Iron-deficiency anemia

It is quite common for a (female) patient to come to my office and tell me she is anemic. And very often, she has been diagnosed with it several months ago. My question is always: “Why are you still anemic if you found out about several months ago?” With the exception of some (rare) complications and rare types of anemias, there is generally no reason anyone should have iron-deficiency anemia for more than about four months.  And this type tends to be the most common, at least in my patients.  Let’s discuss why it occurs and how it can be incredibly simple to correct.  To start, anemia refers to “a condition in which the blood is deficient in red blood cells, in hemoglobin, or in total volume”.  If you are not sure, red blood cells need iron to carry and distribute oxygen around the body by way of the hemoglobin molecule.  By the way, the oxygen carrying molecule in muscles is known as myoglobin.

Iron-deficiency anemia is a “no-brainer” as to why it occurs; that is, lack of sufficient amounts of iron.  The question is always: Why?  There are three answers: a) you are not consuming enough iron, b) you are not absorbing enough, or c) you are losing blood faster than you are making it.  These can all exist together, too.

For answer “a” – this is simply not consuming enough iron-containing foods.  I almost always see this mostly in vegetarian or vegan patients.  Now, I’m not at all against being vegetarian or vegan, but I am against being deficient in vital nutrients that may come as a result of a particular diet.  Unfortunately, for vegetarians and vegans, iron is most abundant (by weight/mass) in animal foods.  Some good sources are: beef, chicken, turkey, pork, liver (beef, chicken, etc.), oysters, egg yolks and other animal foods; and kidney beans, blackstrap molasses, spinach, raisins, peas, dates, broccoli, almonds, apricots, and some other vegetarian/vegan foods.  Check the nutrition information on the foods for the exact amounts.  Here is a chart listing the recommended daily allowance (RDA) for iron according to the National Institutes of Health.

Age	Males (mg/day)	Females (mg/day)	Pregnancy (mg/day)	Lactation (mg/day)
7 to 12 months	11	11	N/A	N/A
1 to 3 years	7	7	N/A	N/A
4 to 8 years	10	10	N/A	N/A
9 to 13 years	8	8	N/A	N/A
14 to 18 years	11	15	27	10
19 to 50 years	8	18	27	9
51+ years	8	8	N/A	N/A

For answer “b” we come to the issue of iron absorption.  This can be caused by many factors.  Here are the most common ones I see.
1) Your intestinal tract can become literally be clogged up!  Iron is absorbed in the duodenum and upper jejunum of the small intestine.  There are little hair-like protrusions lining your small intestine which act to literally take up the food for absorption.  If your villi are clogged with old, undigested food from poor dietary choices, you may not be absorbing iron sufficiently (along with other nutrients as well).

2) You might not be fully breaking down the foods you are eating.  This can be due to improper chewing, or lack of hydrochloric acid and/or other digestive enzymes.  Deficiencies in minerals that stimulate the production of these digestive enzymes are one thing to consider; and possibly an enzyme supplement to help “prime the pump” while you are restoring those minerals.  By the way, iron-deficiency in a male or post-menopausal woman who is consuming enough iron in thier diet almost always results from lack of sufficient amounts of hydrochloric acid in the stomach.

3) Additionally, an outright digestive disorder like irritable bowel syndrome, Crohn’s disease, ulcerative colitis, and others may not allow for proper absorption of iron (and other nutrients).  So these conditions would need to be addressed as well.

By the way, iron from animal sources is called “heme” and from vegetable sources it’s called “non-heme”.  Please be aware that a non-heme source will be absorbed much better when combined with vitamin C in the same meal.  And phytic acid (or phytate) which is high in legumes and grains (e.g.: soy, kidney beans, wheat, rye, oats, barley, corn, and peanuts) will substantially inhibit iron (and other mineral) absorption.  However, vitamin C will also help to counteract the effect of phytic acid.

Lastly, answer “c” has to do with the issue of losing blood, faster than you are making it.

1) The most common cause that I see related to this is when women have a heavy menstrual cycle.  This is usually the result of hormone imbalances, especially a condition known as estrogen dominance.  I’ll discuss that in another article.  This is a rampant problem for females due to many reasons; and you won’t necessarily have heavy periods because of it.

2) Men and post-menopausal women (in particular) may become iron deficient due to gastrointestinal blood loss from digestive conditions like ulcers, Crohn’s disease, ulcerative colitis, irritable bowel syndrome, colon cancer and other digestive disorders.  Also, excessive intake of aspirin or other non-steroidal anti-inflammatory medications (e.g.: Advil®, Motrin®, Aleve®, etc.) can cause blood loss through the gut.  These tend to be the most common reasons for blood loss, however their certainly are others.  And these conditions can obviously occur in menstruating women as well.
Let’s hope you are not losing blood because of undetected internal bleeding!

Now for the symptoms of iron-deficiency anemia.  Some common ones are as follows: pallor (pale skin and mucous membranes – nail beds and inner membranes under the eyeball can often/not always be spotted), fatigue, irritability, brittle nails, cold hands and feet (usually hypo-thyroid though), trouble concentrating, shortness of breath, irrregular heartbeat, mild depression, muscle fatigue/lack of endurance, and perhaps more.

Another strange symptom is called pica which a craving to eat ice (probably most common), soil, paper, soap, chalk, and other things I won’t mention.  This can be especially common in children.  The jury is still out on why it relates to iron deficiency.

The best blood test to run for iron-deficiency is ferritin (the amount of stored iron in your body.  But I’d also want to see levels of actual blood iron, total iron-binding capacity (TIBC), and transferrin (the molecule that transports iron).  And of course of complete blood count, which will measure total red blood cells, hemoglobin, hematocrit, RDW (random distribution of weight) and MCV (mean corpuscular volume).  Beware however, functional/sub-clinical iron deficiency can still (and often does) exist because the reference ranges considered normal by blood labs are extremely wide – so you will be quite deficient if you fall below the lab’s “normals”.

There are several applied kinesiology functional muscle tests that can cause me to suspect iron deficiency, especially one involving muscle fatigue/endurance.  And also in-office, cross-checks to help verify.  But I definitely consider it prudent to have blood levels checked for functional ranges; as an overload of iron can be very dangerous.  Get the blood tests and have them evaluated for functional ranges, it’s simple.

Finally, it can easily be corrected through diet and/or supplements.  And will most likely take a minimum of four months to correct, because the life-span of a red blood cell is about 120 days.  Hope this helps!

Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology