According to one recent study:
43% of people with hypothyroidism have it.
39% of people with subclinical hypothyroidism have it.
Other studies found out that up to 73.2% of people with hypothyroidism and autoimmune Hashimoto’s disease have it.
In fact, anemia is often a first sign that a person has a low thyroid function.
So what are the chances that you as a thyroid patient may have it too?
Pretty high… And yet most people are unaware that anemia affects their energy, memory, mood and is a major contributing factor to their fatigue.
But what disturbs me the most is that after enthusiastically starting to add anemia-fighting foods and take supplements many people discover that by the time of the next check-up their anemia markers didn’t improve or they feel even worse than before.
The reason for this is that a high number of people with hypothyroidism and Hashimoto’s have a supplement resistant anemia when using supplements and changing their diet not only doesn’t solve the problem but also can do more harm than good.
However, an understanding of a mechanism of anemia in hypothyroid patients opened an opportunity for a new treatment approach and you don’t have to suffer from a supplement resistant anemia for the rest of your life. Today I share when supplement and food approach work and when they don’t and what are your better and safer alternatives.
Why You Are At High Risk For Anemia If You Are Hypothyroid
Anemia is a decrease in the amount of red blood cells (RBCs) or the amount of hemoglobin in the blood and a lowered ability of the blood to carry oxygen.
Depending on the type of anemia it could result in B12, iron or folate deficiency. However, if you think that your B12 and iron needs could be met and corrected by taking supplements, eating fortified breakfast cereal or foods rich in these nutrients you are mistaken. You could be at risk of anemia even if you eat a healthy diet and take high quality supplements.
Did you know that hypothyroidism can cause a wide variety of anemic disorders and their severity directly depends on how hypothyroid you are?
Thyroid hormones affect every cell and process in your body. When you don’t have enough of them the formation and development of the blood cells in the bone marrow get altered in a way that it leads to anemia.
In hypothyroid patients anemia has a gradual onset and usually develops over many years. Symptoms may include fatigue, shortness of breath, weakness, poor concentration and a reduced ability to exercise.
If undiagnosed and untreated or anemia onset was quick due to, for example blood loss a person can experience greater symptoms such as mental confusion, loss of consciousness and feeling thirsty. Only in the advanced stages of anemia does a person become noticeably pale.
Is Anemia In Hypothyroid Patients Caused Only By A Poor Diet?
If you believe so then you are here for a surprise. A deficiency of either vitamin B12, folate (vitamin B9) or both due to intestinal malabsorption or autoimmunity are on the top list of causes of anemia in hypothyroid patients.
Hypothyroidism is a direct causative factor that alters the folate mechanism in your body and results in lower folate levels. While folate and B12 deficiency produce many similar symptoms the major difference is that the lack of vitamin B12 can cause neurological symptoms including peripheral neuropathy and balance difficulties due to spinal cord degeneration.
The main cause of B12 or cobalamin deficiency anemia is a malabsorption that can occur due to the following 3 reasons:
1. Pernicious anemia.
Your stomach’s parietal cells secrete hydrochloric acid and a glycoprotein called intrinsic factor. An adequate amount of hydrochloric acid and pepcin ensure the release of B12 from foods and the intrinsic factor binds vitamin B12 and enables its active absorption in the intestine.
This mechanism is responsible for the absorption of at least 60% of B12 that comes from food and if it is broken on any step of this process the pernicious anemia occurs.
Pernicious anemia is an autoimmune disease and depending on the target of autoimmune attack there three types of pernicious anemia:
- The most common type is when the antibodies are directed against the parietal cells causing them to atrophy, lose their ability to secret hydrochloric acid and produce intrinsic factor.
- In other forms of pernicious anemia the parietal cells are unaffected but antibodies are produced against the intrinsic factor itself and attach to it, thus preventing it from binding vitamin B12 and impair absorption.
- In another less common form of pernicious anemia, the antibodies allow vitamin B12 to bind to the intrinsic factor but prevent the absorption of the intrinsic factor-vitamin B12 complex by the ileal receptors of the intestine. This is the case with most autoimmune inflammatory bowl diseases such as Crohn’s and celiac disease.
2. Malabsorption through indigestion.
Food-cobalamin malabsorption could be also caused by autoimmune and non-autoimmune atrophic gastritis. Dietary vitamin B12 which is bound to proteins in food is released in the acidic environment of the stomach. In the absence of adequate amounts of acid, B12 remains protein-bound and passes throughout the gastrointestinal tract unabsorbed.
In the atrophic gastritis B12 vitamin couldn’t be extracted from the foods because of hypochlorhydria that occurs due to the damage to the cells of the stomach wall.
