Why Does Anemia Cause Fatigue? – Thyroid & Gut Health


Updated: December 2021

Most of my new patients have a common symptom called fatigue or chronic fatigue. They talk about how they don’t have energy to do much of anything. They explain how they get short of breath with just a little physical activity.

They also tell me how they have brain fog or lack of mental clarity and acuity. I help patients who have all kinds of different health problems. It’s a lot of fun for me because I get to help people be healthy and happy again.

Many of the conditions I treat have fatigue in common. This is for various reasons which are too many to list in one article. In this article, I’m going to talk about anemia and why it causes fatigue.

What is Anemia?

Anemia is a condition where someone doesn’t have enough red blood cells or hemoglobin in their blood. Red blood cells carry oxygen. When there are low numbers of red blood cells, it can cause hypoxia. Hypoxia is low oxygen levels to all tissues throughout the body.

Hemoglobin is a protein that binds to iron. Healthy red blood cells have 250 million hemoglobin molecules in them. Each hemoglobin molecule can bind 4 oxygens, so a healthy red blood cell can carry up to 1 billion oxygen atoms!

Problems can arise when red blood cell counts go low or hemoglobin count drops. When either of these occur, oxygen levels in all tissues such as the brain, nerves, and heart go low.

According to the neuron theory, nerves need two things: fuel and activation. When there isn’t enough oxygen in the body, nerves don’t get enough oxygen so they lack in fuel.

This can explain much of the brain fog and fatigue, poor memory and lack of normal cognitive function. Low oxygen levels to the brain lead to suppression of nervous system function.

What Causes Anemia?

There are many sources of anemia. These can range from anemia of blood loss, iron deficiency anemia, poor absorption, hemolytic anemia, genetic conditions such as sickle cell anemia, B vitamin deficiencies, and others. This article is going to focus on some of the more common causes that are modifiable.

Females know the feeling of acute anemia due to their monthly menstrual cycle. They will have very low energy levels and will suffer from high grade malaise or fatigue.

This one is easy to explain. When the uterus sheds it’s lining, much blood is lost. Red blood cells and hemoglobin levels can drop rapidly during this process. In healthy women, the red bone marrow will produce new red blood cells to replace the ones that were lost and the process starts all over again.

Some women explain that they feel like they barely recovered from their menstrual cycle before the next one begins. Women who have perfect health with low levels of inflammation can rapidly reproduce their lost red blood cells and will have limited symptoms of anemia during their recovery process.

Women who are unhealthy, estrogen dominant, insulin resistant, decreased breakdown and absorption of protein, or have generalized chronic inflammation will have a slower recovery process each month. It makes sense, right? A healthy body will recover faster from just about anything.

Anemia and Menopause

Women in menopause or that are postmenopausal can still suffer from anemia. Generally, women who have gone through menopause don’t need to supplement with iron as much as women who are still menstruating.

But, if the red blood cells are unhealthy or hemoglobin levels are low, something isn’t right. Iron supplementation isn’t necessarily the answer for these women.

Other factors need to be examined at such as Hemoglobin A1C, gut health or dysbiosis, dietary protein intake and utilization, liver health, possible internal bleeding, poor absorption of iron, glutathione levels, iron storage (ferritin), Total Iron Binding Capacity, Percent Saturation, Reticulocytes, Mean Corpuscular Hemoglobin, and Mean Corpuscular Volume to mention a few.

Does Internal Bleeding cause Anemia?

A common cause of anemia is internal bleeding. A good health screening can help rule out internal bleeding. This should be done in every case of acute or chronic anemia.

Some signs of internal bleeding are: unexplained pain at the site of an injury, swelling, color changes to tissues, blood in stool (black or red), a feeling of needing to drink water, nausea, vomiting, and being short of breath.

Blood loss is blood loss. It doesn’t matter if the blood is being eliminated by the body (such as what occurs with menstruation) or whether an internal organ is bleeding, it can still cause a drop in hemoglobin and create fatigue.

How does Digestion Affect Iron Levels?

Iron is absorbed in the small intestine. When iron levels are low one of the first things to look at is digestive and gut health. Is the small intestine inflamed? Are the necessary ingredients present for proper iron absorption?

Enterocytes are the cells responsible for absorbing iron. Enterocytes are in the duodenum which is the first part of the small intestine. An unhealthy, inflamed duodenum of the small intestine can affect iron absorption.

An interesting fact is that vitamin C is a necessary cofactor for iron absorption. I’ve seen countless patients who suffered from anemia and had been to different doctors trying to get help before seeing me.

They tell me how they were told to take iron when anemic. I have never had an anemic patient come in that has told me that their doctor recommended that they take vitamin C.

Vitamin C is important for so many body functions. Did you know that cardiovascular disease is called scurvy of the blood vessels which is a vitamin C deficiency?

