Anemia

Getting Back in the Pink

The old doctors' joke--that the first order of business is to find the pale patient against the white sheet--makes one good point about anemia: It tends to drain the color out of you, as surely as it pulls the plug on your energy supply.

Anemia is a blood disorder that results from a shortage of hemoglobin in the red blood cells, the disk-shaped cells that carry oxygen to all parts of the body. No matter what kind of anemia you have--and there are several varieties--the symptoms tend to be the same. Along with being pale and fatigued, you can feel weak and short of breath, your heart rate may climb, and you may find it hard to concentrate.

These symptoms occur because without sufficient hemoglobin in the red blood cells, all parts of the body, including the brain, are starved for oxygen. And the heart tries to compensate by pumping more blood more often, explains Paul Stander, M.D., a doctor of quality management and director of medical education at Good Samaritan Medical Center in Phoenix.

Doctors can usually diagnose anemia by examining red blood cells under a microscope to determine their shape, size and number and by tests that measure levels of different blood components.

"Even after we've determined the type of anemia, it's important to figure out what's causing it," Dr. Stander says. Everything from excessive bongo playing (the constant impact on the hands damages blood cells) to arctic temperatures and toxic drugs can cause the disease.

"Nutritional deficiencies are a fairly common cause of anemia, too," Dr. Stander says. In addition to irondeficiency, a shortage of folate(the naturally occurring form of folic acid) or vitamin B₁₂can be a culprit. Rarely, the problem turns out to be an inadequate supply of copper, riboflavin or vitamin A, B₆, C or E.

Here's what studies show.

Iron Out an Oxygen Shortage

We've all heard about iron-poor blood, and for good reason. Irondeficiency is by far the most common cause of anemia. Up to 58 percent of healthy young women may be short on iron, although not always to the point of anemia.

The problem is that many women don't consume enough ironeach day to make up for the 2.5 milligrams or so they lose each month during menstruation. Pregnant women need even more iron. Teens and women nearing menopause also often come up short.

Studies show that women ages 18 to 24 get about 10.7 milligrams a day, which is nowhere near the Daily Value of 18 milligrams.

An ironshortage leads to a reduction in hemoglobin, the iron-based protein in red blood cells that lets these cells pick up oxygen in the lungs and release it in tissues where oxygen is low. "It's simple enough," Dr. Stander says. "These cells simply can't transport the oxygen you need." The cells even look pale under a microscope.

If you do have iron-deficiency anemia, your doctor will initially prescribe large amounts of iron--often 200 to 240 milligrams a day, usually in a form called ferrous sulfate. (Experts caution against taking this much ironwithout medical supervision.) Avoid using over-the-counter preparations such as enteric-coated irontablets or capsules containing slow-release granules, experts say. Both can interfere with the body's ability to absorb the iron. And make sure your doctor continues your treatment for a sufficient amount of time. Although your anemia will be corrected in 3 to 4 months, it takes an additional 6 to 12 months of therapy for your body's iron stores to be replenished.

The large amount of iron used to correct anemia is not available through food, says Sally Seubert, R.D., assistant professor of nutrition at the University of Texas Southwestern Medical Center at Dallas. "We still encourage women to eat more iron-containing foods, however," she says. Even liver, a food often avoided since cholesterol became a bad word, is recommended occasionally to anemic women, she says. "It's an unbeatable source of easily digested iron," she notes.

Getting Enough Copper

While you're stocking up on iron, you'll also want to make sure you're getting two milligrams of copper, the Daily Value.

Your body needs copperas well as ironto make hemoglobin. Although it's uncommon, copperdeficiency can cause a kind of anemia similar to irondeficiency, Seubert says. Most people get less than 1.6 milligrams a day, the amount considered necessary to maintain proper copper balance in the body. Good food sources include shellfish, nuts, fruits, cooked oysters and dried beans.

