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Blood report. Iron deficiency, acidity, water retention problem, leg pain, anxiety & irritability during mid cycle. Suggestions to help increase my hemoglobin / energy levels?

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I am 33 years old, mother of one daughter (5 years old), I recently got my blood test done to check what is wrong with me. Since I used to get tired very often. I am currently not working, I quit my job 1 year back as I found the job stressful and tiring. The blood test shows that my hemoglobin is 8.8 , MEAN CORPUSCULAR VOLUME (MCV) is 75.9 fL and RED CELL DISTRIBUTION WIDTH (RDW CV) is 17.2 fL . Moreover my Iron level is 48 μg/dl , TOTAL IRON BINDING CAPACITY (TIBC) is 391 μg/dl and % TRANSFERRIN SATURATION CALCULATED is 12 %.

I also have acitidy problems and many times I feel that the food is coming up my food pipe many hours after having meals. I feel I also have water retention problems. My legs pain a lot. I also face anxiety and irritability during mid cycle. I have regular periods.

To solve the iron deficiency I am planning to take Iron supplements along with Vitamin C supplement. I was planning to start this Iron supplement : "Nature's Bounty Iron 65 mg" or do you suggest some other supplement ? Should I also take Vitamin B12 and /or B6 supplement ? What are your suggestions to help me increase my hemoglobin / energy levels ?
Many thanks, XXXXXXX
Posted Sat, 2 Jun 2012 in General Health
Answered by Dr. Robert Galamaga 20 hours later
Hello and thank you for somebody your question.

Your question is a very good one and I will work on providing you with some information and recommendations regarding what is going on.

It is very apparent that you have iron deficiency which is related to your anemia as well. It is important at the same time to consider why you may have developed iron deficiency. Sometimes gastrointestinal bleeding can cause chronic blood boss and iron deficiency. At some point you should have a colonoscopy and upper endoscopy performed to evaluate the inside of your gastrointestinal tract.

If for some reason your diet is lacking in daily iron this could possibly explain why you have developed this degree of anemia.

There are some disorders of digestion including celiac disease which can sometimes lead to anemia as well. Your doctor can perform some blood tests to help rule that out.

The Natures Bounty Iron supplement which you have mentioned is perfectly fine for you to take. Ideally you should try to take this at least twice per day and even three times per day would be optimal. This medication can cause some constipation so I just want you to be aware of that. Also it may cause a dark discoloration of your stool.

The leg cramps or leg pain that you're experiencing is most likely related to your iron deficiency and that should certainly improve over the next few weeks.

You should have a repeat blood count drawn in about 4 to 6 weeks to evaluate your anemia. In addition I would recommend that your doctor performs a ferritin level in addition to the other ion studies.

Vitamin D supplementation is not necessary at this time. Your energy level will significantly improve in the next one or two months as your hemoglobin returns to the normal range.

I thank you again for submitting your question. I hope you found my response to be helpful and informative. If you have any additional concerns I would be happy to address them.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Blood report. Iron deficiency, acidity, water retention problem, leg pain, anxiety & irritability during mid cycle. Suggestions to help increase my hemoglobin / energy levels? 8 hours later

Many Thanks for your detailed and insightful diagnosis.

I have never got colonoscopy or upper endoscopy done. However let me give you some more details about myself, which might help you understand my case better.

I had a C section delivery 4.5 years back. After which I had developed Lactose intolerance. We have been trying for a second baby for the last 1.5 years without success. I had got HSG treatment done eight months back for blocked fallopian tubes, but no luck yet.

I am a vegitarian, so I might not be getting sufficient iron from my diet.

I have a habit of using chewing tobacco for the last 15 years. I use a very small quantity and I don't swallow the tobacco, I spit it out after about 15 minutes, which seem to bring relief in digestion. And I use it twice a day. I had tried to quit using tobacco 6 months back, but it increased bloating in the stomach and constipation increased, hence had to restart it.

I have a few questions :

1) You mentioned that I might have Gastrointestinal bleeding, if that is the case will there be any other visible symptoms apart from bloating, constipation and pinching pain that I get sometimes ? How is it normally tested by a Dr. ?

