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Advice Needed for Anemia and Underweight

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Crohn's Disease
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Posted 5/16/2010 12:02 AM (GMT 0)
Recent bloodwork shows my daughter's inflammation levels to be dropping rather impressively since starting 6MP about 4 mos. ago.  She  has been feeling pretty good, with some intermittant tummy aches here and there and occasional diarrhea, but nothing to stop her from enjoying life at present. That said, her doc is concerned about the fact that she is not gaining weight and that she is still "mildly anemic" as he put it.  Any suggestions for weight gain in a picky kid?  Anything we can do to improve the anemia?  She does still look very pale. Thanks.
Posted 5/16/2010 1:34 AM (GMT 0)
Hello, I am sorry your daughter is going through this but am happy to see that she is feeling better. I have been undertreated for a couple of years now and became very anemic and have lost almost 60 pounds. One thing you should talk to her doctor about is putting her on iron pills and also you can buy ensure plus (lactose free) to help with her weight. My insurance covers it for me and I have cases of it here but I can't keep anything in (always running to the bathroom). I am suppose to see my new GI doctor this tuesday and the plan was to start me on steroid and 6mp. Ask your doctor about the ensure plus and maybe your insurance will cover it too. If you keep them real cold they taste better.
Posted 5/16/2010 2:10 AM (GMT 0)
for anemia i use the iron pills by solgar - it is a non constipating form and is gently on the stomach. talk to your doc about dosage. it may take a few months to get the numbers back up to a good level.

as for gaining weight, all you can do is eat more. to gain weight you need more calories. but you need the right ones. be wary of high carb sugar laden processed foods. if she can tolerate fruits and veggies eat those with more meat. gaining weight too takes time. she is just going to have to learn to not be picky. i know easier said than done, but especially so for one with digestive problems and constant tummy aches. the older you get though the easier it is to suck it up and eat things that dont taste so good. perhaps try meal replacement shakes can work as those are extra calories you can doctor up with some frozen fruit or a bit of ice cream.
Posted 5/16/2010 2:26 AM (GMT 0)
Proferrin are excellent iron pills.
Posted 5/16/2010 3:54 AM (GMT 0)
When I needed to gain weight a few years back, I drank something called Scandishakes. They are delicious! I was sad to quit drinking them when my weight got up. I mixed a packet of vanilla with ice cream, milk, and chocolate syrup (this was back in my pre-SCD days). They are high carb and high fat though, if either of those are in issue with your daughter. I guess that's also why they taste so dang good!

http://www.axcan.com/us_scandishake.php?lang=1

"SCANDISHAKE® calorie-rich shake mix is designed to assist patients who need to gain or maintain weight. Mixed with 8 ounces of whole milk, a single serving of SCANDISHAKE® contains approximately 600 calories!"
Posted 5/16/2010 7:36 AM (GMT 0)
 

Hi,

Now that her inflammation is reducing she should find it easier to digect and hold on to those calories. 

I would go along with the suggestion of a high calorie shake, son is on one a day (prescribed) and has gained 22lb. He doesn't do breakfast so the shake gives him a kick start that he would otherwise not have had.

Son has been told minimal/no fruit and veg(which suits him) so it would be best to see what your consultant says about that one.

Hope she starts gaining soon.

Posted 5/17/2010 12:32 AM (GMT 0)
Thanks so much everyone, for your suggestions. I do have her on Ensure but since she doesn't like it at all, she drinks only a little at a time. I did not know iron would help with anemia tho...so great idea! I was thinking b12 might help also?

Posted 5/17/2010 2:01 AM (GMT 0)
Maybe you could make and appointment with a registered dietitian, they would have a lot of great tips. Such as adding extra butter or cream to mashed potatoes to add calories, that way she doesn't feel as though she is eating differently or that much more.
Posted 5/17/2010 2:10 AM (GMT 0)
Usually, anemia is caused by low iron. The Solgar's iron pills CrazyHarry suggested are used by my own daughter - she takes two of the 25 mg ones. Only with orange juice, because food, other vitamins, and other medications all interfere with the absorption of iron. The best time to take the iron is two hours after and one hour before eating any food, taking any meds, or any other supplements.  

A B12 shot probably couldn't hurt, either, as often Crohn's patients have trouble absorbing B12. 

