[emmaegbert]

So my bloodwork finally happened and I came back on the absolute borderline for homebirth eligible due to anemia. Midwives want me to start cooking in cast iron, drinking nettle tea all day long, and supplementing.

I've never supplemented before... never paid much attention and nobody ever said anything (this is my third child). She said she could prescribe an iron pill. But I think I've heard that is not always the best, most available iron source?

My prenatal vitamin (Rainbow Light Just Once line) has 30mc of iron. Obviously not enough b/c I am good about taking it.

I'll look up iron rich foods and try to eat daily. I am ovo-lacto vegetarian and don't really eat grains. Looking at the lists I am seeing... I already eat 2-3 eggs per day, beans, lentils or soy for main protein of 1-2 meals per day, and leafy green veg or broccoli almost every other day. But none of these seem to be very high compared to, say, my multivitamin.

My levels were Hemoglobin 10.8 and hematocrit 30.9 (this means very little to me but MW says this is anemic).

Has anyone dealt with this before? What have you learned? What worked for you?

 

[emmaegbert]

MW also mentioned floradix... I'm asking for clarification if she wanted me to use floradix and a prescription iron pill, or just choose one...

 

[~pi]

Disclaimer: I have really struggled with anemia throughout my life, and just seem to have real trouble keeping enough iron in my body. (It has always made me nervous about celiac, which is linked to type 1 diabetes, but so far, the tests have always come back negative and I have no other symptoms. And I do have very heavy periods and a short cycle, so I have lots of opportunities to lose iron.) I've had some very low iron numbers, especially after DS was born. He also had very low iron stores at a year old. So take this with a grain of salt, because a known long-standing issue can be quite different than transient anemia. I take anemia pretty seriously now.

Having said my disclaimer, my experience has been that it's worth taking the pills. I don't like taking supplements for something that I feel I ought to be able to get from good nutrition, so I worked very hard to avoid taking them. I have put a lot of effort into getting enough iron in my diet. I started eating meat again. I make sure to get heme iron, non-heme iron, both always with a source of vitamin C, and often all three together. The majority of our salads (we have minimum one salad daily) use spinach as the green and are heavy on peppers. When it appeared that, although those efforts helped, they were not enough, I took Floradix religiously for six months. Again, that helped, but not enough.

Whenever I've had bouts of anemia, the only thing that has ever reliably gotten my numbers back in the normal range (not to mention helped me feel like a normal person again) has been prescription supplements. I took them after having DS, because my numbers were so scary low that I didn't want to mess around trying other things, and they did the trick. I didn't like taking them, so when my numbers started to slide again a few years ago, I tried all the other options first, to minimal effect. I finally gave in and started taking pills again when I learned I was pregnant.

The pills really make a difference for me, and quickly. They consistently have noticeable effects within 2-3 months, not the six to twelve that everything else takes before my numbers and symptoms even start to budge. In a way, that speedy action kind of freaks me out, but really, if you need to get iron numbers up before the end of pregnancy, my experience has been that going for supplements is worth it.

Also to give you a sense of how I feel about this now, I plan to give this baby Tri-Vi-Sol prophylactically (which I avoided with DS until it was clear his iron stores were dropping) and will also feed this one iron-enriched cereal when we start solids (which we did not do with DS, having bought into the whole bioavailability thing of iron in breastmilk, which I suspect may be fine for most people, but not when maternal iron is low.)

 

[Jane]

I highly highly recommend Slow-Fe supplements. They come in a generic. Both are over-the-counter. Tons of iron in one pill. Doesn't usually cause stomach upset or extra constipation.
Floradix works decently, but it's expensive. I often suggest adding Slow-Fe to Floradix. Floradix gives the herbs and B vitamins, Slow-Fe supplies the iron, instead of trying to take 5 doses of floradix ($$) a day to get enough elemental iron.
You've got plenty of time to fix this.

10.8 is low, low enough that most women are going to feel quite symptomatic. Like winded when you go up stairs, low energy, etc. You will probably feel better in a week or so of supplementation.

 

[newyorkmommy]

I don't know your specific history, but for a different perspective, you could check out what Nina Planck has to say about anemia in pregnancy in her book Real Food for Mother and Baby. Her "angle" is largely about the importance of traditional foods, but I thought her take on anemia was really interesting. She basically says that anemia in pregnancy is actually a very normal and healthy physiological change in pregnancy and that docs and midwives pushing iron supplements is unnecessary and in some cases not good. Don't know if I agree with her completely or in every case, but you could take a look and see what you think. Although, I suppose that being a vegetarian certainly makes is harder than for those who eat red meat.

