If your blood doesn’t contain enough red blood cells, you have anemia. You can also have anemia if you have enough red blood cells, but they just aren’t doing their jobs. If they aren’t carrying sufficient hemoglobin—the iron-rich red protein that transports oxygen—you’ll have anemia just as surely as if you had a shortage. The symptoms are noticeable, although at first you might not give them much attention. You’ll probably look pale and feel pretty tired, but it’s easy to write off these signs as the results of stress or of not getting enough sleep.
But maybe there’s another reason for feeling drained: Perhaps your blood isn’t delivering the oxygen needed to create energy. If you feel weak and short of breath, if your heart beats faster, and you find it hard to concentrate, it’s time to ask your doctor to take a blood sample. It may take no more than a few minutes to find out whether your blood’s falling down on the job.
The first thing your doctor needs to do is figure out why you are anemic. Anemia is often related to blood loss, says Michael DiPalma, N.D., a naturopathic doctor and director of natural medicine at the Village of Newtown Medical Center in Pennsylvania. For menstruating women, it may mean that they are losing more blood each month than their bodies are able to resupply.
Anemia could indicate blood loss from the intestinal tract, a bleeding ulcer, hemorrhoids, or even cancer. That’s why it’s important to get a proper diagnosis from your doctor. He will want to order a full laboratory evaluation appropriate for your specific symptoms. If internal bleeding is suspected, for example, he may check a stool sample for blood in addition to taking a blood sample for a complete blood count.
It’s also possible that a nutritional deficiency is interfering with your body’s ability to make new red blood cells, Dr. DiPalma says. "Iron deficiency is the most common, and it’s possible to become iron-deficient if you’re regularly losing blood or if you aren’t getting much iron in your diet." Other nutrients may play additional roles. Here are the things that you need to know.
| Add to Your Iron with Yellow Dock One problem with iron supplements is their tendency to cause constipation. That’s why one popular herbal tonic for iron-deficiency anemia, Floradex, includes an herb called yellow dock. While the herb is a source of iron, it also produces a gentle laxative effect. Thus, while it’s contributing to your body’s stores of iron, it can also help counter supplemental iron’s constipating tendencies, says Michael DiPalma, N.D., a naturopathic doctor and director of natural medicine at the Village at Newtown Medical Center in Pennsylvania. “Yellow dock wouldn’t be used alone to treat anemia, but it can be a helpful addition,” says Dr. DiPalma. You shouldn’t self-treat anemia without your doctor’s approval, however. |
Iron Out Anemia
Hemoglobin is so dependent on iron that your blood cells will look pale under a microscope if iron is lacking. And you must have healthy hemoglobin. It’s the Federal Express of your blood cells, constantly picking up oxygen in the lungs and delivering it rapidly to be released in tissues where oxygen is low.
Your doctor can easily check your iron levels with blood tests, including a serum ferritin test, which can detect depleted iron stores before you actually become anemic, Dr. DiPalma says. Iron deficiency may be caused by increased iron requirements during pregnancy, an adolescent growth spurt, or heavy menstrual bleeding. It could also be a sign that you’ve severely decreased your dietary intake of iron—if you’ve gone on a diet, for instance, or switched to vegetarian meals without paying attention to the foods that provide iron.
Less commonly, the deficiency may be the result of absorption problems. You may even be donating blood more often than your body can handle. Often, the reason turns out to be a combination of factors, Dr. DiPalma says.
If your doctor determines that you are short on iron, you will need to take supplements until your anemia resolves, and then some. That is, you not only need to restore normal levels of iron, you also need to build up some excess in your system for future demands.
The amounts of iron used to correct anemia can vary widely. Some doctors initially prescribe large amounts—200 to 325 milligrams a day, usually in the form of ferrous sulfate, which is not easily absorbed and may lead to constipation. Others, such as Dr. DiPalma, use smaller amounts of a more absorbable form.
Dr. DiPalma often recommends that his patients take 30 milligrams of iron succinate or iron fumarate twice a day between meals. Or, if these supplements cause stomach upset, he may advise taking them with meals. He may also recommend an aqueous (liquid) liver extract because it provides heme iron, a natural food form that’s also easily absorbed.
You should avoid using enteric-coated iron tablets or capsules containing slow-release granules, experts say. Both can interfere with the body’s ability to absorb iron. Also, make sure that you continue your treatment for a sufficient period of time, under your doctor’s supervision. Although your anemia will be corrected in 3 to 4 months, it takes an additional 6 to 12 months of therapy for iron stores to be replenished.
