Anemia

Only medication can help improve anemia.

There are dietary, lifestyle considerations and specific nutrients that may significantly effect and improve anemia.

What is iron-deficiency anemia?

Anemia is a reduction in the number of red blood cells (RBCs), in the amount of hemoglobin in the blood, and in another related index called “hematocrit.” All three are measured on a complete blood count (CBC). There are many causes of anemia. Iron-deficiency anemia, the most common type, causes RBCs to be abnormally small.

Iron deficiency can only be diagnosed by a blood test that measures the body’s iron stores. Iron deficiency can have many non-nutritional causes (such as excessive menstrual bleeding, bleeding ulcers or hemorrhoids, gastrointestinal bleeding caused by aspirin or related drugs, frequent blood donations, or colon cancer), but may also be caused by a lack of dietary iron. Menstrual bleeding is probably the leading cause of iron deficiency; however, only about one premenopausal women in ten is iron deficient.

There are also types of anemia where there is plenty of iron in the blood, but is not being able to be utilized by the red blood cells.

Some common symptoms of anemia include fatigue, lethargy, weakness, poor concentration, and impaired immune function. Another peculiar symptom of anemia called pica is the desire to eat unusual things such as ice, clay, cardboard, paint, or starch. Advanced anemia may also result in lightheadedness, headaches, ringing in the ears (tinnitus), irritability, pale skin, unpleasant sensations in the legs with an uncontrollable urge to move them (restless legs syndrome), and getting winded easily.

Anemia occurs when the body produces too few red blood cells, loses too many of them, or if red blood cells are destroyed faster than they can be replaced.

There are close to 100 different types of anemia with many causes, including:

• Serious disease
• Vitamin or iron deficiencies
• Blood loss
• Genetic or acquired defects or disease
• Side effects of medication

Conventional therapy involves a combination of treating the underlying causes of iron deficiency and replacing iron. Common forms of iron include ferrous sulfate (Feosol®, Fer-In-Sol®, Mol-Iron®, Slow Fe®), ferrous fumarate (Femiron®, Feostat®, Fumerin®, Hemocyte®, Ircon®), ferrous gluconate (Fergon®, Ferralet®, Simron®), and polysaccharide-iron complex (Niferex®, Nu-Iron®). Common side effects of iron pills include constipation, diarrhea, nausea, and vomiting. Iron may be administered intravenously for those who cannot tolerate the oral forms.

Self Help:

Key nutritional supplements

• Iron: People who are not diagnosed with iron deficiency should not take iron supplements. Taking iron when it isn’t needed does no good and may do some harm. If a doctor diagnoses iron deficiency, then iron supplementation is essential. In addition to dealing with the cause when possible (avoiding aspirin, treating a bleeding ulcer, etc.), supplementation with iron is the primary way to resolve iron-deficient anemia.
• A common adult level is 100 mg per day, though some doctors use higher amounts. Iron-deficient people usually need to supplement with iron for six months to one year until the blood test (serum ferritin) is well within the normal range. However, symptoms of iron deficiency should disappear much sooner than that.
• Even after taking enough iron to overcome the deficiency, some people with recurrent iron deficiency—particularly some premenopausal women—need to continue to supplement with smaller levels, such as the 18 mg present in many multivitamin/mineral supplements. A doctor should determine whether or not continuous iron supplementation is advisable.
• Warning: Adult iron supplements are the most common cause of fatal poisonings in children. Keep all iron supplements out of the reach of children.
• Liver extracts*: Liver extracts from beef (bovine) are a rich natural source of many vitamins and minerals, including iron. Liver extracts provide the most absorbable form of iron—heme iron—and other nutrients critical in building blood, including vitamin B12 and folic acid. Liver extracts can contain as much as 3–4 mg of heme iron per gram.

Other nutritional supplements that may be helpful

• Vitamin A (10,000 IU per day): Taking vitamin A and iron together has been reported to help overcome iron deficiency more effectively than iron supplements alone.
• Vitamin C (500 mg per day, taken along with iron supplements): Vitamin C increases the absorption of iron.

