Many, many women suffer from anemia, the most common kind being iron-deficiency anemia.

But did you know there are actually several different types of anemia?

If you are very pale, with pale conjunctivae, have heavy periods, or lack energy, you may have anemia.

The only real way to find out if you do and what kind, is to see your doctor and have a blood test run.  A good doctor will be able to discern these results to decide if your anemia is due to iron-deficiency, chronic inflammation or illness, macrocytic anemia or another cause.  

I suggest a doctor who works in functional medicine if you don’t have one you like and trust already.

For my readers, I’m primarily concerned with two types of anemia- iron deficiency and macryocytic.

Iron-Deficiency Anemia

This is the most common kind of anemia and can result from a diet too low in iron, heavy periods or even regular menstruation coupled with low iron intake, vegetarian or vegan diets, or low stomach acid among other things.

Iron is found in two forms- heme and non-heme with heme being the most available, easily used form by the body.  Heme iron is found primarily in meat while non-heme is found primarily in plants.

Vegetarians and vegans may be low in iron because they primarily consume non-heme iron.  Several factors enhance and inhibit absorption of non heme iron.  Inhibitors include polyphenols and flavanoids from things like tea and coffee, oxalic acid found in spinach, chard, berries, and chocolate, phytic acid from grains and legumes, and phosvitin from egg yolks.

Low stomach acid can cause iron deficiency anemia because stomach acid is where protein is primarily broken down for digestion.  

Those with low stomach acid typically take a hydrochloric acid supplement (like this one) that helps supplement the acid in the stomach to properly break down proteins and fats.  The best kinds are those which contain pepsin, an enzyme that helps digest protein.  I like this one.

For those with low iron intake, who don’t eat much meat, or who need supplemental iron, I recommend this brand.  It is easily absorbed and non-constipating.  Make sure with your doctor or qualified nutritionist that you need iron before you begin taking it as too much iron can be toxic.

Megaloblastic Macrocytic Anemia

Sometimes women suspect they have iron-deficiency anemia when they really have a different kind of anemia called macrocytic anemia.  Macrocytic anemia occurs due to deficiencies of Vitamin B12, Folate, or more rarely B6 which cause the release into circulation of red blood cells that are fewer than normal as well as large and immature.  This type of anemia can occur in vegans and vegetarians, those eating poor diets, as well as women with PCOS or the MTHFR gene mutation.

In vegans and vegetarians, vitamin B12 deficiencies are common due to a lack of the vitamin in the diet.  If this becomes chronic, B12 deficiences can cause macrocytic anemia.

In those with poor diet, sources of folate are rare.  Those who I worry most about are those consuming very high protein, low carbohydrate diets with very few vegetables.  Processed foods actually often contain folic acid, helping to avoid deficiency, but in an unprocessed diet that is very low in vegetables, deficiencies could occur.

Women with PCOS are more at risk of having the MTHFR gene mutation.  This mutation causes poor methylation of B vitamins like B12 and Folic Acid.  Chronically low levels of these vitamins can eventually cause macrocytic anemia.

For those with the MTHFR gene mutation, it is usually recommended to supplement with the already methylated forms of Vitamin B12 as methylcobalamin (find it here) and Folate as L-methylfolate (find it here).

Consulting a functional medicine doctor can help you get to the root cause of these issues and figure out the next steps.  A qualified nutritionist can also help you navigate the interchange of diet and anemia.

Eating a diet with ample iron is important for women as well.  Look out for a post next week on that very topic!

Have you struggled with anemia?

 

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