Improve gut health to resolve iron anaemia
Anaemia is a reduction in the total amount of red blood cells or blood haemoglobin, or a lowered ability of the blood to carry oxygen.
Gut function and the gut microbiome
In this blog I’m going to focus on the relationship between our gut and iron anaemia, both from a gut function and gut microbiome perspective. We have a lot to learn about this complicated area, but we know some things…
Assuming you’re eating enough iron from a whole foods diet – which many women especially are not – what can go wrong in your gut?
Gut conditions cause an inability to ABSORB iron properly including coeliac disease, Chron’s, diverticulitis, hiatus hernia, chronic hepatitis and liver conditions, gastrectomy, bariatric surgery, amyloidosis, autoimmunity
Gut conditions cause the body to LOSE iron including IBD, Chron’s, ulcerative colitis, peptic ulcer, some polyps, gut cancers, esophagitis, parasitic infections like hookworm
The stomach infection Helicobacter Pylori causes low stomach acid and hinders iron absorption
Low stomach acid results in inability to breakdown and absorb food
PPI usage has the same effect
Intestinal permeability or leaky gut results in low stomach acid and inflammation, and thus poor food breakdown and absorption
Inflammation due to gut infections and a poor diet high in sugar/refined carbs and processed oils hinders absorption
Low gut SCFAs (short chain fatty acids produced by good gut bacteria that feed off fibre and protect your gut lining and immunity) lower iron absorption
NSAID usage such as ibuprofen and aspirin causes iron loss
Gut infections including SIBO cause inflammation and lower iron breakdown and absorption
A lack of cofactors prevents absorption like vitamin C, copper (test first) and riboflavin (B2)
Iron and the gut
Iron is mainly absorbed in the duodenum (the first of three parts of our small intestine) and is tightly regulated by our body.
Any unabsorbed iron then enters the colon inhabited by our gut microbiota.
But a mechanism comes into play where the body decides whether or not to absorb iron from our food that involves our gut microbiome using communication or ‘cross talk’. If you have a low-iron diet, your body absorbs more of it and vice versa.
Furthermore our gut microbiome depends on iron, with different microbes requiring different types of iron to survive. Iron availability thus affects our microbial ecosystem. But our gut bacteria can also actively compete with our body for dietary iron.
Conversely, an excess of heme iron in the colon (including due to supplementation) has also been associated with reduced microbial diversity and an increase in pathogens that are harmful to our iron level and overall health.
It’s chicken and egg, but we appear to need a balanced diet and healthy digestive system for good iron levels. This is why it’s vital to…
Resolve gut imbalances
NOT supplement with iron for too long
Importantly, our intestinal microbiota and iron balance are also key parts of a dynamic and complex interplay that help manage, or can trigger the inflammatory response in the intestines, impacting disease there.
What to do about your gut and iron levels
Eat an anti-inflammatory diet i.e. a natural whole food diet with a balance of animal and other protein, good fat and healthy carbs (mainly veggies and some fruit)
Get tested for H Pylori, gut infections and SIBO, and resolve them
Resolve hypochlorhydria (low stomach acid), but you may need to do some upper gut healing first. This includes by eating an anti-inflammatory diet (below) and resolving any food sensitivities
Sip apple cider vinegar before meals to improve digestion and lemon/lime water throughout the day
Try a digestive enzyme to also aid food breakdown and absorption
Reduce/avoid over-the-counter medications where possible
Get off PPIs. This is often possible by addressing the root cause
Consume prebiotics and probiotics by eating high-fibre and fermented foods, and/or taking supplementary pre- and pro-biotics. This improves iron absorption and counteracts the impact of iron excess on bacteria communities. One study shows that microbiome-based therapies can successfully treat iron-related disorders through probiotic bacteria that use the metabolites (end products) involved iron uptake regulation
Lower general inflammation, including by eating well, resolving food sensitives and managing stress which is VERY inflammatory on the body
Resolve intestinal permeability where large particles get through the intestinal lining and cause infections, autoimmunity, low stomach and impaired nutrient absorption
And don’t forget to get tested for your key cofactors copper and Vit B2
The type of iron you eat matters
Always remember that Haeme Iron from animal sources (pastured red meats, eggs, chicken liver), is most absorbable at 10%, while Non-Haeme Iron from plant sources (spirulina, pumpkin seeds, spinach) is inferior at 1% absorbability.
Aid iron absorption
Whole grains, nuts, seeds, and legumes should be soaked, sprouted, fermented, or soured to free the iron. Also, consuming plant foods with meat, vitamin C, citrus fruit and fermented foods will help enhance iron absorption.