Gut Dysfunction + Iron Deficiency
SIBO + Poor Gut Health = Iron Deficiency
Anaemia is one of the many complications which can arise as a result of SIBO or any chronic gut condition and there are numerous types - the most common being iron deficiency anaemia. There are a number of reasons it can occur - the restrictive SIBO diet which excludes many mineral-rich foods such as pulses and seeds, poor intestinal absorption as a result of gut damage and dysfunction as well as the heavy metal thieving bacteria themselves (SIBO) who use heavy metals such as iron in the formation of their protective biofilms.
Types of Anemia Common in Those with SIBO
- Iron Deficiency anaemia. A lack of iron in the body leads to a reduction in the number of red blood cells. When you have fewer red blood cells, your organs and tissues don't get as much oxygen as they need. If iron deficiency anaemia is left untreated, it can make you more susceptible to illness and infection, as a lack of iron affects the body's natural immunological defence system.
- Vitamin deficiency anemia - most commonly B12, folate and vitamin C
Look for the Signs + Visit a Doctor
It’s important that everyone understands anaemia and the symptoms and signs such as fatigue, which can creep up on you gradually over a period of months. Fatigue is a common uniting symptom of many chronic illnesses so seeing a doctor to get your iron levels checked, a full blood count (FBC) and ferritin levels tested to check for anaemia, is super important! If left untreated, anaemia can cause many unpleasant symptoms - including fatigue so bad that even getting out of bed feels like a hike up Mount Everest! - as well as a worsening of current SIBO/gut symptoms and other health complications. It took us a long while to realise we had anaemia and I (Sophie) became hypoxic as a result! It’s not fun and safely building up your ferritin levels (iron stores) can take a long time so watch out for this tricky one.
Symptoms of Iron Deficiency Anaemia
Very common symptoms of anaemia include -
- Dyspnoea (shortness of breath)
- Fatigue
- Headache
Common symptoms of anaemia include -
- Cognitive dysfunction.
- Restless leg syndrome.
- Vertigo
Other symptoms include -
- Dizziness, weakness
- Dysgeusia
- Irritability
- Heart palpitations
- Pica (abnormal dietary cravings, for example for ice or dirt)
- Pruritus (very itchy, dry skin)
- Sore tongue
- Tinnitus
Common or very common signs of iron deficiency include -
- Pallor (pale skin) this may be observed even with mild anaemia.
- Atrophic glossitis
- Dry and rough skin, dry and damaged hair
- Diffuse and moderate alopecia
Symptoms Without Anaemia
Just to make things more complicated - iron storage is depleted before there is a fall in haemoglobin levels. Because iron is essential in all cells if they are to function, symptoms of iron deficiency (such as fatigue, hair loss, and irritability) may occur without anaemia. So even if your tests come back negative, this doesn’t necessarily mean you aren’t iron deficient and you may still need to supplement with iron.
Symptoms of Vitamin Deficiency Anemia
A nutrient-poor, restrictive diet plus gut dysfunction (poor absorbency) can lead to vitamin deficiencies which can develop over several months to years. People with endocrine-related autoimmune disorders, such as diabetes or thyroid disease, may have an increased risk of developing a specific type of vitamin B-12 deficiency anemia called pernicious anemia. Vitamin deficiency symptoms may be subtle at first, but they increase as the deficiency worsens(2).
Signs and symptoms of vitamin deficiency anemia include -
- Fatigue
- Shortness of breath
- Dizziness
- Pale or yellowish skin
- Irregular heartbeats
- Weight loss
- Numbness or tingling in your hands and feet
- Muscle weakness
- Personality changes
- Unsteady movements
- Confusion or forgetfulness
Supplementing wth Iron
Supplementing with Iron
Supplementing with iron for those with anaemia and a chronic gut condition and/or SIBO is a tricky business. Swallowing capsules/tablets of iron is far from ideal - we evolved to absorb this heavy metal in a bioavailable form, from foods which contain other vitamins and minerals (such as vitamin C) which aid it’s absorption in the body. Supplementing with iron, especially in high dosages, is well known to cause constipation as it disrupts peristalsis. As fully explained on the Gut Dysbiosis/SIBO In Depth page, slow intestinal transit time allows SIBO the opportunity to feed on the food consumed, giving bacteria the chance to populate the small intestine so anything which slows or interferes with peristalsis should be avoided wherever possible. An overload of iron in the gut due to its malabsorption, can also alter our mucosal immune responses and affect the general health of our gut microbiome(1).
Taking Iron - the Right Way
Supplementing with iron capsules has proven very effective in the treatment of iron deficiency anaemia and we found from trial and error, that taking a low, gentle dose of iron regularly throughout the day with vitamin C and on an empty stomach, can help reduce or avoid the unpleasant side-effects. If you take too much, say above 20mg at any one time, you can feel really unwell. Even dosing with 20mg every hour we found was too much for us - we experienced nausea and twinges of pain as the heavy metal moved down our SI. The trick - as with most supplementing - it working out the dosage which is right for you and your gut.
Dosage
The dosage you will need to take will depend upon your blood results and the severity of your case of anaemia and also the state of your gut. If your gut is in a poor state and you are severely anaemic, it is likely that you are unable to absorb enough iron orally. Intravenous iron injections could be an alternative and you can discuss this with your GP.
Therapeutic dose (curative dose CD) - the quantity of any substance required to effect the cure of a disease or to correct the manifestations of a deficiency of a particular factor in the diet.
Maintenance dose - the quantity of any substance which maintains the desired steady-state drug/vitamin/mineral concentrations.
By mouth -
For low levels of healthy red blood cells (anemia) due to iron deficiency 50-100 mg of elemental iron three times daily for 3 months up to 6 months. Doses between 30-120 mg weekly have been used in adult women(3).
We recommend -
- Liquid Iron - the easiest to absorb, you can buy these sachets from a local pharmacy or online. Remember to take with Vitamin C so it can be absorbed by the body
- Gentle Iron 20mg per capsule, pack of 90 capsules. Always take with Vitamin C
- Gentle Iron Complex 16mg of iron, B12 and vitamin C per capsule.
Iron-Rich Foods
Iron-Rich, Gut-Friendly Foods
The following foods are SIBO-safe, gut-friendly iron-rich sources(4) -
- Dark-green leafy vegetables, such as watercress and curly kale
- Broccoli + spinach
- Organ meats such as chicken liver - easier to digest than red meats and also mineral-rich!
- Seafood + fish
- Free range organic eggs