Articles

Evidence based

Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of licensed nutritionists and dietitians strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

The Best Gut-Healing Treatments for Anemia Headache Relief

Written by Dr. Michael Ruscio, DC on March 8, 2022

Written by Dr. Michael Ruscio, DC on March 8, 2022 — Reviewed by Aimee Gallo

How Fixing Your Digestive Health Can Help Resolve Symptoms of Anemia

• What Is An Anemia Headache?|
• Gut-Healing Strategies for Headache Relief|
• When Should You Take Iron and B Vitamins?|
• Putting a Stop to Anemia Headaches|

Headaches are one of the most common, elusive, and problematic symptoms that send people running to their healthcare provider. Unfortunately, headaches and migraine attacks are non-specific symptoms that can be linked to a myriad of chronic health conditions (or simply dehydration). However, one type of headache may be directly related to your gut health — the anemia headache. 

Anemia headaches occur when red blood cells in the body drop below normal levels, starving the body of oxygen [1, 2]. Research shows that migraines are more frequent in those with iron-deficiency anemia, especially among cycling women [3]. In fact, over 90% of women who suffer from menstrual migraines have low iron storage levels in the body [4].

Aside from low iron intake and menstrual blood loss, poor gut health may be at the root of these bothersome headaches. Inflammation, low stomach acid, and intestinal dysbiosis can lead to multiple types of anemia by decreasing nutrient absorption in the gut. Furthermore, these changes in the digestive tract can alter hormone levels and potentially increase menstrual flow. 

While the first step in treating an iron deficiency is simply increasing your iron intake, some people’s symptoms and iron levels may not improve. When taking iron doesn’t seem to do the trick, healing the digestive tract should be the primary focus for treating anemia-related symptoms. In this article, we’ll dig into the details on how to heal your gut and finally find relief from anemia headaches. 

What Exactly Is an Anemia Headache?

Anemia headaches are a common symptom of low red blood cells. They frequently occur in women, primarily due to blood loss during menstruation. For some, severe headaches can interrupt normal daily activities and lower overall quality of life. Research shows that nearly 80% of women with iron-deficiency anemia report headaches, while 36% experience migraines [5].

Furthermore, over 90% of women who have end-menstrual migraines (migraines that occur at the end of your period) also have suboptimal iron storage levels [4]. Not having enough iron in your body may be accompanied by other common symptoms of anemia, such as [6]:

• Low blood pressure and dizziness
• Headaches
• Poor concentration, memory loss, and brain fog
• Weakness and fatigue
• Dry skin and hair loss
• Pale skin
• Shortness of breath

While low iron intake and a heavy menses are a common cause of anemia, low levels of certain B vitamins (folate and B12) can also decrease production of red blood cells [7, 8, 9]. Anemias caused by folate or B12 deficiencies are unrelated to blood loss and are more closely associated with poor gut health and low nutrient intake.

How to Tell if Your Headache Is an Anemia Headache

How do you know when your headaches or migraines are a result of anemia? Typically, a few simple blood tests from your doctor can check for you. Anemia occurs when your body doesn’t have enough red blood cells to deliver oxygen to the rest of the body. Diagnosing it is typically straightforward, as the majority of cases are caused by iron, B12, and folate deficiencies [1, 2]. 

Common blood tests that assess for anemia include [10]:

• Complete blood count with hemoglobin levels
• Serum iron levels
• Serum ferritin levels (the storage form of iron)
• Total iron binding capacity (TIBC)
• Transferrin saturation
• Serum folate and B12 levels
• Blood platelets

Less frequently, anemia may be caused by an inflammatory disorder, autoimmunity, or a genetic blood disorder, including rheumatoid arthritis, sickle cell anemia, and thalassemia. In older populations, cancer, heart failure, and kidney disease may also cause chronic anemia. 

While these cases are less common, it may be useful for your doctor to investigate your symptoms further if your nutrient levels come back within normal range. However, aside from low iron intake, poor gut health is often at the root of anemia.

Strategies to Heal Your Gut and Resolve Your Headaches

Healing your gut can effectively increase nutrient absorption and help balance your hormones, making it an effective strategy for treating multiple types of anemia. Below are some steps you can take to heal your gut and resolve your anemia headaches. 

1. Decrease Gut Inflammation 

Over time, chronic gut inflammation damages the lining of the GI tract, leading to decreased absorption of important nutrients — including iron and B vitamins [11]. Several digestive disorders are linked to chronic inflammation in the gut, such as:

• Irritable bowel syndrome (IBS)
• Inflammatory bowel disease (IBD) [12]
• Food sensitivities
• Autoimmune and non-autoimmune atrophic gastritis
• Leaky gut syndrome
• Celiac disease [12]
• Infections, like H. pylori and peptic ulcers [12]

When inflammation is left unchecked, these nutrient deficiencies can eventually lead to anemia and the troublesome anemia headache. Some of these conditions, such as peptic ulcers and IBD, can further contribute to anemia, as they can cause intestinal blood loss. 

