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Anaemia

What is anaemia?

When people think of anaemia, they usually think of low iron and that is indeed the main form of anaemia. But it is not the only one. You can be anaemic because of low iron, low folate (folic acid), low B12 and other forms such as as pernicious anaemia (a lack of intrinsic factor), sickle cell, aplastic etc. You can also have low ferritin, but iron looks OK – that might be an early warning sign.

For this page, we will focus on the most common ones I get asked about: iron, B12 and folate.

Essentially, you make red blood cells with lots of haemoglobin in them to carry oxygen around the body. You need iron, folate and B12 to make that happen. In anaemia, you might not make enough red blood cells in the bone marrow, your body might be breaking them down too early or you might have a lot of blood loss – as with heavy periods or a slow, but chronic blood loss from a gut inflammatory disorder, gum infection or whatever. Some people don’t have the ability to use the B12 properly – and that is pernicious anaemia.

Most people find out they have too low haemoglobin in the blood and that triggers a test for anaemia. You’re more at risk of it if you have malabsorption conditions such as an inflammatory bowel disorder or a gluten related disorder such as coeliac disease and non-coeliac gluten sensitivity. In fact, if iron is chronically- low and not picking up OR you have chronic brain fog and your iron is low, I always recommend a gluten test to check. Much of the time, it crops up. Just sayin’.

Anaemia Symptoms

These are the most common symptoms – most people know about the fatigue and weakness, but don’t connect their palpitation type feelings, dizzyness or feeling cold with a lack of these nutrients. Headaches is another really common one that is often missed.

  • Fatigue
  • Weakness
  • Pale or yellowish skin
  • Irregular heartbeats
  • Shortness of breath
  • Dizziness or lightheadedness
  • Chest pain
  • Cold hands and feet
  • Headache

How to test properly for anaemia

You can find the main Anaemia Test in the Nutrient Tests section of the shop. This is a cutting edge test that includes active B12 and red blood cell folate as well as a full bloods count with an inflammatory marker, which means you can rely on the results more – serum can be very misleading. Have a read.

For iron, you need to be looking at ferritin and saturation levels mostly. If I could have a pound for everyone who told me they had had their iron tested and it was fine, but then when I looked at it and found it wasn’t, I would be rich! The general rule I go by is:

  • If ferritin is below 70 and the ESR inflammation marker is OK, you could still need iron supplementation.
  • If the ESR marker is high, sometimes it can make the ferritin look artificially high too so watch out for that.
  • Transferrin saturation should be about 35-45% so any lower than that can still suggest an issue.

For folate, the general consensus is that you need to look at red blood cell folate levels, not normal serum, although both will help. Check the Folate factsheet for more. 

B12 is a tad more complicated. Here, I believe that serum levels can be misleading and you need to be looking at active B12 levels or holotranscobalamin II (HoloTC). This is an excellent resource site for B12 deficiency generally and will help you determine signs, symptoms, testing and treatment.

You can see the red cell folate and active B12 above in the Anaemia Test and you can get Active B12 done separately if needed. See the Nutrient Tests section here. There, you will also find MMA (methylmalonic acid) test, which can be done separately or with B12.

What do my anaemia results mean?

I thought it might help to show you a couple of common patterns, so you can recognise any issues:

Iron-Deficiency Anaemia looks like:

  • Low Hb, Hct, MCV, MCH
  • High RDW
  • Low Iron, Ferritin, Transferrin Saturation
  • High TIBC, Transferrin

B12 or Folate Deficiency clues:

  • MCV high-normal
  • High RDW
  • Low B12 or Folate

Anaemia of Chronic Disease

  • Low Hb
  • Normal or high ferritin
  • Low TIBC
  • High CRP or ESR

How to treat anaemia

First, supplement with an Iron bisglycinate if iron is confirmed low. Add methylated B vitamins and Vitamin C to enhance absorption. Something like this would work well. That should help to get your levels up.

  • Retest every 3 months
  • Look for a 1 g/dL haemoglobin increase every 2–3 weeks if responding
  • Track RDW, MCV, Ferritin, and CRP/ESR

If levels won’t come up enough, think about what might be making you low.

Consider and correct any low stomach acid or absorption issues like gluten illness, support your gut with probiotics and lower any inflammation – is your ESR or CRP high on blood results, or your SIgA high on gut results? If so, consider the causes of that inflammation – is it food allergy/sensitivity, infection, stress, autoimmunity?

For folate, read the Folate factsheet as this can be more complicated than just taking some, although essentially around 400-800mcg of a methylfolate form is likely to help. Similarly, if you need B12, a methyl form can be good. Generally, though, I like to make sure all the B vits are nice and balanced so a multi including the methyl forms of folate and B12 might help. Check the Wellbeing protocol here for multi vitamin and mineral ideas (I am constantly checking them and tweaking as they change a lot, hence a separate page!). I often recommend a base multi with the iron, folate and B12 in and then you can top up with extra if needed.

If your iron is fine and you just need the B12 and folate, or need to top that up, try this. Or, you can take them separately of course. B12. Folate.

That should start you off. Meantime, here are a few blog posts I’ve written that should also help. Do search for more using ‘iron’, ‘B12’ etc in the search box.

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