Black strap molasses for the treatment of inflammatory bowel disease-associated anemia.

To the Editor: Molasses is the final effluent obtained in the preparation of sucrose by repeated evaporation, crystallization, and centrifugation of juices from sugar cane and sugar beets. Black strap molasses is essentially the residue remaining after the final extraction of sucrose in the processing of sugar cane. It is rich in iron, potassium, and calcium. It contains approximately 250 mg/kg of iron. Molasses has been used in livestock and poultry feeds since the beginning of the nineteenth century.

An 11-year-old male was referred to the gastroenterologist for management of inflammatory bowel disease (IBD). He also had iron deficiency anemia with hemoglobin of 9 g/dL. Multiple iron supplements were administered for long durations without any improvement in hemoglobin level.

In inflammatory bowel disease, due to concurrent chronic inflammation, absorption of iron is variable. Assessment of the iron status in inflammatory bowel disease is difficult, as the inflammatory processes influence parameters of iron metabolism. Serum transferrin receptor is a useful parameter for diagnosing iron deficiency in IBD. (1) Iron deficiency is usually treated with oral iron supplements. However, most patients with ulcerative colitis-associated anemia improve on intravenous iron alone.

Our patient was accompanied by his grandmother at a follow-up visit. She asked us if adding black strap molasses to her grandson's diet would help. We encouraged her to try it. At the three-month follow-up the patient's hemoglobin had been raised to 12 g/dL. He reported eating black strap molasses on a daily basis.

A comparative study by Aslan and colleagues (2) concluded that absorption of iron from grape molasses was comparable to that from iron sulfate in non-anemic subjects. However, in the group with iron deficiency anemia, serum iron and total iron binding capacity was higher among infants given iron sulfate than those infants given grape molasses. However, they do emphasize that grape molasses is an effective iron source in preventing anemia in infancy. Excessive intake can have side effects, especially in patients with abnormal renal function. A case of hyperkalemia in a patient with renal insufficiency secondary to chronic intake has been described. (3) Black strap molasses containing iron that has been chelated to fumaric acid for improving absorption and minimizing constipation is being marketed and widely used by patients. Clinical studies on the consistency of black strap molasses raising iron levels in iron deficiency anemia, especially those resistant to standard iron preparations, would help provide a simple and safe alternative.

References

1. Revel-Vilk S, Tamary H, Broide E, et al. Serum transferrin receptor in children and adolescents with inflammatory bowel disease. Eur J Pediatr 2000;159:585-589.

2. Aslan Y, Erduran E, Mocan H, et al. Absorption of iron from grape-molasses and ferrous sulfate: a comparative study in normal subjects and subjects with iron deficiency anemia. Turk J Pediatr 1997;39:465-471.

3. Belknap MK. Hyperkalemia from blackstrap molasses. Wis Med J 1991;90:58.

Anuradha Tunuguntla, MD

East Tennessee State University 

Johnson City, TN

Michael J. Sullivan, MD

Sullivan Digestive Center

Kingsport, TN