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Family Health Magazine - WOMEN'S HEALTH

Are You Anemic?
Anemia is a common condition

Anemia can leave you feeling tired, weak, dizzy and irritable. It is very common. Almost all women in their childbearing years have anemia at least once. (Men have it much less often.) Many chronically ill people are anemic all the time. Anyone with major trauma, major surgery, or chemotherapy goes through it. Understanding how to detect and deal with anemia can help you to feel better.

If you are anemic, your blood is not delivering enough oxygen to your body. The effects vary, and you may not notice symptoms until they become severe. Symptoms include increasing fatigue, weakness, headache, irritability, difficulty exercising, sore tongue, brittle nails, tingling or restless legs, and skin that has become pale or even slightly yellow.

If anemia results from rapid blood loss, as with severe bleeding due to a major trauma, childbirth or surgery, symptoms can be quite abrupt and dramatic. They include fatigue, dizziness when standing, rapid pulse, shortness of breath, inability to exercise, and even confusion.

What causes anemia?

The word anemia comes from Latin: an — not; emia — blood. It describes a reduction in the number or quality of red blood cells circulating in the blood stream. This is measured by blood tests of:

  • hemoglobin concentration (Hgb)
  • hematocrit (Hct)
  • red blood cell concentration (RBC).

Hemoglobin is a major part of red blood cells. Its job is to carry oxygen to all of the tissues in the body. When hemoglobin is reduced, or if it is abnormally formed and does not work properly, all cells in all of the organs and tissues struggle to get enough oxygen. Oxygen is essential to every function of the body. Your heart needs oxygen to beat, your brain to think, and your lungs to breathe. Without enough oxygen, important parts of the body can be damaged and may even die. As it is the hemoglobin in blood that carries oxygen to tissues, an adequate amount of healthy hemoglobin is essential.

About gradual anemia

Gradual anemia comes from a slow reduction of hemoglobin. The two most common causes of this reduction are:

  • Eating too little of or being unable to absorb the building blocks of hemoglobin; iron, vitamin B12, and folate.
  • Gradual or chronic blood loss; this can come from heavy menstrual periods, repeated severe nosebleeds, heavy bruising (bleeding into the tissues), bleeding from the gastrointestinal system (from celiac disease, stomach ulcers or bowel polyps), and frequent blood donation.

Other causes include:

  • Chronic disease; kidney disease, chronic infection, alcoholism, inflammatory bowel disease, some rheumatologic diseases, thyroid disorders, and androgen deficiency are among the culprits.
  • Disorders of the bone marrow (where red blood cells are created) - this includes types of leukemia, effects of some drugs, and cancer chemotherapy.
  • Inherited disorders of red blood cells; such as thalassemia and sickle cell disease.
  • Destruction of blood cells by certain diseases; malaria, severe infections, and rare immune destruction can all reduce the number of blood cells.

Your doctor has many tests that can pinpoint the cause of your anemia. Identifying the cause and starting proper treatment is very important.

Is your diet the problem?

Iron, vitamin B12 and folate are the building blocks of hemoglobin. Getting too little of them can cause anemia. Including more of these nutrients in the diet (and perhaps using supplements) can treat it.

Iron: The most concentrated natural source of iron in the diet is red meat (beef, pork, bison), and organ meats (beef kidney and liver). A valuable source of added iron is in fortified cereals (such as Cream of Wheat‚Ñ¢). Dried peas and beans, such as chickpeas, kidney beans, lentils and white beans, are moderate sources of iron, as are almonds, peanuts, and dried prunes.

A word of warning: More cases of iron deficiency anemia are appearing where poultry and fish are used as the main sources of animal protein in the diet. It also happens in those who follow a vegetarian diet without being mindful of the need for adequate iron. While vegetarian sources of iron are available, the body is less able to absorb them. To get more iron from non-meat sources, eat larger quantities along with high vitamin C foods such as tomato or citrus. Young women with heavy menstrual periods and a vegetarian diet are at great risk of iron deficiency anemia.

Vitamin B12 (cobolamin): The most concentrated sources of this important vitamin are seafood, fish, liver, and red meats. It is also added to fortified cereals and flour. Vitamin B12 requires stomach acid to be properly absorbed. Certain people may have difficulty getting vitamin B12 from food or vitamin supplements, including:

  • those with a stomach ailment that requires medication to lower stomach acid
  • about half of people over age 50, since stomach acidity reduces as we grow older
  • and those who have pernicious anemia, a condition where B12 from the digestive system cannot be absorbed.

