Dr. Nicole Sundene
Anemia is a complex Women’s Health chronic disease that requires a skilled women’s health doctor to assist with the proper nutrition testing and hormone testing needed to address and fully resolve the anemia. Oftentimes a complex myriad of hormone imbalance, malnutrition, and malabsorption are the underlying causes of chronic anemia. Deficiency in the vitamins and minerals needed to form red blood cells and hemoglobin such as iron, folate, copper, and B-12 can also be to blame.
WHAT CAUSES ANEMIA IN WOMEN?
Anemia for women is very different than anemia for men. Today we will focus on the most common cause of anemia for women, as this happens due to bleeding and although it is common, it is not healthy for women to have constant low iron. When men have anemia I am much more concerned because this is not normal. Men do not lose blood each month and therefore naturally have a higher iron store capacity upon testing than women.
The majority of women have anemia due to heavy menstrual bleeding. Women with heavy bleeding and periods that last longer than 5-7 days will suffer from chronic anemia until the cause of the heavy periods has been resolved. In Chinese Medicine we refer to this as “Blood Chi Deficiency” and prescribe foods that are known to help “build the blood.” Herbalists use “blood building herbs” such as Nettles, Dandelion, Cruciferous Vegetables, and Liver Support Foods. In Chinese Medicine a healthy liver builds healthy blood.
To build the blood in anemia for women we need to give proper foods rich in iron, b-12, folate, protein and good fats. I recommend incorporating the iron rich foods you like on my list below into your daily diet.
To properly address the anemia for most women we must correct the underlying hormone imbalance causing the heavy bleeding each month. Women with heavy periods that are constantly bleeding, or losing heavy amounts of blood daily will not be able to resolve their anemia nutritionally until the cause of the heavy bleeding is properly addressed and resolved with Naturopathic hormone balancing. We must conduct proper nutritional testing and hormone testing to properly resolve chronic anemia in women.
If the anemia is from an autoimmune disease such as in Hemolytic Anemia, Hashimotos, Lupus, Scleroderma, and Rheumatoid Arthritis, I generally incorporate foods and herbs that are anti-inflammatory to help slow the autoimmune reaction. Reducing inflammation is critical in autoimmune patients with anemia as well as those with malabsorption. Understanding why a woman is anemic is a complex process as the underlying ROOT CAUSE for most women is multi-factorial and a result of hormone imbalance causing heavy bleeding compounded by nutritional deficiencies or gastrointestinal issues from Heartburn, GERD, Bloating, IBS, Diarrhea, Food Allergies, Food Sensitivities, or Constipation causing an inability to absorb the needed nutrients to build red blood cells and hemoglobin.
WHAT ARE OPTIMAL IRON LEVELS FOR WOMEN?
While anemia labs can be very complex and confusing and involve running a CBC, Transferrin, TIBC, iron, b12, folate, and ferritin. Let me make it simple for you…. As a women’s health doctor the only number I really care about is the ferritin level, or "the iron storage." The ferritin number is the most important number to track as it is the actual amount of iron a woman has “in the bank.” If you are in the single digits with your ferritin you are essentially “bankrupt,” and at high risk of passing out from lack of proper oxygenation to your brain and tissues. This is serious and dangerous and should get corrected ASAP. For optimal energy, mood, skin, and mental health women should have ferritin stores above 75.
Symptoms of anemia are various and vague including fatigue, depression, food cravings, anxiety, dry skin, pale mucous membranes, weakness, shortness of breath, dizziness, cold hands and feet, always feeling cold, dry skin, eczema, chapped lips, dry mucous membranes, vaginal dryness, painful intercourse, headaches, shortness of breath, rapid heartbeat or sudden change in heartbeat such as in POTS (Positional Orthostatic Tachycardia) and feeling easily fatigued especially upon standing up.
Less common anemia symptoms include increased cravings for food and non-nutritive items such as ice, dirt, and paint chips. “Pica” is the persistent eating of non-nutritive substances and is a hallmark symptom of anemia. When pregnant women constantly crave ice chips and have to munch on ice chips I am immediately checking their iron levels. Dermatology conditions such as eczema, psoriasis, and dyshidrotic eczema often are triggered by low iron stores as the body is not able to properly diffuse oxygen to the skin, causing dry skin that is more susceptible to these conditions.
