Anemia & Diabetes: A Vicious Circle

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If you’re feeling weak and easily fatigued for no good reason, ask your doctor about testing for anemia. Although these symptoms could have any number of causes, anemia is a fairly common one. This is especially true for women who are pregnant or of childbearing age, vegetarians, Blacks, Hispanics, and people over age 65, as these groups have an above-average risk of developing anemia.

There’s another high-risk group that’s often overlooked, despite the fact that it comprises 30 million Americans—people with diabetes. Anemia affects 25 percent of those with diabetes, compared to just 5–6 percent of the general population, and oftentimes it’s undiagnosed.

ABCs of Anemia

Anemia is a condition in which the number of healthy red blood cells is too low to deliver adequate oxygen to the tissues. Common causes include:

  • Iron deficiency. Iron is an essential element in hemoglobin, the protein that transports oxygen in red blood cells.
  • Blood loss. This includes monthly menstrual cycles, which is why younger women are at increased risk.
  • Vitamin B12/folate deficiencies. These vitamins are required for the production of red blood cells. Deficiencies are most common in older people who have trouble absorbing B12 from food.
  • Inherited conditions. Genetic disorders such as sickle cell anemia and thalassemia result in fragile red blood cells.
  • Destruction of red blood cells. Hemolytic anemia occurs when red blood cells are destroyed faster than they are made.
  • Inadequate or faulty production of red blood cells. This is a rare but very serious condition called aplastic anemia.

Although any of these factors can contribute to anemia, research suggests that a primary link between diabetes and anemia is diabetic kidney disease.

Diabetes, Anemia & Your Kidneys

Iron, vitamin B12, and folate aren’t the only prerequisites for red blood cell production. Erythropoietin (EPO), a hormone made in the kidneys, is also required. If EPO output falters, the bone marrow cannot manufacture enough red blood cells to meet the body’s demands, and anemia develops.

For people with healthy kidneys, this isn’t a problem. When blood oxygen levels are low, the kidneys make more EPO and red blood cell production increases. Damaged kidneys, however, secrete less EPO—and as kidney disease progresses, EPO output becomes less and less efficient.

Given that up to 40 percent of people with diabetes have some degree of kidney disease, it’s little wonder that anemia is prevalent in the diabetic population.

Anemia Worsens Diabetes & Vice Versa

Although anemia doesn’t raise blood sugar or cause diabetes, it can have serious consequences for people with diabetes.

  • Anemia increases the risk and severity of diabetic ulcers, eye problems, kidney disease, heart disease, and other diabetic complications.
  • It compounds diabetes’ adverse effects on other organs and systems. For example, untreated anemia is an independent risk factor for cardiovascular disease.
  • Anemia further elevates markers of chronic inflammation, which contributes to a host of health problems.

Diabetes also increases your risk of developing anemia.

  • Diseased kidneys, which is a common complication of diabetes, secrete less EPO and therefore impair red blood cell production.
  • Diabetic neuropathy affects nerves throughout the body, including the gastrointestinal tract, and may interfere with the absorption of iron, vitamin B12, and folate—nutrients essential for the production of red blood cells.
  • Diabetes treatment can also play a role. A 2019 meta-analysis linked metformin, the most popular oral diabetes drug, to “...significantly higher risk of vitamin B12 deficiency in diabetic patients.”

As you can see, it’s a vicious circle, underscoring the importance of testing and monitoring both conditions.

Iron Deficiency & Blood Sugar Testing

Most doctors look at hemoglobin and hematocrit (the percentage of red blood cells by volume of blood) to diagnose anemia. Some also measure ferritin, a protein that stores iron in the body, as it gives a better picture of iron status—including iron overload, which increases the risk of developing diabetes and other serious health problems.

If you have diabetes, routine testing also includes A1C. This blood test, which estimates the average blood sugar level over the previous three months, is used by physicians to diagnose and monitor diabetes.

But there’s one important thing you need to know about the A1C test as it relates to anemia.

Untreated anemia caused by iron, vitamin B12, or folate deficiency can elevate A1C results, even when blood sugars are normal. Conversely, taking iron or B12 supplements to treat anemia can cause the A1C level to be erroneously low.

In other words, if you have anemia, treated or untreated, it’s possible to be falsely diagnosed with diabetes based on a skewed A1C test—or to have worse blood sugar control than indicated on A1C testing.

Treatment of Anemia & Diabetes

So, what do you do if you have diabetes, anemia—or both?

  • Maintain optimal blood sugar control with weight loss, diet, exercise, and berberine and other blood sugar-lowering supplements. This will enhance all aspects of health, including kidney function, which may indirectly protect against anemia.
  • Work with your doctor to determine the underlying cause of anemia. Once you do, treat it accordingly. Iron, B12, and folate deficiencies can usually be reversed with diet changes and vitamin and mineral supplements.
  • Take a daily multivitamin and mineral supplement with therapeutic doses of vitamin B12, folic acid, and antioxidants. Read labels carefully and, unless you have a proven iron deficiency, avoid multis with iron.
  • Never take iron supplements unless directed by a physician. Excess iron in the body alters the gut microbiota, raises the risk of infection, unleashes free radical activity—and dramatically increases the risk of diabetes and other serious health challenges.
Dr. Julian Whitaker

Meet Dr. Julian Whitaker

For more than 30 years, Dr. Julian Whitaker has helped people regain their health with a combination of therapeutic lifestyle changes, targeted nutritional support, and other cutting-edge natural therapies. He is widely known for treating diabetes, but also routinely treats heart disease and other degenerative diseases.

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