Why are you dragging your feet, pale-face?

Iron may not help with anemia. Try beets or rhodiola.

Fatigue, weakness, excessive panting, impaired physical and mental performance, and even growth, behavioural and mental development disorders in children – all of these can be the result of anaemia. But iron deficiency is far from always the cause. So why anaemia can bother us and how to deal with it.

We speak of anaemia when there is a deficiency of red blood cells and the blood dye haemoglobin in our blood. Worldwide, it is one of the most widespread health problems – an estimated one-third of the world’s population suffers from it.

The main task of red blood cells is to transport oxygen from the lungs to all cells of the body, and therefore the usual symptoms of anaemia are related to insufficient oxygenation of the tissues. This is mainly due to fatigue and impaired physical and mental performance – oxygen is essential for the conversion of nutrients into energy, and if not enough of it reaches the cells, the result is an energy deficit in cells and tissues throughout the body. Increased shortness of breath even with moderate physical exertion and increased heart rate are also typical – when there is a shortage of ‘oxygen carriers’ in the body, the blood vessels simply have to move faster to cope with the demand for oxygen, which places increased demands on the work of the heart. The typical pallor is often present, but this does not have to be the case – on the contrary, in so-called haemolytic anaemias, in which the blood cells are excessively broken down, the skin tends to be yellow.

The real cause of anemia

Most people associate anaemia with insufficient iron intake, but this is a big misconception. This may have been true in the past, but today this factor plays a significant role only in poorer countries. The diets of the vast majority of Europeans are high in iron, so iron deficiency only comes into play in specific cases – for example, during pregnancy when the need for iron increases significantly, in elite endurance athletes, etc. It is rare in the general population in the Czech Republic and the rest of Europe, so one of these situations is more likely to come into play:

1. We have a problem with iron absorption – which is usually due to an imbalance in the gut microbiome or poor dietary habits, e.g. when iron-rich foods are eaten with substances that inhibit iron absorption. The bioavailability of iron can also be significantly affected by certain health problems – typically Heliobacter pylori infection (the causative agent of gastric ulcers), Crohn’s disease, celiac disease and the use of certain medications.
2. We do not consume enough of the other substances needed for blood formation – vitamin B12 deficiency is typical, and most often affects vegans. Folic acid, vitamin B6 and C, copper or molybdenum are also needed for blood formation.
3. There is an excessive loss of blood cells – this happens, for example, in haemolytic anaemias, but also in excessive bleeding. This can affect women with heavy menstruation, but it also occurs, for example, in ulcers or tumours of the digestive tract. Therefore, when searching for the causes of anaemia, the doctor should always recommend an occult test to detect the presence of blood in the stool.
4. The processes of hematopoiesis are disturbed.

In addition, a number of epigenetic factors come into play, e.g. reduced activity of genes involved in the formation and maturation of red blood cells, hormonal imbalance (e.g. lack of the hormone erythropoietin), etc.

So let’s take a closer look at some of these factors.

When the body lacks iron

Iron is a key element for blood formation. It is part of the blood pigment haemoglobin, which ensures the transport of oxygen. But it also has a number of other important roles in the body. For example, it ensures the transfer of electrons in the respiratory chain, is needed for the formation and repair of DNA and is also a strong epigenetic factor. As a cofactor, it is a component of a number of key enzymes, including those that are essential for reactions that affect the activity of individual genes (e.g. demethylating enzymes). Thus, in addition to anaemia, its deficiency may also contribute to other diseases, including cancer, neurodegenerative diseases, obesity and diabetes.

Iron deficiency can be caused by a number of factors. The essential factor is its intake through diet or supplements. In addition, however, its bioavailability also comes into play. This can be influenced by the state of the gut microbiome, inappropriate food combinations (see below), but also epigenetically, for example through the production of proteins and peptides that influence its absorption and use in the body. Examples include transferrin, hepcidin, ferroportin and ferritin.