Inflammation Can Disrupt Hormone Levels

As a heavy menstrual cycle is a frequent cause of anemia in women, you may be wondering how an unhealthy gut can affect your hormones. 

Chronic gut inflammation can decrease our ability to absorb and utilize dietary fats, which is essential for the production of sex hormones [13, 14]. When this occurs, it can lead to an imbalance in hormones, disrupt the menstrual cycle, and potentially cause a heavier or longer period. Increased blood loss, together with decreased vitamin and mineral absorption, is a recipe for disaster when it comes to developing anemia.

Lowering the inflammatory burden on the digestive tract can help increase fat and micronutrient absorption, and support the body in making the proper amount of sex hormones. For further help with balancing your hormones and treating heavy periods, check out one of our articles on restoring hormone levels naturally.

Fortunately, I often see that targeted dietary changes and probiotic therapy (discussed later on) can be remarkably effective at decreasing inflammation levels and increasing nutrient absorption in the gut [15].

How to Treat: Anti-Inflammatory Diet

Resolving anemia headaches and improving your overall health starts with having the right dietary foundations in place. While many diets are considered healthy, they often don’t fully encompass our four principles of a healthy diet:

• Eat to control inflammation
• Eat to balance blood sugar levels
• Eat your ideal amount of carbohydrates and prebiotics
• Identify your food allergies and intolerances

To expand upon the last principle, common food allergens, like wheat and gluten, egg, corn, dairy, and sugar can trigger an immune response in the gut, creating chronic inflammation [16, 17]. However, everyone’s food sensitivities and intolerances will be a little different, and finding your triggers may take some detective work.

When starting out, we recommend trying a simple elimination framework, like the Paleo diet, which eliminates common food allergens. However, some may require a more restrictive or specialized diet, especially when a bacterial overgrowth is playing a role in your anemia. 

After finding the right diet, many people’s symptoms will improve within three to four weeks, but it may take longer when trying to correct a nutrient deficiency. For more information on finding your ideal diet, we have several articles on how to complete an elimination diet and other gut-healing protocols. 

2. Balance Stomach Acid Levels

Low stomach acid can result in nutrient deficiency anemias, as iron and B12 require hydrochloric acid (HCl) in order to be absorbed in the small intestine [18, 19]. If you deal with symptoms like acid reflux, upper abdominal pain, and excessive gas or belching, along with anemia headaches, it may be time to take a closer look at your stomach acid levels.

Antacids, H2 blockers, and proton-pump inhibitors are another frequent cause of low HCl levels, as these popular medications are directly designed to neutralize or decrease stomach acid. Long-term use of these medications is linked to nutrient deficiencies, especially of B12 and iron [6, 18].

Thankfully, there’s an easy at-home method to see if you need more stomach acid — try supplemental HCl, and see if your symptoms resolve.

How to Treat: Betaine HCl

Betaine HCl is an over-the-counter supplement that can be used to quickly increase stomach acid and nutrient absorption in the digestive tract [19, 20, 21]. Betaine HCl should be taken on an empty stomach, just before eating a meal.

We recommend starting with one to three capsules prior to each meal and waiting two weeks before determining if you have any improvement in your symptoms. However, it may take longer for any anemia-related symptoms to resolve, as betaine HCl can take time to help correct any underlying nutrient deficiencies.

Quick Tip: If you experience burning or pain in your stomach after taking betaine HCl, you should discontinue use immediately, as it may be damaging the lining of your stomach. High doses of betaine HCl can cause damage, even if you don’t feel any symptoms, so it may be best to consult with a functional medicine practitioner before taking this supplement.

3. Restore Your Gut Bacteria

Gut dysbiosis, or an imbalance in the gut flora, can be a hidden culprit of any nutrient deficiencies or hormonal imbalances that lie behind your anemia headaches. When your gut bacteria are at unhealthy levels, immune system activity in the GI tract is heightened and inflammation goes up.

Furthermore, the gut microbiome is responsible for the detoxification of certain hormones, such as estrogen. When the balance of gut microorganisms is disrupted, it can prevent proper metabolism of these sex hormones [22], leading to estrogen-dominance or another hormonal imbalance. These changes may go on to contribute to a heavy or longer menses, making you more prone to developing anemia.