Posted 5/17/2010 3:02 AM (GMT 0)
take iron with vitamin C as that will help the absorption. dont take it with calcium as they block one another.

fat is good. it is not bad like we have been told so dont be afraid to have your daughter eat butter or fatty foods, even foods with saturated fat. just stay away from obviously fatty foods like donuts and fried foods - those are trans fat foods and are bad for you.

you can make your own shakes with yogurt/ice cream/almond milk/kefir and frozen fruit and a bit of honey and flax seed oil. tastes great.

b-12 is good for low energy. probably all of us with crohn's should be on a b-12 supplement.
Posted 5/17/2010 6:47 AM (GMT 0)
I don't have anemia but my weight does fluctuate 5-10 pounds. I eat a lot of meat. Keeps the protein up and my weight a little more regular. Lot of baked or grilled chicken and lots of steak.
Posted 5/17/2010 7:03 AM (GMT 0)
I dont really like the normal ensure either but there are other weight gain drinks available. I take ensure plus juice they are much better tasting and easy to drink than the milkshake ensure which I find very thick and difficult to drink if you aren't feeling well. I tried a variety of these drinks and the ensure plus juice are by far the best. I live in the UK but think they should be avaliable in the States.

I have also been anemic in the past my iron count is fine now although I still look like casper the ghost. I took iron pills for it which done the trick.
Posted 5/17/2010 7:56 AM (GMT 0)
Lack of B-12 causes pernicious anemia. You should also have her blood checked for b-12 levels.
Posted 5/17/2010 3:26 PM (GMT 0)
@ Spookyhurst - Thanks. I have called and requested a Free Sample of the Scandishake mix to let her try that.

 

@ All - Iron! Cool!  Will def. get her the Solgar iron tablets. Hope they are small so she can swallow them.  Will be hard to find a time to give it away from other meds tho. She takes meds. first thing in the morning, then off to school, then more meds. at bedtime.

Posted 5/17/2010 4:04 PM (GMT 0)
I think you're less likely to have side effects and more likely to have absorption of iron from a heme iron source such as Proferrin than from the glycinate in the Solgar. See article below.

http://www.ajcn.org/cgi/content/full/72/6/1592

As someone who's struggled with anemia for 10+ years, the Proferrin are the best pills I've ever tried and I've tried them all.
Posted 5/17/2010 4:08 PM (GMT 0)
Rider Fan - Good to know. Do they come in a small enough pill for a tiny girl to swallow? Are you buying them online? And are you careful what time you take them also, i.e. away from meals or other meds, as suggested here? Sorry so many questions.

Posted 5/17/2010 4:37 PM (GMT 0)
I know this isn't specific advise, but I got to the point where they were going to hospitalize and tube feed me if I didn't gain weight.  My husband figured out that if I ate something and it worked okay, to just keep buying more of it and feeding it to me.  So, it may not have been the healthiest diet, but whatever I found that tasted okay and didn't make me sick, he kept buying and bringing to me.  I think that chips and spinach queso kept me out of the hospital, as much as that foods seems like it would make things worse.  So, if there is something she can eat, keep making it and offering it to her as much as you can.  It did take some time with me and I'm sure it will with her, but seeing an improvement each week was great and kept my husband doing it. 

Posted 5/17/2010 6:36 PM (GMT 0)

MoobyDoo said...
Rider Fan - Good to know. Do they come in a small enough pill for a tiny girl to swallow? Are you buying them online? And are you careful what time you take them also, i.e. away from meals or other meds, as suggested here? Sorry so many questions.

They're medium sized pills. Do you have a pill cutter? You could cut them in half or quarters.

I'm in Canada and I have my pharmacy, Shoppers Drug Mart order them from the Canadian supplier. They're made in Colorado I think, just google Proferrin.

Because they're heme (ie. animal) iron it doesn't matter if you take them with meals or not.

Hope that helps!
Posted 5/17/2010 9:14 PM (GMT 0)
Food, meds, and supplements can all interfere with any kind of iron. Which is why my daughter takes it only with orange juice, because the vitamin C will, as CH said, boost iron absorption.   

Whichever brand you try - give it about a month, then have labs done to check iron status. The most important iron lab test is "ferritin" - second most important is "hemoglobin" and third in importance is "serum iron."

www.labtestsonline.org makes it easy for you to find out which labs are required, and what the lab results mean. You can insist on copies of all lab reports, especially the one that the doc says shows she is anemic. This way, when you get another test done, you can compare the two and see whether her ferritin (otherwise known as iron storage) or hemoglobin improved.

 

Posted 5/17/2010 9:29 PM (GMT 0)

njmom said...
Food, meds, and supplements can all interfere with any kind of iron.

Actually it doesn't matter with heme iron, that's why it's a better choice.

"Absorption of heme iron is very efficient and not significantly affected by the composition of your diet(1)."

http://ibdcrohns.about.com/cs/nutrition/a/fdairon.htm
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