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. I mean, 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- healthy meats, spinach, kale, chard and other green leafy veggies.

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. I don’t know of one off hand that is commercially available, but if you talk to someone in the supplement section of a Sprouts or a Whole Foods they should be able to help you. Functional medicine doctors such as myself often carry good quality Iron supplements in their office, but these products will only be available through the doctor’s office.

Happy to be out of their box,

Nikki