Anemia is a disorder caused by the reduction of hemoglobin in the blood.
Hemoglobin is directly related to red blood cells, which in turn are an expression of the hematocrit (corpuscular part of the blood). In the case of anemia, the latter may undergo a negative change, confirming the diagnosis.
In the most serious cases: splenomegaly, related pains and slight hypothermia; a further indication is the fragility of the nails.
Anemia can be differentiated based on etiopathogenesis. The forms that mostly depend on the diet are:
- Iron deficiency anemia: iron deficiency
- Pernicious anemia: lack of cobalamin (vitamin B12) and / or folic acid.
Because of menstrual losses, anemia is more common in fertile women than in pre-pubescent or menopausal age and in men.
Anemia can be triggered by inappropriate diets and worsened by certain special conditions (extreme physical activity, etc.).
What to do
Since anemia causes quite general symptoms, first of all it is necessary:
- Consult your doctor, who will prescribe a complete blood test.
- Evaluate any blood loss or other forms of hematocrit depletion:
- Some not obvious pregnancies.
- Excessive menstrual cycle.
- Motor activity that affects the integrity of red blood cells.
- Gastro-intestinal blood loss
In case of positive diagnosis:
- Contact a dietitian for a food history in order to verify the nutritional balance of the diet. They must be evaluated:
- Total iron intake:
- The percentage of bio-available iron:
- The best is the "emic" one.
- Non-emic iron is classified into:
- Ferrous (2+), poorly absorbed.
- Ferric (3+), almost totally NOT absorbed.
- Vitamin C intake: necessary for the conversion of ferric iron into ferrous; it increases their bioavailability.
- The presence of other compounds that improve the absorption of ferric iron:
- Citric acid: typical of sour fruit such as lemon.
- Fructose: typical of fruit and vegetables.
- The presence of anti-nutritional factors:
- Excess fiber.
- Excess of phytates.
- Excess of oxalates.
- Excess of tannins.
- Excess of ethyl alcohol.
- Vitamin B12 (cobalamin) intake: necessary for erythropoiesis.
- Folic acid intake: also necessary for erythropoiesis.
- If the cause is food-related, the dietician will (as far as possible) correct the nutritional scheme in accordance with personal needs (veganism, vegetarianism, Hindu religion, Buddhist etc.).
- If anemia does not heal, it becomes necessary to go back to the doctor and look for other responsible causes such as:
- Thalassemia.
- Hereditary disorders.
- Hepatic or renal insufficiency.
- Gastric complications:
- A deficiency of hydrochloric acid (hypochloridria) inhibits intestinal absorption of iron.
- A deficiency of intrinsic factor inhibits intestinal absorption of vitamin B12.
- Intestinal complications, especially of the terminal ileum where vitamin B12 is absorbed.
- Other diseases that can compromise absorption such as:
- Celiac disease or celiac disease.
- Tropical sprue: it occurs during trips abroad. It is probably due to food poisoning and infestations.
- Inflammatory bowel disorders (Crohn's disease, rectum-ulcerative colitis): sometimes, they are also responsible for the surgical resection of a part of the intestine.
- Other diseases that can aggravate the symptoms of anemia (low blood pressure, hypoglycemia, etc.).
What NOT to do
In case of anemia it is not recommended:
- Ignore the doctor's recommendations.
- Practice intense and prolonged motor activity (if anemia is not compensated).
- Follow slimming or unbalanced low-calorie diets.
- Dedicate yourself to alcoholism.
- Ignore the dietitian's recommendations.
- Ignore the diagnoses of diseases that can cause or worsen anemia and / or its symptoms.
- Ignore a pregnancy, even if it is due to an abortion and the first few weeks.
What to eat
The diet against anemia is quite complex because different nutrients and food groups are involved. Below we will list the most important dietary recommendations:
- To guarantee the intake of iron, especially haem and ferrous (2+), it is necessary to eat:
- Muscle tissue: both of terrestrial and aquatic animals: horsemeat, bovine, swine, avian, fish, whole molluscs (also land snails), whole crustaceans etc.
- Eggs: any, especially the yolk.
- Offal and fifth quarter: mainly spleen and liver, but also marrow, diaphragm, heart, etc.
- To ensure the supply of vitamin C, citric acid and fructose, it is necessary to eat:
- Sweet and sour fruit: lemon, grapefruit, orange, mandarin, kiwi, cherries, strawberries etc.