WHAT IS ANEMIA?
Generally with anemia there are not enough red blood cells and/or not enough hemoglobin present in the red blood cells to carry oxygen molecules around the body. This results in tissues not perfusing oxygen properly and results in weak muscles, fatigue, dizziness, and is the common trigger behind POTS or Positional Orthostatic Tachycardia Syndrome which can cause women to feel dizzy and pass out or feel as if they will pass out.
TREATMENT FOR ANEMIA
Treatment for anemia involves replacing the lost iron every month with a better form of iron than iron sulfate or ferrous sulfate which is the most commonly prescribed form of iron at the pharmacy. If you have anemia that is not improving, or stomach pains, nausea, constipation or your levels remain low despite taking it regularly….please just throw your iron sulfate or ferrous sulfate into the garbage can. Ferrous bisglycinate or iron bisglycinate is the more gentle form of iron, that is better absorbed and women with anemia should be taking it at 25-30mg two to three times daily. Research shows women can absorb iron just as easily by taking 65mg every other day as taking it throughout the day. However, some women cannot always stomach high doses of iron even when taken with sufficient food. Women with anemia that cannot stomach iron should consider smaller doses of iron taken with meals. There are now iron patches available as an alternative that may be helpful. Many of my anemia patients see them helping and the numbers are coming up faster when we combine an iron patch with iron supplementation, and iron rich foods.
Black tea and minerals such as calcium, magnesium, and zinc should be taken away from iron supplements and certain medications such as thyroid hormones and, other minerals that will compete for absorption. Minerals and thyroid hormone require a rich stomach acid, therefore less minerals will be absorbed when taken within 2-4 hours of each other.
Men do not lose their iron stores by bleeding each month and generally do not need as much iron as women do. When men develop anemia this is a very serious concern that should not be ignored, similar to menopausal women developing anemia when they are no longer losing blood each month.
#1 Problem for anemia is understanding “The Root Cause.” We should not blindly give every “anemic” patient iron when they may need B-12 or may have actual iron overload which can look like anemia in the red blood cells but the iron levels are actually too high from excessive dietary iron intake such as an all red meat diet, or hemochromatosis a genetic condition causing excessive iron absorption. Proper diagnosis for anemia is critical.
ANEMIA PREVENTION FOR WOMEN
A simple multivitamin or prenatal vitamin can prevent a host of annoying women’s health symptoms I see from anemia in my women’s health practice such as hair loss, fatigue, anxiety, depression, dry skin, eczema, and brittle weak nails.
As a women’s health doctor I do not find it realistic for women to go without a multivitamin or a prenatal if the bleeding is heavy. While it is important to pretend you are eating a healthy variety of foods in lieu of a multivitamin, I do not agree that women are fine without a multivitamin to replace their lost nutrients each month. Menstruating women lose too much blood and often cannot get enough nutrients from our nutrient-poor foods.
OTHER CAUSES OF ANEMIA
Aside from hormone imbalance causing heavy bleeding, women that are Vegetarian are often anemic due to lack of dietary B-12 and iron. Women with chronic anemia generally have issues with their gastrointestinal tract whether it be heartburn causing them to not produce enough acid to absorb iron, or inflammation in their digestive tract causing them to not be able to absorb the iron they are taking.
Sickle Cell Anemia, Aplastic Anemia, Thyroid Disease, Pernicious Anemia, Low B-12, Liver Disease, Cancer, Kidney Disease, and Autoimmune Disease also can cause anemia although I rarely see these. It is important we have a proper diagnosis and have ruled out some of these dangerous conditions with proper labs and never just ignore anemia. Especially since many women with untreated anemia end up with depression, chronic fatigue, hair loss, headaches, moodiness, heart palpitations, and cold intolerance.
When women with anemia are regularly taking iron and the ferritin store levels are not increasing then we have to investigate “The Root Cause” of the malabsorption.
