Why does nutritional anaemia matter?

Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal. Haemoglobin is needed to transport oxygen from the lungs to the tissues and to remove carbon dioxide waste.

You can learn more about iron deficiency in the post, “Is it iron deficiency anaemia or something else?”  Today, I’m reviewing other types of nutritional anaemia’s that are common but often overlooked.


Symptoms of anaemia include fatigue, shortness of breath, muscle pain, exercise intolerance, dizziness and brain fog. These are common to other problems such as thyroid dysfunction, so it’s important to assess these carefully and keep an open mind about what’s going on.


A significant contributor to these types of anaemias is a micronutrient poor diet. Micronutrients include all the essential amino acids, vitamins, minerals and trace elements in the correct quantities and ratios with each other. There may be a number of reasons why we aren’t getting the micronutrients we need.

Our current “grainatarian” diet is very low in micronutrients despite an excess of energy (calories) from processed carbohydrates and fats. These foods often contribute to digestive inflammation, reducing our ability to break down and absorb nutrients. Gastrointestinal problems including IBD, IBS and ulcerative colitis along with celiac disease and gluten sensitivities also affect our ability to absorb nutrients from the small intestine.

Many medications, including those for reflux, pain, birth control, and depression interfere with proper digestive function, reducing our ability to absorb the nutrients from our food.

Another common problem is the incorrect use of supplements or poor quality formulations that create nutrient imbalances. For example the use of zinc and vitamin D may block the absorption of copper and vitamin A, leading to deficiencies and reducing the ability to load, transport and recycle iron.

Other reasons for nutritional anaemia’s include pregnancy and growth spurts in children when nutrient demands increase. The loss of blood through GI bleeding, injury, surgery and heavy menstrual bleeding may be contributing factors that need investigating.

I haven’t touched on the quality of soil and farming practices that affect the uptake of nutrients into our foods, as this is a huge topic on its own. However, the source of our food is important when considering it’s nutrient quality.  

Nutrients are needed for oxygen transport

There are a number of nutrients with very complex interactions that are involved in the production and recycling of red blood cells and the transport of oxygen. These include:

  • Minerals: Iron, copper, zinc and magnesium
  • Vitamins: B12, B6, B5, B1 and folate
  • Anti-oxidant vitamins: A, E, C
  • Essential fatty acids: Omega-3
  • Protein: amino acids

Assessing nutritional anaemias

It can be very challenging to get the testing completed to identify these types of anaemias. Doctors tend to order a complete blood count (CBC) and if you’re very lucky a complete iron panel. Often they will order ferritin or serum iron on its own. Unfortunately, this often doesn’t provide an explanation for the symptoms and it’s very common for people to be told there is nothing wrong.

People are often sent home with advice to reduce stress, lose weight or exercise more. Or, sometimes they are told, “you’re just getting older, what do you expect”. Due to the limited training doctors receive in nutritional assessment, many haven’t been taught to look deeper and are unfamiliar with the use of additional testing as part of a patient assessment.

I believe including magnesium, copper and Ceruloplasmin, (a copper dependant anti-oxidant, with a vital role in iron transport), is an important part of a nutritional anaemia assessment. Vitamin A, B12 and folate are often useful additions to the testing menu.

Best sources of nutrients

Animal foods are a superior source of these nutrients for a number of reasons. They come in the form that our body recognises and are easier to digest and absorb. Plant nutrients often come with anti-nutrients, such as oxalates and phytates that interfere with digestive function. These may also be in a precursor form that our bodies don’t always convert to the active nutrient very well, such as beta-carotene rather than retinol.

Liver and other organs meats are a great source of these nutrients. If you don’t like the idea of consuming these, there are organ supplements you can use instead. Homegrown Primal is an excellent NZ based company that is building a great reputation for the quality of their organ supplements. Bee pollen may be another good food based supplement, particularly if you’re on a plant-based diet.

Why anaemia’s shouldn’t be ignored

It’s important to pay attention to nutritional anaemias, because all our cells need adequate oxygen delivery to make energy (ATP). However, during this process we create damaging metabolites that need to be neutralised and removed. Compare this to a car that’s not properly able to clear it’s exhaust.

Whenever a cell struggles to clear its metabolic exhaust, oxidative damage occurs, leading to inflammation that decreases the ability of the cell to function properly. Damage to our DNA can occur and the disease process begins.

Keep in mind this oxygen delivery and exhaust clearing happens in every cell in our body, every second throughout the day. It is estimated that the average adult (while resting) makes between 50-75 kg of ATP each day. It’s a lot more when we are exercising. That’s a lot of reactions that need the right kind of chemicals – many only available from our food.

Although iron deficiencies do occur, it’s important not to automatically assume this is the cause of your fatigue and other symptoms, particularly if you’re an adult man, or post-menopausal woman. All the micronutrients mentioned above play an important role in production of red blood cells, the recycling of iron and helping to deliver oxygen to cells while clearing the exhaust as we make energy. It’s worth considering all of these when investigating anaemia.

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