Anemia is a relatively common condition in which the blood's Oxygen carrying capacity has been compromised. This may be due to a loss of red blood cells, low Iron or hemoglobin, lack of B vitamins, or misshapen red blood cells as is seen in Sickle Cell Anemia.

The most common form of anemia both worldwide and in the United States is Iron deficiency anemia (IDA). Commonly seen in women, particularly those whom are pregnant, have a heavy menstrual period or are vegetarians, IDA is easily corrected by increasing your consumption of Iron. This is usually accomplished by taking a prescription Iron pill that I have nicknamed the "Home Depot Special Pill". Have you ever cut one of those things open? It looks like someone took a chunk of Iron ore from the Home Depot, made it into a pill, and painted it red!

IDA seems like a simple enough condition with an even simpler cure: take Iron. But after our last blog post where we discuss just how toxic inorganic Iron can be to the human body, it may leave our anemic readers a bit confused. On the one hand, you don't want to be anemic- without proper oxygenation of your tissues your body will be less able to build and repair itself and it will leave you feeling worn down. On the other hand, being the well-read, informed patient that you are, you probably don't want to take the Home Depot Special pills, either.

First we must ask the question, why is your Iron low in the first place? The many different causes of IDA require completely different treatments.

1. You lose a lot of blood. This is generally seen on a CBC as a high RDW value (above 15 on most labs). Perhaps you have a heavy menstral period because of a hormonal imbalance or PCOS, in which case addressing those conditions would correct the problem. Perhaps you have an internal bleed such as an ulcer, which would require a completely different work up and treatment than the above.

2. You don't eat enough Iron. Most people will tell you that this is seen in vegeterians, but I have found that vegan and vegeterian eaters can get along quite alright without extra protein and Iron. In my experience, this is more often due to just plain old unhealthy eating habits. There's not a whole lot of nutrients in Doritos last time I checked, guys. Stop fooling yourselves and eating that garbage.

3. You're not absorbing the Iron you are taking in. Honestly, I think this is by far the most common (perhaps in combination with number 2) reason people develop IDA. The big thing you need to know is that you need two things to digest and absorb Iron: Stomach acid (to break it down) and a healthy intestinal tract (to bring it into the body).

Low stomach acid, or hypochlorhydria, can be caused by a myriad of things including infection by a bacteria called H Pylori, or drugs that decrease stomach acid. For example, proton pump inhibitors (Prilosec, Omprezole) decrease the stomach cells' ability to make stomach acid. These drugs are used to treat ulcers, but all too often patients are left on these drugs for years after the ulcer has healed. Likewise, acid blockers such as Zantac and Pepsid have become increasingly popular and are often taken on a long term basis. These drugs are often advertised with the implication that you can now eat whatever you want without all those pesky unpleasant symptoms. I guess they forgot to mention the fact that those symptoms are just your body screaming please don't do this to me.. For Pete's sake put down the hot dog!!

Altering the state of the stomach's acidity not only leaves you vulnerable to nutrient deficiencies such as IDA, but it leaves the GI tract vulnerable to infection by opportunistic bugs like H Pylori. Because these drugs drastically alter your ability to digest your food properly (especially protein), food transit time through the stomach slows, allowing food to sit in the stomach for long periods of time and fester. This putrid food hanging out in the stomach longer than it's supposed to may produce symptoms of indigestion. Wait, wasn't that what we were trying to avoid in the first place?

Many, many things can cause malabsorption at the small intestine level. Celiac Disease, Crohn's Disease, Ulcerative Colitis, and Leaky Gut Syndrome have all been known to cause multiple nutrient deficiencies, and as you can imagine, their treatment involves far more than one little Iron pill. Another increasingly common reason for malabsorption in this country is due to malabsorptive surgery such as the gastric bypass. There are several various flavors of bariatric surgery, and they all have slightly different effects on the GI tract. For example, the gastric bypass mostly alters the stomach size, and therefore has the greatest impact on one's acid producing equipment. The Roux-en Y Gastric Bypass, on the other hand, is a procedure in which they actually bypass the first part of the small intestine all together. This sets the stage for great potential weight loss, but also for great potential nutritional consequences. Since about 90% of the vitamins and minerals in food are typically absorbed in that first, short portion of the small intestine, bypassing it severely handicaps that GI system for the rest of that persons life.

