Exploring the Connection: IBS and Anemia - Tips for Iron Absorption

Are you dealing with both IBS and fatigue?

IBS on its own can be exhausting, but when your provider also diagnoses you with anemia, it can feel like a double blow. It’s physically and emotionally tiring, no pun intended.

Here’s the thing: all of this is not in your mind! There is a potential link between iron deficiency anemia (IDA) and IBS. Today, we’ll discuss dietary tips and helpful lifestyle habits to help you feel energized again.

If you’re here for the first time, let’s quickly define these terms so we speak the same language. Irritable bowel syndrome (IBS) is multifactorial and is primarily diagnosed based on gastrointestinal (GI) symptoms (diarrhea, constipation, bloating, nausea, and abdominal discomfort). For some, these symptoms alone can lead to feelings of fatigue, but fatigue is also a symptom of anemia (low red blood cell count).

Iron deficiency anemia, the most common cause of anemia, occurs when there is a lack of iron in the body from food and supplements. Iron, a mineral, is needed to produce hemoglobin, the protein inside red blood cells that carries oxygen, but it’s also important in maintaining healthy cells, skin, hair, nails. Iron is needed so our bodies can obtain the oxygen and nutrition from cells to function optimally every day.

The combination of the lack of iron plus the lack of red blood cells providing oxygen to the tissues can lead to IDA symptoms such as:

• dizziness or lightheadedness
• pale skin or nail beds
• brittle nails or hair loss
• shortness of breath or chest pain, especially while active
• cold extremities (hands of feet)
• unusual cravings for ice, dirt, clay, or other non-food substances (pica)
• sore tongue 

IBS and Iron Absorption: What’s the Connection?

Typically, IBS does not directly cause anemia, but it can increase your risk of developing it if your gut cannot absorb iron from your food.

When you eat foods that contain iron, only a small amount is absorbed by the cells in the GI tract. However, when your GI tract is not working properly because of conditions like IBS, which affect the gut microbiome, your body cannot digest and absorb nutrients (like iron) as it should—and it doesn’t matter how “good” you think you’re eating!

Bowel dysmotility (which includes malabsorption) and maldigestion (the inability to break down foods into smaller parts for proper absorption) can also occur in those with IBS. When patients have IBS-diarrhea (IBS-D) symptoms, a form of malabsorption, they may limit the types of food they eat to control or manage these symptoms. Restrictive diets can lead to nutrient deficiencies, including iron. Additionally, alterations in the gut microbiome may impede your body from ingesting insoluble fiber or FODMAPs, leading to nutrient malabsorption.

Food is Medicine: Choosing Iron-Rich Options

Several iron-rich foods may be gentle on your belly and maximize iron absorption. Here are a few:

• lean red meat
• lentils, beans, peas
• salmon, sardines
• leafy greens (kale, turnips, collards)
• poultry (dark meat)
• iron-fortified breads, pastas, cereals 

Boost your iron absorption by pairing iron-rich foods with Vitamin C. (Yep…most people think of oranges or citrus, which is great, but it also includes broccoli, tomatoes, etc.).

Minimize medication interactions. Iron levels in your body will fluctuate, which can be more pronounced when taking certain medications.

1. Avoid calcium supplements with iron-rich foods since iron and calcium compete for absorption in the body.
2. Some medications for acid reflux (ex, famotidine (Pepcid), cimetidine (Tagamet), and Zantac) decrease stomach acid production, which impairs the absorption of iron.
3. Some antibiotics (penicillin, tetracyclines, ciprofloxacin) and other classes of medications also lead to iron deficiency.

Beyond the Plate: Lifestyle Hacks for Optimizing Iron Absorption

Your lifestyle impacts your gut in so many ways! We have busy lives, and this often leads to stress. It’s important to manage your stress levels. Stress can lead to chronic overactivation of the sympathetic nervous system (fight or flight) and can affect GI motility, which leads to gut dysbiosis.

There’s also good news! Listen to your body when you feel tired or fatigued from your IBS or IDA symptoms! It’s giving you permission to REST!!! Ignoring these signals is not wise. Ensure you wake up well-rested (at least 7 hours of sound sleep each night).

Building a Holistic Approach: Explore Supplements with Your Provider

Remember, you are never alone! Always discuss your individual needs with your provider. Depending on the underlying cause of the anemia, iron supplementation may help. Studies show that some forms of iron can worsen IBS symptoms due to their effect on the gut microbiome. Like everything, supplements can impact your gut in other ways, so ask about potential side effects and medication interactions to ensure you are approaching your IDA safely and effectively.

1. _{Bek, S., Teo, Y. N., Tan, X. H., Fan, K. H. R., & Siah, K. T. H. (2022). Association between irritable bowel syndrome and micronutrients: A systematic review. Journal of gastroenterology and hepatology, 37(8), 1485–1497. https://doi.org/10.1111/jgh.15891}
2. _{Bloor, S.R.; Schutte, R.; Hobson, A.R. (2021). Oral Iron Supplementation—Gastrointestinal Side Effects and the Impact on the Gut Microbiota. Microbiol. Res., 12, 491-502. https://doi.org/10.3390/microbiolres12020033}
3. _{Hujoel, I.A. (2020). Nutritional status in irritable bowel syndrome: A North American population-based study. JGH Open, 4: 656-662. https://doi.org/10.1002/jgh3.12311}
4. _{Iron Deficiency Anemia. (2022, Mar 24). National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia}
5. _{Iron: Fact Sheet for Consumers. (2023, Aug 17). National Institutes of Health: Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Iron-Consumer/}
6. _{Yilmaz, B. and Gamze, A. (2021). The Evaluation of the Nutritional Status in Patients with Irritable Bowel Syndrome. Clin Exp Health Sci 2021; 11: 119-126. https://doi.org/10.33808/clinexphealthsci.646176}