First the movement, then the food

A little-known but nevertheless very important factor is, for example, the peptide hormone hepcidin, which is produced in the kidneys and plays a crucial role in maintaining the iron balance in the body: When iron levels rise, hepcidin is released, which inhibits the absorption of this element in the intestines and its release from stores. Conversely, when iron levels fall, hepcidin production is suppressed, thus promoting the absorption of iron from food. That is, if everything works as it should. In fact, disturbances in hepcidin production are a common cause of both anaemia (when iron is overproduced) and, conversely, iron overload and deposition in the liver and other tissues.

Interestingly, the production of hepcidin can also be partially regulated by physical activity – after physical exertion, its production is suppressed for up to 12 hours, which makes iron from food and supplements more readily absorbed during this time. Adequate physical activity is therefore very important in anaemia, and the timing also matters: it is ideal to go for exercise in the morning or in the morning to make better use of the iron from the food eaten during the day.

A cup of coffee after the meal? I’d rather not!

However, certain dietary habits can also interfere with iron absorption. There are a number of substances that impair its bioavailability.

Caffeine

Caffeine and theine have a relatively high ability to limit iron absorption, so it is not advisable, for example, to wash down an iron-rich meal with tea or to follow the common habit of having coffee immediately after lunch.

In one study, for example, volunteers ate burgers and washed them down with various drinks. If they drank coffee during this lunch, they experienced a 39% reduction in iron absorption compared to the control group, and even a 64% reduction if they had tea with their meal! The stronger the drink, the more absorption was inhibited.
In addition, the polyphenols in coffee and tea, especially chlorogenic acid or EGCG, may also contribute to poorer absorption.

Phytic acid

Phytic acid, a substance found in seeds, legumes and cereals, can also interfere with the absorption of iron (and other minerals and trace elements). For this reason, it is advisable to soak these foods before cooking (and then discard the soaking water), as much of the phytic acid is removed by leaching. The phytic acid content is also reduced, for example, during the germination process.

Calcium and magnesium

Calcium also interferes with iron absorption in the short term. It is therefore advisable to separate the use of iron supplements or foods rich in this element from calcium supplements or larger portions of dairy products. Higher doses of magnesium may also be problematic.

It must be added, however, that the vast majority of these substances inhibit iron absorption when consumed with, shortly before or after iron. Moreover, for non-anemic persons, their action will only be endangered if they are combined with iron-rich foods to a greater extent and for a longer period of time.

Polyphenols

It is not only polyphenols from coffee and tea that interfere with iron absorption, but also other plant polyphenols such as quercetin and resveratrol. Therefore, iron-rich foods or iron supplements should not be consumed together with polyphenol supplements or with large amounts of foods that are rich in these substances.

Foods promoting iron absorption

On the other hand, simultaneous consumption of foods rich in vitamin C, which promotes iron absorption, can be beneficial – this is especially true for so-called non-heme iron from plant sources. This is much less easily absorbed than the heme iron from animal sources, which is why vegetarians and vegans are often recommended to take higher doses of iron than meat eaters. However, the “C” will significantly enhance the absorption of non-heme iron.

Regular consumption of beetroot is also very useful, as it improves the ability of red blood cells to carry oxygen in addition to absorbing iron. In one study, for example, a group of anaemic women consumed as little as 8 g of beetroot a day and after just 20 days had an increase in both iron and haemoglobin levels, a decrease in transferrin levels and an increase in overall iron binding capacity.

The effect of protein is interesting – while proteins from meat tend to increase iron absorption, proteins from egg white or soy tend to suppress it. The same applies to fibre: insoluble fibre impairs the absorption of iron and other minerals, while soluble fibre, especially inulin, promotes it.

What’s wrong in the body?

Although sufficient iron and other nutrients are essential for blood formation, they are not enough on their own. There is also the process of the actual production and maturation of red blood cells. And this is happening at a tremendous pace in the human body – 2-3 million of these blood cells are created in a single second! It is no wonder, then, that many people cannot keep up this pace.

A number of (not only) epigenetic mechanisms are involved in blood formation. Both methylation and demethylation of genes and modification (especially deacetylation) of histones are involved to a large extent.