Cooking in cast iron is a great idea, though. It's actually pretty amazing how much iron leeches from the pan into your food, and it's a pretty painless solution.

Good luck!

 

[emmaegbert]

I do want to get my levels up in order to be homebirth eligible (the bureaucratic reason), but also because I am concerned that its not healthy for me, and that my baby will be born with low iron stores and possibly my milk will not have enough iron either. And it looks like I will be tandem nursing, though DD is down to 2 or 3 nursings a day. I did not supplement the olders for iron, but you know Pi, this is a good point and I might do it for the baby. DD has a dr appt in a little over a week, so I'll have her levels checked too.

And Jane and Pi, thanks for the recommendations. I bought some floradix but yeah its not cheap if I have to take 5 doses a day!! I am thinking I will try supplementation and dietary approaches together. I have to go pick up my blood glucose meter (other risk factor...) today and I'll look for that kind of iron while I am there. I *do* feel tired, winded going up stairs and hills, etc. But I thought it was just pregnancy symptoms! And the fact that I care for 2 young kids as well. I really wasn't worrying about iron as its just never come up for me before. I wonder if the close spacing of my pregnancies and tandem nursing is part of the problem? Perhaps my own iron stores haven't had a chance to recover? (I got pregnant unexpectedly despite using birth control when DD was about 21mo). I hope this isn't the beginning of a chronic problem. Sigh.

Newyorkmommy- I will read through the Planck book at some point. It might be good to have an alternative view, especially if I can get in the "HB eligible" range but don't get to optimal levels... In general I am familiar with the TF approach and I find it such a mixed bag. I am sure it is good for some people but their approach to eating is too limited for me. I am a vegetarian by choice, and its not a choice they support, nor do they acknowledge that there are "traditional" diets that are more plant-based. Also, b/c I have an obvious problem with carbs, including gestational diabetes with my second child, probably exposure to high glucose environment as a fetus, and a mother and many other relatives with type II diabetes (and then the clincher for me realizing this is really true was a dramatic dropping of excess weight effortlessly when I cut carbs down to under around 100 per day), I just can't load up on all the grains, and largely avoid them, and certainly sweeteners, natural or no, are just not good for me. However, I do soak and sprout legumes before cooking, I eat cultured dairy, I eat pastured eggs, natural fats (and plenty of them) etc. Sprouting grains doesn't make enough of a difference in the carbohydrate count to make it worth it though I buy sprouted-grain bread for my kids, and I soak their morning oatmeal (which I don't eat). I do not buy into that soy is poison, and I don't eat a ton of it, but feel like its fine (FOR ME, anyway) in moderation, and usually in traditional preparations (miso, tofu, tempeh).

 

[Amy May]

Just a few more thoughts to add.. when did you have the blood drawn? One thing to keep in mind is that as your blood volume expands, it also dilutes, so your hematocrit & hemoglobin do go down. Newyorkmommy- that may be what Nina Planck is refering to- physiological anemia to some exent can be normal (meaning your iron levels should be lower at 26 weeks then they were at 4 weeks). But, I personally think staying on top of iron levels is extremely important, especially for a homebirth (my understanding of the research is that it is somewhat mixed as to whether anemia makes you more likely to hemorrhage or not, but certainly, there are increased risks to actually hemorrhaging if the woman is anemic).

Jane- I will look at Slow-Fe as well- I haven't heard of those. I'm taking Floridex about every other day (my MIL got me a big bottle, but yeah, everytime I take a dose of it I think about it in basically a dollar-amount per swallow...)

Also, as Pi mentioned, definitely make sure to get Vitamin C along with all your iron rich foods, because it helps with absorption. Also, I don't know if you're taking calcium, but if so, make sure you take that at night, and iron supplements in the morning (or whatever combo so that you're not taking iron and calcium at the same time). I also agree that supplementing is worthwhile. Doesn't mean you stop trying to get iron in your diet, but you also definitely have time to increase those levels, and supplementing may help a lot!

 

[emmaegbert]

Amy May, thanks for the further info. I did have the blood draw right around 20/21 weeks, I think that is when blood volume starts to go up... I don't know how soon MWs will want me to retest but I assume we'll have a couple chances for that...