So what can we do to try to correct IDA without taking the Home Depot Special pills?

1. Stop to think, why am I anemic in the first place? Yes, getting to the root of the problem might be harder than simply popping a pill for the rest of your life, but it will be worth it. Really.

2. Stop with the acid blockers already! If this means going off a prescription medication communicate with your doctor, but be aware that they might think you've lost your mind. Your doctor should know that these medications were never meant for long term use, but if they give you a hard time just stick to your guns and explain why you are concerned.

3. Eat food that actually contains Iron. I know, it's a wild concept. And no, this does not mean that Iron fortified cereal is now a health food. I'm talking about real food that has real Iron- meats, spinach, kale, chard and other green leafy veggies. Keep in mind that meat will have the most bio-available form of Iron as most minerals in plants and grains are chelated (bound) to something else such as phytates, which typically impedes their absorption.

4. Even after all that if you are still Iron deficient (perhaps due to pregnancy), find a source of Iron supplementation that didn't come from a hardware store.


Floradix
is a pretty good, commercially available Iron supplement, for example.


In health,

This is part of a series I call "My Approach Mondays" where I discuss how I approach different symptoms and diseases. I hope you find this information helpful! Anemia is a remarkably misunderstood problem. Most people, doctors and patients, see it as a straight forward nutritional deficiency. Not eating enough Iron? Take some Iron. But what if there was more to it than we once believed?

1. Properly diagnosing the type of anemia is the first  and most crucial step in ensuring that you receive proper treatment. The most common cause of anemia today is Iron Deficiency Anemia (IDA) but another common culprit, Anemia of Inflammation, can mimic IDA on blood work. When running any lab work to evaluate for anemia it is crucial to run the marker that tells these two apart- Total Iron Binding Capacity (TIBC). If you have been diagnosed with anemia in the past go look at your blood work and make sure that TIBC was run. If it was not run I strongly suggest that you get new blood work done to include that marker and have the results interpreted by someone who knows how to do so.

Sadly, running the appropriate blood work does not necessarily guarantee that the doctor will reach the proper diagnosis. I learned first hand that not all doctors are good at interpreting blood work.  A few years ago I asked my GP to run some blood work for me that included an anemia panel. When the results came back I was told to take Iron despite the fact that my results very clearly indicated a different type of anemia! I believe that finding yourself a functional medicine practitioner who routinely orders such tests is the best way to ensure that you get the proper diagnosis and treatment.

There are many, many things that can cause anemia. Some are more obscure than others, while some are quite common. Make sure that you find yourself a doctor (preferably a functional medicine doctor) who is well versed in this area. Don't be afraid to ask them questions- it's the best way to judge weather they're worth their salt and it can give you a good indication of their character. It takes humility and guts for a doctor to admit when they don't know something, and I believe that their reaction to a question they don't know the answer to can tell you a lot of valuable information.

2. If you do need Iron or a vitamin, make sure it's a form that is easily digestible. I call the normal Iron pills "Home Depot special pills" because they look like Iron filings when they are ground. This form of Iron is not only poorly digested and notorious for causing constipation, but "inorganic Iron" such as this has now been linked to inflammation and Alzheimer's Disease.

3. The question needs to be asked, "why do you need this vitamin or mineral now?" Do you legitimately not get enough Iron or B vitamins in your diet, or is something hindering your ability to absorb them? Ulcer medications like acid blockers and proton pump inhibitors are notorious for causing IDA because you need stomach acid to break down the Iron in your food. Some people get B12-vitamin deficiency anemia because of an autoimmune disease called pernicious anemia.

If you or somebody you know is interested in working with a functional medicine doctor please call my office at (919) 238-4094 and see if we are the right fit for you. Infinity Holistic Healthcare is located in Chapel Hill, North Carolina, part of the Raleigh-Durham "triangle" area.