Other causes of B12 malabsorbtion could include gastritis associated with Helicobacter pylori infection, partial or full gastrectomy, use of certain medication such as antacids and metformin, gastric or small intestinal bacterial overgrowth (SIBO), alcohol abuse, Sjögren’s syndrome, systemic sclerosis, haptocorrine deficiency and ageing.
3. Impaired B12 absorption through passive diffusion.
About 1–5% of free or unbound B12 (crystalline cobalamin) is absorbed along the entire intestine by passive diffusion without the involvement of intrinsic factor. This type of absorption explains the mechanism underlying oral B12 treatment of cobalamin deficiencies with high dose medication and supplements.
Iron deficiency anemia has many common symptoms with B12 anemia and can occur due to:
- Insufficient dietary intake. A healthy person usually gets all iron it requires from foods such as meat, eggs, leafy green vegetables, beans, lentils and iron-fortified foods. However, lack of these foods in the diet or increased dietary requirements for iron can make you deficient over time.
- Malabsorption occurs when iron is poorly absorbed from the food in the small intestine. Many intestinal disorders such as insufficient production of hydrochloric acid in the stomach and celiac disease can reduce your body’s ability to absorb and utilize iron.
- Parasitic infection (hookworms, amebiasis, schistosomiasis, H. Pylori and whipworms). Worms can cause both inflammation and chronic intestinal bleeding that is not easy to diagnose with standard tests.
- Bleeding or blood loss that occurs from non-parasitic causes related to the gastrointestinal tract such as gastric and duodenal ulcers, colon polyps or gastrointestinal cancer
- Small intestinal bacterial overgrowth (SIBO). Certain species of bacteria such as Escherichia coli, Streptococcus, Lactobacillus, Bacteroides, and Enterococcus are more commonly found in people with abnormal gut flora. These bacteria have the ability to cause inflammation and use nutrients including iron by impairing their absorption.
- Chronic disease
The only treatment modern medicine currently has to offer to patients with anemia is a replacement therapy for missing nutrients. If you get diagnosed with anemia you are most likely prescribed pills, supplements, spray or injections.
Oral supplements can cause many negative side effects. Sprays and injections are used to bypass the digestive tract to reduce digestive symptoms associated with supplements.
List Of Supplements You May Consider
Active B12 ingredients: Cyanaocobalamin and methylcobalamin (more superior to cyanaocobalamin). Methods: injection, B12 tablets or sublingual B12 supplementation, transdermal B12 patch, sublingual B12 spray and nasal spray.
Folic acid is not the same as folate that naturally occurs in your body and also available as supplement. It can cause many undesirable effects and is better to avoid.
Alternative practitioners focus more on a combination approach by using supplements and/or adding more folate, iron- and B12-rich foods to your diet.
The highest folate foods include: citrus fruits and fresh-made juices, liver, beans, dark green leafy vegetables and poultry.
Meat, poultry, eggs and fish are at the top of the list of products that provide the highest amounts of iron and B12 vitamins. That is why it is essential to make sure that your diet contains these foods and you eat liver.
Research studies show that iron absorption from foods and supplements can be greatly reduced when iron is taken together with milk, tea or coffee. However, fruits and vegetables rich in vitamin C increase absorption of iron from meats and it is a good idea to include them into your diet.
Meats cooked in water are easier to digest for a person with digestive issues and bone broth provides additional therapeutic benefits.
Juicing and special tea formulations can also help with iron deficiency anemia. In the video below you will find two natural solutions for iron deficiency anemia: a great juice and herbal tea recipes for anemia.
…or watch it on YouTube: Juicing for Anemia
You can find the ingredients that were mentioned in the recipe for the anemia herbal tea here: organic Burdock root with Stinging Nettle leaf and Dandelion leaf and root (or organic roasted dandelion root tea from a health food store)
Limits And Misconceptions Of A Food And Supplement Approach
Contrary to popular belief trying to replenish missing nutritional deficiencies with foods may not be effective for everyone who has anemia.
The most important factor that determines if your treatment will be successful or is going to fail is to know the exact cause of your anemia and understand the mechanism of B12, iron and folate absorption.
If you have a type of B12 anemia when your intrinsic factor is affected you lose the ability to absorb cobalamin from foods and supplements. In this situation eating more B12-rich foods and taking low dose supplements won’t help at all.
There are only two dietary options to increase B12 in your system if you have intrinsic factor pernicious anemia:
1. Eating liver and other organ meats at least once a week.
Pernicious anemia used to be a fatal disease until it was discovered in early 90s that eating liver can help restore B12 reserves. In fact, 90% of B12 is stored in the liver.
2. Take a high dose B12 medication or a supplement that is designed to be absorbed by a mechanism of passive diffusion when the involvement of the intrinsic factor is not required.
