Dear Dr Mitchell,
My doctor says I'm severely anaemic and gave me iron tablets to take. The problem is that they make me constipated and have stomach aches. Aside from eating liver (I'm a strict vegetarian) is there anything else I can do or take to naturally combat the anaemia

Anaemia is a fairly common problem in women especially in developing countries. This may be due to several factors and the underlying cause should be investigated before assuming that it is due to iron deficiency.

The causes of anaemia include iron deficiency, folic acid deficiency, Vitamin B12 deficiency, chronic infections, renal failure, certain malignancies especially of the stomach or bowel, inherited causes such as sickle cell disease, thalessemia and some bleeding disorders.
Iron deficiency is a common cause of anaemia in Jamaica.

This may be due to chronic loss from the body or due to poor dietary intake. Uterine fibroids are common in black women and often present with heavy bleeding thus causing anaemia. Vegetarians, especially strict vegetarians, are at risk for anaemia due to Vitamin B12 deficiency because of the lack of intake of meat.

The average person with a normal diet has adequate Vitamin B12 for up to 2 years and does not need supplementation, but strict vegetarians need daily supplementation of Vitamin B12. The anaemia which you experience is probably due to Vitamin B12 deficiency so you need to be properly investigated by doing blood tests to determine the specific cause. Taking iron tablets will not help if you are deficient in Vitamin B12.

Constipation and stomach aches are common side effects of taking iron tablets. You should consider changing the preparation to one that is coated specially to protect the stomach walls and this will reduce the stomach cramps.

The constipation may be relieved by eating some extra fruits and vegetables and also prunes. Calaloo, spinach and other green leafy vegetables are excellent sources of iron. You may improve the absorption of iron by taking the tablets with fruit juice. Do not use milk, antacid or drink tea with the iron to relieve the stomach aches. This will reduce the amount of iron absorbed.

In severe cases of anaemia, Vitamin B12 injections or transfusion of iron preparation may have to be done especially if there is no improvement on oral iron or vitamin B12 tablets.
Consult your doctor who will advise you further.
Best wishes.

Dr. Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.

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