Anemia and IBS: What to know

If someone with irritable bowel syndrome (IBS) cannot absorb enough iron from their food, they may develop anemia. However, anemia is not a classic symptom of IBS.

Iron deficiency anemia is a form of anemia that happens when a person’s body does not have enough red blood cells. These cells carry oxygen in the blood, so a person with anemia can feel tired and fatigued.

About one-quarter of the world’s population has anemia, usually due to iron deficiency, and it is particularly prevalent among menstruating individuals. Although anemia is not a standard symptom of IBS, it is not uncommon for it to affect people with this condition.

A 2014 study found that about half of those with the condition may have a mild iron deficiency, suggesting a link between IBS and anemia. People with IBS may develop anemia if they are unable to absorb enough iron from their food.

Keep reading to learn more about the symptoms and diagnosis of anemia and its connection with IBS.

Anemia means that a person does not have enough red blood cells. Although there are several different forms of anemia, iron deficiency anemia is the most common. It can happen when a person does not get enough iron in their diet, does not absorb enough iron from their food, or has excessive bleeding that depletes their iron stores.

A 2014 study of 217 people with IBS found that about half of them had subclinical iron deficiency. A subclinical deficiency is one in which a person’s iron levels are low but not low enough to constitute true iron deficiency anemia.

Subclinical iron deficiency can cause symptoms similar to those of traditional anemia, such as fatigue, breathlessness, and headaches.

However, the symptoms vary from person to person. Some individuals may have more severe symptoms, while others will have none.

Some people may find that IBS contributes to their anemia. This can happen when the body does not absorb nutrients from food properly.

Difficulty digesting certain carbohydrates and insoluble fiber is common in IBS. Many carbohydrates and fibrous foods, such as breakfast cereals, are fortified with iron. Additionally, many plant-based sources of iron — such as beans, lentils, and leafy greens — are rich in carbohydrate, fiber, or both.

If the body struggles to digest these foods, it might not absorb enough iron. In addition, some individuals may choose to avoid these foods if they aggravate their digestion or cause IBS flare-ups.

However, some people with IBS may develop anemia for unrelated reasons.

As anemia is common, many people with IBS may already have it. Some risk factors for iron deficiency anemia include:

• pregnancy
• menstruation
• insufficient consumption of iron through food
• bleeding in the gastrointestinal tract
• blood loss due to heavy periods, injuries, or childbirth

Anemia is more common in people with inflammatory bowel disease (IBD), a chronic inflammatory digestive condition, than in those with IBS. In fact, the co-occurrence of digestive issues and anemia suggests IBD.

People with IBD may develop anemia because of poor nutrient absorption. They may also have low iron because of bleeding in the digestive tract.

Although both IBD and IBS can cause digestive problems, they are distinctly different conditions. IBD is a group of conditions that cause chronic inflammation in the gut. In contrast, IBS is a functional disease with no singular cause.

Most people with low iron do not experience symptoms until their iron levels fall below 7–8 grams per deciliter of blood. By the time a person has symptoms, they may already have been anemic for a long time.

To test for iron deficiency, a doctor may do a complete blood count, test iron levels, and measure ferritin levels.

Some symptoms that can indicate anemia include:

• unusually pale skin
• fatigue
• weakness
• restless legs
• shortness of breath

People who have IBS and anemia may wish to discuss with their doctor the best ways to manage their condition.

In some cases, a doctor may previously have misdiagnosed a person as having IBS when they actually have a form of IBD. Tests can determine whether this is the case.

Chronic, untreated IBD can cause malnourishment, bowel damage, and infections. Therefore, it is important to seek a medical evaluation for anemia symptoms that occur alongside digestive issues.

Vitamin B12 deficiency is a nutrient deficiency that can cause macrocytic anemia. This means that the red blood cells are abnormally large and that there are fewer of them than normal.

People following plant-based diets are particularly vulnerable to vitamin B12 deficiencies because the primary way to consume the nutrient is through animal products, such as meat, cheese, and eggs. However, these deficiencies can affect anyone.

Vegans and vegetarians can get vitamin B12 from supplements and fortified foods.

Although some people with IBS may have macrocytic anemia, there is no evidence that IBS increases a person’s risk of vitamin B12 deficiency or that vitamin B12 deficiency causes IBS. A 2020 review including 12,295 participants found that there was no difference in vitamin B12 deficiency rates between people with and without IBS.

