Have you been feeling tired and listless for no particular reason? It could be stress, depression or, most likely if you're a woman, the ubiquitous but very fixable anaemia.
Stress is fairly easy to measure, you need to accept that your brain is on a multitasking overdrive and look for physiological and psychological ways to wind down. Depression, too, is usually accompanied with other signs such as sleeplessness, anxiety and mood swings, and can usually be discounted if tiredness is the only symptom.
This leaves out anaemia, which usually gets missed unless it pops up in a blood test report. In people otherwise healthy, even mild anaemia can cause tiredness, headache, dizziness, fatigue and lack of concentration, with pale skin, nails and gums being the only visible and overlook-able symptoms.
Anaemia affects more women than men, with pregnant women, lactating mothers and adolescent girls being at most risk. In India, three in five women have haemoglobin - the oxygen-carrying iron-containing protein in red blood cells - counts below the recommended healthy level of 13 gm/dl. So common is anaemia among women that many physicians regard 12 gm/dl as the "Indian healthy normal."
One in seven meet the textbook definition of "severely anaemic", with haemoglobin levels below 7gm/dl. Yet, very few women do anything about it. For haemoglobin below 7gm/dl, physicians in developed countries prescribe iron, vitamin B12 and folate supplementation. Some even consider blood transfusion. But not in India. Here we prefer the natural route of a few spoonfuls of honey or an apple a day, which does nothing to push up your haemoglobin counts.
Low haemoglobin lowers the blood's capacity to carry oxygen to the cells and organs, leaving you feeling sluggish and tired. In acute cases, the body puts pressure on the heart to compensate for the oxygen deficiency, leading to palpitations, chest pain and aggravation of existing heart problems. Extreme anaemia over time may even enlarge the heart, which can lead to heart failure.
It's an easily avoidable cause of maternal deaths. According to the National Family Health Survey 3, anaemia causes one in five pregnancy-related deaths, triples the risk of premature delivery and low-birth weight babies and increases risk of foetal death nine-fold. Anaemia during pregnancy can hurt the baby by causing irreversible brain and developmental damage.
Though iron deficiency may be because of an inherited disorder (sickle-cell anaemia); digestive disorders such as Crohn's disease or Celiac disease; worm infestations; chronic dieting; the metabolic stress of pregnancy and lactation; weight loss or intestinal surgeries; certain medications or alcohol abuse; the most common cause is low dietary intake of iron, B12 and folate, which are essential for haemoglobin production in the bone marrow.
A lesser known trigger is air pollution from use of biofuel, report researchers in the journal Annals of Epidemiology. This happens because carbon monoxide and other pollutions from incomplete combustion bind to and reduce the available amount of haemoglobin for oxygenation. Some toxic compounds in smoke also directly destroy red blood cells.
If the deficiency is not acute, an iron-rich diet is enough to push haemoglobin levels over the recommended 13 gm/dl. The best sources are foods with a high iron content and high iron bioavailability, which means the iron in the food can be easily absorbed by the body.
Haem iron - from animal sources such as red meat, chicken, liver, shrimp, oysters and eggs - is best absorbed, with 15-35% being utilised by the body as compared to the 2-10% from iron found in fortified cereals, legumes, leafy vegetables, dried peas, beans, dried apricots and raisins.
Cooking in an iron pot or pan pushes up iron-content in cooked food while having vitamin C with your meals - fresh lemon or citrus fruit juice, for example - increases iron absorption from vegetarian food by making the stomach more acidic. Tea, coffee and other caffeine drinks lower absorption, so it's a good idea to say no to coffee right after dinner.
Unless you are deficit - found from a simple complete blood count, which should be done once a year - don't take supplementation as an overdose may cause nausea, vomiting, diarrhoea, irritability and joint problems. Those with acute deficiency need supplementation for up to one year, so if you haven't already, consider getting your haemoglobin levels tested right away.