I do take calcium at night already (mostly so I remember, and so it doesn't interfere with the other stuff I take). So, I will try to add iron to morning as well as mid-afternoon (at least when I am home). I usually take some emergen-c before physical exercise (at the moment I walk about 2mi each in the morning and afternoon... school commuting... that will change in a few weeks). So anyway, I will try to take floradix or the iron pill with that.

 

[Jane]

Midwives usually draw at 28 weeks - that's when blood volume is at maximum. When you are okay at 28, you'll usually be okay the rest of the time, ie, we test when we expect minimum. If still okay, then awesome!
It's no secret where the iron is going. Some is due to volume expansion, but most anemia at that level is due to baby taking it. Most nutrients, the baby asks for some, your body replies with levels and you work it out. For iron, the baby just takes it.
I'm not surprised that you were fine for a certain amount of pregnancies and nursing, but eventually ran out. But rest assured the baby is fine in all this.
I'm not a huge fan of treating "the numbers" but insteD want to treat the woman. Most women below 11 will feel like crap. Iron supplies a quick return to health, in many cases.
I haven't seen anyone really be able to keep up with a growing baby with food sources once already low. Obviously, many woman do just fine with no supplement at all. But once you get behind the 8 ball, hard to recover without help.

As far as diet, I personally thrive on a more primal diet, but with lots of fruit. I have clients who thrive on vegan diets. And some that don't thrive on vegan or primal. Some woman do great on a super carb heavy diet. There's no one-shot recommendation from me...well, except encouraging veggies to eat meat for the sake of a hemoglobin number is mean and cruel and unlikely to be effective.

 

[Amy May]

Emmaegbert- I know it is frustrating to have anemia as a concern during pregnancy, but I also wanted to say that wow, it looks like you are really taking good care of yourself. I hope your body is responsive to supplementation and you can build those stores, but you have so many awesomely healthy habits that I hope you feel encouraged by all the really good ways you are caring for yourself, your pregnancy, and your family.

 

[emmaegbert]

thank you all for the encouragement and I do feel better today now that I have some ideas of what I can do to help my body with this process. I was so unpleasantly surprised by the results and by knowing that it could make me ineligible for the MWs! I already have other risk factors that we're managing closely (well, gestational diabetes... my age-- almost 37-- is as you all know "geriatric" but nothing I can control).

And I am actually looking forward to feeling more energy when my iron levels go up! That is an exciting prospect.

I ate some spinach for lunch. With lemon juice and hummos. Very tasty...

 

[AlexisT]

I'm also anemic and take Slow-Fe. I find it much easier to tolerate; most iron pills make me terribly constipated. I eat red meat, but my levels are always around 10-11. Not terrible, but not great, and if I bleed like last time it won't be pleasant (I was an 8.4 after delivery).

 

[Jane]

At 22 weeks, at 10.8, I have 100% faith you'll qualify for home birth, if your midwives use 10/30 as the cut off. No one has ever failed to get it as long as working on it and changing things as labs dictate. I mean, worse case scenario, you can have iron injections or IV at 36 weeks.
Take your supplements at least 5 days out of seven and retest at 28 weeks when you do your GTT. Chance are you'll hold steady. If you hold steady, you'll be fine on that regime as you get towards delivery. If you drop, you add some more things and retest.
You'll be just fine.

I'm out of iron and I'm not nursing anyone and this is my first baby.
But I'm a long time blood donor, every 70 days since 16, except during pregnancy. I know where my iron went.
Youre doing fabulous to make it this far!!

 

[emmaegbert]

Jane, all day I've been feeling lucky for all us ladies that we get to be in your ddc!

And, yes, MW doesn't seem too upset just wants me to get on this ASAP. They do use 10/30 (may be condition of their licensing here?)

 

[KABB]

I take prenatal vitamins but still become anemic. Because I don't eat a lot of the things that contain Iron and even being borderline anemic cause me to suffer symptoms that significantly impact my life and body I choose to supplement with pills. There are two (I think, my brain is a bit fuzzy right now) types of Iron and one is more easily absorbed by the body so I look for a supplement of that kind.

 

[Dreamy]

My iron levels were at 111 (equivalent to 11.1 in the US I think) at around 15 weeks, so I've been supplementing with Floradix. It contains ferrous gluconate in a plant-based formula. I've read that the gluconate form is more easily tolerated by the body/better absorbed than ferrous fumarate (harder to absorb and constipating).

