Anaemia

Definition

Anemia can broadly be defined as meaning low in hemoglobin. Hemoglobin, which is found in red blood cells, is a protein that transports oxygen to the tissues and carries carbon dioxide away to the lungs. So, Anemia is a condition in which the blood cannot carry enough oxygen, either because there is a low number of red blood cells or because each red blood cell is able to carry less oxygen than normal. This reduced red blood cell count results in poor supply of oxygen to the tissues. This low supply of oxygen weakens your lungs and heart leading to symptoms like fatigue, weakness, dizziness, irritability and depression, difficulty in breathing, drowsiness, paleness of the nails and lips and cessation of menstruation in women. Normal adult hemoglobin has two alpha globin chains and two beta globin chains, and is represented as HbA for adults or HbF for fetal, which is the major form for the first six months of life. Normal hemoglobin levels are 13-18g/dl for males and 11.5-15.5g/dl for females.

Causes of anemia

Anemia has many causes. These include hormonal disorders, drug use, infections, surgery, hemorrhoids, peptic ulcers, heavy menstrual bleeding, repeated pregnancies, diverticular diseases, liver disorders, thyroid disorders and bone marrow diseases. Sometimes deficiencies occur from a diet that contains too little of one or more of the nutrients like iron, folic acid or vitamin B12.Iron is an important factor in Anemia because this mineral makes hemoglobin, the component of the blood that carries oxygen. The red blood cell formation is impaired in those people whose diet is poor in sufficient amounts of iron. Premature or excessive destruction of blood cells in the spleen due to any disease of the spleen can also be a causative factor in the development of anemia. Anemia is common in both poor and rich countries and is rampant in developing countries. Other causes include poor absorption of iron due to mal absorption diseases, stomach surgeries and chronic diarrhea. Heavy blood loss from ulcers, cancer, internal bleeding and heavy menstruation and pregnancy when the baby’s demand for iron is high are some other causes for anemia.

Different types of anemia

The main types of anemia are caused by shortages of iron, vitamin B12 and folic acid, all of which are needed (among other things) to produce red blood cells, so if one or more of these are missing or running low then anemia will develop.

1) Iron-deficiency anemia: It is the most common, and can affect up to one in five women of child-bearing age, and 2% of adult men. Iron deficiency anemia commonly results from inadequate dietary intake of iron or excessive blood loss from ulcers or other problems in the bowel or due to heavy periods. The mode of treatment will depend on the cause. Iron tablets and inclusion of foods rich in iron like green vegetables, whole grain cereals, lean meat, beans and dry fruits are recommended. Blood transfusion may be required depending on the severity.

2) Folic acid deficiency anemia is, as the name says, caused by a lack of folic acid in the diet. Folic acid deficiency is one of the causes of megaloblastic anemia, so called because of the large, deformed cells seen in the blood. This type of anemia generally occurs because of inadequate dietary intake of folic acid. Folic acid is not stored in the body, so a regular supply is necessary through foods like green vegetables, lean meats and fortified cereals. This type of anemia is most commonly seen in pregnant women, whose folic acid requirement increases during the pregnancy. If left untreated risks of low birth weight and neural tube defects are high. For this reason, doctors recommend that pregnant women take folic acid supplements during early pregnancy. Folic acid deficiency may also be a consequence of diseases which interfere with the absorption process in the bowel, such as celiac disease or Crohn’s disease.

3) Vitamin B12 deficiency anemia: B12 deficiency may also cause a megaloblastic anemia. This vitamin is found in foods of animal origin only and must combine with a chemical called intrinsic factor in the gut before it can be absorbed. Excess vitamin B12 can be stored in the liver; therefore inadequate dietary intake is relatively uncommon although a strict vegetarian diet may result in vitamin B12 anemia. The most common cause of this type of anemia is due to the body’s inability to produce the intrinsic factor caused by an autoimmune disease called Pernicious anemia. Eggs, yogurt, cheese and liver are good sources of vitamin B12.

4) Hemolytic anemia: It is a disorder wherein the body's red blood cells are destroyed prematurely. This destruction may be caused by a problem within the red cells, which is usually inherited or by a problem outside the red cells which cause physical disruption of the cells.

5) Sickle cell anemia: This type of anemia is a genetically inherited disorder that affects the red blood cells’ ability to carry oxygen to the body’s tissues.

6) Thalassemia: It is also a genetically inherited anemia. It affects the synthesis of hemoglobin, which carry oxygen around the body. It is also known by the alternative name of Mediterranean Disease as it primarily affects people of Mediterranean origin.

7) Aplastic anemia: it is a rare and serious disease which affects the body's ability to produce red blood cells in the bone marrow. Sometimes, a bone marrow transplant is the only remedy.

Milder forms of anemia may be caused by alcohol abuse, aspirin overdose and as a result of some ailments that cause bleeding.

Prevention

To avoid getting anemia one should follow a healthy balanced diet and ensure you eat foods that contain good sources of iron, folic acid and vitamin B12.A vitamin B12 supplement is recommended if you are a strict vegetarian.

Diagnosis of anemia

Advancement in laboratory testing has made diagnosis of iron deficiency easier and even before anemia actually develops. Iron deficiency is the stage before the development of low hemoglobin. At this stage or the pre anemic stage the iron storage is less but the body is not yet deficient enough to show signs or symptoms of anemia. Very few tests are needed to diagnose anemia, the main test is a full blood count, and this is basically a blood test that looks at the number, size and shape of red blood cells. The doctor may also measure hemoglobin, iron, vitamin B12 and folic acid levels. Your physician or doctor may also advice to have an x-ray done to rule out internal bleeding  if anemia is diagnosed without an obvious cause.

