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Anemia is an exhausting condition and when treatment doesn’t produce the hoped for results it can be very frustrating! This article contains the most common blocks to anemia treatment that I see in my practice and how to overcome them.
Not Supplementing Long Enough
Iron and B12 supplementation can take time to show improvements. Improvements in symptoms are often felt within 2-4 weeks of starting iron supplements, but this may not be enough time for changes to be reflected on labs. Improvements in energy may start the same day as supplementing with B12, but again, it may take longer to see improvements in blood work. If labs are rechecked after only 1 month of supplementation, results might be disappointing. Usually B12, ferritin and complete blood count are rechecked 3-6 months after starting supplementation. Often this therapy needs to continue for 6-12 months or more in order for the body to fully restore iron and/or B12 stores.
Not Supplementing With The Right Form Of Iron Or Vitamin B12
All forms of iron are not equally easy to absorb. I often recommend iron bisglycinate because it is easy on the stomach and more effective than some other types of iron at treating iron deficiency. There are several forms of vitamin B12 available. Methylcobalamin is the most bioavailable, especially for people with genetic polymorphisms that affect methylation.
Not Absorbing Nutrients
Stomach acid is required to absorb iron and vitamin B12. Iron deficiency can lead to problems that can decrease stomach acid as can stress and certain medications. Apple cider vinegar, bitter herbal formulas, or digestive enzymes containing HCl may help. Some people can’t absorb vitamin B12 from food. In these cases, vitamin B12 injections are required.
Other Untreated Micronutrient Deficiencies
Iron and B12 aren’t the only micronutrient deficiencies to consider when treating anemia. Folate, vitamin A, vitamin C, zinc, and molybdenum may all play a role.
Untreated Blood Loss Is Occurring
Sometimes blood loss continues to occur even while treating anemia. Heavy menstrual bleeding, fibroids, endometriosis, gastrointestinal bleeding, and runner’s anemia are all sources of blood loss that need to be considered and treated in order to recover from anemia.
Misdiagnosis
Some types of anemia don’t respond well to nutrient supplementation; for example, anemia of chronic disease shouldn’t be treated with iron. If anemia isn’t responding to treatment, it may be an indication that further investigation is needed.
Summary
Anemia is a common and sometimes severe condition that results in symptoms like fatigue, dizziness, headaches, heart palpitations, cold hands and feet, chest pain, and more. In anemia caused by nutrient deficiency, treatment with the appropriate micronutrients should help restore proper red blood cell function and energy levels. If treatment results don’t match up with expectations there may be a problem with the length or type of supplementation, absorption of nutrients, other micronutrient deficiencies, or undiagnosed/untreated underlying health problems.
References:
Tolkien, Z., Stecher, L., Mander, A. P., Pereira, D. I., & Powell, J. J. (2015). Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PloS one, 10(2), e0117383. https://doi.org/10.1371/journal.pone.0117383
Name, J. J., Vasconcelos, A. R., & Valzachi Rocha Maluf, M. C. (2018). Iron Bisglycinate Chelate and Polymaltose Iron for the Treatment of Iron Deficiency Anemia: A Pilot Randomized Trial. Current pediatric reviews, 14(4), 261–268. https://doi.org/10.2174/1573396314666181002170040
Busaleh, F., Alasmakh, O. A., Almohammedsaleh, F., Almutairi, M. F., Al Najjar, J. S., & Alabdulatif, A. (2021). Microcytic Anemia Hiding Vitamin B12 Deficiency Anemia. Cureus, 13(12), e20741. https://doi.org/10.7759/cureus.20741
Sanz-Cuesta, T., Escortell-Mayor, E., Cura-Gonzalez, I., Martin-Fernandez, J., Riesgo-Fuertes, R., Garrido-Elustondo, S., Mariño-Suárez, J. E., Álvarez-Villalba, M., Gómez-Gascón, T., González-García, I., González-Escobar, P., Vargas-Machuca Cabañero, C., Noguerol-Álvarez, M., García de Blas-González, F., Baños-Morras, R., Díaz-Laso, C., Caballero-Ramírez, N., Herrero de-Dios, A., Fernández-García, R., Herrero-Hernández, J., … OB12 Group (2020). Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care: a pragmatic, randomised, non-inferiority clinical trial (OB12). BMJ open, 10(8), e033687. https://doi.org/10.1136/bmjopen-2019-033687
Nebl, J., Schuchardt, J. P., Ströhle, A., Wasserfurth, P., Haufe, S., Eigendorf, J., Tegtbur, U., & Hahn, A. (2019). Micronutrient Status of Recreational Runners with Vegetarian or Non-Vegetarian Dietary Patterns. Nutrients, 11(5), 1146. https://doi.org/10.3390/nu11051146
Fisher, R. L., McMahon, L. F., Jr, Ryan, M. J., Larson, D., & Brand, M. (1986). Gastrointestinal bleeding in competitive runners. Digestive diseases and sciences, 31(11), 1226–1228. https://doi.org/10.1007/BF01296524
Helmer, P., Schlesinger, T., Hottenrott, S., Papsdorf, M., Wöckel, A., Diessner, J., Stumpner, J., Sitter, M., Skazel, T., Wurmb, T., Härtel, C., Hofer, S., Alkatout, I., Girard, T., Meybohm, P., & Kranke, P. (2022). Patient Blood Management in der Geburtsvorbereitung, Geburtshilfe und postpartalen Phase [Patient blood management in the preparation for birth, obstetrics and postpartum period]. Der Anaesthesist, 10.1007/s00101-022-01109-8. Advance online publication. https://doi.org/10.1007/s00101-022-01109-8
Annibale, B., Capurso, G., & Delle Fave, G. (2003). The stomach and iron deficiency anaemia: a forgotten link. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 35(4), 288–295. https://doi.org/10.1016/s1590-8658(03)00067-7
Betesh, A. L., Santa Ana, C. A., Cole, J. A., & Fordtran, J. S. (2015). Is achlorhydria a cause of iron deficiency anemia?. The American journal of clinical nutrition, 102(1), 9–19. https://doi.org/10.3945/ajcn.114.097394
https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
https://irondisorders.org/anemia-of-chronic-disease-2/https://www.merckmanuals.com/en-ca/home/blood-disorders/anemia/overview-of-anemia
