An enthusiastic weight-watching colleague on a perpetual near-starvation diet confessed last week that her haemoglobin — the oxygen carrying, iron containing protein in red blood cells — count was a startling low, 7 gm/dl. The normal should be over 13 gm/dl.
Since that number falls in the textbook definition of 'severely anaemic', I asked her if she'd done anything about it. She informed me she ate an apple and a beetroot each morning to treat it. That, it appeared, was the prescription given by her family physician.
All physicians in the West would have prescribed iron, vitamin B12 and folate supplementation to boost haemoglobin, with some even considering blood transfusion. But not in India. Here we prefer the natural route of an apple a day, even when what you need is a truckload a day to get anywhere near healthy.
Low haemoglobin reduces the blood's capacity to carry oxygen to the cells and organs, making you sluggish and tired. In acute cases, the body puts pressure on the heart to compensate for the oxygen deficiency, causing palpitations, chest pain and aggravation of existing heart problems. Extreme anaemia may even enlarge the heart, which can lead to heart failure.
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 more visible symptoms.
Iron-deficiency anaemia affects all ages across gender, with pregnant women, lactating mothers and adolescent girls being the most affected. More than half (57.8%) of pregnant women have anaemia, with 13% being severely anaemic like my colleague (haemoglobin levels below 7gm/dl).
According to the National Family Health Survey 3 (2005-06), 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. Mother's anaemia may also lead to irreversible brain damage and poor development in the baby.
The most common cause is low dietary intake of iron, though a new study on Saturday reports that people in countries that use a lot of biofuel — burning wood, straw, dung and other natural materials — have higher levels of anaemia. The reason, said researchers in the journal Annals of Epidemiology, is that the carbon monoxide and other pollutants from incomplete combustion bind to and reduces the available amount of haemoglobin for oxygenation. Some toxic compounds in smoke destroy red blood cells directly.
If the deficiency is not acute, then 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 iron bioavailability, which means the body absorbs the iron easily.
Haem iron — from sources such as red meat, chicken, liver, shrimp, oysters and eggs — is better 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 pushed up iron-content in the cooked food while having vitamin C with your meals — fresh lemon or citrus fruit juice, for example — makes the stomach acidic and enhances non-haem iron absorption. Tea, coffee and other caffeine drinks lower absorption, so it's a good idea to have your after-dinner coffee an hour later.
Unless you are deficit — found from a simple blood count — avoid popping iron tablets without prescription as an overdose may cause nausea, vomiting, diarrhoea, irritability and joint problems. Those with acute deficiency, such as my weight-obsessed colleague, need supplementation for up to one year.