Moreover, the study did not find evidence of widespread nutritional deficiencies in people with IBS.

The treatment for anemia usually involves taking an iron supplement. These come in the form of tablets, capsules, or liquids.

If a person has a severe iron deficiency, a doctor may recommend IV iron infusions.

It is also important to check for any underlying causes. A healthcare professional may ask a person to track their food intake to assess how much iron they are consuming.

Although anemia can occur with IBS, it is more common in people with IBD. However, because anemia is common, it can be unrelated to these conditions.

Treating iron deficiency anemia is fairly simple, and in most cases, a person can expect their iron levels to improve in a few weeks.

How One Can Lead to the Other, Symptoms

While anemia is not a typical symptom of IBS, people with IBS may develop anemia if they cannot absorb enough iron from their food.

Irritable bowel syndrome (IBS) is a common gastrointestinal disorder that affects the intestines.

IBS is characterized by symptoms such as bloating, abdominal pain, diarrhea, and constipation and is often associated with changes in bowel movements.

Anemia occurs when your body doesn’t have enough red blood cells. This leads to fatigue, weakness, and shortness of breath, among other symptoms.

Read on to learn more about the connection between IBS and anemia.

IBS does not directly cause anemia. However, it can increase your risk of developing anemia, especially if you cannot absorb enough iron from your food.

Iron is an essential nutrient involved in the production of hemoglobin, a protein in red blood cells that carries oxygen throughout your body. When your body doesn’t have enough iron, it can’t make enough hemoglobin. Your red blood cell count goes down, leading to iron deficiency anemia.

According to a 2020 study, people with IBS may be more likely to follow restrictive diets or avoid certain foods due to their symptoms. This can cause insufficient nutrient intake, including a lack of iron, which can lead to anemia.

Reduced iron absorption in IBS may also be due to changes in bowel movements. Frequent diarrhea may not give your body enough time to absorb nutrients such as iron from your food.

In some cases, IBS can make it difficult for your body to digest certain types of carbohydrates, such as FODMAPs and insoluble fiber, due to dysfunction of your gut microbiome. This can lead to malabsorption of nutrients.

Anemia occurs when your body does not have enough red blood cells. This can lead to various symptoms. In people with IBS, anemia is often caused by low iron levels due to insufficient absorption of nutrients.

Symptoms of anemia may include:

• fatigue and weakness
• shortness of breath
• dizziness or lightheadedness
• rapid or irregular heartbeat
• pale skin or nail beds
• chest pain or discomfort
• sore or swollen tongue
• cold hands or feet
• headaches
• difficulty concentrating
• brittle nails

Anemia stool color

Anemia does not typically cause significant changes in stool color or appearance. However, if anemia is caused by gastrointestinal bleeding, stool may appear black or tarry due to the presence of blood. This is known as melena.

Melena can indicate a more serious underlying condition, such as peptic ulcer, and it’s important to speak with a doctor to get a proper diagnosis and appropriate treatment.

If you have IBS and are experiencing symptoms of anemia, such as fatigue, weakness, shortness of breath, or rapid heartbeat, you should contact a doctor.

You should also contact a doctor if you experience any of the following:

• unexplained weight loss
• severe abdominal pain or cramping
• long lasting diarrhea or constipation
• fatigue, weakness, or shortness of breath that gets worse or does not go away
• changes in stool color or consistency

The treatment of anemia in people with IBS often depends on the underlying cause and severity of the anemia. Common treatments for anemia in people with IBS include:

• Iron supplements: If your IBS in is remission, doctors may recommend oral iron supplements to help increase your iron levels. However, one 2017 review suggests that iron supplements may worsen digestive symptoms.
• Dietary changes: Eating iron-rich foods such as poultry, red meat, seafood, fortified cereals, and legumes while in remission can help increase your iron levels. However, if you have difficulty tolerating certain foods, consider discussing appropriate dietary changes with your doctor.
• Treatment of underlying medical conditions: If anemia is caused by an underlying medical condition such as gastrointestinal bleeding, treating that condition can prevent further blood loss.
• Blood transfusions: In severe cases, blood transfusions may be necessary to improve symptoms and correct the anemia.

Here are some frequently asked questions about IBS and anemia:

Can low iron affect IBS?

