Tag Archives: anemia


Could the Bacteria in Your Gut be the Key to Your Anemia?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: //www.mckinley.illinois.edu/handouts/dietary_sources_iron.html

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 //www.wjgnet.com/1007-9327/13/4716.pdf

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)

Preventing Vitamin B12 Deficiency with the Paleo Diet |The Paleo Diet

We require vitamin B12 for proper red blood cell formation, various neurological functions, DNA synthesis, and much more. Vitamin B12 deficiency is a serious issue, especially for the elderly, partly because we produce lower levels of stomach acid when we age. In food, vitamin B12 is bound to protein and requires the activity of hydrochloric acid and gastric protease to liberate the B12, thereby enabling absorption.1

The Food and Nutrition Board at the Institute of Medicine (IOM) recommends 2.4 mcg of B12 daily for adults and children 14 years or older. According to the National Health and Nutrition Examination Survey (NHANES), mean daily B12 intake for the US population is 3.4 mcg.2 Although most people are above the recommended intake level, a significant segment of the population may be B12 deficient.

The Framington Offspring Study, for example, found B12 deficiency rates to be similar among adults in three different age groups (26–49 years, 50–64 years, and 65 years and older).3 According to the study, nearly two fifths of the population (39%) has plasma B12 levels in the “low normal” range or lower.

A primary consequence of insufficient B12 is vitamin deficiency anemia, also known as megaloblastic anemia or pernicious anemia.4 Vitamin deficiency anemia is different from the anemia caused by insufficient iron, but is no less serious. Vitamin deficiency anemia is characterized by immature or incompletely developed red blood cells, which crowd out healthy red blood cells.

Red blood cells transport oxygen throughout the body and without sufficient supplies, various tissues and organs are underserved. Symptoms of vitamin deficiency anemia include fatigue, muscle weakness, loss of appetite, diarrhea, and numbness or tingling of the hands and feet.

Vitamin B12 deficiency is also suspected to promote various neurological disorders, including depression and dementia.5 Researchers have observed associations between low B12 and depression, both among severely depressed patients and the general population, but haven’t identified a causal mechanism.6 If there is one, however, it probably involves homocysteine.

Homocysteine is a metabolite of the amino acid methionine. Influenced by dietary and genetic factors, homocysteine is normally present in the blood. At elevated levels, however, it’s a risk factor for scores of diseases and conditions, including cardiovascular disease, stroke, osteoporosis, infertility, depression, and dementia. Increased homocysteine is a functional marker of B12 (as well as folate) deficiency.7 According to a 2005 study published in the Journal of Psychopharmacology, “There is now substantial evidence of a common decrease in serum/red blood cell folate, serum vitamin B12 and an increase in plasma homocysteine in depression.”8

Preventing Vitamin B12 Deficiency with the Paleo Diet

So how can the Paleo Diet help us maintain increased B12 levels? First, the Paleo Diet includes many B12-rich foods. Eating clams and/or liver once per week, for example, is an excellent strategy for consuming sufficient quantities of B12. The chart to the left shows the B12 levels for common Paleo foods. Second, it’s one thing to consume enough B12, but another thing to absorb it.

The Paleo Diet improves gut health by eliminating foods that irritate the gut (grains, sugar, dairy, vegetable oils, alcohol, caffeine), while embracing foods that heal the gut (fermented vegetables, bone broth, fermentable fibers, and healthy fats). Because the Paleo Diet promotes a healthy gut while featuring many vitamin B12-rich foods, Paleo Diet adherents are likely to maintain healthy B12 levels.

Christopher James Clark, B.B.A.

Nutritional Grail

Christopher James Clark | The Paleo Diet TeamChristopher James Clark, B.B.A. is an award-winning writer, consultant, and chef with specialized knowledge in nutritional science and healing cuisine. He has a Business Administration degree from the University of Michigan and formerly worked as a revenue management analyst for a Fortune 100 company. For the past decade-plus, he has been designing menus, recipes, and food concepts for restaurants and spas, coaching private clients, teaching cooking workshops worldwide, and managing the kitchen for a renowned Greek yoga resort. Clark is the author of the critically acclaimed, award-winning book, Nutritional Grail.


[1] Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press, 1998.

