I have a form of anemia that causes me to have low hemoglobin. I was told that it is a genetic form found in Asians. I was told to take iron to help. I haven’t been taking my iron for a while. I exercise a lot, and when I run I get side aches at about one mile. I have been told that the body not getting enough oxygen causes the side aches. Hemoglobin transports oxygen to the cells. If I take the iron will it help me to produce more hemoglobin, thus increasing my body’s ability to transport oxygen, subsequently causing me to have less side aches? How much iron should I take? I heard that iron should be taken on an empty stomach with orange juice, is this true?
Konger75

Answered by: Maria/MDHealth Forum.com Team
Sharp pain below the rib cage, usually on the right side that occurs during vigorous activities such as running is called side stitch or exercise related transient abdominal pain. This is a commonly experienced problem, but the exact mechanism as to how the pain occurs is still not completely understood. Suggested etiologies of side stitch include diaphragmatic ischemia- lack of oxygen in the diaphragm, and stress on the visceral ligaments. Some say that the it has something to do with the breathing pattern plus the pulling of the internal organs, particularly the liver, on the ligaments that extend to the diaphragm while the body is engaged in strenuous activity like running. Health history and physical examination are necessary to arrive at a working diagnosis.

Abdominal pain during vigorous activity is usually not related to an underlying disease. However, in some cases it may be an indicator of some disorders such as problems in the gallbladder and the biliary system, chronic inflammatory bowel disease, nephrolithiasis-kidney stones and infection, just to name a few. Persistence of symptoms after physical exertion could be a sign of an underlying disorder and it would require further investigation. In addition to physical exam, blood tests and imaging procedures may be requested.

I am not quite sure if the genetic disorder that you were referring was thalassemia, a blood disorder prevalent among people of Mediterranean descent as well as Mid-Easterners, North Africans and South Asians. It is also referred to as Mediterranean anemia. This genetic anomaly causes the body to produce fewer number of healthy blood cells or insufficient hemoglobin in the red blood cells which leads to lack of oxygen in the blood stream. The severity of the symptoms manifested generally depends on the severity of the disease condition. Some patients don’t experience any symptoms while others suffer from symptoms of severe anemia as well as enlargement of internal organs like the spleen, liver and heart, yellowish discoloration of the skin and bone deformities. Complete blood count as well as test to measure the different types of hemoglobin may also be ordered to confirm diagnosis. The interventions for thalassemia include: iron chelation therapy, folic acid supplements and blood transfusion.

You mentioned that you haven’t been taking iron preparations for a while. It is important to inform your doctor about this. A number of complications may arise if anemia is left untreated. The amount of iron that you should take would be determined by your doctor. Iron supplements such as ferrous sulfate are best absorbed when taken on an empty stomach, but it may cause stomach irritation. Taking ferrous sulfate with food may decrease the risk of stomach upset. Vitamin C is known to enhance iron absorption. Your doctor may recommend you to take iron tablets with orange juice or other beverage that also contain Vitamin C.

This is blog entry is for general information only, I recommend that you discuss your symptoms with your own doctor.

References:
Med Sci Sports Exerc. 2000 Feb;32(2):432-8. Characteristics and etiology of exercise-related transient abdominal pain. Morton DP, Callister R.

Noakes, T. 1991 The Lore of Running. Champaign: Leisure Press

British Journal of Sports Medicine 2004;38:e24; doi:10.1136/bjsm.2003.007237
Abdominal pain in long distance runners: case report and analysis of the literature
F C Dimeo, J Peters and H Guderian

Curr Sports Med Rep. 2006 Dec;5(6):289-92. Stitch in the side: causes, workup, and solutions.
Eichner ER.

Tags: anemia, exercise related transient abdominal pain, hemoglobin, iron, stitch, thalassemia