Category Archives: anemia
Iron-Deficiency Anemia is a very common health issue. Many women have been told at some point in their life they have Iron-Deficiency Anemia and that it is “chronic.” Unfortunately, the term “chronic” typically means the diagnosing doctor has chosen to not identify the cause of the condition. The doctor assumes the woman’s anemia is “normal” for her and therefore can only be controlled, not treated. I beg to differ.
Iron-Deficiency Anemia always has a cause or causes. It is never a “normal” state of being. Never. Let me clarify that I am speaking about Iron-Deficiency Anemia, the type of anemia that occurs when the body’s iron stores are below normal. Please note I am solely referring to Iron-Deficiency Anemia, not Sickle Cell Anemia, Thalassemia, Pernicious Anemia, Aplastic Anemia or any other form of anemia. Although the symptoms of the various types of anemia may be similar, they each have very distinct causes and cannot be addressed using the same approach. Please note that all references in this article are for adults, not children.
Iron-Deficiency Anemia results in a deficiency of red blood cells and diminishes the body’s ability to carry oxygen to the cells and carbon dioxide away from cells. The most common symptoms of Iron-Deficiency Anemia include:
- Easy bruising
- Cold hands and feet
- Elevated heart rate/heart palpitations/chest pain (Seek immediate medical attention for any form of chest pain)
- Swollen tongue/sore tongue/cracks in corners of mouth
- Muscle pain
- Pale skin
- Depression and/or a lack of motivation
- Brittle nails
- Frequent infection/illness
- Irritability/inability to concentrate
- Bluish coloration to whites of eyes
- Cravings for unusual items (chalk, clay, paper, etc.) or a strong desire to chew ice
Each of those symptoms could also be a sign of other health conditions, some more serious than others. Please consult a trained practitioner if you experience any of the symptoms listed above.
Possible Tests for Iron-Deficiency Anemia
Iron-Deficiency Anemia is typically identified via blood tests. When checking for Iron-Deficiency Anemia, the following tests should be run at a minimum. Please note that each lab has its own definition of what “normal” ranges are. The ranges provided below are general guidelines:
- Complete Blood Count (CBC): An overview of blood composition.
- Hemoglobin: A protein in red blood cells that carries oxygen throughout the body. Normal range for men is between 13.5-17.5; for women 12.0-15.5. Please note that results which are within “normal” but are at the low end may still cause symptoms of Iron-Deficiency Anemia.
- Iron: A measure of the iron in the blood stream. Normal ranges between 60-170 mcg/dL.
- Ferritin: A protein that stores iron. Is a measure of the body’s iron stores. Although some labs state that levels as low as 10 are “normal,” most people do not begin to feel anything close to normal until their Ferritin levels are at least 40. Please note that levels as low as zero are not a definite indicator of cancer or other serious disease. Extremely low levels need to be researched in more detail to determine the cause, but are not necessarily an indicator of a terminal condition. I once had Ferritin levels of zero which my doctor erroneously assumed meant I had cancer. After having a bone marrow biopsy, the consulting hematologist looked at me and asked why on earth the doctor ordered a bone marrow biopsy instead of investigating the cause and type of anemia first. Good question!
- Vitamin B12: Vitamin B12 is essential for iron to be absorbed. A deficiency can lead to Iron-Deficiency Anemia. Normal ranges vary between 200-900 pg/mL.
- Total iron-binding capacity (TIBC): A measure of the number of proteins available for transporting iron. Normal ranges are typically between 240-450 mcg/dL.
- Transferrin Saturation: A measure of how saturated with iron the proteins responsible for transporting iron are. Normal ranges are between 20-50%.
Potential Causes of Iron-Deficiency Anemia
Your doctor may order other tests if s/he wishes to identify the specific cause of the Iron-Deficiency Anemia. Potential causes of low iron levels and Iron-Deficiency Anemia may include:
- Lack of iron in the diet
- Inability to absorb iron in the digestive tract
- Unidentified bleeding (in oral cavity, lungs, stomach, digestive tract, etc.)
