Spotted with bruises and out of energy? Anemia is bad enough without experiencing severe stomach pain from iron pills. Low iron and constipation shouldn't go together. And they don't have to. It's all about how you're getting your iron.
Is Anemia Causing Your Constipation?
A deficiency of iron in your blood causes anemia. If you've been dealing with low iron, then you already know that it has its complications. What you may not know is that constipation doesn't have to be one of them.
While there may not be evidence that anemia causes constipation, it is linked to a few different gastrointestinal issues. For example, it's noted in the Drugs November 2013 issue that patients with inflammatory bowel disease (IBD) often have anemia as well. Of course, IBD doesn't cause constipation. Irritable bowel syndrome (IBS), on the other hand, does cause constipation.
Furthermore, Harvard Health Publishing noted in January 2017, that IBS constipation can lead to anemia. So even if your anemia didn't cause your constipation, low iron and constipation may be related.
Effects of Iron on Constipation
It may be true that you're experiencing constipation from GI issues. But if it didn't start until you began taking iron supplements, then the supplements may be the cause.
Iron pills caused constipation in more than 40 trials, according to a February 2015 PLoS One review and meta-analysis. These effects weren't linked to any specific dosage, which means limiting your intake won't resolve the problem.
Supplemental Iron Without Constipation
It seems that there has to be an iron supplement that doesn't cause the severe stomach pain that iron pills create. If only there were a simple answer.
In the February 2015 PLoS One study, it's noted that ferrous sulfate is the most common supplement to cause constipation. Unfortunately, it's also the most commonly prescribed. That may be because there aren't any iron pills that don't cause constipation.
Looking Into Conflicting Results
You can avoid the side effects of iron pills (ferrous sulfate) by using other supplements. But there's debate over which is best.
Researchers at the University of Wisconsin-Madison studied the different forms of iron supplements and found that for some patients, polysaccharide-iron doesn't cause constipation. In their study, they concluded it was the best option for the fewest side effects. But a February 2013 article in Current Medical Research and Opinion disagrees, suggesting that extended-release ferrous sulfate with mucoproteose has fewer side effects.
These different studies show the conflicting results around iron pills and constipation, which begs the question, what's your best option?
Are Supplements the Best Option?
If most iron supplements cause constipation, are they the best option for your anemia? In an October 2013 ACG Case Reports Journal study, researchers reported that iron pills caused gastritis and were poorly tolerated by patients. The study also noted poor absorption of iron from iron pills. An article in the May 2015 Blood Journal goes a step further, stating that iron supplements decrease overall iron absorption.
If iron pills do decrease absorption, it may be time to try another route.
Improve Iron Absorption: Battling Anemia
There are a few things you can do to improve your iron absorption. A September 2017 article in Free Radical Biology and Medicine suggests that vitamin C enhances iron absorption. It also promotes tissue iron load and assists the metabolism of iron in the brain. You can get vitamin C from supplements or from a diet rich in fruits and vegetables.
Tannins also improve iron absorption, according to an article in the January 2017 issue of Current Developments in Nutrition. Tannins are in plenty of things you likely already consume. Tea for example, is great natural source.
While there are foods that improve iron absorption, there are those that deplete iron as well. Some examples include eggs, calcium-rich foods like milk, and cocoa or coffee.
Read more: Foods that Inhibit Iron Absorption
Better Options Than Iron Pills
Considering iron pills' side effects and their absorption issues, there has to be a better solution. Low iron and constipation shouldn't be bound together.
A May 2015 article in the Journal of International Society of Sports Nutrition recommends eating iron-rich foods over taking a pill. The article suggests that it's easier for your body to absorb iron from foods than from pills. Best of all, food lacks the undesired side effects.
Some food sources packed with iron are leafy, green vegetables, legumes, seafood and organ meats like pâté. Of course, before you start creating an iron-rich diet plan, make sure your doctor agrees it'll be enough to restore your iron levels.
- PLoS One: Ferrous Sulfate Supplementation Causes Significant Gastrointestinal Side-Effects in Adults: A Systematic Review and Meta-Analysis
- ACG Case Reports Journal: Iron Pill–Induced Gastritis
- Drugs: Current Management of Iron Deficiency Anemia in Inflammatory Bowel Diseases: A Practical Guide
- Harvard Health Publishing: Diagnosing and Treating Irritable Bowel Syndrome
- University of Wisconsin-Madison: A Prospective Open Label Study Evaluating the Efficacy and Adverse Reactions of the Use of Niferex@-150 in ESRD Patients Receiving EPOGEN@
- Current Medical Research and Opinion: Tolerability of Different Oral Iron Supplements: A Systematic Review
- Free Radical Biology and Medicine: The Active Role of Vitamin C in Mammalian IRON Metabolism: Much More Than Just Enhanced Iron Absorption!
- Blood: Oral Iron Supplements Increase Hepcidin and Decrease Iron Absorption From Daily or Twice-Daily Doses in Iron-Depleted Young Women
- Journal of the International Society of Sports Nutrition: Iron and the Female Athlete: A Review of Dietary Treatment Methods for Improving Iron Status and Exercise Performance
- Current Developments in Nutrition: The Impact of Tannin Consumption on Iron Bioavailability and Status: A Narrative Review
- American Academy of Family Physicians: Constipation