Anemia: A hidden cause for fatigue

Do you sometimes feel weak and tired? Do you lack energy? Do people say you look a bit pale? If so, then I would suggest we check for anemia.

Anemia is a common condition wherein the body lacks red blood cells or the cells cannot carry enough oxygen. We learned from biology class that red blood cells carry oxygen in the blood and distribute it to all parts of the body. Hemoglobin is the specific iron-rich component inside the red blood cell, which carries oxygen.

The usual type of anemia we encounter is iron-deficiency anemia or IDA. Iron is needed by the body to produce healthy red blood cells. If this condition is not treated, then the person will feel weak.

According to the DOST-FNRI’s Seventh National Nutrition Survey in 2008, iron- deficiency anemia affects four out of 10 pregnant Filipino women and three out of 10 nursing mothers. For babies six months to less than a year old, the prevalence of anemia is at a high 56 percent! By the time the children reach one to 12 years old, the prevalence goes down to 20 percent. Senior citizens are also at risk with more than three out of 10 people over the age of 60 years having anemia.

For pregnant women, anemia may result in premature delivery and a higher risk of illness and death. For babies and children, anemia can lead to poor appetite, stunted growth, various illnesses, and lower learning capacity.

In some individuals, mild cases of iron-deficiency anemia may have no symptoms. However, for other people, they can develop fatigue (tiredness), pale skin, coldness of hands and feet, shortness of breath, palpitations, chest pain, dizziness, and even fainting spells.

If you don’t have enough oxygen in your red blood cells, your heart has to work harder to get enough oxygen circulating in the body. This can cause serious heart problems.

Here are the risk factors for iron-deficiency anemia:

• The two common causes of iron-deficiency anemia are blood loss and poor diet. When a person has any kind of bleeding, the body will need to produce more red blood cells. For this process, your body needs enough iron. When the body’s iron stores are depleted, the person will develop iron-deficiency anemia. In women, the common cause of bleeding is heavy and prolonged menstruation; it can also happen after childbirth and due to the presence of uterine problems. Other possible causes of blood loss are a bleeding ulcer, parasitic infection (worms), urinary tract bleeding, and colon cancer. Regular use of aspirin or pain relievers may likewise lead to stomach bleeding.

• A diet low in iron predisposes one to iron-deficiency anemia. For example, strict vegetarians may not have enough iron in their meals.

Meat and fish are excellent sources of iron. As a substitute, vegetarians can eat more iron-fortified breads and cereals, dark green leafy vegetables, beans, and tofu.

• Poverty itself is a risk factor for anemia. Those with low incomes eat poorly because they can’t buy enough food. Parasitism is also common in poor children and this contributes to blood loss.

• Infants and young kids need more iron to grow. In addition, babies use up their iron stores in the first four to six months of life. Hence, there is a high prevalence of anemia among babies six months up to one year old.

• Young children who drink mostly cow’s milk and don’t take in a variety of foods may develop anemia. Since milk alone has little iron, we should encourage kids to eat fish, meat, and vegetables.

• Women and teenage girls who are menstruating are at higher risk for anemia compared to men.

• Many pregnant women have iron-deficiency anemia because mothers need double the amount of iron for themselves and the fetus. Thus, all pregnant women are advised to take iron supplementation (with folic acid) during pregnancy to prevent premature birth and congenital abnormalities.

• People with kidney disease, stroke, cancer, and other illnesses are prone to develop anemia. Therefore, they need to build up their strength by resting and eating more. There are also some not-so-common conditions wherein the iron in the diet is not absorbed by the body. For example, those who have had operations like a gastric bypass and those with some intestinal diseases can have difficulty absorbing dietary iron.

Diagnosis of anemia is simple. We just need a complete blood count or CBC. This test will reveal the hemoglobin and hematocrit level in your blood. As mentioned, hemoglobin is the iron-rich protein inside the red blood cells that carries oxygen. In a similar way, hematocrit levels gauge how much space red blood cells occupy in the blood. If your hemoglobin and hematocrit levels are low, then you have anemia.

Depending on your doctor’s suspicion as to the cause of the anemia, he/she may request for tests to detect possible sources of bleeding. If the cause of the anemia is not obvious, the doctor may check for a peripheral blood smear (to see what your red blood cells look like) or test for iron levels in the blood.

The medical treatments and food remedies are as follows:

• If bleeding is the cause of the anemia, then the approach is to find and stop the cause of bleeding. Severe iron-deficiency anemia may require blood transfusion and iron injections done in the hospital.

• Taking iron supplements can improve iron levels within a month or two. Your doctor will decide the right dose for you. However, too much iron can cause side effects such as dark stools, stomach irritation, and constipation. Try to eat more vegetables and fruits like papaya and grapes to soften the stools. There are cheap ferrous sulfate tablets and more expensive iron supplements with folic acid. Both are effective.

• Increase dietary intake of iron. For meat sources, the highest levels of iron can be found in beef liver, beef, pork, chicken, turkey, fish, oysters, and clams. For non-meat sources, we have spinach, green leafy veggies, potatoes with skin, iron-fortified breads and cereals, beans, peas, and dried fruits like prunes and raisins.

• Together with a high-iron diet, taking in vitamin C-rich foods can help the body absorb iron. Excellent sources of vitamin C are citrus fruits like dalandan, orange, pineapple, and grapefruit. Vegetables like tomato, cabbage, potato, and spinach also have vitamin C.

• Follow a healthy lifestyle. Get more sleep and drink enough water.

• Stop smoking and limit alcohol intake. Remember that iron-deficiency anemia is an easily treatable condition. The challenge is in finding it early.