as periods for women. [4]

4. increased destruction of iron from iron stores and defective iron use caused by chronic inflammation.

 

 

How Much Iron Do I Need?

While our bodies are very good at adapting to lower or higher levels by absorbing more or less iron as needed, the recommended levels are set to meet the needs of the greater majority of the population.

The amount of iron you need each day is measured in milligrams (mg). The general recommendations for healthy people are:

 

  • Women (ages 19-50 years): 18 mg iron per day
  • Women (ages 19-50 years): 27 mg if pregnant; 9 mg if breastfeeding
  • Men (ages 19 years and older): 8 mg iron per day
  • Older women (ages 51 years and older): 8 mg iron per day

 

The rate of absorption depends on a person’s iron status and iron stores [5]. The lower the iron stores, the greater the rate of absorption. Individuals with iron deficiency anemia can absorb 20-30% of dietary iron compared with 5-10% absorbed by those without iron deficiency.

 

 

What Foods are Good Sources of Iron?

Iron in food exists as two types: heme and non-heme. Animal foods such as meat, seafood and poultry provide both types and are better absorbed by the body.

Non-heme iron is found in plant foods, such as spinach and beans, grains that are enriched, like rice and bread, and some fortified breakfast cereals.

To increase the absorption of iron from plant sources [6], it’s recommended to eat them with meat, seafood, or poultry or a good source of vitamin C, such as citrus fruits, kiwi, strawberries or bell peppers. A good way to improve your iron intake is by eating a balanced, healthy diet that includes a variety of foods.

Below, please find how much iron is in a serving size as food:

 

Unless otherwise noted, all foods are cooked: meat is roasted, fish is cooked with dry heat, and vegetables are cooked from fresh. Fruit is raw.

 

This is a guide. Actual values may vary depending on the product and/or processing. Vegetables and/or beans that are frozen or canned may have higher iron values. Iron-fortified foods may vary widely in the amount of iron they have [7].

 

High Iron Foods (contain more than 2 mg)

Moderate Iron Foods (contain 1-2 mg)

Low Iron Foods (contain less than 1 mg)

·       Bagel, 4″: onion, sesame, or poppy seed 1 each = 5.4 mg

·       Bagel, 4″: egg or raisin 1 each = 3.5 mg

·       Beans, baked with pork ½ cup = 4.5 mg

·       Beans, kidney ½ cup = 2.6 mg

·       Beans, lima or navy ½ cup = 2.3 mg

·       Beans, white, canned ½ cup = 3.9 mg

·       Beef liver 3 oz = 5.2 mg

·       Beef, ground 3 oz = 2.2 mg

·       Beef, veal, or lamb 3 oz = 3 mg

·       Biscuits, 4″ 1 each = 2.9 mg

·       Cereal, 100% iron-fortified bran or whole grain ½ cup = 9-12 mg

·       Cereal, other ½ cup = 2-7 mg

·       Chex mix 2/3 cup = 7 mg

·       Chicken liver 3 oz = 10.8 mg

·       Chickpeas (garbanzo beans) ½ cup = 2.5 mg

·       Clams 3 oz = 6.3 mg

·       Clams, canned 3 oz = 23.8 mg

·       Cream of wheat ½ cup = 5.2 mg

·       Dried peas, cooked ½ cup = 2 mg

·       Fish, sardines 3 oz = 2.5 mg

·       Grits, instant, prepared ½ cup = 7.1 mg

·       Lentils ½ cup = 3.5 mg

·       Muffin, English or bran 1 each = 2.3 mg

·       Oatmeal, instant, fortified ½ cup = 5 mg

·       Oysters 3 oz = 13.2 mg

·       Pork 3 oz = 2.7 mg

·       Pretzels 2 oz = 3.1 mg

·       Seeds, pumpkin 1 oz = 4.2 mg

·       Shrimp 3 oz = 2.6 mg

·       Soy milk 1 cup = 2.7 mg

·       Soybeans ½ cup = 4.4 mg

·       Spinach, canned, cooked, or raw ½ cup cooked, 1 cup raw = 3 mg

·       Tofu, firm ½ cup = 3.4 mg

·       Tomato paste ½ cup = 3.9 mg

·       Vegetable or soy burger 1 patty = 2.9 mg

·       Waffle, 4″ 1 each = 2.3 mg

 

·       Asparagus, canned 6 spears = 2 mg

·       Beans, baked, plain ½ cup = 1.5 mg

·       Beans: black, pinto, or great northern ½ cup = 1.8 mg

·       Beans: kidney or garbanzo, canned ½ cup = 1.6 mg

·       Beets, canned ½ cup = 1.5 mg

·       Brussels sprouts ½ cup = 1 mg

·       Chicken breast 3 oz = 1.1 mg

·       Egg 1 large = 1 mg

·       Egg substitute, liquid ¼ cup = 1.3 mg

·       Figs, dried 5 each = 2 mg

·       Fish, tuna, canned 3 oz  =1.3 mg

·       Fish, mackerel 3 oz = 1.3 mg

·       Greens: collards or beet (fresh), turnip (frozen) ½ cup = 1.2-1.6 mg

·       Greens, Swiss chard ½ cup = 2 mg

·       Molasses 1 Tbsp = 1.5 mg

·       Mushrooms ½ cup = 1.4 mg

·       Noodles, egg, enriched ½ cup = 1.2 mg

·       Nuts: almonds or pistachios ¼ cup = 1.3 mg

·       Nuts: pinenuts or cashews 1 oz = 1.6 mg

·       Nuts: walnuts or mixed 1 oz = 1 mg

·       Peas, green, frozen ½ cup = 1.2 mg

·       Pita, 4″ round 1 each = 1 mg

·       Potato, baked with skin 1 medium = 1.9 mg

·       Prune juice ½ cup = 1.5 mg

·       Pumpkin, canned ½ cup = 1.7 mg

·       Roll, hamburger or hotdog 1 each = 1.4 mg

·       Sauerkraut, canned ½ cup = 1.7 mg

·       Seeds: sesame or sunflower 1 oz = 1.2 mg

·       Spinach, frozen ½ cup = 2.5 mg

·       Sweet potato, baked with skin 1 medium = 1.1 mg

·       Tomato sauce ½ cup = 1.3 mg

·       Tomatoes, canned, sauce ½ cup = 1.3 mg

·       Tortilla, flour 1 each = 1 mg

·       Turkey, dark meat 3 oz = 2 mg

·       Turkey, light meat 3 oz = 1.1 mg

·       Wheat germ 2 Tbsp = 1.2 mg

 

·       Beans, green or yellow ½ cup = 0.6 mg

·       Blackberries ½ cup = 0.5 mg

·       Bread, white or wheat 1 slice = 0.7 mg