Anaemia can potentially be a very complex medical issue. There are actually over 400 types of anaemia of varying causes, these can be genetic in origin or be caused by faulty destruction or formation of red blood cells. It can also be caused by blood loss-acute and chronic, dietary insufficiency i.e not enough folate, vitamin B12 and B6 to make healthy blood cells or it can simply be due to malabsorption issues. Always speak to your doctor before self-diagnosing or supplementing with iron (which may make matters worse in some cases).
This newsletter will cover the most common types of anaemia and how they may link to Hashimoto's. Iron is one of the most crucial nutrients needed for life and yet it can potentially be incredibly toxic. As such the body has mechanisms in place to guard against iron overload and to increase its absorption when more is needed- clever huh?!
When we are deficient in iron it can make us feel exhausted, breathless, dizzy, and unable to concentrate, iron deficiency has also been linked to psychiatric issues such as anxiety, depression, and also problems with sleep. What does this have to do with Hashimoto's? Well....... there are a few things.
1. Being hypothyroid may cause suboptimal stomach acid production and impaired gastrointestinal absorption -this makes it much harder to get optimal iron absorption from food despite eating all of the right things.
2. Being in a hypothyroid state can potentially slow the production of red blood cells in the bone marrow.
3. Hashimoto's is often seen alongside other autoimmune diseases such as coeliac disease and pernicious anaemia. In terms of pernicious anaemia - this is where the body mistakenly attacks the parietal cells in the stomach that produce stomach acid and intrinsic factor which is involved in absorbing vitamin B12. A blood test can confirm if there are antibodies being produced against the parietal cells and intrinsic factor. Pernicious anaemia is caused by a lack of vitamin B12 and not a lack of iron. In terms of coeliac disease- unexplained iron deficiency is often seen as a sign that warrants investigation into the possibility of coeliac disease. (By the way, coeliac disease can sometimes be silent in terms of gut symptoms).
4. Hashimoto's can interfere with our sex hormones and result in heavy periods which can further contribute to iron deficiency anaemia.
5. Thyroid hormone conversion from T4 to the metabolically active T3 relies on adequate iron- the lower iron stores become the more hypothyroid we may potentially become and so the vicious cycle continues.
6. Nutritional anaemia (not an iron deficiency) can be due to low B12 of a non-autoimmune cause. This could be due to poor dietary intake such as vegetarianism or veganism or simply having low stomach acid and poor digestion as often seen with Hashimoto's. Vitamin B6 and folate also play a role in creating healthy red blood cells. Again- intake may be poor or there may genetic factors at play that interfere with the metabolism of folate and B12. This metabolic process is called methylation. A simple methylation genetic test can tell us if there is anything to look out for and support in this area.
In the case of nutritional anaemia, a full blood count may show depressed haemoglobin and red blood cell count and yet an elevated MCV, MCH, MCHC, and normal or even high ferritin. For some context- an optimal MCV from a functional medicine perspective would be 82-89.9fL, whereas the NHS uses much broader ranges often up to 100fL.
So, let's say that you have the incredibly common form of anaemia- which is iron deficiency anaemia. This will often be seen with low ferritin- remember ferritin is your bodily store of iron and will be sacrificed in order to continue to make healthy blood cells. Think of it as the savings account which is getting raided to keep you healthy. What can you do about it? First, you need to identify why you are iron deficient. Is it due to a lack of iron in the diet i.e vegetarian or veganism? The iron available from vegetarian sources is not only poor it is also poorly absorbed. The most absorbable iron comes in heme form in meat, fish, and shellfish. Is it due to blood loss- may be heavy periods or endometriosis/fibroids? (Endometriosis may cause internal blood loss in the pelvis). Is there a more sinister cause- perhaps coming from the bowel or an ulcer?
Endurance sports and overtraining can increase our need for iron and result in a deficiency. Other causes may be stomach and GI complaints such as SIBO, Crohn's, Candida and inflammatory bowel disease/ulcerative colitis- these questions are all something to ask your GP.
A full iron panel which includes total iron binding capacity, total iron saturation, transferrin saturation, unsaturated iron binding capacity and full blood count can be ran to get the entire picture. Test- don't guess and talk to your GP first.
What if you have high ferritin? Healthy ferritin levels (again, from a functional medicine 'optimal' perspective) are 70-90 ug/L for women and 70-100 ug/L for men. I often see clients with ferritin over 200 ug/L. When ferritin levels are high it's prudent to rule out haemochromatosis with your GP as a precaution. Raised ferritin is often seen in the presence of infection, inflammation, autoimmunity and malignancies. In these cases the red blood cell count may be depressed along with depressed haemoglobin and haematocrit and yet ferritin is elevated. This is often called 'anaemia of inflammation or chronic disease'. Once this type of anaemia has progressed there may also be depressed MCV, MCHC AND MCH in addition to low haemoglobin and haematocrit. The focus here is to look for the root cause- it may be due to the autoimmune process or poor gut health driving systemic inflammation. As before- speak to your GP to rule out anything more serious.
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I hope you found this blog useful,
Best wishes
Nicola.