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Could the bacteria in your gut be the key to your anemia?

By Dr. O. H. Okoye, MD, MBA, MSEpi
October 8, 2015
Could the bacteria in your gut be the key to your anemia? image


An essential part to healthy living and Paleo is making sure that you are getting the right amount of key nutrients. One such element is iron.1 Maintaining a proper balance of iron in the body is crucial to ensure the body can make red blood cells.1 Red blood cells act as oxygen carriers taking oxygen from the lungs to your body’s tissues. In cases where a shortage of iron exists, an anemia occurs. Extreme fatigue due to decreased ATP energy production from the insufficient amount of red blood cells,2 is a key symptom. Ward anemia away by including Paleo friendly food options rich in iron, such as meat, poultry, fish, spinach, and almonds.1

Healthy people naturally lose about 0.5 to 2 mg of iron daily.2 So how does the body regulate iron? Hepcidin, a hormone produced in the liver, serves as the main regulator of iron homeostasis.3 When a person consumes food rich in iron, it enters the body via the intestine. When there is iron supply depletion, the body has a symbiotic mechanism, through the release of hepcidin, which encourages iron absorption.3 The same is also seen with infections or inflammation in the body. On the other hand when iron concentration increases, the liver releases hepcidin, which inhibits absorption.3

The Research Study

Earlier research studies focused upon the mechanism of uptake through the intestinal epithelial cells. Recent research from France shows that the actual intestinal microbiota, the bacteria within the gut, may play a more meaningful role in the process.4

In a controlled study, researchers removed the intestinal microbiota from mice. In another group, the mice were later colonized with a controlled microbiota. In the germ free group, the mice had low iron supplies whereas the mice with microbiota present in the intestine exhibited high levels of iron supply, with the presence of ferritin, the iron storage protein and increased levels of ferroportin, the iron transporter protein, which distributes iron in the body.

Researches also saw that certain commensal organisms (Bacteroides thetaiotaomicron VPI-5482 and Faecalibacterium prausnitzii A2-165) and a probiotic strain (Streptococcus thermophilus LMD-9) resulted in an increase of 12-fold induction of ferritin in the colon.

Based on these results, the researchers concluded that microbiota in the intestine leads to transformation of the intestinal cells. This encourages them to allocate iron around the body and store it.

Paleo, Anemia, and Crohn’s Disease: What’s the Connection?

The study’s findings seem to suggest that the microbiota serves as part of the regulatory control process. This guides our understanding of certain iron overload diseases in addition to the iron levels in people diagnosed with gastrointestinal conditions such as inflammatory bowel diseases like Crohn’s disease and Ulcerative Colitis.

It is also important to connect these findings with those from a study published in Nature5 where researchers studied fecal samples from the Matses in the Amazon, one of the last hunter-gatherers communities in the world. Their samples were compared to those of a group of residents from Oklahoma, and showed the Matses’ microbiota was much more diverse. Notably present was a strain of bacteria known as Treponema which is not normally seen in civilized western populations. This bacteria is also found in other Paleolithic communities such as the Hadzas in Tanzania. Researchers further stated that this high level of microbial diversity appears to have real benefit to host populations.


Anemia is a prevalent problem seen in individuals diagnosed with Crohn’s disease due to excess gastrointestinal blood loss.6 The antibiotics that are often prescribed to combat symptoms remove microbes and impact the gut flora.6One can speculate that this could further cause iron deficiency and anemia, given the results of the earlier study on the role of microbial flora in supporting the uptake of iron. Because microbiota diversity may play a role in preventing conditions like Crohn’s diseases, what do you have to lose? Keep your gut in check by following a risk free Paleo diet – you only have your health to gain.


1. University of Illinois At Urbana Champaign. (2010). Dietary Sources of Iron. Retrieved Sep 29, 2015, from McKinley Health Center: //

2. Sharp, P., & Srai, S. (2007). Molecular mechanisms involved in intestinal iron absorption. World Journal of Gastroenterology, 13(35), 4716-4724. Retrieved Sep 29, 2015, from //

3. Nemeth, E., & Ganz, T. (2006, Aug). Regulation of Iron Metabolism by Hepcidin. Annual Review of Nutrition, 26, 323-342. doi:10.1146/annurev.nutr.26.061505.111303

4. Deschemin, J., Noordine, M., Remot, A., Willemetz, A., Afif, C., Canonne-Hergaux, F., . . . Nicolas, G. (2015, Sep 14). The microbiota shifts the iron sensing of intestinal cells. The FASEB Journal. doi:10.1096/fj.15-276840

5. Obregon-Tito, A., Tito, R., Metcalf, J., Sankaranarayanan, K., Clemente, J., Ursell, L., . . . Marin-Reyes, L. (2015, March 25). Subsistence strategies in traditional societies distinguish gut microbiomes. Nature communications. doi:10.1038/ncomms7505

6. National Hematologic Diseases Information Service. (2013, August 26). Anemia of Inflammation and Chronic Disease. Retrieved Sep 30, 2015, from National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

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