However, not every oral supplement can bring desirable results. Only high doses of oral cobalamin medication of 1000–2000 µg/day is actually effective in correcting the B12 deficiency because only the small amount of B12 is absorbed by the mechanism of passive diffusion bypassing the need for intrinsic factor.
The severity of pernicious anaemia can vary substantially. It has a tendency to develop gradually and show remissions in its early stages. This means that the required amount of B12 and the dose of the supplement or medication that is necessary to keep a patient at the optimal levels may thus vary greatly from case to case and over time.
It is also important to note that oral supplements may not be effective for people with ileal resection, short bowel syndrome, active inflammatory and autoimmune bowel conditions such as Crohn’s and celiac disease.
Another alternative to replenish B12 levels in people who lake the intrinsic factor is to bypass the digestive system completely and use nasal spray or administer intramuscular injections.
Increasing cobalamin levels by consuming B12-rich foods is only possible for those who have B12 deficiency due to hypochlorhydria and were able to correct it or are supplementing with betaine hydrochloride to increase their stomach acid.
While supplementing and dietary measures can be helpful for some patients they could be completely ineffective for many others who suffer from a chronic disease or a supplement resistant anemia. And this happens because the underlying problems that were causing anemia weren’t identified and corrected in the first place.
Is Anemia Of Chronic Disease What Holding You Back?
Anemia of inflammatory response is also referred to as anemia of chronic disease and results in low iron levels. This type of anemia is seen in patients with chronic illness and is a direct consequence of chronic infection, malignancy and chronic immune activation.
Anemia of chronic disease may also be due to health conditions with abnormal proliferation of cells (neoplastic disorders) such as Hodgkin’s disease, lung and breast carcinoma and non-infectious inflammatory diseases such as rheumatoid arthritis, Hashimoto’s thyroiditis and systemic lupus erythematosus.
Hashimoto’s thyroiditis involves chronic inflammation and it shouldn’t be a surprise that anemia of chronic disease is the most frequent type of anemia in people with hypothyroidism and Hashimoto’s.
Anemia of chronic disease could be a part of our body’s protective mechanism in fighting infection. Almost all bacteria require some amount of iron for their survival and ability to multiply. In response to the inflammation, your liver starts to produce higher amounts of hepcidin that blocks iron release from the iron stores.
Short-term this effect could be positive because it makes less iron available for feeding pathogenic bacteria and prevents their growth while producing more immune cells to fight off the infection.
However, if inflammation becomes chronic the effect of locking up iron stores ultimately results in the lowered ability of the bone marrow to produce red blood cells and reduced oxygen supply with all negative effects of iron deficiency for the rest of the body.
Your body is smart and everything it does happens for a reason. In real life when the resources are limited it has to prioritize between supporting some organs and functions at the cost of others to ensure your survival. This happens when your body doesn’t produce enough thyroid hormones to meet its needs as well as when it decides between fighting the infection and limiting iron availability.
Does it mean that locking down iron stores and cutting iron supply to the pathogenic bacteria in order to fight infections is more important than consequences of low grade anemia as it happens in the anemia of chronic disease?
And if so, is supplementing with iron, administering iron injections and eating more iron-rich foods contradictive to this process and brings more harm than good?
In the light of this new knowledge would it be a better way to help your body to eradicate the infection and let it restore your iron metabolism naturally instead of just taking iron pills?
More about Dr. Natasha Campbell-McBride
3 Hidden Factors Of B12 Anemia That Prevent You From Recovery
Autoimmunity, infections and abnormal gut flora are also a big factor for B12 deficiency anemia.
According to multiple research studies, antibodies against gastric parietal cells that are typical for the autoimmune atrophic gastritis were noticed in up to a third of patients with hypothyroidism and the clinical diagnosis of pernicious anemia was seen in 10% of patients.
Bacterial infections of the gastrointestinal tract with H. Pylori were found to be directly responsible for thyroid autoimmunity in Hashimoto’s disease but also as one of the causes of anemia.
Helicobacter pylori infection neutralizes and decreases secretion of gastric acid to aid its survival in the stomach. By damaging the intestinal lining H. Pylori also decreases the number of active functioning parietal cells reducing the production of hydrochloric acid and as a result lowering the absorption of nutrients from food leading to anemia.
Many people are surprised to discover that they need physiological strains of E. coli (which are different from the pathogenic one) in order to ensure a proper nutrient absorption from their food and produce a variety of vitamins including vitamins of group B and in particular B12, vitamin K2, various amino acids and antibiotic-like substances called colicins.
This nutrient synthesis by the gut bacteria within the digestive tract is one of the reasons why humans can become accustomed to a variety of diets and survive during times when food supply is scarce.