Low iron levels can affect IBS by causing fatigue, weakness, and digestive symptoms such as abdominal pain, constipation, and diarrhea. These effects can further complicate IBS management.

Can digestive problems cause anemia?

Digestive problems such as irritable bowel disease, celiac disease, and gastrointestinal bleeding can cause anemia by reducing your body’s ability to absorb iron or causing blood loss.

Can I take iron supplements if I have IBS?

Yes, you can take iron supplements when your IBS is in remission. But it’s important to speak with a doctor first, as some forms of iron supplements may worsen IBS symptoms.

What foods help with anemia and IBS?

Foods high in iron, such as poultry, red meat, seafood, fortified cereals, and legumes, can help with anemia in IBS. However, consider speaking with a doctor to determine appropriate dietary changes for your needs.

There is a potential link between IBS and anemia, with research suggesting that people with IBS may develop anemia if they cannot absorb enough iron from food. Common symptoms of anemia in people with IBS include fatigue, dizziness, and shortness of breath.

Treatment for anemia in IBS may involve addressing the underlying cause, changing your diet, and taking iron supplements. If you have IBS and suspect that you may have anemia, consider speaking with a doctor to get a proper diagnosis and treatment plan.

The most important questions about irritable bowel syndrome

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• The most important questions about irritable bowel syndrome

Arabova R.D.
Gastroenterology

What problems in the body does irritable bowel syndrome indicate? Does he need a strict diet? What is more important – heredity or lifestyle? The most important questions about irritable bowel syndrome are answered by the practicing gastroenterologist of the Kaliningrad medical center Class Clinic Robiya Damirovna Arabova.

How can I suspect irritable bowel syndrome?
Irritable bowel syndrome, or IBS, has two main symptoms. Firstly, these are abdominal pains that decrease or disappear after passing gases and / or stools, as well as bloating. The second is changes in the frequency, consistency, shape of the stool, the act of defecation (constipation, diarrhea, feeling of incomplete emptying of the intestine, difficulty defecation). And, since this disease is a psychosomatic disorder, there are additional extraintestinal symptoms: increased fatigue, migraine pains, feeling of a coma in the throat, dissatisfaction with breathing, sleep disturbances, urination, sexual dysfunctions, etc.

Diagnosis is established by the presence of the main symptoms within the last 12 weeks, their onset at least 6 months ago, and with the exclusion of organic diseases of the gastrointestinal tract (infectious, inflammatory, neoplastic, developmental anomalies, etc.).

Is it true that irritable bowel syndrome occurs due to nerves?
Irritable bowel syndrome begins to develop when the interaction in the “brain-large intestine” system is disrupted. In other words, it is a dysregulation between the central nervous system and the autonomic enteric (intestinal) nervous system. One eating disorder for the development of IBS is not enough.

It must be remembered that serious pathologies can be disguised as irritable bowel syndrome: inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), infections, parasitosis, and at the age of 45-50 years – tumors, polyposis, intestinal diverticulosis. They must be excluded when there are symptoms characteristic of IBS.

What examinations are carried out?
General and biochemical blood tests, coprogram, fecal analysis for helminth eggs and protozoa, gastroduodenoscopy, fibrocolonoscopy and / or irrigoscopy, ultrasound of the abdominal cavity and small pelvis are performed. This is a mandatory minimum that is needed for differential diagnosis and exclusion of serious organic diseases.

In addition to the typical manifestations of IBS, which symptoms are considered especially disturbing?
In medicine, there is the concept of “red flags” – these are symptoms, the appearance of which you need to urgently see a doctor. In our case, “red flags” are unmotivated weight loss, fever, the appearance of blood or pus in the stool, anemia, leukocytosis, and an increase in ESR. And you also need onco-alertness if there have already been cases of colon cancer in relatives.

Is it true that irritable bowel attacks occur when certain foods are consumed or, for example, coffee, alcohol – that is, after a “provocation”? Should these potentially provocative foods be restricted?
If symptoms are associated with certain foods, then reasonable limits should be followed. For example, exclude legumes if they cause increased gas formation. There is a so-called diet with the exclusion of FODMAPs (short-chain carbohydrates that are poorly absorbed in the small intestine and lead to gas formation), gluten restriction. But there is no single scheme of recommendations for patients with IBS.

Not all patients have so-called “flare-ups” associated with provocative foods, and then we recommend not to follow a diet with strict restrictions, because. they further impair the quality of life of such patients.