[2] Ervin, RB, et al. (March 2004). Dietary intake of selected vitamins for the United States population: 1999-2000. Advance Data from Vital and Health Statistics, 339. National Center for Health Statistics. Retrieved from //www.cdc.gov/nchs/data/ad/ad339.pdf

[3] Tucker, KL, et al. (February 2000). Plasma vitamin B12 concentrations relate to intake source in the Framingham Offspring Study. American Journal of Clinical Nutrition, 71(2). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/10648266?dopt=Abstract

[4] Mayo Clinic Staff. Diseases and Conditions: Vitamin deficiency anemia. Retrieved from //www.mayoclinic.org/diseases-conditions/vitamin-deficiency-anemia/basics/causes/con-20019550

[5] Bottiglier, T. (December 1996). Folate, vitamin B12, and neuropsychiatric disorders. Nutrition Reviews, 54(12). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/9155210

[6] Coppen, A, et al. (January 2005). Treatment of depression: time to consider folic acid and vitamin B12. Journal of Psychopharmacology, 19(1). Retrieved from //www.ncbi.nlm.nih.gov/pubmed/15671130

[7] Ibid, Coppen.

[8] Ibid, Coppen.

Anemia | The Paleo Diet

Anemia is a condition that is all too common in the world.1, 2, 3, 4, 5, 6, 7, 8 Many individuals, who are vegan or vegetarian, end up with some form of anemia. Whether this is due to lack of iron, vitamin B12, or other deficiencies – the end result is roughly the same., 10, 11, 12, 13, 14 Because a Paleo Diet is rich in vitamin B12 and iron, it begs the question – can we ward off anemia with the Paleo Diet?

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Muñoz, Manuel et al. “Perioperative Anemia Management in Colorectal Cancer Patients: A Pragmatic Approach.” World Journal of Gastroenterology : WJG 20.8 (2014): 1972–1985. PMC. Web. 24 Nov. 2014.

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Muñoz, Manuel et al. “Perioperative Anemia Management in Colorectal Cancer Patients: A Pragmatic Approach.” World Journal of Gastroenterology : WJG 20.8 (2014): 1972–1985. PMC. Web. 24 Nov. 2014.

The short answer: Yes. The longer (and more complex) answer: Usually. Between the complexity and poor understanding of the condition, the different, and the sometimes hereditary nature,15, 16, 17, 18, 19, 20, 21 this is a condition which is quite complex.

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Board, A.D.A.M. Editorial. Iron Deficiency Anemia. U.S. National Library of Medicine, 24 Feb. 2014. Web. 24 Nov. 2014.

To start, there are variable definitions of anemia, but the most widely accepted is ‘a condition where the number of red blood cells in the blood is below normal’.22 This is the main definition upon which we will focus. Red blood cell production can be low, and oftentimes, this is due to dietary requirements not being met.23, 24, 25, 26 However, intervening with improved nutrition can prove beneficial.

Iron deficiency is the main statistical cause of anemia, and incorporating iron-rich foods into your diet is a great way to improve your anemic condition27, 28 Iron-rich foods include: chicken, turkey, fish, meats (liver is the highest source), spinach, and kale.29 Those well-accustomed to the Paleo Diet will note that these foods form the basis of many Paleo recipes.30, 31  This is not an accident, as the Paleo Diet will provide the most nutrients, and give the best physiologic results, out of any approach to eating. 32

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Iolascon, Achille, Luigia De Falco, and Carole Beaumont. “Molecular Basis of Inherited Microcytic Anemia Due to Defects in Iron Acquisition or Heme Synthesis.” Haematologica 94.3 (2009): 395–408. PMC. Web. 24 Nov. 2014.

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Abbaspour “Review on Iron and Its Importance for Human Health.” Journal of Research in Medical Sciences

The amount of iron required for daily renewal of red blood cells (20-30 mg) is provided mostly by senescent erythrocyte iron recycling at macrophages.33, 34 This small required amount is usually why supplementing with iron is a poor idea, especially with the relative ease at which it is possible to intervene by dietary means.

Besides iron deficiency, vitamin B12 deficiency can also lead to anemia.35 Meat, eggs, fish, and shellfish are also great sources for vitamin B12.36 A diet devoid of these foods directly correlates to the growing number of vegetarian and vegan anemics.

