Anemia describes an abnormal decrease in red blood cells (erythrocytes) or their depletion in hemoglobin (the protein responsible for transporting oxygen to the body’s organs) (1).
Mild anemia often goes unnoticed, but as it worsens, it causes a number of symptoms related to poor oxygenation of tissues: shortness of breath on exertion, pale skin, intense fatigue, increased heart rate, dizziness, trouble concentrating... (2)
In order to treat anemia, it’s essential to first understand what’s causing it. Anemia is either the result of defective red blood cell production in bone marrow (central causes), or loss or destruction of red blood cells by the body (peripheral causes).
Deficiency in iron remains the primary cause of diagnosed anemia, affecting up to 1.5 billion people worldwide: this is unsurprisingly referred to as iron-deficiency anemia(3). As a component of haem, this key mineral plays a direct role in the normal formation of red blood cells and hemoglobin. Pregnant women are more likely to be affected by this type of anemia, as the growing fetus and greater blood volume results in increased iron requirements (4).
Anemia may also be caused by a lack of either vitamin B9 or B12 (5-6), (both of which are necessary for red blood cell maturation), intestinal malabsorption of these vitamins (pernicious anemia) (7), chronic inflammatory disease, kidney disease causing a deficiency in erythropoietin (EPO), or failure of bone marrow to produce blood cells (8).
Blood loss due to heavy periods or gastrointestinal bleeding are the most common peripheral causes of anemia (9-10). In rarer cases, abnormalities in hemoglobin structure (seen in sickle-cell disease or thalassaemia) or antibody production directed against red blood cells cause premature destruction of erythrocytes, potentially inducing haemolytic anemia (11).
Once a medical diagnosis of iron-deficiency anemia has been confirmed, oral supplementation with iron is usually prescribed as a first-line treatment (12). Supplements should be taken in-between meals for at least 3 months.
When oral supplementation fails to correct the problem, in cases where loss of iron exceeds the body’s ability to absorb supplemental iron, or there is an underlying intestinal disorder, an intravenous iron infusion may be necessary (13).
Sudden onset anemia (following significant blood loss or surgery, for example) sometimes requires a blood transfusion (14). However, this carries a risk of complications and is therefore a treatment of last resort.
EPO injections are sometimes used in serious and chronic situations (dialysis, chemotherapy …) to stimulate bone marrow and treat anemia while reducing the risks of transfusion (15).
A person being treated for iron-deficiency anemia should see an improvement in their symptoms within a few weeks.
To assess the treatment’s efficacy, blood tests are taken to check the patient’s hemoglobin levels which usually return to normal within 6-8 weeks. Their levels of ferritin (a marker of the body’s iron reserves) will also be checked three months after the start of treatment: normal levels usually mean supplementation can cease (16).
If you’re anaemic, it’s obviously important to adopt a diet that contains sufficient iron, but also one that provides plenty of vitamin B9 (green leafy vegetables, pulses…) and vitamin B12 (animal-source foods).
With 16.1mg/100g, black pudding is justifiably top of the list of iron-rich foods. Calves’ liver and red meat are also good sources, which can be consumed twice a week (17).
In terms of plant-origin foods, soya beans and tofu (2.4mg/100g) are respectable sources, though they’re a long way off nori seaweed with 234mg/100g (18). Be aware that non-haem iron (from plant-source foods, eggs and milk) is less well-absorbed by the body than haem iron (from meat products).
Fresh fruit naturally contains little iron. Oil seeds and oleaginous fruits (such as sesame seeds, almonds, hazelnuts…) and dried fruits (such as dried figs) fare a little better. Conversely, citrus fruits, peppers and kiwi fruit, with their high levels of vitamin C, help to boost absorption of iron from plant-source foods when consumed as part of a meal (19).
Spinach is a fairly good source, offering 3.61mg/100g, though pulses (lentils, flageolet beans, red kidney beans…) contain almost twice as much. Topping the list, however, are dried aromatic herbs such as thyme (124mg/100g) (20).
Ginger, and even more so, cumin, fenugreek and turmeric, have a particularly high iron content (21). Even when consumed in small quantities, these spices conveniently combine with the iron provided by other foods over a day. Other good dietary sources are cocoa powder and dark chocolate.
It’s now recognized that the tannins in tea (as well as in grapes and red berries) inhibit good iron absorption, as do the phytates in grains and legumes(22-23). So if you’re anaemic, it’s wise to leave a gap between consuming these foods and taking your iron supplements.
Iron supplementation should only be started once anemia has been confirmed by a blood test, since excess iron levels are harmful to health. Once there is a clear diagnosis of iron deficiency, it’s then a good idea to take a safe and effective iron supplement.
Some forms of iron, such as ferrous sulfate, ferric citrate or iron D-gluconate, are associated with a number of adverse side-effects including stomach problems(24). Iron bisglycinate (found in the supplement Iron Bisglycinate) is not only very well tolerated but also offers optimal bioavailability because it has a low molecular weight and no ion charge (which reduces interactions with other nutrients) (25).
When anemia is due to a lack of folates (malnutrition, pregnancy, cytotoxic drugs …) or vitamin B12 (strict vegan diet), targeted supplementation can be initiated, but always with your doctor’s approval (try, for example, SuperFolate 200 mcg for vitamin B9 or Methylcobalamine for vitamin B12).
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