I agree that the Floradix is expensive though, and I'm just so tired lately it's hard to muster the energy to mix up my drink (Floradix, water and orange juice), so I've ordered these slow-release ferrous gluconate pills to try: http://www.jamiesonvitamins.com/2496

Elemental Iron 50 mg from ferrous gluconate.
Excipients: Cellulose, Water-Soluble Cellulose, Sorbitol, Vegetable Magnesium Stearate.


I get re-tested at 26 weeks - if my levels aren't higher, I'll concede to my doctor's suggestion to take the prescription pills. I got through my first pregnancy just find with the Floradix, but my levels are lower this time around.

 

[emmaegbert]

so I am doing floradix 2x per day, and an iron pill I got at Whole Foods (all the ones at the drugstore had food coloring in them and that just seemed gross). It is 25mg a pill, and I am taking 2x per day. I upped the magnesium I am taking in the AM and so far I am not constipated (its been 3 days).

I am also drinking nettle tea, cooking in cast iron, and consciously including more iron-rich foods (though truly I already ate them). I am trying to cut out dairy at least one meal where I have greens. I love me my cheese but I can do it at least one meal a day. I also ordered a bunch of bulk herbs to meet me in the place where I am spending July and August. So I will be able to mix up a big pot of tea every few days and drink that throughout the days. I now recall that I did that w/ #2, since a friend gave them to me... nettle, RRL, and some alfafa and dandelion.

SO, thats the big news. I swear today I already feel a little better- psychosomatic??

I have my next prenatal on June 28 so I'll talk to MW about when they want me to retest.

(And Jane, we have decided to forgo GTT and just treat me as if I have GD, so I am pretty much eating that way again, just slightly less strict... only slightly though. Probably more strict than the official "GD diet" I was given last time. I am spot-checking blood glucose levels, but rotating when I check, fasting and 1hr post-prandial, different meals. Once a day for now. If numbers are consistently good that is how we will approach it. If they start rising, I will start checking more often.)

Thanks everyone for your helpful suggestions and support. It really helps!!

 

[TayTaysMama]

I have been suffering with low iron for several months now. It has dropped as low as 10.4. It is exhausting! I never had this issue with any of the other 3 pregnancies and we just can't pin point what the issue is. I did get it back up once to 11 and I was shocked at how much more energy even that little bit made. Unfortunately it was back down to 10.5 last week.

I had been taking just the Floradix 2x a day but just this past week I added different iron sup to the other multitude of supplements. Nothing I have found has really worked. I may try to Slow-FE after this if I can't get my numbers up.

I risk out of my HB at 10 as well so I really am worried about getting it up high enough. It would also be nice to be able to do a load of laundry without feeling like I am about to fall over from exhaustion.

 

[saoirse2007]

I am getting tested today...I can barely function....

even drinking coffee to get started in the morning.

def want to keep my hb!!!

 

[emmaegbert]

I wonder when we'll retest? I swear I am feeling better already and its day 5 of the supplementation. Was able to walk 1.5 miles this morning without feeling exhausted. (I realize now I was feeling tired after 1mi, normally I walk 4mi per day minimum, so that is unusual for me). AlexisT, Jane, Dreamy, Kabb, Pi, TayTaysMama and Saoise2007- good luck finding something that keeps your levels up and healthy. I really want my HB and I am reassured that there are other things like iron injections that we can try if all this supplementation doesn't help.

And, yeah, feeling the *other* effect of the iron pills now, yuck. But still having, you know, daily "movement", so I am not going to let it get me worried. I try no to think about the way I will have to keep this up until baby is at least 6m old. I want to feel confident that I am not endangering myself or setting baby up to have low iron stores. When these iron pills are out I will try the floradix pills- several people told me those helped a lot with less side effects (and I don't think I can afford-- or stomach-- that much liquid floradix!). Adding my 2x per day floradix (total 20), 2x per day iron pills (total 50) and prenatal (total 30), I am getting 100mg of iron supplements in the day. I am also doing the nettle tea, cooking in cast iron, and eating some iron-rich foods at every meal and watching that I am not having too much dairy, or at least, that I am having a couple of dairy-free or low-dairy meals at least (to keep calcium from interfering with absorption).

I never worried about iron levels with my two kids, but will have the 2yo tested at her appointment on June 29, and I guess I will have baby tested and probably will do iron supps as recommended (I never did those with the olders). DH has his physical today after work and I suggested he ask the docs about testing that (he hasn't had a physical in maybe 6 years? I am sure they will do bloodwork anyway, why not add a couple of level checks?)