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This is what makes this forum such a goldmine of information. I just received notification from my doctor, in Portland, Oregon, USA, that I'm anemic. I eat a well balanced diet but don't eat much meat since my wife is a vegetarian, so I just kind of got away from BBQing steaks. I did some research and found that DAA and cirrhosis can contribute to anemia. My doctor wants to wait 10 days for stabilization, which only means to me that it's still stabilized on the low end. Why not do something about it as long as it does not interfere with the DAA's.

Does anyone have any experiences with this situation and consequently suggestions as to how to increase my blood count without interrupting the benefits of the Epclusa? It was a total surprise to me since I'm not tired, I'm sleeping better now, have good energy, etc. I can always start BBQing again, which I kind of missed anyway, but if there is something else I would appreciate the input.

Thanks, Ron

It's a little different for women, but I have had to supplement iron for 20 plus years- since having kids, I guess- and I have tried and tried to get enough from diet, it just doesn't do it, I know vitamin C needs to process it, I make sure of both. I had HCV 30 years- decompensating cirrhosis in 2015- been cured about 2 years and my liver is nearer normal, I tried not taking any to see if I absorb better now from food but no, not enough. The stuff the doctors can prescribe here in NZ is really hard on my digestion, she suggested years ago I use this health food shop one, is the best I ever had. If I take a couple or 3 of these per week, I stay right. thompsons.co.nz/products/search/?term=iron

Hi Ron,

If you wife with stomach you doing it there is little doubt that meat is a great natural source of iron and protein.

If keeping the peace means no BBQ then iron tablets help.

Iron deficiency is not the only cause of anaemia so it needs looking into. For meat or iron to work we should see a microcytic anaemia (small red cells)

Red cells also need B12 and folate. Vegetarians tend to be B12 deficient as it is only made by animals (so flat out vegans survive on B12 contamination or chemical factory produced B12 supplements). With B12 or Folate deficiency we see a macrocytic anaemia (big red cells)

Sometimes people are both iron AND B12/Folate deficient in which case we can see a normocytic anaemia (like we may see with bleeding) as the small vs big balance out.

In non cirrhotic patients taking DAAs it is unusual to see anaemia. Even in cirrhotics it is very unusual to see much change in red cells unless we are using Ribavirin in which case it is expected.

Hazel, I want to thank you for leading me to researching natural methods for increasing my iron intake. The information about Vitamin C was crucial. Even though I was and still am a good athletic, I did not know that Vitamin C aided in the absorption of non-heme iron. Actually, I didn't know the two types of iron. I'm fortunate that I grow a large garden, which includes spinach (non-heme iron) and have a store very close that processes grains using the old granite grist wheels. Many cereals, I find out are high in non-heme iron. The name of the company is Bob's Red Mill. It's now world wide. The other nugget of information I learned today is that all Heme iron comes from animals and Non- Heme iron is plant generated. It's amazing what you can learn sometimes. My research isn't totally complete, but I think I'm well on my way to decreasing my anemia. Thanks again, Hazel

Ron

Thank you for your input Dr. Freeman, After discussing this with Linda, it sure didn't take much to convince her that increasing my intake of red meat was better than pills. One of your patients responded to my post and led me to investigate the benefits of including vitamin C when eating Non-heme iron foods. As I mentioned to your patient, I was unaware that there are two types of iron. Heme from animals and Non- Heme from plants. I am very fortunate that I grow a large garden, which includes peppers, spinach and tomatoes. So Heme = seafood and meats and Non-Heme plant based / Vitamin C. I remembered back in 1985 when I had to have L4,5and L1 fused, I was found to be anemic then, and I was a competitive cyclist. So this anemia thing has been hanging around for a long time. It sure is nice to have this forum and computers for research. I also am fortunate to like eating many types of hot cereal so I will just add a little Vitamin C with the meal. Where I live, there's a company (Bob's Red Mill) that produces grains the really old fashion way; they use the old granite wheels. All of the grains are organic and many are high in iron.

Will Power, the first Australian to win the Indy 500!!!