Treatment of anemia

Treatment is usually simple and may be resolved with an improved diet or by taking supplements. Anemia caused by vitamin B12 deficiency requires B12 supplementations or injections which are usually administered every 3 months. If the cause of anemia is internal bleeding due to ulcers proper medicines or surgery may be advised.

Prevention of iron deficiency should be the focus. Supplementation is an easy alternative when one cannot manage an iron friendly diet. But, once the iron deficiency anemia develops, supplements are usually the only alternative to replenish your iron bank. Supplementation, though simple and inexpensive has side effects like nausea, constipation and other digestive problems.

Eating iron rich foods, including a source of vitamin C along with it and limiting coffee and tea with meals can ensure adequate iron absorption.

Nutritional recommendations:

There are two forms of iron, namely heme and nonheme iron in foods. Heme iron is found in mostly animal foods like meats, poultry, and fish. Nonheme iron is found in both plant and animal foods.

Heme iron is more easily absorbed (three times better) by the body than nonheme iron. Heme iron also promotes the absorption of non-heme iron. Vitamin C is also needed to maximize iron absorption. So inclusion of citrus fruits and juices is beneficial.

Two compounds found in foods called phytic and tannic acids , when consumed in large amounts also inhibit iron absorption. Phytic acids are present in whole grains and rye breads and tannic acid is found in tea, coffee, cola drinks, chocolate, and red wines. So, it is advisable to avoid drinking tea, coffee or colas with a meal.

List of foods which help or prevent iron absorption:

Foods that enhance iron absorption are fruits like oranges, strawberries, grapefruit, cantaloupe, vegetables like brussels sprouts, broccoli, tomato, tomato juice, green and red peppers, and meat, fish and poultry.

Foods that inhibit iron absorption are coffee, tea, red wine, colas, spinach, greens, rhubarb, soy products, whole grains and bran.

Foods rich in iron:

Animal Sources:liver, kidney, chicken and turkey, shellfish, lean meat, fish tinned, fresh or frozen.

Non-Animal Sources: dried fruit, dates, nuts, molasses, cereals like ragi, whole wheat, brown rice, wholegrain breads, dried beans and lentils like soyabeans, sprouts, green leafy vegetables, ,lotus stem, brinjal, banana, jaggery, beets, spinach, almonds, fenugreek and sesame seeds.

Sample Menu for treating anemia:

Diet plays an important role in the treatment of anemia. Refined foods like white bread, polished rice, sugar, and desserts inhibit the absorption of iron. Iron, taken in its natural organic form is more easily absorbed. Focus should be on the consumption of raw vegetables and fresh fruits which are rich in iron and also ensure that the diet is rich in folic acid, vitamin B12 and vitamin C.

Breakfast: Breakfast cereals, whole grain breads and legumes contain iron. To increase absorption, include a rich source of Vitamin C. (eg. a glass of orange juice or fruit with the cereal). 

Lunch and Dinner: Eat a combination of legumes or pulses, brown rice or wheat or other millets and vegetables.  Vitamin C in lemon or tomato helps absorption.

Dietary Recommendations

• Iron absorption is enhanced with Vitamin c (ascorbic acid)
• Avoid drinking tea, coffee, hot chocolate and caffeine containing cold drinks, (colas) with meals as it decreases the amount of iron that the body can absorb. Iron absorption is nearly decreased by 60%.
• Avoid use of antacids as it will also decrease iron absorption
• Avoid excessive milk consumption with meals. Milk is a good source of calcium and calcium decreases iron absorption.
• Improve food choices to increase amount of dietary iron

If Iron supplements have been recommended:

• Supplements should ideally be taken in between meals together with foods rich in vitamin C or a vitamin C supplement
• If discomfort is experienced, then take the supplements with the meal, but the best time to take supplements is at bedtime (after 3 hours of meal on a nearly empty stomach)
• Avoid taking supplements with tea, milk or coffee.
• Do not take supplements with antacids
• Do not discontinue use of  iron supplements as soon as you start to feel better, unless you have been told to so by the doctor or dietician.

Summary

Diet is of utmost importance in the treatment of anemia. Iron deficiency anemia can be prevented by eating a balanced diet which includes rich sources of iron, folic acid, vitamin B12 and vitamin C. Refined foods like white bread, polished rice, sugar, and desserts rob the body of its much-needed iron. Iron should preferably be taken in its natural organic form in food. The emphasis in the diet should be on raw vegetables and fresh fruits, dried fruits and nuts which are rich in iron.

Follow these guidelines for better understanding

Opt for iron fortified breads and cereals.

It’s advisable to discuss your diet and your need for supplements with your nutritionist or doctor.

Reduce consumption of coffee, tea and other caffeine rich products. These substances along with excess fiber, excess calcium and phytates found in certain vegetables can inhibit iron absorption.

It is advisable to follow safety instructions when working with paint and petroleum products and other lead containing materials.

A word of caution

Avoid overloading your body with iron without any guidance as this can have dangerous effects. (Iron overload is a serious condition called hemochromatosis. Symptoms of this condition include weight loss, fatigue, joint pains, abdominal pains and shortness of breath.)