TYPES OF ANEMIA
There are many types of anemia with iron deficiency anemia (IDA) being the most common type of anemia. Anemia is categorized as normocytic (normal-sized red blood cells often found in kidney disease and chronic disease) microcytic (red blood cells are too small such as in IDA) and macrocytic anemia (red blood cells are too large) The most common types of anemia aside from IDA include hemolytic anemia which is an autoimmune disease, pernicious anemia caused by an inability to absorb B-12. Kidney disease and disease of the gastrointestinal tract also cause anemia. Women that run can become anemic as the constant pounding of their feet on the ground can rapidly destroy red blood cells and thus should compensate for this inevitable loss of red blood cells.
Chronic infections also cause iron stores to be hidden from the body as a protective measure and should be investigated once other common causes of anemia are ruled out.
Treatment for anemia involves first investigating the Root Cause of the anemia as it is often different for women. Most women with anemia should take a high-quality women's multivitamin or prenatal vitamin every day in addition to eating lean red meat or the following foods that are rich in iron while avoiding the foods that block iron absorption:
FOODS RICH IN IRON WOMEN SHOULD EAT DAILY
Red meat, oysters, blackstrap molasses, swiss chard, dulse, lima beans, potatoes, soy beans, garbanzo beans, enriched rice, pinto beans, kidney beans, turkey dark meat, leeks, dandelion greens, apricots, cornflakes, enriched cereals, kale, pumpkin, squash, black beans, spinach (cooked is more absorbable) broccoli, almonds, cocoa powder, peas, beans, brewers yeast, quinoa, figs, sunflower seeds, raisins, beans, lamb, prunes, endive, cod, turkey, tofu, egg, parsley, kelp, oats, corn, peanuts, cashews, rice, pork chops, lettuce, almond butter, blueberries, bananas, and raspberries.
AVOID FOODS THAT BLOCK IRON ABSORPTION
Tannic acid from Black Tea (not Green Tea) has been shown to block iron absorption. Pectin and phytic acid from beans and citrus are traditionally thought to interfere with iron absorption, although the same 2015 study on female iron levels concluded neither actually interfered with iron absorption. Another iron study in 2015 found that beans and legumes did not interfere with iron absorption except for soy which was found to only slightly decrease iron absorption. Soy is also a natural source of iron.
Patients with anemia should not consume black tea or if they do, should definitely not consume black tea with their iron supplements or meals. Phenolic compounds in some green leafy vegetables may also block the absorption of iron. Cooking the greens can diminish this effect. I like to saute my greens with olive oil for better absorption of nutrients.
Important Anemia Final Note: Cooking vegetarian sources of iron generally improves absorption for anemia patients. Research indicates eating “Heme iron” or iron from meat will also help the iron supplement absorb better. Generally for most women simply taking an iron supplement each day is sufficient but for complex cases of anemia we should take these factors into consideration when treating anemia.
If you need help with your anemia treatment simply pop over to my SCHEDULE page, I would be happy to help you!
Dr. Nicole Sundene
Dr. Sundene is a Naturopathic Doctor in Scottsdale, Arizona, and is a Female Hormone Expert in Women's Health and Bioidentical Hormones. She specializes in Holistic Women's Health for Menopause, Thyroid, Hashimotos, PMS, Perimenopause, Autoimmune, Postpartum, Chronic Fatigue, Depression, Anxiety, Food Allergies, Digestion, Dermatology, Acne, Psoriasis, Eczema, and Adrenal Hormonal Conditions. In 1999 she began working for a Hormone Doctor prior to starting Naturopathic Medical School. With over 23 years of experience in both Prescription and Natural women's health and hormones, she presents to women the best-integrated health solutions for their Chronic Disease.
She has been an Herbalist for over 28 years and enjoys teaching women how to use herbs to balance their hormones, nutrition and optimize their health. Dr. Sundene relies on blood testing for her hormone metrics. The hormone testing is covered per the patient's insurance plan (not Medicaid) and conducted at certain points in the woman's menstrual cycle. To learn more about Hormone Testing for Women Visit: Bioidentical Hormones. Follow Dr. Sundene on Instagram, Twitter, and Facebook for more tips on Women's Health, Female Hormones, and Naturopathy!