3 Things To Do When Hemoglobin Is Low

February 20, 2025

Hemoglobin is an important, iron-rich protein found in our red blood cells, responsible for transporting oxygen throughout our bodies. In this episode, registered dietitian Britni Vincent shares the causes and impact of low hemoglobin, particularly when linked to iron deficiency. She discusses how to approach this common issue and offers guidance on how to manage it effectively with the help of your healthcare team. Tune in this week for an insightful, educational discussion on how to better understand your body’s needs and improve your health.

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• Are You Iron Deficient? - Ask a Nutritionist
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• Are You Iron Deficient?

Transcript:

BRITNI: Hello and welcome to Dishing Up Nutrition's midweek segment called “Ask a Nutritionist”. My name is Britni Vincent. I'm a Registered and Licensed Dietitian at Nutritional Weight & Wellness. Today's show, I am going to be addressing a topic I see pretty frequently with my clients, and that is low hemoglobin. Specifically, I'm going to talk about three things to do when hemoglobin is low.

What is hemoglobin?

So let's start by doing a little bit of a science refresh and discuss what hemoglobin is. Hemoglobin is an iron rich protein found in our red blood cells and it's responsible for transporting oxygen throughout the body. And it's what gives blood its red color. That hemoglobin is going to bind to oxygen in the lungs and release it to our tissues and organs.

Then it's used for cellular respiration. So hemoglobin is so important for our body and as you can imagine, if it's low, it can really impact how we're feeling. And when we talk about causes of low hemoglobin, the most common cause of low hemoglobin is iron deficiency.

So that's what I'm going to be focusing today's episode on, is low hemoglobin that's caused by iron deficiency specifically. Iron absorption is crucial for producing hemoglobin in the body. So if we don't have enough iron, we're not going to be producing enough hemoglobin. So once you discover you have low hemoglobin, work with your doctor to determine if it's caused from iron deficiency or something else.

Symptoms of low hemoglobin from iron deficiency

Symptoms of low hemoglobin from iron deficiency include weakness, tiredness, headache, hair loss, paleness, chills, bleeding, weight loss, shortness of breath, dizziness, and fainting. I think the most common symptoms that I see from people are the shortness of breath, the dizziness, and the fatigue.

So you've identified you have low hemoglobin and it's from iron deficiency. I would then make sure to work with your doctor to identify if there isn't a more serious medical reason for this, but if your doctor doesn't find anything and you're told to just take an iron supplement and then retest then today's episode is for you because I have some additional things to consider.

Because yes, you could be taking iron ongoing and that's going to fix the problem in the sense that it's going to increase your hemoglobin, but it's not addressing the root cause of what's actually causing the low hemoglobin and the iron deficiency.

Main reasons why people have low hemoglobin from iron deficiency

And I think there's really typically two main reasons why people have low hemoglobin from iron deficiency. Either they're not eating enough iron rich foods or they're not absorbing the iron rich foods they're eating very efficiently. And so the three things that I'm going to be talking about to do when hemoglobin is low is eat more iron rich foods, do a trial of gluten free, and assess if you have low stomach acid.

You know, I do want to mention another reason that can cause low hemoglobin and iron deficiency that I'm not going to be diving into. And it's, if you are a woman, a menstruating woman, and you have heavy periods , that can cause iron deficiency. And if that's the case, you know, working with a nutritionist; we could help to improve your overall cycle and specifically reduce the flow of your periods.

And all these things that I have mentioned, you know, these are not necessarily going to solve all the cases of low hemoglobin from iron deficiency. But the three that I'm addressing today are the most common ones that I see.

3 things to do when hemoglobin is low (#1: eat iron rich foods)

So let's dive into the three things to do when hemoglobin is low from iron deficiency. So the first thing, make sure you're eating enough iron rich foods. And there are two different sources of iron in our foods. First is heme iron, and that's the most absorbable. Up to 30 percent of heme iron from food is going to be absorbed. And that's far more than plant sources. So meat, fish, and poultry are going to be the primary sources of heme iron.

Non heme iron are going to include eggs, beans, lentils, nuts, seeds, and dark, leafy green vegetables. And only 2 to 20 percent of non heme is absorbed. You know, eating the meat, fish, poultry is really going to be the best bet to increasing your hemoglobin. Now, if you are consuming some of these non heme sources, consuming them with vitamin C can actually increase the absorption and great vitamin C sources would be citrus, red, yellow and orange peppers and tomatoes.

