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The Anemia of Rheumatoid Arthritis

We get a check up at the doctor’s office.  Lab results show that the iron circulating in our blood, our hemoglobin, is a bit low.  We’re anemic.

Iron is an important  nutrient that plays a key role in transporting oxygen through the bloodstream to all body tissues. It is a necessary and complex mineral.

Your doctor may tell you, as mine did me, that you need to take an iron supplement. According to those who study iron, anemia, and chronic disease, this is exactly the wrong advice.

The ‘anemia of chronic disease’ (ACD) is also known as the ‘anemia of inflammatory response’ and  goes hand in hand with Rheumatoid Arthritis and many other autoimmune conditions.  Due to a complicated metabolic process, iron supplements make it worse.

In one of the human body’s miraculous, natural, adjustments to danger, the anemia of inflammatory response is in fact a protective mechanism that the body uses to limit the amount of iron available to potential harmful bacteria and cancer cells, which need iron to flourish, just like all other living things.

From the Iron Disorders Institute:

When the body senses a potential threat, iron gets shuttled to ferritin to be contained so that the harmful invader cannot get to the iron. Just enough iron is made available to make red blood cells but no surplus is left to nourish harmful pathogens.

…  a person with ACD [due to Rheumatoid Arthritis] will experience a modest decline in hemoglobin. … Hemoglobin values will generally reach a low normal range of 9.5–10.5 g/dL and remain there … until the underlying condition is cured.

… Taking iron pills for anemia of chronic disease could be harmful, even fatal.

…. The greatest risk for harm is mistaking anemia of chronic disease for iron-deficiency anemia and allowing the patient to take iron pills.

…. There is no treatment for anemia of chronic disease except to address the underlying condition. Iron supplementation is inappropriate in these patients because the added iron can become free to nourish bacteria and cancer cells.

Bottom line: Iron is not a freebie. It can be a dangerous metal in our bodies and is closely regulated by our metabolism. Our low-normal anemia is standard for those of us with Rheumatoid Arthritis and other inflammatory conditions and should not be treated with iron supplements.

However, the body reacts differently to naturally occurring  iron in food than it does to iron from pills.  Below is a list of foods that will provide the unprocessed iron our bodies need. 

Note that foods enriched with iron, like many breads and cereals,  count as supplements and not as sources of natural iron:

  • Red meat – the most easily absorbed form of iron
  • Egg yolks
  • Dark, leafy greens (spinach, collards, kale, broccoli)
  • Dried fruit (prunes, raisins)
  • Mollusks (oysters, clams, scallops, other shell fish)
  • Beans, lentils, chick peas and soybeans
  • Liver
  • Artichokes
  • Blackstrap mollasses

If you eat iron-rich foods along with foods that provide plenty of vitamin C, your body can better absorb the iron, especially iron from non-animal sources.

A more technical description of the mechanics of the anemia of inflammation can be found at the links below.