By Dr Pranab Gyawali, Consultant Gastroenterologist
Why I Made This Video
As a gastroenterologist with over 25 years of experience—first in London and now in Dubai—I’ve seen hundreds of patients with Crohn’s disease and ulcerative colitis struggling with unexplained fatigue, breathlessness, and brain fog.
Just this week, I performed a colonoscopy on a patient with Crohn’s disease who was also severely anemic. It reminded me how under-recognized iron deficiency is in IBD, despite being so common.
With the new 2025 British Society of Gastroenterology (BSG) guidelines on managing iron deficiency in IBD just published, I felt it was the right time to break this down for patients.
How Common is Iron Deficiency in IBD?
Iron deficiency is actually the most common complication in IBD, affecting up to 60–80% of patients at some point—especially during or after flares.
It’s often missed because the symptoms can be vague, or blamed on “just having IBD.” But even when your Crohn’s or colitis is under control, iron levels may still be low—especially if your diet is restricted or you're not absorbing nutrients properly.
Symptoms of Iron Deficiency & Anemia in Crohn’s or Colitis
Here are common signs I see in clinic among patients with IBD and low iron:
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Constant fatigue or exhaustion
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Brain fog, poor focus or concentration
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Shortness of breath or low exercise tolerance
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Dizziness or lightheadedness
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Pale skin or cold hands
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Restless legs or tingling sensations
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Feeling irritable or unusually low in mood
If any of these symptoms sound familiar, it’s worth checking your iron levels—not just a standard blood count, but also ferritin, iron saturation, and CRP (inflammatory markers affect interpretation).
How Do We Treat It? (Using the BSG 2025 Guidelines)
The new BSG Guidelines on Iron Deficiency in IBD provide much-needed clarity.
Here are the key takeaways I share with patients:
If you're in remission and your ferritin is low but you’re otherwise well:
– A single daily low-dose oral iron tablet (like 100mg elemental iron) is preferred.
– Higher doses or twice-daily iron can actually reduce absorption and irritate the gut.
If you’re flaring or can’t tolerate oral iron:
– You may need intravenous (IV) iron, especially if your hemoglobin is below 10 g/dL, or you're not absorbing oral iron effectively.
– IV iron is more effective and faster-acting in many IBD patients, and we now have safer formulations.
You can read the full 2025 BSG Guidelines here.
Treatment choices depend on your individual case, your inflammation status, and whether you have other deficiencies (like B12 or folate).
My Advice to Patients in Dubai (and Beyond)
In my Dubai practice, I regularly treat patients with IBD and iron deficiency—many of whom didn’t realize they were anemic.
The good news is:
Once diagnosed, iron deficiency is very treatable
It can dramatically improve your energy and quality of life
And it's often a sign we need to look deeper at how your IBD is being managed overall
If you’re in Dubai and unsure whether your fatigue is “just part of IBD,” you can always reach out here . My team can help guide next steps.
What’s Next?
In my next video, I’ll go through the Top Iron-Rich Foods that are Gut-Friendly, including which foods to eat and which ones to avoid—especially if you have Crohn’s with strictures or are recovering from a flare.
It’s important to recognize-food also plays a powerful role in your recovery.