And if you're taking zincsupplements, you'll want to pay special attention to your copperintake. That's because zincactually interferes with copperabsorption. For each 10 milligrams of zincyou take, you should make sure that you're getting 1 milligram of copper. (It's also worth noting that people who take more than 30 milligrams of zinc a day are at increased risk of developing anemia. So don't take more than this amount without medical supervision.)

The B₁₂ Anemia

There's no doubt that a little bit of vitamin B₁₂ can go a long, long way. The Daily Value is only six micrograms, the lowest requirement for any of the vitamins. But a dietary deficit of this nutrient causes major problems.

The anemia associated with vitamin B₁₂ deficiency is called pernicious anemia. Until 1934, this form of anemia was invariably fatal. People survived for months or even years while growing ever weaker, but they eventually succumbed. Then in 1934, two Boston doctors won the Nobel prize in medicine for demonstrating that a diet rich in lightly cooked liver, which contains a lot of B₁₂, could ward off the deadly deficiency.

Vitamin B₁₂ is needed throughout the body to make DNA, a cell's genetic material. So a shortage leads to impaired cell production. Without adequate amounts of B₁₂, red blood cells suffer what is called maturation arrest, Dr. Stander explains. "They grow big, but they never mature into properly working red blood cells," he says. "Often they never make it out of the bone marrow, where they're made."

Fatigue is only one of several possible symptoms of pernicious anemia. Others include a burning tongue, tingling and numbness in the hands and feet, loss of appetite, irritability, mild depression, memory loss and vague stomach pains.

Today doctors know that usually it is not a shortage of this nutrient in the diet but an inability of the body to absorb vitamin B₁₂ that causes deficiency problems.

As people get older, they may have reduced production in their stomachs of an enzyme called intrinsic factor. Intrinsic factor escorts any vitamin B₁₂ that you've eaten across your intestinal lining into your bloodstream. As levels of intrinsic factor drop, less B₁₂ gets absorbed, and what's stored in the body gets used up.

"Those who've had stomach surgery or who have Crohn's disease or other stomach or intestinal problems may also lose the ability to absorb vitamin B₁₂," Dr. Stander says.

Most people with vitamin B₁₂ deficiencies need injections of B₁₂ to bring levels back to normal. "And most will need injections for the rest of their lives," says Dr. Stander. Only the small percentage of people whose B₁₂ deficiencies are caused by dietary shortages, such as strict vegetarians, will benefit from oral supplements or from getting more B₁₂ from food to help meet the Daily Value of six micrograms.

Folate Shortage Can Cause Problems

They're called tea-and-toasters. And that's a fairly accurate description of the diets of some people who end up with anemia caused by a shortage of folate. Folate is a B vitamin found in brewer's yeast and in spinach and other dark green, leafy vegetables--the foliage foods from which this nutrient gets its name.

The body needs folateto make DNA. As with vitamin B₁₂, when folate is in short supply, blood cells never reach maturity. Instead, they become large, egg-shaped cells that just can't do their jobs right, Dr. Stander says.

Unlike vitamin B₁₂, folateis not stored in large amounts in the liver. The liver's supply is used up within two to four months, so symptoms of folate-related anemia can occur much more quickly than symptoms of vitamin B₁₂ deficiency.

Blood tests can determine which vitamin is in short supply. "It's important to make this distinction, since supplementing with folic acidwhen it's actually vitamin B₁₂ that's needed can mask symptoms and lead to B₁₂-
related nerve damage," Dr. Stander says. So check with your doctor before taking folic acid as a supplement.

People found deficient are given 1,000 micrograms of supplemental folic acid a day to replenish their tissues' supplies. Pregnant women may need as much as 2,000 to 3,000 micrograms, Dr. Stander says. Those amounts are much more than you can get from even the best food sources.

Some research indicates that older people, especially those in not-so-great health, are better able to maintain normal blood levels of folate if they get 400 micrograms a day. That's an amount found in many multivitamin/ mineral supplements.

Good food sources of folateinclude spinach, kidney beans, wheat germ and asparagus. If you're relying on greens to boost your supply of this nutrient, stick to salads and lightly steamed vegetables. Folate is destroyed by lengthy cooking.