For these people, higher doses of oral supplements or vitamin B12 by injection may be necessary.

Folate (folic acid): The best sources of folate are asparagus, dried peas, beans, lentils, and dark green leafy vegetables such as spinach, broccoli, and turnip greens. Folate is also added to many fortified grains and cereals in Canada.

As both vitamin B12 and folate are water-soluble vitamins, they do not store well in the body. You need to eat an adequate amount every day.


If anemia is due to sudden blood loss or cannot easily be corrected by improving the diet, supplements may be necessary.

How much iron should I aim for?

Age Daily intake goal* Do not exceed
Men 19 and older 8 mg 45 mg
Women 19-50 18 mg 45 mg
Women 51 and older 8 mg 45 mg
Pregnant women
19 and older
27 mg 45 mg
Breastfeeding women
19 and older
9 mg 45 mg
*This includes sources of iron from food and supplements.
Go to Dietitians of Canada website and search ‚'Food Sources of Iron' to see other tables that list iron sources.

Iron supplements: These should generally only be taken on the advice of a health care provider, as side effects, effectiveness, and toxicity must be monitored. Iron supplements are almost always kept behind the counter at the pharmacy because of such concerns. To make sure your levels are adequate, your doctor will want to check the hemoglobin and body iron levels after you have taken the supplements.

Tips for taking oral iron supplements

  • Avoid enteric-coated iron tablets, as they can pass through the whole digestive system without dissolving.
  • Do not take food, tea or coffee, milk, antacids or calcium supplements at the same time as iron tablets.
    These substances interfere with the amount of iron your body can absorb. Instead, take the iron supplement an hour before or two hours afterward.
  • Iron is absorbed best in an acidic environment. At the same time that you take the supplement, include a 250-milligram (mg) vitamin C tablet or a glass of orange or tomato juice.
  • Several effective forms of iron supplement can be taken by mouth. You will want to check the amount of elemental iron in the tablet or liquid. This is the amount of actual iron that the body can use. Each iron formulation has a different percentage of elemental iron. For instance, a ferrous sulfate 325 mg tablet contains 65 mgs of elemental iron. A 325 mg ferrous gluconate pill contains only about 30 mgs of elemental iron. You will need to take two tablets of ferrous gluconate to get the same dose of elemental iron in one tablet of ferrous sulfate.
  • The recommended daily dose of elemental iron for adults with iron deficiency is 150 to 200 mgs per day.
    Iron supplements are well known to cause stomach and bowel side effects for some people, including nausea, stomach upset, and constipation or diarrhea. If this happens, there are a few ways to find the most tolerable dose. First, try reducing the number of doses of iron taken in a day. You might also use a tablet with a lower elemental iron concentration or a liquid formula. Any of these measures mean you must take the iron supplement for more days, but this is often much more acceptable.

Vitamin B12 (cobolamin) supplements: Most people do very well taking vitamin B12 supplements by mouth, unless they have a severe shortage of stomach acid or pernicious anemia. Since B12 is a water-soluble vitamin, overdosing on it is almost impossible. However, if your anemia is due to vitamin B12 deficiency, the doctor will test to ensure the level improves. While B12 is not as carefully controlled at the pharmacy, this supplement is still best taken under supervision.

At one time, it was thought that B12 needed to be given by injection to achieve adequate levels. We now know that for most people, oral supplements of 1000 to 2000 micrograms (mcg) per day are enough to restore the body.

If B12 must be rapidly replaced in the system, the injectable form may still be used. This method is often needed when severe vitamin B12 deficiency is causing problems in the nervous system.

Folate (folic acid) supplements: Folate is another water-soluble vitamin, so overdosing with it is unlikely. It also requires daily supplements to build levels in the body.

Generally, one mg of folate daily will be enough to replace a folate deficiency. Rarely, a doctor may recommend up to five mg of folate daily, but this dose should only be taken with a doctor’s recommendation.

Treatment of other causes of anemia

Usually therapy first treats the cause of the anemia, and in some cases stimulates the body to make more red blood cells.

When anemia is severe or cannot be cured, blood transfusions are necessary to replace red blood cells so that the tissues and organs of the body can survive.

While anemia is common, its causes are many. It may be the first sign of a serious illness or condition. If you suspect you have anemia, see a doctor for a correct diagnosis and get on track with the right treatment. To prevent the most common anemias, eat a healthy, varied diet including iron, vitamin B12, and folate.

FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2019, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1    [WH_FHd11]
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