In fact, it is not the lifestyle that predisposes to the development of IBS, but such factors as heredity (genetically determined increased visceral sensitivity – a decrease in the pain perception threshold), a tendency to anxiety, depressive, hypochondriacal disorders. And also provoke irritation of the intestines can be transferred intestinal infections, taking antibiotics with subsequent violation of the intestinal flora, long-term traumatic situations.

I also want to emphasize that to track the relationship of symptoms with diet, diet, stool regularity, etc. it is important only at the initial stage to clarify the diagnosis, identify provoking factors. Once the diagnosis is made, “listening” to one’s symptoms, concentrating on them, and fixating on them only exacerbate the “withdrawal into illness” characteristic of many patients with IBS.

What measures should be taken during exacerbations? What should be avoided (e. g. climate change, taking certain over-the-counter medications, etc.)?
It is not so much the restrictions during exacerbations that are important as the prevention of deterioration. And here tactics are individual for each patient. For example, if there is an air flight ahead, and in a particular person it is often accompanied by emotional stress, suppression of the urge to defecate due to unwillingness to visit a “foreign” toilet, there is no need to aggravate the situation with dehydration, irregular meals, eating on the go, fast food.

For constipation, for example, uncontrolled intake of antacids, non-selective antispasmodics that provoke intestinal atony, and choleretic drugs for diarrhea should be avoided. When taking antibiotics – in parallel to carry out the prevention of dysbacteriosis, take pro- and prebiotics. The most important thing with irritable bowel syndrome is to know the characteristics of your body (and your disease) and learn to live with them.

Do you recommend any special diet for irritable bowel syndrome?
I have already told a little about the diet and the principles of restriction. I will add that for constipation, it is important to include in the diet foods containing dietary fiber – vegetables, fruits, buckwheat and oatmeal, whole grain bread, bran. With diarrhea, coarse vegetables, sour and unripe fruits, coarse cereals, whole milk are excluded. With flatulence, it is better to abandon legumes, rye bread, muffins, fresh raw vegetables.

Is it possible to play sports with irritable bowel syndrome?
There are no restrictions on physical education, sports with irritable bowel syndrome. Well, except at the moment of acute pain syndrome. On the contrary, physical activity helps to reduce anxiety, normalize the motor function of the intestine. Useful breathing exercises involving the diaphragm, exercises for muscle relaxation.

There are doctors who do not consider irritable bowel syndrome to be a serious illness. How to find a really good specialist?
I think irritable bowel syndrome is a thing of the past. Even taking into account the relatively favorable course in most cases, the absence of severe and dangerous complications, irritable bowel syndrome causes a marked deterioration in the patient’s quality of life, periodically and disability. This means that the patient needs medical attention. The doctor needs patience, the ability to convince and reassure the patient, to support him psychologically, not to brush aside in the absence of a pronounced effect from therapy, but to persistently search for acceptable and suitable methods of treatment together with the patient.

Make an appointment with Robiya Damirovna Arabova on the website or by phone (4012) 33-44-55.

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Irritable bowel syndrome – health articles

11/10/2022

Irritable bowel syndrome is a digestive disorder that can cause intestinal cramps, flatulence, diarrhea, and constipation. Irritable bowel syndrome cannot be completely cured, but symptoms can be managed with lifestyle changes, diet, and, if necessary, medication.

Irritable bowel syndrome is not a life-threatening disease, this disease does not lead to structural disorders of the intestine, it only creates a state of discomfort.

Irritable bowel syndrome is one of the most common diseases in the world. According to statistics, about 15 – 20% of the population of our planet suffers from this disease, and people aged 20 to 45 are most susceptible to this disease, and women are 2 times more likely than men. Also, due to mild symptoms, about 2/3 of the population suffering from irritable bowel syndrome do not seek medical help.

Reasons

The disease develops under the influence of a combination of several factors, the main of which are: stress, eating under stress, illiterate diet planning, too high levels of caffeine, alcohol, fatty foods (fatty foods greatly stimulate intestinal motor activity), soda, lack of vegetable fiber in the diet, gluttony.

The fairer sex suffers more from the disease during menstruation, as the symptoms are provoked by sex hormones, the amount of which is increased during this period.

According to some reports, the syndrome may be triggered by an acute intestinal infection.

