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Are you Tired all the Time?

Understanding the Connection Between Anemia and Fatigue

One of the most common health issues that I see in my practice is fatigue - patients who feel tired all the time, experience low energy, those who do not wake in the morning feeling refreshed, or those who feel that they no longer have the energy they used to have.

While there are many reasons why a person can experience chronic fatigue and low energy, one underlying cause that I observe regularly in practice is due to a condition called anemia. Anemia is a condition in which the body does not have enough healthy red blood cells to deliver oxygen to the body’s tissues. Red blood cells are replaced by the bone marrow every 90-120 days. This process requires adequate nutrients every day, as well as proper functioning of the kidneys and bone marrow in order to produce hemoglobin, which is the oxygen-carrying protein component of red blood cells. Those with anemia do not have enough hemoglobin and eventually suffer from a gradual onset of oxygen deprivation. With less oxygen, the body’s cells do not regenerate optimally, which in turn means that every metabolic process in the body functions less efficiently. As a result, those suffering from anemia experience symptoms of fatigue and lower energy.

There are many different types of anemia. Generally, anemia is caused by excessive blood loss, increased destruction of red blood cells, or deficient production of healthy red blood cells in the bone marrow. Iron deficiency is the most common cause of anemia in the world, although in North America iron deficiency rarely results from a straightforward deficiency in the diet. Iron deficiency anemia occurs when there is inadequate iron, vitamin B12, and folate (folic acid) in the diet, as well as when there is an inability of the body to absorb these nutrients properly. In any type of illness that is due to the deficiency of a nutrient, the digestive system must also be addressed.

The assessment of anemia is typically determined through general blood work. A complete blood cell count (a CBC) obtains red blood cell count, hematocrit, and hemoglobin. Also relevant to the diagnosis of anemia are measurements of vitamin B12 and folate, which can also be obtained if deficiency of these nutrients is suspected. Mean corpuscular volume (MCV) is also reported on a CBC to measure the average volume of red blood cells, as well as to distinguish the cause of anemia. The best diagnostic testing for iron levels in the body is ‘serum ferritin’. In my experience, ferritin levels of less than 50 are often associated with symptoms such as fatigue and low energy.


Anemia often signifies other underlying conditions. Some clinical signs and symptoms of anemia include:

  • Malaise (a general sense of feeling unwell)
  • Loss of stamina, feeling weak or tired more often than usual
  • Shortness of breath, especially on exertion
  • Heart palpitations
  • Irritability, low mood
  • Difficulty concentrating
  • Headaches

  • Light-headedness (especially when standing up)
  • Tingling (“pins & needles” sensation) in fingers and toes
  • Brittle, dry nails (in severe cases, flat and spoon-shaped)
  • Pale skin colour
  • Hair loss
  • Insomnia
  • Indigestion


Here are a few naturopathic tips to improve your energy if you suffer from anemia:

  • Remember that food is medicine: include a variety of protein from fish, meat, beans like kidney beans, green leafy vegetables like spinach, and grains such as quinoa in your diet. These are good sources of iron, vitamin B12, and folate. Helpful herbs include: alfalfa, yellow dock, nettle, dandelion, ginseng, parsley root, and ginger
  • Tissue salts and homeopathics such as ferrum phos can also be used to stimulate the production of red blood cells
  • Add a good vitamin B complex to aid the absorption of iron
  • Avoid foods that interfere with iron absorption such as caffeinated products, dairy products, alcohol, and sugar
  • If you supplement with iron, be sure to use a form that is well absorbed and non-irritating to the digestive system (note that iron is toxic in large quantities , so take caution with excessive use of supplements)


*Naturopathic treatment seeks to uncover root causes of illness to determine appropriate treatment that will lead to optimal energy levels. It is always advisable to work with a naturopathic doctor prior to taking any natural therapies.



Dr. Suzanne Bartolini practices Naturopathic Medicine in both Toronto & Oakville clinic locations. For more information contact doctorbartolini@gmail.com