2) Your pointer towards Celiac disease was very useful and we will visiting a gastroenterologist for the same. I will also be getting the Tissue transglutaminase antibody (tTG), IgA test ordered to screen for Celiac disease. Are there any other tests for determining Celiac disease ?

3) Can I start taking the Iron supplement now, or should I wait for the evaluation from the gastroenterologist to find out the underlying cause? Won't the Iron supplements increase the discomfort that I currently face in my stomach ?

4) Do you recommend I also start Vitamin C supplement along with the iron supplement ? If yes, how many mg. Vitamin C should I take ?

Many thanks for your guidance and time.


Answered by Dr. Robert Galamaga 2 hours later
Hello and thank you for your follow-up question.

Regarding the iron supplementation I think you should start right away. I don't think there is any problem in starting to supplementation prior to being seen by a gastroenterologist. I would recommend that you start taking the iron once per day for about one week. After that you can increase it to twice per day and see how your body tolerates this. Ideally three times per day would be optimal but I am just in this might be hard for you to tolerate. The reason why we recommend vitamin C is because this vitamin helps your body absorb the iron from the supplement.

The transglutaminase test is very helpful in diagnosing celiac disease. There is also one additional test called endomysial antibody screen which is also helpful. In addition during a colonoscopy the gastroenterologist can take a small biopsy which is a very definitive method in diagnosing celiac disease.

I realize you are a vegetarian. We can still not assume that the only reason why your iron level is low is because you have a low dietary intake. This is why a visit to the gastroenterologist is a very reasonable consideration.

I also know you have a sensitive stomach. While there is some concern that tolerating iron might be difficult I still think it would be very worthwhile to start very slowly to see how your body tolerates it.

Regarding gastrointestinal bleeding there is a simple test that a physician may perform in order to see if there is some degree of bleeding. This test involves a rectal examination and what is called a heme-occult test. This test is fairly simple and is relatively accurate in diagnosing gastrointestinal bleeding. The other way a physician might be able to find bleeding would be through the colonoscopy or upper endoscopy

I thank you again for submitting your question and follow-up questions. If you have any additional concerns I am always here for you.


Dr. Robert
Above answer was peer-reviewed by
Follow-up: Blood report. Iron deficiency, acidity, water retention problem, leg pain, anxiety & irritability during mid cycle. Suggestions to help increase my hemoglobin / energy levels? 2 days later

I got my Vitamin B-12 blood test done and the result was 176 pg/ml (normal range : 187 to 883 pg/ml) Hence mine is very low.

So I assume starting a B-12 supplement would also be required. I have shortlisted this B-12 supplement : Nature's Bounty Sublingual Liquid B-Complex with B-12. ( WWW.WWWW.WW )

The constituents of these B complex liquid are :

Amount Per Serving      %Daily Value
Riboflavin(Vitamin B-2)      1.7 mg (100%)
Niacin (as Niacinamide)      100% (20 mg)
Vitamin B-6       100% (2mg)
Vitamin B-12       0000% (1,200 mcg | 1.2mg)
Pantothenic Acid       300% (30 mg)

My questions :

1) Is this combination of vitamin B ok or do you suggest any other vitamin B-12 supplement ?

2) How many mcg of B12 should I be taking per day ? Is 1200mcg B-12 sufficient for my low B12 levels ?

3) Should I be taking B12 after meals along with Iron and Vitamin C (500mg)?

Answered by Dr. Robert Galamaga 31 hours later
Hello and thank you for submitting your question.

This B-12 supplement what you have listed here would be absolutely fine to take to help restore your vitamin levels. I think at least 1000 µg per day would be adequate so this is more than enough for you to take on a daily basis.

As far as when to take the vitamin B you can take it along with your other supplements without a problem.

I am very confident that within the next couple of months you will start to feel much much better with these supplementation's.

Thank you so much for submitting your question. I appreciate the opportunity to discuss your health here on our website. If you have additional concerns I am always here for you.


Dr. Robert

Above answer was peer-reviewed by
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