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Herrmann, Wolfgang, and Rima Obeid. “Causes and Early Diagnosis of Vitamin B12 Deficiency.” Deutsches Ärzteblatt International 105.40 (2008): 680–685. PMC. Web. 24 Nov. 2014.

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Kassebaum, Nicholas J. et al. “A Systematic Analysis of Global Anemia Burden from 1990 to 2010.” Blood 123.5 (2014): 615–624. PMC. Web. 24 Nov. 2014.

From the figure to the right, we see anemia has declined since 1990.37 Public awareness of the condition has gone up, as well as advancements in the supplement industry’s budget. These factors have helped some become more aware of this debilitating condition.

Age relation with respect to anemia is also interesting, as it seems to play a more significant role than one might suspect. We see that as adults move into their thirties and forties, their risk of anemia goes up. Neglecting diet, when one is focused mainly on career advancement and other pressures that cause high stress, are potentially related.

Yet, while cases of anemia have declined since the ‘90s, the global implications for anemia are surprisingly higher than one might suspect.38, 39, 40 Anemia is still responsible for 68.3 million years of life lived with disability.

While it is near impossible to calculate anemia’s exact effects, with more than 20 diseases linked to its development, you can take preventative measures to meet iron and vitamin B12 dietary requirements. The best course of action is following a delicious and nutritious Paleo Diet and start cooking delicious Paleo recipes, which are available in The Paleo Diet Recipe Library!

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Kassebaum, Nicholas J. et al. “A Systematic Analysis of Global Anemia Burden from 1990 to 2010.” Blood 123.5 (2014): 615–624. PMC. Web. 24 Nov. 2014.

Can We Ward Off Anemia with The Paleo Diet? | Dr. Cordain

Kassebaum, Nicholas J. et al. “A Systematic Analysis of Global Anemia Burden from 1990 to 2010.” Blood 123.5 (2014): 615–624. PMC. Web. 24 Nov. 2014.


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[2] Melku M, Addis Z, Alem M, Enawgaw B. Prevalence and Predictors of Maternal Anemia during Pregnancy in Gondar, Northwest Ethiopia: An Institutional Based Cross-Sectional Study. Anemia. 2014;2014:108593.

[3] Douglas NM, Lampah DA, Kenangalem E, et al. Major burden of severe anemia from non-falciparum malaria species in Southern Papua: a hospital-based surveillance study. PLoS Med. 2013;10(12):e1001575.

[4] Macciò A, Madeddu C. Management of anemia of inflammation in the elderly. Anemia. 2012;2012:563251.

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[6] Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-24.

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[8] Tettamanti M, Lucca U, Gandini F, et al. Prevalence, incidence and types of mild anemia in the elderly: the “Health and Anemia” population-based study. Haematologica. 2010;95(11):1849-56.

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[10] Den elzen WP, Van der weele GM, Gussekloo J, Westendorp RG, Assendelft WJ. Subnormal vitamin B12 concentrations and anaemia in older people: a systematic review. BMC Geriatr. 2010;10:42.

[11] O’leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010;2(3):299-316.

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[13] Vitamin B12 and cognitive function: an evidence-based analysis. Ont Health Technol Assess Ser. 2013;13(23):1-45.

[14] Thomson CA, Stanaway JD, Neuhouser ML, et al. Nutrient intake and anemia risk in the women’s health initiative observational study. J Am Diet Assoc. 2011;111(4):532-41.

[15] Available at: //www.webmd.com/a-to-z-guides/understanding-anemia-basics. Accessed November 18, 2014.

[16] Cattan D. Pernicious anemia: what are the actual diagnosis criteria?. World J Gastroenterol. 2011;17(4):543-4.

[17] Mohammed mujib AS, Mohammad mahmud AS, Halder M, Monirul hasan CM. Study of Hematological Parameters in Children Suffering from Iron Deficiency Anaemia in Chattagram Maa-o-Shishu General Hospital, Chittagong, Bangladesh. Anemia. 2014;2014:503981.

[18] Wallerstein RO. Laboratory evaluation of anemia. West J Med. 1987;146(4):443-51.