Stress and sleep deprivation are typical factors disrupting blood formation. Increased oxidative stress (i.e., excessive production of free radicals), which can damage the structure of red blood cells, can also play a role. However, thyroid hypofunction may also contribute to anaemia. Up to 60 % of people with this problem suffer from iron deficiency, which is not necessarily due to inadequate iron intake, but to limited absorption from food. This condition is often related to an imbalance in the gut microbiome – the optimal condition of the gut inhabitants is also important for the optimal absorption of minerals and trace elements from food. Moreover, the relationship is two-sided: iron is essential for the synthesis of thyroid hormones, and its deficiency exacerbates the hypofunction of this organ.

However, taking iron supplements or increasing red meat consumption may not help here – both may worsen the condition. Unabsorbed iron can accumulate in the gut, where it worsens the gut microbiome and increases inflammatory processes.

A very specific case is anaemia associated with an inflammatory process. It is very difficult to treat and can have serious consequences. Its development is probably related to oxidative stress, which leads to inflammatory processes and subsequently to anaemia. This problem is more common in the elderly.

Herbs and nutrients for better blood formation

Rhodiola

In traditional Chinese medicine, this plant (Czech name: rozchodnica rosova) has been used for centuries to treat altitude sickness and hypoxia, one of the reasons being to promote blood formation. The active ingredients, especially salidroside, exert epigenetic effects on certain genes and cell receptors related to hematopoiesis, while limiting apoptosis (programmed cell death) of blood cells.

Baikal pine cone

Baikalin and other substances contained in this herb positively affect the formation of red blood cells or hemopoiesis. It does so even if the production of blood cells has been disturbed by sleep deprivation or psychological stress.

Green food

Green foods include young shoots of grains and legumes (barley, wheat, alfalfa) and single-celled freshwater species (chlorella, spirulina). All have in common a high content of the green pigment chlorophyll, which can be very useful in anaemia. In fact, its structure is very similar to the blood dye haemoglobin – both are based on the same complex organic molecule, with a magnesium atom in the centre of chlorophyll and an iron atom in the centre of haemoglobin.

In one study, for example, a group of volunteers with anaemia were given a dietary supplement with organically bound iron (ferrous gluconate), while the other received chlorophyllin – a chlorophyll derivative that has virtually the same effects as this plant dye but is significantly more stable, and is therefore often substituted for chlorophyll in research. And while the administration of iron was effective in 32% percent of cases, the effectiveness of chlorophyllin administration was 92%! In so-called aplastic anaemia (a disorder of blood cell formation), the use of chlorophyllin has been shown to be significantly more effective than the drug cyclosporine A.

Pomegranate

The substances contained in this fruit can help on several levels: they improve the absorption of iron from food (in one study, they increased iron absorption threefold, whereas taking vitamin C only increased it 1.6-fold), and they improve its uptake by cells and assimilation within cells.

Chinese angelica

This herb, especially popular in traditional Chinese medicine, is most often used for gynaecological problems, but it can also be very effective in cases of anaemia. It increases the production of growth factors necessary for blood formation (including erythropoietin), activates the process of red blood cell formation and reduces the production of hepcidin (a substance that inhibits iron absorption). Its use in research has generally improved blood iron levels and the homeostasis of this element.

Astaxanthin

The orange dye contained in salmon and shrimp meat, for example, is excellent for its antioxidant properties and is therefore able to protect red blood cells from the negative effects of free radicals. This ability has also been confirmed in people with cancer and athletes.

On the other hand, caution is advisable when taking one of the most common epigenetic dietary supplements – curcumin. Although it is known for its anti-cancer effects, one of the reasons for this is its ability to form chelates with heavy metals found in the body, and unfortunately the same reaction takes place with iron. A person with a healthy hematopoietic system is not at risk, but in people with low iron levels this leads to a further reduction in iron levels. So if you are anaemic, do not take curcumin. With one exception: Due to its strong anti-inflammatory action, curcumin works very well in elderly people with anaemia associated with inflammatory processes.