Are You Anemic?

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Are You Anemic?

By Dr. Justin Marchegiani

Someone with anemia has blood that is deficient in either red blood cells or hemoglobin. This means their blood does a poor job circulating oxygen, and as a result, the anemic person will oftentimes feel fatigue, brain fog, and weakness. If anemia is severe enough, possible complications include heart and brain damage.

So, what causes anemia and who is most at-risk? Anemia is most common among women of reproductive age, and is strongly linked to iron deficiency. As menstruation means monthly blood and iron loss, it’s easy to see why this demographic makes up a large portion of those with anemia. Other people at risk are those over 65 with a pre-existing health condition, those with a poor diet, and those who aren’t getting enough iron in their diet.

There are three general types of nutritional anemia

  1. Hypochromic microcytic anemia is linked to iron deficiency
  2. Normochromic macrocytic anemia (megaloblastic) is due B vitamin deficiency (B12, folate, and B6),
  3. Pernicious anemia is caused by an autoimmune disease in the stomach affecting intrinsic-factor production and the destruction of parietal cells, which produce intrinsic factor and hydrochloric acid (HCL)

Nutrition and Anemia

Iron is very important because it’s part of the hemoglobin that carries oxygen. One of the main jobs of the red blood cell is to carry oxygen to all of the cells so aerobic metabolism can occur.

If you remember back to middle school science class, when a glass jar was placed over a candle, the candle went out! This shows that the ability for oxygen to be transferred throughout the body is vital for health. A significant percentage of thyroid-hormone production involves iron as well.

Nutrition and Anemia

Red blood cells get excessively small when they are iron deficient, hence the term microcytic anemia (micro meaning “small”).

If you have a think you might be anemic, click here!

Erythroid Maturation Diagram

B vitamins are very important for the maturation of red blood cells. Red blood cells need certain B vitamins, like B12, folate, and B6, or they stay large, immature, and goofy, so to speak. Because of the red blood cells’ large size without B vitamins, the term macrocytic anemia (macro meaning “large”) is given.

Do you have symptoms of Anemia?

Anemia Symptoms

Leaky Gut, Celiac Disease, and Anemia

Leaky gut syndrome occurs when the normally tight junction of the gut unzip, which allows undigested food particles and bacteria into the bloodstream. The immune system overreacts to these unknown particles in the bloodstream.

With the immune system wound up from all of this, additional gastrointestinal stress can start attacking other tissues in the body, like the thyroid, pancreas, brain, skin, and even microvilli in the small intestine. This is how autoimmune disease starts.

Celiac Disease Anemia

Leaky Gut and Malabsorption

With leaky gut comes malabsorption due to the excessive inflammation in and around the areas of the microvilli, where nutrients, like vitamins, minerals, fatty acids, and amino acids, are absorbed.

The inflammation in the GI tract also creates excessive activation of the sympathetic nervous system (fight or flight), which makes it harder to produce hydrochloric acid, enzymes, and bile salts to effectively break down these nutrients as well.

Without the ability to break down, assimilate, absorb, and utilize, it’s as if the nutrients weren’t even eaten in the first place. Most people make the assumption that if they put the food in their mouth, chew, and swallow, then their body will utilize the nutrition for energy. This couldn’t be further from the truth when someone has excessive GI inflammation from celiac disease and/or leaky gut syndrome.

Anemia Treatment

When dealing with iron or B vitamin-based anemia, supporting with the deficient nutrients can be helpful but may not address the underlying issues. Below are some common patterns that need to be ruled out to ensure long-term success.


Without adequate stomach acid and enzyme production, it may be hard to break down, ionize, and absorb iron. Many people are stressed out, which shifts the nervous system away from the parasympathetic branch, which is needed for HCL secretion. Without enough HCL, bad bacteria tend to overgrow, and eventually even infections may take up residence in your gut. This chronic stream of inflammation continues to compound the issues and make the problem worse over time, even causing adrenal fatigue and low thyroid symptoms. Getting to the root cause of the gut issues, including the removal of stress and infection, can help improve HCL production. Taking supplemental HCL and enzymes in the meantime can be a great help.

Female Hormone Imbalances

Many females have estrogen dominance and/or inadequate production of progesterone. These hormone imbalances cause more PMS as well as excessive bleeding during menstruation time. This excessive bleeding can drive iron loss via the blood and potentially cause an anemia. This blood loss is a common cause of fatigue during menstruation, and I have seen it personally in dozens of my patients. Getting the patient on a female hormone-balancing program along with addressing diet and lifestyle stressors can help fix the underlying imbalances.

Everyone’s female hormone issues are a little different; to get yours assessed, click here!

Pernicious Anemia

This kind of anemia is autoimmune in nature and can be driven by gluten, infections, and stress (physical, chemical, and emotional). These types of patients need some type of autoimmune diet as well as sublingual B12 to ensure absorption, or perhaps even B12 injection. Most of the time, good methyl B12 along with activated L-folate in a sublingual form can be enough to maximize absorption.

FYI: If you have anemia, removing gluten from your diet is essential for healing!

Anemia and Diet

Dietary Deficiencies

Vegan and vegetarian diets are notorious for causing B12 deficiency and sometimes even iron deficiency. The iron found in vegetables is non-heme iron, is poorly absorbed, and does very little to improve ferritin (stored iron levels) on a blood test.  Iron from animal sources, especially liver, tends to be the best for raising iron levels. Most patients do better on a liver glandular as well as an amino acid iron chelate to help get their iron levels back to normal. Some may need an iron IV depending on how low their ferritin levels are.

If the deficiency is truly caused by dietary means, supplementing and changing your diet may be enough to fix the root of the problem.


If you have chronic fatigue, digestive distress, or low thyroid symptoms, there is a good chance there may be anemia issue holding back your health. If you want to dig a little deeper into what is driving your health challenges, click here!

Functional medicine does a great job figuring out the root cause behind your anemia. Stay tuned for the next article on how to diagnose anemia using lab tests!

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