Anaemia

Introduction
Anaemia is a condition in which the blood has a low count of red blood cells or is deficient in haemoglobin, the iron containing red pigment of red blood cells. Haemoglobin has a very important role to transport oxygen from the lungs to the tissues around the body and carbon dioxide from the tissues to the lungs. Hence the main symptom in anaemia is very low energy or extreme fatigue because of lack of adequate oxygen for energy production and the accumulation of carbon dioxide in the tissues.

There are many types of anaemia but the few important ones are usually caused by excessive blood loss, nutrient deficiencies, inadequate red blood cell production and excessive red blood cell destruction.
Because the nutrients needed to prevent anaemia are involved in a series of reactions at the cellular level, anaemia is just the last stage of many other processes that have already gone wrong in the body as a result of iron and B12 deficiencies.

The two commonest types of anaemia are:

• Iron deficiency anaemia
• Vitamin B12 deficiency anaemia (pernicious anaemia)

In most cases, iron deficiency is the major cause of nutritional anaemia.


Iron Deficiency Anaemia

Iron deficiency anaemia is a very common nutrient deficiency occurring in 30 - 50 % of the population

The Symptoms

• Extreme fatigue (very low energy)
• Learning disabilities
• Impaired immune function
• Decreased physical performance
• Rapid heart beat
• Depression

Who is at Risk?
The groups in the society who are at high risk of developing anaemia are children below 2 years, teenage girls, women in their reproductive years, pregnant women and the elderly, those who have just had surgery, HIV AIDS patients, those who have kidney disease, diabetes, rheumatoid arthritis and heart attack. Also those on vegetarian or vegan diets which do not contain any animal foods are at increased risk.
Foods rich in easily absorbable iron are animal foods such as beef, livers, eggs, clams. Although many green leafy vegetables contain a high level of iron, only a very small percentage is absorbed from the intestines.
Anaemia if not treated can become a very serious condition and can lead to life threatening-complications. When the oxygen carrying capacity of the blood decreases ( i.e. low haemoglobin or decreased number of red blood cells) the heart must work harder to pump more blood to send enough oxygen throughout the body. If the heart is overworked, the left ventricle wall muscle may enlarge (left ventricular hypertrophy) and or rapid heartbeat (tachycardia) both which can lead to heart failure.

The Causes

• Diet deficient in good sources of iron
• Diet excluding animal products
• Poor absorption from the gut – a very small percentage of plant iron can be absorbed
• Decreased iron absorption due to lack of hydrochloric acid especially in the elderly
• Chronic diarrhoea, antacid use
• Poor utilization of the absorbed iron and deficiency of the support nutrients
• Increased iron requirement such as in teenage or during pregnancy
• Blood loss in women of child bearing capacity due to excessive menstrual bleeding
• Bleeding from peptic ulcers, haemorrhoids and blood donating
• Vegetarian or vegan diets lacking in the more available iron from animal food
• Surgical removal of the stomach

Because there are many causes, iron deficiency should be accurately diagnosed and confirmed by tests so that the treatment can be directed at the root cause. Unnecessary or excess iron supplementation has serious implications as it has been associated with increased risk of heart disease through increased free radical production. Free radicals damage the artery wall and blood cholesterol. Iron over-load has also been implicated in an increased risk of cancer.
Those with iron deficiency anaemia or having any of the above symptoms might like to consider **Nutritional consultation.


Pernicious Anaemia (B12, folic acid and intrinsic factor)

Introduction
Vitamin B12 (cobalamin) is needed for many functions in the body including the prevention of pernicious anaemia, a condition in which large inefficient red blood cells are produced. Vitamin B12 together with folic acid are needed for DNA synthesis, red blood cell and nerve insulating sheath formation, clearing homocysteine from the blood and protection against heart attack.

Absorption of Vitamin B12 from the gut needs an “Intrinsic factor” (IF) which is secreted by the digestive system and Folic acid so deficiency of these leads to pernicious anaemia.

Because vitamin B12 is available in very small quantities, the intrinsic factor secreted in the gastric lining of the stomach is needed to increase its absorption from the small intestine. So a deficiency in vitamin B12 can arise from lack of good sources of B12 in the diet and or lack of Intrinsic Factor to promote its absorption from the intestine.
The best sources of vitamin B12 are animal foods, such as liver, kidneys, eggs, fish, cheese and meat. Unfortunately the fermented foods claimed to be excellent vegetarian sources of vitamin B12, such as Tempeh, contain types which cannot be used by the body. The same applies to cooked sea vegetables which may contain very high quantities of the non-usable vitamin B12. Vegetarian and vegan diet need supplementation.

The Symptoms and Signs
Although vitamin B12 is water soluble, it is stored in the liver and it can take several years before signs and symptoms of deficiency appear. However, the brain and nervous system are affected before this. The symptoms and signs include:

• Pernicious anaemia
• Incomplete red blood cell production
• Impaired nerve function
• Pins and needles, numbness and burning feet
• Impaired mental function, especially in the elderly
• Depression, especially in the elderly
• Diarrhoea
• Smooth, beefy red tongue.

Vitamin B12 therapy - A number of diseases are associated with vitamin B12 and folic acid deficiency and can be corrected or their symptoms improved with vitamin B12 supplementation. Before taking supplements it is important to know whether the problem is caused by a lack of intrinsic factor, a deficient diet or poor digestive function so it is recommended that you consult with your healthcare provider. Vitamin B12 if properly supplemented has been shown to improve or correct the following diseases:

• Human Immuno-Deficiency Syndrome (AIDS)
• Alzheimer’s disease and impaired mental function in the elderly
• Asthma and sulphite sensitivity
• Depression, especially in the elderly
• Diabetic Neuropathy and Multiple Sclerosis
• Low Sperm count
• Tinnitus (noise in the ears) and noise induced hearing loss.

Who is at risk?
The elderly.
Those dependant on vegetarian or vegan diets.
Those with low or no secretion of intrinsic factor by the gastric lining of stomach.

The Causes
Diet lacking in good food sources of Vitamin B12 such as vegetarian or vegan diets.
Lack of intrinsic factor in the stomach.
Conditions and diseases that inhibit proper food absorption.

Those with Vitamin B12 deficiency, on vegan or vegetarian diets or who have any of the above symptoms might like to consider **Nutritional consultation.