Most people know that iron is a vital mineral for our survival. It’s required for oxygenation, energy production and DNA synthesis. Rather important functions!
However, I find in clinic that there is a large number of people who are living with undiagnosed iron deficiency anaemia that is driving a lot of their underlying health issues and is often un-addressed.
Causes Of Iron Deficiency
A huge reason why this is happening is their inability to break down protein and absorb the iron from it due to hypochlorhydria – low levels of hydrochloric acid (HcL).
Ferritin: the iron storage in the liver. The reserves. The most sensitive screening test for iron deficiency, because in most situations the body will sacrifice the reserves to keep the serum levels or iron optimal.
The biggest cause of iron deficiency is low stomach acid (hydrochloric acid or HcL).
As simple as that. When HcL levels fall low, it becomes very challenging for the body to digest protein, particularly animal protein, thereby compromising iron absorption (as well as B12 and zinc in particular).
Often, people with low stomach acid will complain of:
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‘the food feels like it’s just sitting there for hours’,
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‘meat feels like a brick in the stomach’
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‘I feel sick when I eat meat’
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‘I’m not hungry in the mornings at all’
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‘I often burp in the morning before I’ve had any food or water’
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‘I have so much bloating and gas’
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I am deficient in nutrients.
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‘I think I have reflux’ or ‘too much acid’ and ‘often take an over-the-counter antacid for relief’.
Oftentimes, the HcL deficiencies are made worse by a PPI prescriptions for symptoms such as indigestion and reflux which commonly accompany LOW stomach acid.
The PPI then further reduces HCL, people are often on it for years and their iron malabsorption is continuous. PPIs have recently been linked with gastric cancer. They are supposed to be prescribed for very short term duration treatment, however people are staying on them for decades with very severe consequences.
Why Is Low Stomach Acid A Problem?
Common symptoms of low stomach acid include:
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heartburn
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reflux
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constipation
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diarrhoea
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food malabsorption
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parasite infections
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yeast overgrowth (candida).
Basically it impacts every aspect of our digestion both ‘upwards’ (into the oesophagus) and ‘downwards’ into the intestine and the colon.
SIBO and IBS both start with low stomach acid which impacts bacterial overgrowth and reduces motility of the gastrointestinal tract.
What Causes Low HcL?
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Stress. This is by far the biggest reason I see in clinic. Long term physical or emotional stress will drive down hydrochloric acid levels and compromise protein digestion and iron absorption. Why? Because when you are constantly being chased by a sabre tooth tigre (aka: your boss or financial troubles) your body will de-prioritise digestive function in favour of pumping blood into the muscles so you can fight or run away from the tiger. For many people, this happens 50 times on a daily basis, all on the way to work in traffic.
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Helicobacter Pylori (H. Pylori) infection. This is a very common bacteria that will proliferate in a low acid environment and lower the acid even further.
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Proton pump inhibitors (PPIs) as above
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Genetics
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Zinc, B6, B1 deficiency. In addition to the above with zinc and B6, B1 deficiency is also very common, particularly in alcoholism. People who regularly consume more than 1 standard drink per day will have a strong tendency to low stomach acid often due to this.
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Long term vegan and vegetarian diets– lack of zinc on these diets depletes HcL. Also a lack of animal protein will downregulate HcL- it’s simply not needed in big quantities to digest a low protein diet, so the body will reduce its production. Sadly, a large number of vegan dieters are iron deficient and often a supplement is not enough.
