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By Dr Justin Machegiani
There are three general types of nutritional anemia.
- Iron: hypochromic microcytic anemia
- B vitamins (B12, folate, and B6): especially in normochromic macrocytic anemia (megaloblastic)
- Pernicious anemia: 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!
Red blood cells get excessively small when they are iron deficient, hence the term microcytic anemia (micro meaning “small”).
B vitamins are very important for the maturation of red blood cells. As you can see by the picture above, red blood cells actually get smaller as they get more mature (this is the opposite in humans). They 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?
- Weight gain
- Leaky gut syndrome
- Low thyroid symptoms
- Digestion problems
- Celiac disease
- Female hormone issues
Leaky Gut, Celiac Disease, and Anemia
Leaky gut syndrome is a phenomenon where the tight junction of the gut unzips and allows undigested food particles and bacteria into the blood stream. The immune system over reacts and becomes on high alert due to it’s inexperience of seeing these unknown particles in the bloodstream.
The immune system being 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 the start of how autoimmune disease starts.
Tissue Destruction and Autoimmune Disease
What tissues are destroyed will determine what the diagnosis is.
Pancreas: type 1 diabetes
Brain: MS, Parkinson’s, ALS
Skin: exczema or psoriasis
The list goes on as there are over 130 autoimmune diseases. The research done by Dr. Alessio Fasano shows that leaky gut is a common factor in all autoimmune diseases, and gluten seems to be one of the strongest stimulators of zonulin (which causes leaky gut).
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.
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.
Low HCL: 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 be 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!
Deficient diet: 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 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!