Running with Crohn’s: Anemia

Over my history of Crohn’s disease, I’ve dealt with mild, moderate, and severe anemia.  In my early years with Crohn’s Disease, I never suspected anemia as the cause of chronic fatigue – even when the fatigue was severe and I knew I was bleeding.  I always attributed it my small children, long workdays, and lack of sleep.

Symptoms

When the anemia was severe, I couldn’t stand for more than a few minutes without getting a splitting headache.  I often felt faint or weak when I stood up suddenly and I still didn’t suspect anemia as the reason.

Ironically I sometimes feel anemic even when I haven’t noticed signs of bleeding in my stool.  At other times, I find frequent signs of bleeding in my stool and don’t feel anemic.  So if you discover blood in your stool (or you have very dark stools), you should ask your doctor to test you for both anemia and “fecal occult blood” (blood hidden in your stool).

These are the symptoms that I experience with bleeding and anemia:

• Red or black stools (or something in between)
• Extremely pale appearance
• The whites of your eyes look abnormally white
• Low capillary refresh rate - press on the pink portion of your fingernail enough to turn it white.  Observe how fast the nail returns to pink when you release it.
• (for me) standing gave me headaches
• (for me) Just standing tired me out
• (for me on more than one occasion with severe anemia) taking a hot shower made me pass out
• If you’ve been running for a while, anemia will cause you to experience higher than normal heart rate for the same workout

Here's a list of symptoms provided by WebMD that covers anemia due to conditions other than intestinal bleeding.

If you think you are anemic, seek medical attention.  Severe anemia can be live threatening.  Furthermore, it is essential that you discover the reason for your anemia and correct it.

Treatment

Mild to moderate Anemia

If you suffer from mild to moderate anemia, your doctor will prescribe iron supplements.  I have experience problems with iron supplements especially the very cheap iron sulfate supplements.  They can cause severe cramping and will usually turn your stool black.  If you sometimes experience constipation, you should take these with care because they can also cause severe constipation (this last side-effect has never caused me trouble).

Before following my advice, please check with your doctor.

I have four recommendations for iron supplements:

1. Take them with food
2. Take them with nutrient supplements that help with its absorption
3. Take more easily digested iron compounds
4. Split the dosage between evening and morning meals

The first recommendation is self-explanatory.

The second recommendation

The three nutrients / vitamins I used to help with iron absorption were vitamin B-12, vitamin C, and Folic acid.  Some iron supplements include one or more of these with the iron supplement but I found these combination supplements to cost much more than the nutrients supplied separately.  Therefore, I regularly took all of these at the same time (one of each or a multivitamin with an iron supplement).  I found that adding these nutrients not only increased my iron absorption (judged by the color of my stool after taking the supplements) but also by the amount and severity of side-effects like cramping that I suffered after taking the iron supplement.

If you do it for no other reason, take these supplements to reduce the cramping.

Note that due to the damage Crohn's Disease has caused my intestines and my small bowel resection, my body no longer can absorb a sufficient amount of vitamin B-12 through the intestines.  Therefore, I have to take all of my vitamin B-12 through a subcutaneous (under the skin) injection that I give myself once a month.

The third recommendation

I only recall taking three different supplement types: iron sulfate, iron gluconate, and iron fumerate.  Of these, I suffered the least side effects with iron fumerate and the most with iron sulfate.  My recollection is that iron fumerate (in combination with vitamin C) was much more expensive (say $30 / bottle) than iron sulfate ($2-4 / bottle).  I felt like I absorbed the iron fumerate better but that was a very subjective observation based upon the color of my stool.  I had fewer side-effects with iron gluconate than iron sulfate and the price was much more reasonable than iron fumerate.

My last recommendation

When I took the iron dosage recommended by my doctor, I almost always suffered cramping from the iron supplements.  When I cut the iron supplement dosage in half, I often did not experience cramping.  So I split my daily dose in half and took it twice a day.  Alternatively you can take a time release version of the supplement but these usually cost a fair amount more.

Severe Anemia

When you suffer severe blood loss or have very low hemoglobin counts, your doctor will recommend or direct you to get a blood transfusion.  In my case, all of my transfusions occurred in a hospital.  I do not know whether the medical establishment gives transfusions on an outpatient basis.

During one of my transfusions of 3 units of blood, I experienced an allergic reaction that required prompt medical attention (intravenous Benadryl).  It appears that allergic reactions due to blood transfusions are not uncommon. So I suspect that the possible negative side-effects to a transfusion require that it be done in a medical facility that can supply.

During my hospital stay, the hospital administered 3 units of red blood cells when my hemoglobin levels fell below 6 g/dl (~16 g/dl represents my normal healthy concentration of hemoglobin).  Similarly my doctors never suggested getting a blood transfer for hemoglobin levels above 6 g /dl.  I can only assume that they used oxygen saturation levels as their guideline and that my body was able to maintain adequate oxygen saturation after having lost 10 or more units of blood.

The US government guidelines indicate that a level of 9 g/dl is normally recommended for adequate oxygenation.

Staying active

I had not started running when I was chronically anemic.  However, I was participating in a variety of physical activities.  As you might expect the anemia made it much more difficult to do most physical activities.

While anemic I participated in master’s soccer and swam.  When I was aware of my anemia, I essentially understood that the purpose of my exercise (mostly swimming) was simply to rebuild my body after it had been ravished by extreme anemia and a major surgery.  I did NOT attempt any new swimming activities, speeds, distances, races, or anything else.  In fact, my first attempts involved simply trying to swim elementary backstroke for one lap of the pool (this was after being a competitive swimmer used to swimming two miles in a work out).

If you attempt to remain active with anemia, you must factor your anemia into your expectations.  You will NOT be able to run as long or hard as you could when not anemic.  Do not distress over this.  You are training under adversity.  In the long run, this will help you achieve running goals by forcing your body to work with less oxygen; it will actually improve your body’s use of oxygen.  When you recover from your anemia, it ought to make you a better athlete (similar to exercising at high altitude).