Anaemia

A different kind of anaemia, driven by inflammation itself

Anaemia, a shortage of healthy red blood cells, is often assumed to simply mean low iron. A significant share of cases, particularly in people with gut inflammation, work through a completely different mechanism called anaemia of inflammation, or anaemia of chronic disease. Between 30% and 60% of people with inflammatory bowel disease develop anaemia during the course of their illness, and it's frequently a mix of both true iron deficiency, from bleeding and malabsorption, and this separate inflammatory process.

Source: The role of hepcidin in the inflammatory and iron homeostasis axis in inflammatory bowel diseases: a systematic review

How gut inflammation traps iron the body already has

The key player is hepcidin, a hormone that controls how iron moves around the body. Inflammatory cytokines from an inflamed gut push hepcidin levels up, and high hepcidin blocks iron from being released from storage and from being absorbed from food in the first place. The result is a person can have enough iron in their body's stores, yet still be anaemic, because that iron is effectively locked away where the bone marrow can't use it to make new red blood cells. This is a genuinely different problem from simple dietary iron deficiency, and it means more iron supplements alone often don't fix it, since the issue isn't a lack of iron but the body's inability to access it while inflammation continues.

Source: Pathogenesis and treatment of anemia in inflammatory bowel disease

Treating the gut inflammation, not just the blood count

Because gut inflammation is what's driving hepcidin up in the first place, calming that inflammation is often central to correcting this type of anaemia, not just prescribing more iron. Intravenous iron, which bypasses the absorption problem entirely, is frequently preferred over oral iron in people with active gut inflammation for exactly this reason. Interestingly, oral and intravenous iron replacement have also been shown to affect gut bacteria differently, an active area of research as clinicians try to work out which delivery method causes the least disruption to an already inflamed gut.

What this means for you

Persistent fatigue, pale skin, or breathlessness deserve a proper blood test, including markers like ferritin and inflammatory markers such as CRP, rather than assuming plain iron deficiency and self-treating with supplements. This is especially true for anyone with a diagnosed gut condition such as Crohn's disease or ulcerative colitis, where the anaemia may need the underlying inflammation treated directly rather than iron alone. Once any active inflammation is being properly managed, a varied, plant-rich diet supports the same gut lining and bacterial balance this research ties to healthier iron regulation. That's the same idea behind GutLab, everyday gut health starts with regularly feeding the microbiome a broad range of plant-rich ingredients.