What I Wish Everyone Knew About Anemia

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Photo: Jovo Jovanovic

As a nutritionist, I frequently have clients come into my practice and tell me that they’ve been suffering from long-term anemia, most commonly from a deficiency in iron. Many of these people have been told to take an iron supplement, only to experience constipation, nausea, and other digestive distress that causes them to stop taking it. More notably, clients will tell me that they’ve been deficient for their whole life no matter what they have tried before.

Iron deficiency gets all of the spotlight, but other types of anemia also exist and can affect the body in similar ways—causing fatigue, neurological symptoms like brain fog or depression, or dizziness. When we’re anemic, there is a lack of oxygen getting circulated around the body and that can damage different tissues, including the brain. In fact, long-term deprivation of oxygen to the brain can lead to neurodegeneration and increase your risk for cognitive decline. However, many people who are anemic don’t realize that it's linked to their symptoms, and others aren't properly tested to determine if they're truly anemic and what the cause is.

Let's talk about the different types of anemia.

This helps us not only determine the cause but how it can be resolved. First—and most notoriously—is iron deficiency. This is typically seen in women during years of menstruation due to blood loss, but it can also be found in those consuming a diet low in iron or from another source of bleeding (like undiagnosed bleeding in the GI tract). With iron deficiency anemia, it's important to request serum iron testing as well as ferritin, which is the storage form of iron. Low iron and ferritin are often screened alongside a complete blood count (CBC), which identifies the degree to which the red blood cells are affected by the lack of oxygen.

Another common form of anemia is due to a lack of vitamin B12 and folate, which is also important in the oxygenation of your red blood cells. This is easily determined by a complete blood count (CBC) done in a regular blood screening. Other important values to screen for include serum B12, methylmalonic acid, and homocysteine levels, as these can rise due to a deficiency. B12 deficiencies can be common in those who are eating a poorly balanced vegan diet, those with low stomach acid, and those with other imbalances within the digestive tract that may block absorption.

This third type of anemia isn't very well-known.

However, another less-commonly discussed type of anemia is what we call the anemia of inflammation or anemia of chronic disease. This type of anemia manifests similarly to an iron-deficiency anemia; however, serum iron levels are often normal. Most importantly, you want to measure ferritin levels as they are typically high with chronic inflammation and indicate an imbalance in iron utilization. This deficiency happens whenever the body is in a constant state of stress. This can be due to toxins (like heavy metals, chemicals, or pesticides), different infections in the body, and can even be due to dysbiosis or imbalances within the gastrointestinal system. It is largely important to determine if this is the root cause of the anemia because iron supplementation given during this state of inflammation can potentially create more damage and oxidative stress. More recently, an excess of iron has been shown to increase one's risk for Alzheimer's and dementia.


Don't despair: There's a lot you can do if you're anemic.

First of all, you want to have the proper testing done to identify the true cause of the anemia. If it is purely an iron deficiency, I will often first recommend increasing iron-rich foods like organic/grass-fed liver, grass-fed red meats, and dark leafy greens. Vitamin C also helps aid in absorption of iron, so toss a few orange slices or broccoli alongside your meal.

It is important to understand that iron can often become depleted during times of dysbiosis in the gut. Restoring this balance can help to improve your body’s iron absorption naturally (and improve absorption of your other vitamins and minerals, too). If you’ve tried an iron supplement and noticed the discomfort of constipation, nausea, or other digestive upset, it may be because this imbalance exists in your gut. Iron acts as a "food" for the bacteria in your gut, meaning if you have an overgrowth of too much bacteria, supplementation can further upset the balance.

The moral of the story is that you want to understand WHY the deficiency is happening. Working with a functional medicine practitioner or functional nutritionist can help you to resolve the root cause to eliminate your symptoms for good (instead of just putting on a Band-Aid).

Iron deficiency could be what's making you tired all the time.

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