What is anaemia?

Anaemia is a condition with low levels of red blood cells, or haemoglobin in the blood. Haemoglobin is the part of red blood cells which contains iron.

Red blood cells carry oxygen from the lungs to the body tissues, and then carry carbon dioxide back to the lungs where it is exhaled, therefore fatigue is a common symptom of various types of anaemia. Other common signs and symptoms are pallor (paleness of the face and inner eyelids) and weakness.

What are the possible causes of anaemia?

Iron deficiency anaemia

Anaemia can occur when there has been excessive blood loss, for example during an operation or with heavy menstruation or conditions such as haemorrhoids. However, the most common factor leading to anaemia is a deficiency of one or more specific nutrients including iron, vitamin B12 and folate/folic acid.

Iron deficiency anaemia is one of the most common [i], and it is easily diagnosed through a serum ferritin blood test. To get optimal absorption of iron through food, it is best consumed with vitamin C, as they work synergistically together.

Vitamin B12 deficiency anaemia

A vitamin B12 deficiency is usually due to an issue with absorbing B12, rather than a lack of B12 in the diet. B12 needs sufficient hydrochloric acid in the stomach and the efficient production of a compound called the intrinsic factor produced by the parietal cells in the stomach, which then binds with B12 for absorption at a site further down the small intestine.

This type of vitamin B12 deficiency anaemia is called pernicious anaemia and is a subgroup of a Megaloblastic anaemia producing enlarged red blood cells. All well as extreme fatigue, people may experience lack of concentration or focus and problems with memory and recall. Even though it is a water-soluble vitamin, vitamin B12 can be stored in the body for some time[ii], which is why it can take a while for symptoms to occur. Vegan diets are typically low in vitamin B12 and so either consumption of food choices such as algaes or supplementation may be helpful as a preventative measure.

Folate/folic acid (vitamin B9) deficiency

Folate/folic acid (vitamin B9) deficiency is fairly common if there are not sufficient amounts consumed in food or if there is high alcohol consumption[iii]. Alcohol consumption often leads to a folic acid deficiency because it prevents proper absorption and metabolism of this nutrient amongst others and also causes the body to excrete more of it. Pregnant women also need higher levels of folic acid especially during the first trimester as it is imperative for healthy foetus development and prevention of neural tube defects[iv].

Nutrition support and supplement suggestions for anaemia

To enhance iron absorption:

Iron - Viridian Balanced Iron Complex / Spatone / Viridian Liquid Iron

Vitamin B12 - Pure Encapsulations B12 Liquid / Phytality Fermented Chlorella 240 Pressed Tablets (200mg)

Folate/ Folic acid - Viridian Folic acid 400mcg

Vitamin B12 combined with folate/ folic acid - Viridian High Twelve B-Complex B12 / Pure Encapsulations B12 Folate (60 Caps)

Erbenobili Anemivin (50ml) - Natural remedy that helps to rebalance the processes of absorption and utilisation of iron, such as to be useful in all cases of anaemia associated with deficiencies or alterations in the absorption of trace elements.

Viridian Synerbio Daily High Strength Probiotic - Some studies have suggested that certain probiotic strains, such as Lactobacillus, may enhance iron absorption. These strains are thought to promote the conversion of dietary iron into a more absorbable form[vii].

Terranova Easy Iron Complex - Bioavailable and easy on the digestive system form of Iron combined with ingredients to facilitate absorption.

Diet and anaemia

If a deficiency has been diagnosed, then addressing the diet is advised. This can be through additions of specific foods or food combinations in the diet and supplementation can be helpful in the interim to support this.

Heme and non-heme food intake

In relation to iron deficiency anaemia, we need to consider intake of what is called heme and non-heme food intake, which are foods that contain iron whilst taking into account the food choices made by the individual. For example, foods high in heme iron which has the highest bioavailability are organic calf or lamb liver, various seafoods and lean meats.

Examples of non heme iron which is less bioavailable but has lots of other nutritional properties include green leafy vegetables, white beans, lentils and organic tofu.

Vitamin C intake with iron

As mentioned above, vitamin C greatly improves the bioavailability of non heme iron[v], so when consuming these foods, it can be helpful to include a little vitamin C alongside such as a little dash of lemon with water or cooking. Many formulas of supplemental iron will include vitamin C for that reason, good quality iron supplements will also include a non-constipating form of iron. Calcium and tannins from tea are another worthy consideration here as they can hinder the absorption of iron so keep these separate from your iron food sources if you are addressing low iron, or iron deficiency issues.

Vitamin B12

When it comes to vitamin B12 deficiency, food sources include animal meats, especially liver and kidney, eggs, cheese, fish are also good sources. Vitamin B12 found in plant-based sources is not utilised by the body well and therefore shouldn’t be used as an alternative for supplementing B12 if there is a deficiency. It might be necessary for someone with a B12 deficiency to have regular B12 injections and this will be decided by a medical professional. It is generally recommended that vegans supplement with vitamin B12 to prevent any deficiencies.

Food sources of folate/folic acid are organic liver (again), lentils, dark green leafy vegetables and whole grains. You can also supplement folate/folic acid. Its most bioavailable form is folate, so this would be more beneficial to get levels up if there is a deficiency. It is also worth noting that for some people, their genetics will disable them from converting folic acid effectively so these people should also supplement with folate/methyl folate.

Vitamin B12 should always be supplemented along with folic acid as the folic acid supplement can mask a B12 deficiency[vi].

Please note

It is important to be cautious when supplementing iron, as having excessive levels of iron in the bloodstream can be very dangerous. People who are having regular menstrual cycles are less at risk, due to loosing a certain amount of blood each month and those who do not menstruate should practice extra caution. However, just to be safe, it is recommended that everyone should check their iron levels via a blood test, whilst, or prior to supplementing with iron.