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Not red enough

Anaemia is a condition due to the lack of red blood cells in blood.

WHEN a young woman comes into my clinic, appearing pale and complaining of fatigue, weakness and lightheadedness, my first suspicion is usually iron-deficiency anaemia. Anaemia is a condition where the body does not have enough red blood cells. In many women, especially Asian women, it is caused by iron deficiency in the diet.

There are also other types of anaemia, caused by haemolysis (destruction of red blood cells), such as in patients with sickle cell disease or thalassaemia, or anaemia caused by other deficiencies (for example, vitamin B12 or folate). As many as 25% of pregnant women and 19% of adolescent girls in Malaysia have some form of iron-deficiency anaemia.

How red blood cells are made

Iron is very important for making red blood cells. Without adequate iron, your body does not produce enough red blood cells. This is cause for concern because red blood cells contain a protein called “haemoglobin”, which is responsible for carrying oxygen to the rest of the body. When the body has a low red blood cell count, that means there is not enough oxygen getting to the tissues, muscles and organs of the body.

You need an adequate supply of these red blood cells to perform daily physical activities and maintain overall well-being, as oxygen is essential for muscles to burn calories from food and convert them into energy. That is why someone with low iron often feels tired and weak, and experiences a host of other health problems.

Many factors contribute to a woman’s risk of becoming anaemic. They include a diet low in iron, restricted calorie intake, eating disorders, heavy menstrual flow, pregnancy and lactation, and blood donations. A woman who suffers from bleeding in the gastrointestinal tract – sometimes caused by excessive use of anti-inflammatory medications such as aspirin and ibuprofen – may also suffer from anaemia.

Women and anaemia

Women are more prone to suffering from anaemia, but it is certainly not because they are the “weaker sex”! Women lose more iron than men due to menstrual blood loss. Thus, women need nearly twice as much iron in their diet (18mg per day) compared to men (10mg per day). Women who are athletes may also have increased iron needs, by up to another one to two milligrams per day.

I mentioned earlier that Asian women are particularly prone to iron-deficiency anaemia. The reason is because Asian diets do not contain as much red meat, such as beef and lamb, which are the richest food sources of iron. Along with fatigue, dizziness, lightheadedness and paleness of skin, the other symptoms of low iron and anaemia are irritability, difficulty concentrating and loss of appetite. Anaemia can also be present in children. However, it is often overlooked because symptoms like difficulty concentrating are sometimes blamed on the child’s age or naughtiness.

Low iron or anaemia?

Just because a woman has low iron levels doesn’t necessarily mean she has anaemia. And certainly, not every women who appears pale, tired and weak is anaemic. Furthermore, mild iron deficiency and mild anaemia may not produce any significant symptoms.

How can you tell whether you have anaemia or just low iron levels? Your doctor should perform a blood test to measure the total blood cell count, the size and shape of the red blood cells, the rate of the new red blood cell production, the amount of iron present, and if necessary, an analysis of the haemoglobin.

Pumping iron

So how much iron do you need in your diet every day, and how do you get it? The 2005 Recommended Nutrient Intakes for Malaysia state that women from the ages of 19 to 50 need, on average, between 20mg and 30mg of iron per day (for 10% and 15% bioavailability, respectively). Admittedly, achieving this is not so simple. Asian women do not consume much lean red meat and organ meats, which are the best choices for iron that is easily absorbed (called “haem iron”). However, there are other animal foods that contain haem iron, such as fish and chicken.

Non-haem iron is found in plant foods, such as breads, cereals, vegetables, legumes and eggs. The amount of iron absorbed by the body from these foods is far lower than that from meats.

Here are some tips to increase iron in your diet:

>Consume high-haem iron foods at least four times a week.

>Choose processed food products that are fortified with iron, such as fortified bread or cereals.

>Avoid excessive intakes of substances that can block the absorption of non-haem iron such as large intakes of tea, coffee and fibre.

>Increase the absorption of iron from vegetable foods by adding small amounts of haem iron such as meat, fish or chicken. This can increase iron absorption as much as four times.

>Foods and beverages high in vitamin C such as citrus fruits and their juices can increase iron absorption from non-haem iron sources. Try drinking a glass of fruit juice with your breakfast cereal or adding a slice of lemon to your cup of tea.

It is important for women to be alert to symptoms of constant fatigue and weakness, as these could be signs of iron-deficiency anaemia. You should seek advice from your doctor if you suspect that you have anaemia.

Why go through life with tired blood, when you can pump some iron into your diet and get more energy?

The Star Newspaper, Sunday November 16, 2008

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