Dietary changes that may be helpful

• Dietary iron: While iron deficiency is not usually caused by a lack of dietary iron alone, it is often part of the problem; thus, ensuring an adequate supply of iron is important. Heme iron is found in meat, poultry, and fish. Non-heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine, and most iron supplements. Cooking acidic foods (such as tomato sauce) in an iron pan can also provide some additional iron, but this is not a recommended method of iron replenishment.
• Vegetarian diet: Vegetarians eat less iron than non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores. Vegetarians can increase their iron intake by eating more iron-containing foods (see above) or, in some cases, by supplementing iron.
• Reduce coffee intake: Coffee interferes with iron absorption. However, moderate intake of coffee (4 cups per day) may not increase the risk of iron-deficiency anemia when the diet contains adequate amounts of iron and vitamin C.
• Avoid black tea: Black tea contains tannins that strongly inhibit the absorption of non-heme iron.
• Eat fiber separately from iron supplements: Foods high in bran fiber are generally healthful, but they can reduce iron absorption from food if they are consumed at the same meal. Therefore, people needing to take iron supplements should avoid doing so at mealtime if the meal contains significant amounts of fiber.

Dietary Modification

Iron deficiency is not usually caused by a lack of dietary iron alone. Nonetheless, a lack of iron in the diet is often part of the problem, so ensuring an adequate supply of iron is important for people with a documented deficiency. The most absorbable form of iron, called “heme” iron, is found in meat, poultry, and fish. Non-heme iron is also found in these foods, as well as in dried fruit, molasses, leafy green vegetables, wine, and most iron supplements. Acidic foods (such as tomato sauce) cooked in an iron pan can leech iron into the food and thus also be a source of dietary iron.

Vegetarians eat less iron than non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians are more likely to have reduced iron stores.1 Vegetarians can increase their iron intake by emphasizing iron-containing foods within their diet (see above), or in some cases by supplementing iron, if needed.

Coffee interferes with the absorption of iron.2 However, moderate intake of coffee (4 cups per day) may not adversely affect risk of iron-deficiency anemia when the diet contains adequate amounts of iron and vitamin C.3 Black tea contains tannins that strongly inhibit the absorption of non-heme iron. In fact, this iron-blocking effect is so effective that drinking black tea can help treat hemochromatosis, a disease of iron overload.4 Consequently, people who are iron deficient should avoid drinking tea.

Fiber is another dietary component that can reduce the absorption of iron from foods. Foods high in bran fiber can reduce the absorption of iron from foods consumed at the same meal by half.5 Therefore, it makes sense for people needing to take iron supplements to avoid doing so at mealtime if the meal contains significant amounts of fiber.

Nutritional Supplement Treatment Options

Before iron deficiency can be treated, it must be diagnosed and the cause must be found by a doctor. In addition to addressing the cause (e.g., avoiding aspirin, treating a bleeding ulcer, etc.), supplementation with iron is the primary way to resolve iron-deficiency anemia.

If a doctor diagnoses iron deficiency, iron supplementation is essential. Though some doctors use higher amounts, a common daily dose for adults is 100 mg per day. Even though symptoms of deficiency should disappear much sooner, iron deficient people usually need to keep supplementing with iron for six months to one year until the ferritin test is completely normal. Even after taking enough iron to overcome the deficiency, some people with recurrent iron deficiency—particularly some premenopausal women—need to continue to supplement with smaller levels of iron, such as the 18 mg present in most multivitamin-mineral supplements. This need for continual iron supplementation even after deficiency has been overcome should be determined by a doctor.

Liver extracts from beef are a rich natural source of many vitamins and minerals, including iron. Bovine liver extracts provide the most absorbable form of iron—heme iron—as well as other nutrients critical in building blood, including vitamin B12 and folic acid. Liver extracts can contain as much as 3–4 mg of heme iron per gram.

Taking vitamin A and iron together has been reported to help overcome iron deficiency more effectively than iron supplements alone.6 Although the optimal amount of vitamin A needed to help people with iron deficiency has yet to be established, some doctors recommend 10,000 IU per day.

Vitamin C increases the absorption of non-heme iron.7 Some doctors advise iron-deficient people to take vitamin C (typically 100–500 mg) at the same time as their iron supplement.8

Hydrochloric acid produced by the stomach improves the absorption of non-heme iron from food and supplements. 9 10 Some practitioners recommend a hydrochloric acid supplement, e.g., betaine hydrochloride (betaine HCl), to enhance iron absorption in people with iron-deficiency anemia.

A high degree of association between iron-deficiency anemia and vitamin D deficiency in Asian children has been previously reported.11 In three different ethnic groups living in England, iron-deficiency anemia was found to be a significant risk factor for low vitamin D levels in children.12 These findings suggest that children with iron-deficiency anemia should be screened for vitamin D deficiency and be given vitamin D supplements if necessary.

Caution: People who are not diagnosed with iron deficiency should not supplement iron, because taking iron when it isn’t needed does no good and may do some harm.

Contraindications
Refer to the individual supplement for information about any side effects or interactions.