- Other forms of anemia not yet tested for or identified
- Pregnancy and lactation
- Extremely heavy menstruation
- Frequent blood donation
- Excessive exercise (Iron-Deficiency Anemia is common in long-distance runners)
- Celiac, Inflammatory Bowel Disease, Crohn’s or other digestive disorders
- H Pylori infection (stomach ulcer)
- Use of a proton pump inhibitor such as Prilosec, Nexxium, etc.
- Kidney disease
- Gastric bypass surgery/colostomy
- Thyroid imbalances or other hormonal imbalance
- Enlarged spleen or splenic dysfunction
- Lead poisoning
Further Testing to Identify the Cause of Chronic Iron-Deficiency Anemia
Consistent Iron-Deficiency Anemia can be caused by any of the factors discussed previously, but may also be an indicator of more severe health issues. I advise considering the following to identify the root cause of Iron-Deficiency Anemia:
- Check antiparietal antibody levels to ensure Pernicious Anemia is not the cause of the anemia
- Test for other forms of anemia if symptoms and blood work indicate a possibility
- Test for digestive disorders
- Test for vitamin and nutritional deficiencies and supplement as needed
- Test for food allergies (the inflammation caused by food allergies can impair iron absorption)
- Check for bleeding in the digestive tract and digestive disorders
- Check for bleeding in the respiratory system
- Test thyroid levels (with a complete thyroid panel including TSH, Free T3, Free T4, TPO and Reverse T3 at a minimum)
- Test hormone levels and have a gynecological exam if extremely heavy menstruation is suspected as the cause
- Test for pregnancy (if appropriate)
Reversing the Deficiency
Many factors may contribute to Iron-Deficiency Anemia, so work with your doctor to determine what approach should be taken to reverse the deficiency. The most common approaches used to reverse the deficiency include:
- Identify and Address the Cause: Although it is imperative to get iron levels up using supplements or other approaches, it is also essential to identify why the iron deficiency exists and address the cause. If the cause can be identified and eliminated or greatly alleviated, the body can more easily restore iron levels to normal levels. If testing reveals a more severe form of anemia exists, additional steps will be needed. I will share more about the other forms of anemia in future posts.
- Increase Iron Consumption: Increasing the amount of iron eaten on a daily basis can be helpful, but may not be sufficient in cases of absorption and digestion challenges. Please be aware that the iron contained in plants is called “non-heme” iron. It is not as easily absorbed as the heme iron in animal products. The body must convert non-heme iron into heme iron before it can absorb it. The best way to assist the body in making converting non-heme iron into heme iron is to eat fruits or veggies high in Vitamin C with foods containing non-heme iron. (Eating foods high in Vitamin C will assist with the absorption of iron in animal products, too, but is especially important for vegetable sources of iron.) This is one reason why spinach salads often contain oranges. The food that is highest in iron content is liver. Other foods high in iron include red meat, chicken and turkey, quinoa, organ meats, raisins, dark leafy greens, egg yolks, prunes, molasses, beans and lentils, salmon, nuts and seeds, dark chocolate (at least 80%), broccoli and others. I am not a fan of “iron fortified” milk and cereals because the iron those foods contain is in a form that is very difficult to absorb.
- Use Iron Supplementation: Iron pills or supplements should never be taken if testing has not proven you are deficient in iron. Excess iron in the bloodstream can have negative affects which are as bad or worse as an iron deficiency. Please also be aware the forms of iron most commonly sold in drug stores are difficult to absorb and often cause constipation. Ferrous sulfate is the most commonly sold form of iron, but is very poorly absorbed and often causes constipation. It is not a form I recommend. My preferred forms of supplemental iron include iron citrate, iron gluconate, iron bisglycinate and/or chelated iron. Iron is best absorbed when it is taken on an empty stomach. My favorite iron supplements are Hematinic Formula and Vitamin Code Raw Iron.
- Severe cases of Iron-Deficiency Anemia may require blood transfusions or intravenous iron. Those approaches are usually not needed unless other health issues are present.
In conclusion, I’d like to say that Iron-Deficiency Anemia can usually be quickly addressed and reversed. More difficult cases may require further testing and additional therapies, but quality of life can usually be restored fairly quickly.
Red Blood Cell Photograph courtesy of Wellcome Images
Anemia Blood Cell Photograph Courtesy of Alpha Images