[19] Imashuku S, Kudo N, Kaneda S. Spontaneous resolution of macrocytic anemia: old disease revisited. J Blood Med. 2012;3:45-7.

[20] Brown RG. Normocytic and macrocytic anemias. Postgrad Med. 1991;89(8):125-32, 135-6.

[21] Kim H, Yang K, Dejsuphong D, D’andrea AD. Regulation of Rev1 by the Fanconi anemia core complex. Nat Struct Mol Biol. 2012;19(2):164-70.

[22] Available at: //www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0021987/. Accessed November 18, 2014.

[23] Kaniewska M, Bartnik W, Gonciarz M, et al. Iron deficiency anaemia in patients with inflammatory bowel disease: National Consultant for Gastroenterology Working Group Recommendations. Prz Gastroenterol. 2014;9(5):259-63.

[24] Pisani A, Riccio E, Sabbatini M, Andreucci M, Del rio A, Visciano B. Effect of oral liposomal iron versus intravenous iron for treatment of iron deficiency anaemia in CKD patients: a randomized trial. Nephrol Dial Transplant. 2014;

[25] Karefylakis C, Näslund I, Edholm D, Sundbom M, Karlsson FA, Rask E. Prevalence of Anemia and Related Deficiencies 10 Years After Gastric Bypass-a Retrospective Study. Obes Surg. 2014;

[26] Beck KL, Mitchell S, Foskett A, Conlon CA, Von hurst PR. Dietary Intake, Anthropometric Characteristics, and Iron and Vitamin D Status of Female Adolescent Ballet Dancers Living in New Zealand. Int J Sport Nutr Exerc Metab. 2014;

[27] Gonçalves C, Oliveira ME, Palha AM, Ferrão A, Morais A, Lopes AI. Autoimmune gastritis presenting as iron deficiency anemia in childhood. World J Gastroenterol. 2014;20(42):15780-6.

[28] Tatala S, Svanberg U, Mduma B. Low dietary iron availability is a major cause of anemia: a nutrition survey in the Lindi District of Tanzania. Am J Clin Nutr. 1998;68(1):171-8.

[29] Demir S, Olgac M, Unal D, Gelincik A, Colakoglu B, Buyukozturk S. A Practical and Successful Desensitization Protocol for Immediate Hypersensitivity Reactions to Iron Salts. Int Arch Allergy Immunol. 2014;165(2):100-103.

[30] Turner BL, Thompson AL. Beyond the Paleolithic prescription: incorporating diversity and flexibility in the study of human diet evolution. Nutr Rev. 2013;71(8):501-10.

[31] Armelagos GJ. Brain evolution, the determinates of food choice, and the omnivore’s dilemma. Crit Rev Food Sci Nutr. 2014;54(10):1330-41.

[32] Boers I, Muskiet FA, Berkelaar E, et al. Favourable effects of consuming a Palaeolithic-type diet on characteristics of the metabolic syndrome: a randomized controlled pilot-study. Lipids Health Dis. 2014;13:160.

[33] Iolascon A, De falco L, Beaumont C. Molecular basis of inherited microcytic anemia due to defects in iron acquisition or heme synthesis. Haematologica. 2009;94(3):395-408.

[34] Muñoz M, Gómez-ramírez S, Martín-montañez E, Auerbach M. Perioperative anemia management in colorectal cancer patients: a pragmatic approach. World J Gastroenterol. 2014;20(8):1972-85.

[35] Watanabe S, Ide N, Ogawara H, et al. High Percentage of Regulatory T Cells before and after Vitamin B12 Treatment in Patients with Pernicious Anemia. Acta Haematol. 2014;133(1):83-88.

[36] Watanabe F, Yabuta Y, Tanioka Y, Bito T. Biologically active vitamin B12 compounds in foods for preventing deficiency among vegetarians and elderly subjects. J Agric Food Chem. 2013;61(28):6769-75.

[37] Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-24.

[38] Pasricha SR. Anemia: a comprehensive global estimate. Blood. 2014;123(5):611-2.

[39] Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014;123(5):615-24.

[40] Fayet-moore F, Petocz P, Samman S. Micronutrient Status in Female University Students: Iron, Zinc, Copper, Selenium, Vitamin B12 and Folate. Nutrients. 2014;6(11):5103-5116.

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