For example, the diet of Inuits consists of up to 80% fat, 20% protein and hardly includes any vegetables or fruits. However, they are not dying from vitamin or amino acid deficiencies because their gut flora is producing all these substances for them.
The problem is that the antibiotics side effects, contraceptives, some types of prescription drugs and many other factors destroy your healthy gut flora and diminish your ability to produce these vitamins within the body. You cannot rely anymore on your ability to produce these vitamins internally and could even develop nutritional deficiencies despite adequate nutrition and healthy diet if your gut flora is damaged.
How To Treat Supplement Resistant Anemia Effectively
Most people with anemia have abnormal gut flora. They cannot absorb essential blood-forming nutrients from food they eat and lose the ability to produce vitamins within their digestive tract completely or to some degree. The best way to deal with nutritional deficiencies, low iron and vitamin B12 is to restore your gut flora to ensure that nutrient absorption and synthesis are optimal.
When you dig deeper into the true causes of anemia it all comes to autoimmunity, chronic inflammation, gut infections and abnormal gut flora.
Will supplements or eating foods rich in iron and B12 correct all these problems?
The answer is NO.
This is merely a shortcut in an attempt to improve the symptoms by replenishing missing nutrients. In the best case it may work temporarily and for many people it may not work at all resulting in a supplement resistant anemia or even the worsening of their initial symptoms.
What Can You Do?
1. Correct thyroid imbalance.
Thyroid dysfunction affects the structure and function of almost all parts of the gastrointestinal tract and blood synthesis. Anemias are very common in hypothyroidism due to lack of thyroid hormones and silent or active autoimmunity. Many studies show that this type of anemia improves with thyroid therapy.
Correcting thyroid imbalance is the first step on your way to recovery from anemia if you are hypothyroid or have Hashimoto’s.
2. Get properly diagnosed.
The effectiveness and success of your treatment strategy depend on what type of anemia you have. There is also a high probability that you may have more than one nutrient deficiency caused by anemia.
While 55% of all anemias in people with hypothyroidism and Hashimoto’s are due to autoimmune pernicious anemia, chronic disease anemia is the most frequent type. This means that the majority of patients have vitamin B12 and iron deficiency at the same time and need a treatment protocol that corrects both.
B12 levels should be checked before starting any supplementation with folate. Correcting folate deficiency can mask B12 deficiency by reversing many symptoms of anemia. However, if reserves of vitamin B12 in your body remain depleted you still may continue to have neurological symptoms and permanent neurological damage can occur.
3. Use dietary modifications and replacement therapy if necessary and when appropriate.
Choose the right treatment option to replenish your B12, iron and folate reserves because treatment effectiveness largerly depends on the type of anemia.
Keep in mind that both iron supplementation and injections may have negative digestive side effects and not always result in improvements of your symptoms due to supplement resistant anemia. Following the crowd is not in the best interest for your health.
4. Realize that thyroid autoimmunity, chronic disease, inflammation, SIBO, parasitic infection H. Pylori and abnormal gut flora may result in diet and supplement resistant anemia. All of them have the same root cause – leaky gut syndrome.
Healing your gut damage is your best strategy to improve nutrient absorption, stop autoimmune attack, reduce inflammation and restore your gut flora necessary in order to recover from anemia and prevent its reappearance in the future.
To help you get started I would like to share with you a FREE Report on how to heal leaky gut.
1. An update on cobalamin deficiency in adults. QJM. 2009 Jan;102(1):17-28. doi: 10.1093/qjmed/hcn138. Epub 2008 Nov 5.
2. The gastric mucosal barrier: tight junction structure in gastritis and ulcer biopsies. Virchows Arch A Pathol Anat Histopathol. 1989;414(3):217-22.
3. Characteristics of anemia in subclinical and overt hypothyroid patients. Endocr J. 2012;59(3):213-20. Epub 2011 Dec 27.
4. Is Oral Vitamin B12 as Effective as Intramuscular Injection? Am Fam Physician. 2006 Jan 1;73(1):65.
5. Clinical significance of autoantibodies to parietal cells in patients with autoimmune thyroid diseases. Folia Med (Plovdiv). 2013 Apr-Jun;55(2):26-32.
6. The thyroid and the gut. J Clin Gastroenterol. 2010 Jul;44(6):402-6. doi: 10.1097/MCG.0b013e3181d6bc3e.
7. Prevalence and predictive factors of parietal cell antibody positivity in autoimmune thyroid disease. Endocrinol Nutr. 2010 Feb;57(2):49-53. doi: 10.1016/j.endonu.2009.11.001. Epub 2010 Feb 10.