So, if you're having a salad with dark leafy greens, include a squirt of lemon juice on there, or include some tomatoes, or some yellow peppers, and that vitamin C is going to help to increase the absorption of the iron from dark leafy green veggie.

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Suggestion #2: do a trial of going gluten free

The second thing I'm going to talk about is do a trial of gluten free. Before doing this, if you haven't already, it would be a smart idea to get tested for celiac disease because you do need to be consuming gluten to get an accurate celiac test result. And the initial test is a blood test, so pretty quick. And you can do that through your doctor. And celiac is an autoimmune condition that requires you to be 100 percent gluten free.

And I did a different “Ask a Nutritionist” episode on gluten sensitivity versus celiac in October of 2024. So I take a much deeper dive into that topic and celiac, so you can listen to that one for more information. If you do have celiac, your villi, which are finger like structures in your intestines, are going to be flattened.

And this is going to create malabsorption, which will result in nutrient deficiencies. Basically, you are not able to absorb the nutrients from the food that you're consuming. A gluten sensitivity, on the other hand, isn't going to flatten and damage the villi as severely, but it can still damage them enough to affect our absorption of nutrients.

So, if your celiac test was negative, then it would still be worth exploring trialing gluten-free and see if you have a gluten sensitivity because once gluten is removed, the gut will be able to heal. Then you can start to absorb iron more effectively leading to an increase in hemoglobin levels. This is not going to happen overnight, so it will take months in order for this healing to occur if, if this is the case for you.

You know, other signs of gluten sensitivity can be digestive issues, constipation, diarrhea, stomach aches, cramping. You may not necessarily have digestive symptoms if you have a gluten sensitivity. It could affect your mood or your energy more so.

It can also cause skin issues. So there are various different signs of gluten sensitivity, but if you remove it from your diet a hundred percent for at least a few weeks and you feel better, well, then that is a sign you do have a gluten sensitivity. But again, it's going to take longer than a few weeks of being gluten free to be able to start absorbing iron from your food more efficiently.

Possible reason #3 for low hemoglobin: low stomach acid

The third reason I'm talking about today is assess if you have low stomach acid. And if so, consider supplementing with a digestive enzyme that contains hydrochloric acid. So believe it or not, many people have low stomach acid, not too much stomach acid. And there's various reasons for this that include age, antibiotic use, stress.

A big one is antacids. This could be a prescription. Or it could just be taking a lot of over-the-counter Tums or other over-the-counter medication that's going to reduce your stomach acid. And low stomach acid can lead to low hemoglobin specifically because stomach acid is crucial for the proper absorption of iron from food.

Sign of low stomach acid

And without sufficient acid, the body can't effectively extract the iron needed to be able to produce hemoglobin. So some signs that you have low stomach acid, you've been on some sort of antacid medication for an extended amount of time, you see food particles in your stool, you feel bloated and heavy, particularly after eating meat.

I did another episode on digestive enzymes, and I took a deep dive into low stomach acid in that episode in more detail. So you can listen to that one for more information, but if you do resonate with this, consider taking a supplement that contains betaine HCL, like Key Digestive Enzymes.

And this also has enzymes in it to help to break down fat, carbohydrate, and protein in addition to some herbs that are actually going to tell your body to make more stomach acid. It also contains some herbs that will tell your body to stimulate your own production of stomach acid, and you can take one to two of those with a meal.

Recap

To recap today's episode, once you identify you have low hemoglobin, work with your doctor to determine if iron deficiency is the cause and if there's a more serious medical condition that may explain this. If you low hemoglobin is caused by iron deficiency and there was not an underlying reason identified by your doctor, the three things that are to do when your hemoglobin is low: first, eat more iron rich foods. Secondly, do a trial of gluten free. And thirdly, assess if you have low stomach acid. And if you think you do, consider supplementing with a digestive enzyme that contains hydrochloric acid in it, or you'll see it listed as HCL.

These may not address all causes of low hemoglobin from iron deficiency, but they are definitely a good place to start. And if you don't know what to try first, I understand this can be really overwhelming. To know how to navigate all of this, I would consider scheduling an appointment with one of the nutritionists at Nutritional Weight & Wellness.

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Your health insurance might even cover your visits, which would be a big perk. So you can visit our website, weightandwellness.com for more info, or you can give us a call 651-699-3438.

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