Yes, it’s the same scurvy that the sailors who got deathly ill and sick back in the old days experienced. It wasn’t until they realized that they needed to eat oranges with vitamin C that helped them end the outbreak of scurvy.

Vitamin C levels can cause a breakdown of collagen tissues and a loss of elasticity. Sailors who had scurvy had a breakdown of tissues throughout their bodies but also their blood vessels and heart.  When blood vessels don’t have enough vitamin C, they can get hard.

Hardening of the arteries is called arteriosclerosis. Arterioscerosis of blood vessels is a loss of elasticity. The loss of elasticity of cardiovascular disease is due to vitamin C deficiency. Unbelievably simple, right?

With my anemic patients, I look for nutrient deficiencies before I rush to recommend iron supplementation.  Sometimes the obvious isn’t so obvious.  I look for the simple and easy methods of improving iron absorption as I put a plan together for my patients.

Can Iron be Bad?

Too much iron can be a really bad thing. Iron can cause hydrogen peroxide to convert into free radicals. Free radicals that attack tissues and damage DNA. Free radicals damage tissues in the body and cause cell damage, death and aging in general.

Excess iron in the blood stores in places where it doesn’t belong. Places such as joints, muscles, and organs throughout the body. Iron supplementation should always be carefully done with a monitoring system in place.

A laboratory test that can help determine if iron storage is too high is the “Ferritin Test“. Ferritin is a protein that stores iron. High levels of ferritin can be a sign of too much iron being stored at the tissue level which can be serious.

How is Liver Health related to Anemia?

The liver recycles old worn out red blood cells. Red blood cells have a life cycle of 120 days. Red blood cells die at around 120 days and the liver will break them down to recycle their contents.

As I discussed, red blood cells contain iron. The liver will recycle the iron from the dead red blood cells. The recycled iron goes into systemic circulation and gets used again by the body.

An inflamed liver can break down red blood cells before they are supposed to die. Premature breakdown of red blood cells can cause deviations in total serum iron.

How Can You see if there are Immature Red Blood Cells in the Blood?

A lab test called the Reticulocyte Count can help determine if bone marrow is producing enough red blood cells. A high reticulocyte count means that the red bone marrow is producing a lot of reticulocytes.

It’s a good thing to know that the bone marrow can produce new red blood cells. But when it is producing them in an otherwise healthy individual, it can be an sign of health problems.

This should help us better understand the possible tie in with the liver and anemia. If the liver is unhealthy and destroying red blood cells before they are mature, the red bone marrow will make new red blood cells called reticulocytes.

Everything with that sounds good accept for the fact that immature, baby red blood cells (reticulocytes) can’t bind oxygen the same as mature red blood cells.

Reticulocytes are round and have a nucleus. As they age and become mature red blood cells, they lose their nucleus and become “bi-lobular”. It’s the mature “bi-lobular” form of a red blood cell which can carry the most oxygen.

So, a high reticulocyte count is an indication that there are many immature red blood cells in the blood. Immature red blood cells that can’t carry much oxygen and therefore, create anemia and fatigue.

Can a High MCV be an Early Sign of Anemia?

MCV stands for “Mean Corpuscular Volume”. Now you see why we call it the MCV! The MCV is a measure of the size of red blood cells.

When the MCV is high, it can be a sign that there aren’t enough mature red blood cells in the blood. In efforts to compensate, the red blood cell size enlarges in every effort to bind more oxygen.

Signs of anemia can be present for decades before full blown anemia can show up on blood testing. Hypothyroidism can cause a high MCV and MCH which can be early signs of anemia.

Is Glutathione good for Red Blood Cells?

Glutathione is the king of all antioxidants. Gluathione gobbles up free radicals in the body. It’s very aggressive and protects our cells from premature damage to our DNA.

Red blood cells carry oxygen. Oxygen is a direct contributor to free radicals. Even though we need oxygen to live, it can also cause a tremendous amount of cellular damage. This free radical damage can lead to premature cell death.

Red blood cells and other cells in the body depend on glutathione to give them antioxidant protection. This becomes especially important as we get older.  As people age, they produce less glutathione and have less antioxidant protection.

When people are inflamed, the glutathione and other antioxidants can get depleted. Antioxidant depletion causes more free radical damage as a result. Glutathione support can be helpful for people who suffer from anemia. Glutathione can help support red blood cell health.

As we discussed, anemia can be life altering for those who suffer from low blood oxygen levels. Natural strategies can help reduce fatigue associated with anemia and even improve overall health.

I hope you enjoyed this article and that you spend some more time in my Library reading other articles. Check back often to read new and exciting articles about natural health!

Health is Happiness,

Dr. Keith Currie

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