Fibromyalgia and Anemia

While common, iron deficiency remains underdiagnosed

woman fatigued fibromyalgia
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For people living with fibromyalgia, nutritional deficiencies can be an on-going concern. This is especially true among women with fibromyalgia of whom 90 percent have some level of iron deficiency. In fact, according to research published in the European Journal of Clinical Nutrition, fibromyalgia can increase the risk of iron deficiency in women by as much as 88 percent.

Chief among the concern is the development of iron deficiency anemia. As the name suggests, this form of anemia develops when you lack a sufficient amount of iron in the blood. Without iron, your body cannot produce enough of the substance, known as hemoglobin, needed to carry oxygen to cells.

Why iron deficiency may be higher in women with fibromyalgia is not entirely clear, and some have come to believe that the association may be, at best, incidental.

Despite the contention, it doesn't negate the impact that anemia can have on a person living with fibromyalgia or the importance of diagnosing and treating the condition early to ensure the best possible quality of life.

Symptoms of Iron Deficiency Anemia

Iron deficiency anemia can both exacerbate the symptoms of fibromyalgia and mirror them. Because of this, anemia will often go undiagnosed in women with fibromyalgia or, conversely, fibromyalgia may be overlooked in women who present with anemia.

By way of comparison, women with iron deficiency anemia may experience some or all of the following symptoms:

  • Fatigue
  • Cognitive problems
  • Cold hands and feet
  • Headaches
  • Pale skin
  • Heart palpitations
  • Shortness of breath
  • Chest pain
  • Anxiety

Based on these symptoms, it is easy to see how diagnoses can be missed when fibromyalgia is similarly characterized by fatigue, lack of concentration, cold intolerance, cold hands, and anxiety.

The same could be said of hypothyroidism (low thyroid function) which also shares many of the same symptoms and is also underdiagnosed.

Diagnosis and Treatment

The diagnosis of anemia is pretty straightforward and involves a battery of blood tests to evaluate, among other things, the size and color of your red blood cells. With iron deficiency anemia, the blood cells will usually be smaller and lighter in color. Similarly, low levels of ferritin, a protein that stores iron in the body, is a strong indicator of low iron levels.

When diagnosed, iron deficiency anemia will typically be treated with over-the-counter iron supplements. While it may take time to get your iron levels up again, the treatment is usually effective if taken correctly. To do so:

  • Take the iron tablets on an empty stomach. If they cause stomach upset, you can take them with meals.
  • Avoid taking antacids with your iron tablets. Instead, take the iron supplement two hours before or four hours after you've taken the antacid.
  • Take iron tablets with vitamin C to assist with iron absorption.
  • If the supplements cause constipation, speak with your doctor about getting the appropriate stool softener.

While beneficial for treating uncomplicated anemia, iron supplements do not appear to have any impact on fibromyalgia itself.

In fact, a​ 2017 review of studies showed that, while the use of nutritional supplement with high among people with fibromyalgia, there was no evidence of clinical benefit with respect to either the symptoms or severity of the disease.

Source:

Joustra, M.; Minovic, I.; Janssens, K. et al. "Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis." PLoS One. 2017; 12(4):e0176631. DOI: 10.1371/journal.pone.0176631.

Mader, R; Koton, Y.; Buskila, D. et al. "Serum iron and iron stores in non-anemic patients with fibromyalgia." Clin Rheum. 2012; 31(4):595-9. DOI: 10.1007/s10067-011-1888-x.

Ortancil, O.; Sanli, A.; Eryuksel, R. et al. "Association between serum ferritin level and fibromyalgia syndrome." Eur J Clin Nutr. 2010; 64(3):308-12. DOI: 10.1038/ejcn.2009.149.