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


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. 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.

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. All the tests mentioned pretty much are available through the shop.


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.

Homocysteine is here. As are the methylation profiles.

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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