People suffering from chronic infectious and parasitic diseases of the digestive system are also at risk.

Most often, IBS is combined with giardiasis, since giardia secrete substances that destroy the colon mucosa. Individuals suffering from dysbacteriosis are also at risk. The intestines of such people are very sensitive to any slight violations of the microflora.

Symptoms

In its manifestations, symptoms, irritable bowel syndrome is not much different from typical intestinal disorders. Today there are several variants of it.

In the variant when among the symptoms in the first place is diarrhea, there is a pronounced urge to defecate immediately after or even during meals, and this pattern is repeated several times a day. More typical for this are the morning hours and the first half of the day. Sometimes loose stools occur with strong emotional arousal or feelings, fears. In the people, this condition is known as “bear disease”, because it is the brown inhabitants of the forest who react with involuntary defecation to fear or danger. Also, with this variant of IBS, there is bloating, pain in the lateral sections of the abdomen below the navel, which precede the sudden urge and decrease after relief.
In the variant with a predominance of constipation, the same bloating and pain along the colon are observed, but accompanied by stool retention for more than three days. Pain can occur in the form of intestinal colic or have a long aching character, somewhat subside after a bowel movement. The stool often changes shape, becomes firmer like “sheep feces” and is laced with clear or white mucus. Against the background of stool retention, digestive disorders can also appear in the form of appetite disorders, nausea, heartburn, and an unpleasant aftertaste in the mouth.

The third variant is the alternation of diarrhea and constipation The variant of IBS, in which abdominal pain and alternation of constipation or diarrhea become the leading ones, is the third type of the syndrome.

Diagnostics

Often, the above symptoms occur with other, more serious diseases of the gastrointestinal tract. Therefore, a complete comprehensive examination is relevant.

If you experience abdominal pain, stool disorders and flatulence, it is recommended to consult a gastroenterologist and undergo the following diagnostic tests:

– Complete blood count. Detects anemia as a manifestation of occult bleeding and an increase in the number of leukocytes, which indicates the presence of inflammation.
– Biochemical blood test. For example, an increase in the concentration of amylase indicates inflammation of the pancreas – pancreatitis, which explains diarrhea.
– Fecal occult blood test will help detect bleeding that is not visible to the eye, and increased fat loss in feces indicates the presence of pancreatitis.
– Coprological and microscopic examination of feces will reveal the underlying disease, including the infectious process.
– Ultrasound of the abdominal organs is the gold standard for the detection of pancreatitis, cholecystitis, neoplasms of internal organs.
– Colonoscopy – instrumental examination of the intestine. Helps in the diagnosis of inflammatory diseases, developmental anomalies, tumors, diverticula (protrusion of the lining) of the intestine.

In the absence of abnormalities, a diagnosis of irritable bowel syndrome is made.

Treatment

Treatment of irritable bowel syndrome should be comprehensive.

If constipation predominates, a diet with the addition of wheat bran is indicated. In case of diarrhea, it is recommended to limit foods rich in fiber (vegetables, fruits, bran). All, without exception, patients with irritable bowel syndrome are recommended to follow a diet that does not contain caffeine, lactose, fructose, sorbitol, vinegar, alcohol, pepper, smoked meats, as well as products that cause excessive gas formation – milk, sour-milk products.

A set of measures aimed at improving the functions of the central nervous system and correcting autonomic disorders, includes psychotropic drugs, rational psychotherapy. Ideally, a psychoneurologist or psychotherapist should be involved in the diagnosis of psychoemotional disorders and their elimination.

Indications for the use of antibacterial drugs in irritable bowel syndrome are diarrhea, flatulence and abdominal pain.

Long-term (up to 1.5-2 months) intake of bacterial preparations (probiotics) is recommended after antibiotic therapy.

All patients with irritable bowel syndrome during exacerbation of diarrhea are prescribed astringents, as well as herbal decoctions of a similar effect (chamomile, peppermint, St. John’s wort, alder cones, blueberries and bird cherry). Some antacids can be used for a similar purpose.

With irritable bowel syndrome with a predominance of constipation, it is necessary to develop the lost morning reflex to defecate and increase the amount of dietary fiber in the diet due to the introduction of wheat bran into it. To stimulate defecation at the first stage of developing a lost reflex, duphalac (lactulose) 1-2 dessert spoons should be prescribed the night before.