Have you ever felt exhausted even after a full night’s sleep? Do your hands and feet seem cold all the time? Maybe you’ve been told your labs look “fine,” yet you still feel off. If so, you’re not alone—and you may be dealing with anemia. But not the kind most people think of. As a functional medicine practitioner, I’ve seen it time and again: red blood cell markers that fall within “normal” ranges, yet the body is clearly struggling. That’s because the hidden causes of anemia often go undetected in standard lab reviews. The truth? Anemia is more complex—and more correctable—than most people realize.
Could You Have Anemia? A Quick Symptom Checklist
☐ Cold hands and feet
☐ Dizziness when standing
☐ Pale inner eyelids
☐ Shortness of breath climbing stairs
☐ Heavy periods or frequent blood donation history
☐ Brain fog or difficulty concentrating
☐ Fatigue despite adequate sleep
☐ High MCV on your labs (over 90)
☐ Unexplained hair thinning or brittle nails
If these sound familiar, keep reading….
Anemia Isn’t Just “Low Iron”
Most people think anemia equals low iron. But that’s only part of the story. Anemia really means your cells aren’t getting the oxygen they need. This can happen for many reasons:
- You don’t have enough red blood cells.
- Your red blood cells are too small to carry enough hemoglobin (iron-deficiency anemia).
- Your red blood cells are too large to efficiently deliver oxygen into the tiniest capillaries (macrocytic anemia).
- Your cells can’t use the oxygen due to deeper imbalances like poor thyroid function or nutrient insufficiencies.
Key Insight #1: You can be anemic even if your iron levels look “normal.”
The Bloodwork You Need (and Why Standard Labs Miss the Mark)
A standard CBC (complete blood count) is a good place to start—but it’s not the whole story. Here are key markers I always look at through a functional lens:
- MCV (Mean Corpuscular Volume): Tells me if your red blood cells are too small or too large. A high MCV often points to B12 or folate issues, not iron.
- Ferritin: Your iron storage tank. Even if your serum iron is fine, low ferritin means your reserves are running on empty.
- RDW (Red Cell Distribution Width): High RDW can show a “battlefield” of old and new RBCs—suggesting recent blood loss or nutritional shifts.
- B12 & Folate: Crucial for making healthy red blood cells. Serum levels might look good, but they don’t show what’s happening inside your cells.
- Thyroid Panel: Hypothyroidism is a hidden driver of anemia that often goes undetected if only TSH is tested.
Key Insight #2: “Normal” lab ranges don’t equal optimal function. Symptoms often show up before labs get flagged.
The Root Causes of Anemia (It’s Not Always About Food)
Here’s where a functional approach shines. We look upstream to ask why your oxygen delivery system isn’t working well. Common root causes include:
- Heavy menstrual cycles → chronic blood loss → low iron
- Poor digestion → low stomach acid means you don’t absorb iron or B12 well
- Food sensitivities & gut inflammation → damage absorption pathways
- Medications like antacids, birth control pills, and SSRIs → reduce absorption of key nutrients
- Chronic stress → depletes nutrient reserves and suppresses stomach acid
- Low thyroid function → slows down production of red blood cells
Key Insight #3: The root cause of your anemia might be in your gut, your hormones, or even your stress levels.
What You Can Do (Beyond Taking a Supplement)
Yes, supplementation has its place—but it’s only one piece of the puzzle. Here’s how to support healthy red blood cells holistically:
✅ Eat Iron-Rich Foods Smartly
- Choose heme iron (animal-based) when possible: red meat, liver, shellfish
- Combine with Vitamin C-rich foods (like citrus, tomatoes, or peppers) to boost absorption
- Avoid drinking tea or coffee with meals—they block iron absorption
✅ Optimize Digestion
- Chew slowly, avoid water with meals, and reduce stress while eating
- Consider testing or support for low stomach acid (especially if other minerals are low)
✅ Rebuild Your Reserves Carefully
- If supplementation is needed, forms like iron bisglycinate or liquid iron are gentler on digestion
- Take supplements under guidance—iron isn’t always the answer and can cause harm if root causes aren’t addressed
✅ Test, Don’t Guess
- If you’re still feeling exhausted or foggy despite eating well, it’s time to dig deeper with the right lab testing. A comprehensive thyroid panel, ferritin, B12, and gut health assessments can reveal what your body’s really asking for.
Key Insight #4: Iron pills aren’t always the solution. Treating the root cause matters most.
It’s Time to Feel Like Yourself Again
Anemia doesn’t have to be a life sentence—or a mysterious fatigue that gets brushed off. Your body is talking. If you’re cold, tired, foggy, or struggling with cycles or digestion, there may be an oxygenation issue at the root.
If this blog sparked some insights for you, I invite you to reach out. Together, we can uncover the root causes of your symptoms and rebuild your vitality from the inside out. Let’s get your energy—and your oxygen—flowing again.
Curious where your ferritin or MCV stand? We offer personalized lab reviews to help you interpret your results functionally. Let’s puzzle-piece your story together.
Schedule a discovery call today here.
