Anemia: Its Two Faces



ALMOST 10 PERCENT OF WOMEN in the United States are iron-deficient, according to the CDC, and low iron is the most common nutritional deficiency in the U.S., according to Stephanie Watson on WebMd.

At my last physical exam, among all the blood test results, the only one my doctor mentioned doing anything about was iron, measured by the level of ferritin — a protein that stores the body’s iron and releases it in a controlled fashion, to make up for the iron our bodies lose constantly in the course of daily bodily functions: “urination, defecating, sweating and sloughing off skin cells,” as well as bleeding.

My ferritin level was 13 ng/ml, in a normal range of 10 to 291, according to my printout, although my doc said that a better “normal” for women is 18 to 160. A web literature search on HealthBoards found different sources citing “iron depletion” levels that ranged from less than 12 to less than 20 — and referred to a British Medical Journal study that showed iron supplements helped alleviate fatigue in women whose levels measured as much as 50.

Iron is necessary for the body to produce hemoglobin, the component of red blood cells that carries oxygen from the lungs to the heart and the rest of the body – as well as for many other bodily functions. The end result of prolonged iron deficiency is anemia, which occurs when either the number of red blood cells is too low or those blood cells contain too little hemoglobin.

In the evolution of iron-deficiency anemia, ferritin levels fall first, followed by hemoglobin (below 12 g/dl is considered anemic) – for which the first signs can be pale or sallow skin, fatigue and difficulty exercising due to muscle weakness. Other symptoms include paleness in the palms of the hands and eyelids, caused by the decreased levels of oxygenated, red-colored hemoglobin; cold hands and feet; restless leg syndrome; a sore tongue; difficulty swallowing; and heart failure.

When my second child was three months old, his terrible colic made it hard for me to sleep, and I developed a staph infection accompanied by anemia – about which that doctor informed me with a very stern look. Also sternly, he told me I must take iron supplements every day, and I must get retested before stopping them. I was definitely tired, but unsure about how seriously to take his warning and apprehensive about the main side effect of iron supplements: constipation. By the time I got retested, the colic was finished. I was better rested, and my levels were fine.

Until menopause, women need 18 mg. of iron/day, while post-menopausal women and men need only 8 mg. Iron levels can be boosted by diet — red meat, liver, egg yolk, shellfish, beans, nuts and cereal that is fortified and/or contains bran. Increasing vitamin C levels can enhance the body’s ability to absorb iron, while milk and cheese can limit absorption. Vegetarians might need to take iron supplements because the iron found in plants is absorbed less well by the body than that in meat.

Anemia does, however, have another face. In people infected with malaria, tuberculosis or HIV, the body appears programmed to reduce iron production “so that bacteria or viruses don’t have enough of this nutrient to grow,” Marta Zaraska wrote in the Washington Post.

High intake of dietary iron has also been linked to colon cancer. Too much iron can disturb  “the delicate balance of bacteria in the gut,” according to Zaraska. She quotes Dr. Ryan Zarychanski at the University of Manitoba saying “anemia is a body’s genetically programmed response to illness” and calling it “our innate antimicrobial strategy.” Zarychanski believes the anemia that commonly accompanies cancer, heart disease and autoimmune disorders “helps us fight illness.”

The World Health Organization stopped recommending iron supplements for children in malaria-infected areas. More startling, a 2008 trial showed that bloodletting decreased cancer risk among otherwise healthy people with peripheral artery disease. The great hope for treatments that involve reducing iron levels is to combat antibiotic-resistant bacteria.

My doc’s advice: stop my once-a-day aspirin, which could be causing minute amounts of bleeding – though my main reason for taking it was familial risk of colon cancer, which might be countered by low iron levels. Also: take iron gluconate supplements, but only twice a week to reduce the risk of constipation. My personal effort: occasionally adding clams to my pasta.

–Mary Carpenter