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Winnipeg Free Press - ONLINE EDITION
Even healthy people get anemia
Q: My doctor recently told me that I have anemia. I was surprised to hear that because I thought only really sick people got anemia. How does one get anemia?
A: You are striving to be the picture of health. Your lifestyle habits are on the right track: getting regular exercise, avoiding junk food, watching your weight — all the smart choices to keep yourself full of energy and vitality. So, with everything going your way, how could you possibly get anemia?
What is Anemia?
Anemia is a condition where we lack enough red blood cells. Red blood cells contain a protein called hemoglobin, and iron is part of hemoglobin. Oxygen attaches to hemoglobin, and this is how we get oxygen to our tissues. If we lack red blood cells, we lack oxygen supply to the tissues, and fatigue ensues.
Anemia is often associated with those who are sick with a chronic illness or cancer. However, anemia — especially iron-deficiency anemia — is a common problem that occurs in healthy individuals. Young or old, marathon runners or yoga enthusiasts, men, women or children, anemia can occur across a broad spectrum of individuals.
A Balancing Act
A lack of red blood cells can result from red blood cell destruction (genetic conditions such as sickle cell anemia), blood loss or decreased red blood cell production (usually from iron deficiency). Iron-deficiency anemia is the most common type of anemia, with 10 per cent of women in North America experiencing this problem. Every day, our bodies balance out iron levels with the amount lost through our gut equalling the amount absorbed, so we do not become deficient. However, if the body requires more iron or loses more iron then we can supply, then a deficiency can occur.
Women of reproductive age account for the majority of cases of iron-deficiency anemia. Pregnancy increases the demand for iron and breastfeeding resulting in more daily iron loss. A large blood loss with delivery can also lower iron levels. Blood loss from heavy menstrual cycles is a common source of iron loss. If you couple this with poor iron intake, then iron-deficiency anemia can occur in an otherwise very healthy female.
Anemia in men and women who do not menstruate is less common and it can be a sign of various medical conditions from ulcers to cancer to celiac disease, to name a few possibilities. Certain drugs such as anti-inflammatories and alcohol can lead to stomach bleeding and iron loss.
Diagnosis
Iron-deficiency anemia can occur very gradually, so you may not notice any symptoms except an increase in fatigue. If you suffer from stress, lack of sleep or depression, it can be difficult to notice that your fatigue could be a sign of another problem like anemia. To get to the point where you feel symptoms from iron-deficiency anemia, your body has to be near depletion of storage supplies of iron located in the bone marrow, spleen and liver. Other than fatigue, you may feel light-headed, look pale, have palpitations and become more irritable. Some individuals may even crave ice and chew it several times per day.
Usually a blood test can be helpful, along with your history, to detect iron-deficiency anemia. It is possible to pick up low storage levels of iron even before your red cell count falls.
The exception is in those with infection, inflammation, cancer or liver problems, where storage iron may test high or normal even with an iron deficiency. Other tests are then required to confirm an iron-deficiency anemia.
If you are a vegetarian or lack ironrich foods in your diet, other causes of iron-deficiency anemia should be excluded before it can be concluded that it is a dietary issue.
Fixing The Problem
Treatment of iron-deficiency anemia really depends on the cause of the anemia. If the anemia is due to a chronic condition, cancer or alcohol abuse, then these conditions need to be treated, not just supplemented with iron. For excessive menstrual bleeding, certain medications, such as the birth-control pill, are sometimes used. If there is a lack of iron-rich foods in your diet, then these should be added. Good choices include red meats, beans, green peas and fortified cereals. The animal sources of iron are better absorbed than non-animal sources. Iron absorption can be helped by consuming vitamin C (juices or fruit) with your iron foods. Consuming animal sources of iron with non-animal iron sources will aid the absorption of the non-animal iron sources as well. Foods that decrease iron absorption include antacids, tea, coffee, dairy, calcium and some vegetables.
You can find more info about iron-rich foods from registered dietitians at heatlthcastle.com, with the link: www.healthcastle.com/iron.shtml Iron supplementation is recommended when iron storage is very low or red cell count is low, resulting in anemia. Most iron therapy is taken for about four months or longer. Although iron is taken in a pill form, it is not advisable to self-diagnose anemia and self-prescribe iron therapy. Like many medicines, iron can be dangerous when an excessive amount is consumed. Once treated, you should have a repeat blood test to confirm that your red cell count and iron storage levels are back to normal. The bottom line is that if you have any symptoms of anemia, see your doctor. Even if you feel fine, early anemia can be detected with periodic blood tests ordered by your doctor when you go in for your checkups.
Dr. Maureen Kennedy MD, CCFP, FCFP, Dip. Sport Med., is a Sport and Exercise Medicine Physician at the Sport MB-Sport Medicine Centre and the Reh-Fit Centre in Winnipeg.
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About Dr. Maureen Kennedy
Born and raised in The Pas, Dr. Kennedy graduated from the University of Winnipeg Collegiate, earned a BSc and BA from the University of Winnipeg and an MD from the University of Manitoba in 1994. After certifying in family medicine at the University of Manitoba, Dr. Kennedy was awarded a two-year fellowship in primary care sport medicine at the University of Calgary Sport Medicine Centre. She completed this fellowship along with a MSc in Kinesiology at the University of Calgary. Her research focus was exercise counselling by family physicians. Dr. Kennedy further explored the use of exercise in medicine with PhD projects examining aerobic exercise in individuals scheduled for total hip or knee replacement surgery. She holds a diploma in sport medicine from the Canadian Academy of Sport Medicine and has served on numerous provincial and national committees for organizations such as the Alberta Medical Association, Canadian Academy of Sport Medicine, College of Family Physicians of Canada and Canadian Society for Exercise Physiology.
For the past 11 years, Dr. Kennedy has practised as a consultant in primary care sport medicine.
Dr. Kennedy's practice focuses on the diagnosis and treatment of injuries, muscle, bone and joint problems, orthopedic triage, weight management, osteoarthritis and dance medicine. She has served as the head physician for Alberta Ballet for the last nine years and has worked with the national women's hockey team along with many elite and amateur athletes in various sports. She points out that sport medicine physicians provide a tremendous service to the general public and the health-care system by shortening orthopedic waiting lists and providing non-surgical treatment options. "It's great to be back home in Manitoba and Winnipeg is a fantastic city," she adds. Readers can expect coverage on a wide range of fitness and health topics, including insider's tips on how to navigate the health-care system.
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