Correcting low stomach acid, a low-FODMAP diet, and probiotic supplements can help reduce dysbiosis and any associated symptoms [18, 23, 24, 25, 26, 27, 28, 29]. As we have already touched upon the first two strategies, let’s take a deeper look into probiotics.

How to Treat: Probiotics

Probiotics restore the normal balance of gut microorganisms, calm the immune response in the gut, and decrease intestinal inflammation [30, 31, 32]. All of these effects work together to improve absorption of vitamins and minerals from our diet, and can help correct nutrient deficiency anemias. 

Three clinical trials showed that multi-strain probiotics can improve the treatment of iron-deficiency anemia in children, and reduce the risk of unresolved anemia by nearly 50% [33]. This means that probiotics not only help treat anemia, but may actually prevent it from occurring.

We like to recommend using a triple therapy approach for probiotic supplements, where you use strains from three different categories of probiotics:

1. Lactobacillus and Bifidobacterium species
2. Soil-based probiotics, containing Bacillus species
3. Saccharomyces boulardii (a beneficial fungus)

We find that people experience the most benefit when strains from all three categories are used together for a minimum of three to four weeks, and when combined with your ideal diet. 

When Should You Take Iron and B Vitamin Supplements?

Healing your gut is a great long-term strategy for optimizing nutrient absorption and balancing hormone levels in order to resolve anemia. However, increasing nutrient intake or taking iron and B vitamin supplements is often an effective first step for correcting nutrient deficiencies. This is particularly true when you have significant changes on your blood tests or your symptoms don’t fully resolve from fixing your gut alone. If you have any of the following risk factors for anemia, you’ll likely benefit from taking supplements [1]:

• Heavy menstrual cycles
• A vegan or vegetarian diet
• Pregnancy
• History of gastric bypass surgery
• Elderly populations

Having a healthy gut will maximize the benefit that you receive from taking oral supplements, so it may be best to work on your digestive health while taking vitamins. Additionally, it’s advisable to work with a healthcare provider who can determine your specific type of anemia, recommend the appropriate supplements, and monitor your progress.

Iron Supplements

Oral iron supplements are an easy, safe, and effective way to treat iron-deficiency anemia. However, oral iron comes with a high risk for digestive side effects, namely nausea, stomach pain, gas, and bowel changes [6]. Intravenous (IV) iron may be an option for those with extremely low iron levels, or who cannot tolerate oral iron [10, 12].

Quick Tip: Ferrous gluconate (liquid iron) and ferrous bisglycinate (chelated iron) appear to come with the least side effects, while ferrous sulfate is less absorbed and is a leading form for causing GI distress [6, 34].

B Vitamins

Even in those without anemia, low levels of folate and B12 are linked to headaches and migraines [3, 5, 35, 36, 37, 38, 39]. A 2020 systematic review looked at 12 different studies, and found that vitamin B12, folate, and B6 supplements may prevent migraines, likely making them an effective therapy for anemia headaches [40].

Quick Tip: Contrary to popular belief, the benefits of folic acid and other, more “active” folate supplements are similar (even in those with MTHFR mutations) [41]. Any form of folate is fine, but folic acid typically comes with a lower price tag, making it cost-effective.

In special cases, those with pernicious anemia (B12 deficiency due to atrophic gastritis), may require very high doses of oral B12 or B12 injections to normalize serum levels [42, 43].

Food Sources of Iron and B Vitamins

If your micronutrient intake is low (like in the standard American diet), or if you have a minor nutrient deficiency, eating a nutrient-dense diet may resolve your headaches and other symptoms. When combined with your individualized elimination diet (discussed above), adding in folate, B12, and iron-rich foods can help to restore your body’s nutrient levels naturally. 

Table 1: Nutrient-Dense Foods

Quick Tip: Eating foods high in vitamin C (think citrus) with iron food sources may help increase iron absorption, but the research is conflicted [45]. Avoiding coffee and tea while consuming iron may also be helpful, as their tannin content can decrease iron absorption [1].

Putting a Stop to Anemia Headaches

Anemia headaches affect the majority of women with iron-deficiency anemia, especially during their menses. However, these bothersome headaches and migraines can affect people with any type of anemia, making them a common complaint. 

Treating anemia headaches starts with a proper foundation of good gut health and an anti-inflammatory diet that’s been tailored to your needs. Addressing inflammation, low stomach acid, and a gut flora imbalance can all help correct anemia caused by nutrient deficiencies. 

For more information on how to heal your digestive tract with natural therapies, check out my book, Healthy Gut, Healthy You. If you would like more hands-on guidance, our practitioners are currently accepting appointments at our functional medicine clinic. 

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.