The B12 Connection
A shortage of vitamin B12 causes its own form of anemia, called pernicious anemia. Until 1934, this form was invariably fatal. That year, two Boston doctors demonstrated that a diet rich in barely cooked liver, which is rich in B12, could ward off the deadly deficiency.
Since the symptoms of this type of anemia resemble those of other types, your doctor will need to do a blood test to figure out what’s really going on, Dr. DiPalma says. If you do have a B12 deficiency, your red blood cells suffer from what is called maturation arrest. They grow large, but they never mature into properly working cells. In fact, they may never make it out of the bone marrow, where red blood cells are normally created and released into your blood.
Doctors no longer recommend liver to correct a B12 deficiency. Because liver is high in cholesterol, it can cause other health problems. Instead, you’ll need supplemental B12 to correct a deficiency. This deficiency is uncommon, however, except in people who are strict vegetarians (vegans) or whose bodies have lost the ability to absorb vitamin B12, Dr. DiPalma says. Absorption problems are most likely in older people with reduced stomach acid or those who have had stomach surgery. People who have Crohn’s disease or other stomach or intestinal problems may also be susceptible.
| Liver without the Cholesterol Calf’s liver, and lots of it, used to be the remedy for anemia. Liver is loaded with an easily absorbed form of iron, plus it has lots of B vitamins and other minerals that stimulate the production of red blood cells. It also has some things that you don’t want, however—it’s high in cholesterol, and if you eat enough of it, you can exceed the recommended limits for fat-soluble vitamins A and D. That’s where aqueous extracts of liver come in. These liquid extracts are free of cholesterol and fat-soluble vitamins but are loaded with iron, vitamins B6 and B12, folate, riboflavin, copper, vitamin C, and protein, says Michael DiPalma, N.D., a naturopathic doctor and director of natural medicine at the Village of Newtown Medical Center in Pennsylvania. “These are all things that your body needs to rebuild blood.” Some doctors may think the use of liver therapy to treat anemia is a shotgun approach, but to others, “shotgun” is right on target. “It’s really a whole-foods approach, which works better at resolving anemia than any single supplement,” Dr. DiPalma says. Concentrations vary, so follow the dosage directions on the liver extract label—and let your doctor know that you’re taking it. |
Injections are one way to maintain adequate blood levels of B12, Dr. DiPalma says, but some people with absorption problems can correct a deficiency by taking oral doses of 2,000 micrograms daily for at least one month. He advises taking methylcobalamin, the active form of B12. After the first month, Dr. DiPalma has his patients take 1,000 micrograms daily. This form of B12 is taken sublingually—that is, under the tongue.
Other oral forms of B12 work well for some people, says Alan Gaby, M.D., professor of nutrition at Bastyr University in Bothell, Washington. You should follow this regimen under your doctor’s supervision; he can determine whether you’re absorbing as much B12 as you need.
The Folic Acid Factor
If you don’t get enough folic acid, another B vitamin, your blood cells don’t reach maturity. Instead, they become large, immature, egg-shaped cells that can’t do their jobs well.
Folate (the naturally occurring form of folic acid) is found mostly in fruits and vegetables, so you’re short-changing yourself if you’re getting along on a very skimpy diet without those nutritional essentials. You might be short on folic acid during pregnancy, says Dr. DiPalma, and celiac disease or Crohn’s disease can contribute to deficiency as well, he notes.
Unlike vitamin B12, folic acid is not stored in large amounts in your liver. The liver’s supply is used up within two to four months if none of the nutrient is incoming, so symptoms of this type of anemia can occur much more quickly than those of vitamin B12 deficiency. And it’s not just anemia that shows up. A deficiency of folic acid can cause diarrhea; gingivitis; depression; cervical dysplasia; a swollen, red tongue; and elevated levels of homocysteine, an amino acid by-product that has been shown by research to be an independent risk factor for heart disease.
It takes only a blood test to determine if you are short on folic acid. "You may need large amounts of supplemental folic acid until blood levels are restored," Dr. DiPalma says. He recommends that his patients take 800 to 1,200 micrograms a day. High amounts of folic acid can affect the laboratory diagnosis of pernicious anemia, however, which means that some B12-deficiency nerve damage could worsen even though the deficiency goes undetected. You should check with your doctor if you think you are deficient and want to take a supplement.
Add a Multi
In addition to iron, B12, or folic acid, it’s best to take a good multi vitamin/mineral supplement when you’re working to restore blood supplies, Dr. DiPalma says. For example, your body needs copper along with iron to make hemoglobin, and vitamin C helps many parts of the body function at their best, so look for a supplement that has these two nutrients. "People tend to get better faster when they are on a comprehensive program," Dr. DiPalma says.