- Vegetables and tubers: parsley, pepper, lettuce, spinach, radicchio, broccoli, tomato, potato etc.
- To ensure the intake of vitamin B12 (cobalamin) it is necessary to eat:
- The same foods source of heme iron
- To ensure the intake of folic acid it is necessary to eat: liver, vegetables (eg tomatoes), sweet fruit (orange, apple, etc.) and legumes (eg beans).
NB . Vitamin C or ascorbic acid is a thermolabile molecule and is degraded by cooking. This means that to ensure their intake it becomes necessary to consume many raw foods. Moreover, being involved in the absorption of low-available iron, it is important that it is taken with specific foods.
Remember that certain foods may contain anti-nutritional principles that reduce iron absorption. To reduce its content, you need to practice:
- Soaking.
- Fermentation (yeasts or bacteria).
- Cooking.
NB . Since cooking inhibits the nutritional principles but limits the availability of thermolabile vitamins, it is recommended that raw and cooked foods are equally present in the diet.
It is advisable to reserve heat treatment especially for legumes and cereals, while most fruits and vegetables could be eaten raw.
What NOT to Eat
The foods not to be eaten in the event of anemia are those that lose certain nutrients or that contain too many anti-nutritional principles:
- Private foods of important molecules: cooked and / or preserved vegetables, fruits, potatoes and legumes. They tend to drastically reduce the concentration of vitamin C or ascorbic acid and folic acid.
- Foods that contain too many anti-nutritional principles:
- Dietary fibers: they are essential for the health of the intestine but in a quantity of about 30g / day. In excess (especially over 40g / day) they can trigger a laxative effect, produce liquid stools and expel most of the nutrients taken with the diet; among these also iron.
- Phytic acid and phytates: they tend to chelate iron preventing intestinal absorption. They are very abundant: in the skin of legumes, in the skin of cereals (bran) and in certain oily seeds (eg in sesame).
- Oxalic acid and oxalates: like the previous ones, they tend to bind iron hindering intestinal absorption. They are rich: the peel of cereals, spinach, rhubarb, etc.
- Tannins: also with chelating power, although they are also antioxidants, they can hinder the uptake of iron. They are present: in wine, in tea, in fruit seeds (eg grapes, pomegranate, etc.), in persimmons and unripe bananas, in cocoa, etc.
- Calcium: it is essential for the body but, at intestinal level, it comes into conflict with iron absorption. Foods rich in iron and calcium should be taken at different meals. Those that abound in calcium are mainly milk and derivatives.
- Alcoholic: ethyl alcohol is an anti-nutritional molecule and hinders the absorption of all nutrients, including iron, vitamin C, folic acid and cobalamin.
Natural Cures and Remedies
The natural remedies for anemia are few and are limited to taking food supplements with single or combined molecules:
- Iron.
- C vitamin.
- Folic acid.
- Cobalamin.
A natural remedy against anemia that was very popular in the Middle Ages was solid iron (today it is not recommended for practice):
- Spiked apple: the apple is enriched with iron thanks to the reaction between it and the food acids. It is produced by sticking the nails into the apples and removing them after one or two days, before consuming the fruit.
We also remember that:
- It is not always recommended to take natural teas; regardless of the presumed function, many of them bring certain anti-nutritional molecules of which we have already spoken.
Pharmacological care
Orally, intramuscularly or intravenously they can treat both iron deficiency and pernicious anemia.
The most common treatments for iron deficiency anemia are:
- Ferrous salts: taken orally, in some cases they cause side effects such as heartburn, abdominal cramps, constipation or diarrhea.
- Ferrous sulfate (es Ferrograd): is the product of the elite for the treatment of pernicious anemia. It is effective and has few side effects.
- Iron dextran: injectable.
- Iron fumarate (eg Organic Iron): available in solution to be taken orally.
- Iron gluconate (eg Sidervim, Cromatonferro, Bioferal, Losferron): available in effervescent tablets.
- Carbonyl iron (eg Icar): available orally.
- Saccharate iron (eg Ferrum Hausmann Orale, Venofer): available for oral use.
- Haemopoietic growth factors: they are useful when iron deficiency anemia depends on renal failure or cancer.
Against pernicious anemia, injections based on folic acid and cobalamin are mainly used.
Prevention
The prevention of anemia is exclusively food-based.
It is advisable:
- Follow a varied but specific diet:
- With foods rich in iron heme and cobalamin:
- About two portions of meat per week (150g each).
- About two portions of fishery products per week (150-200g each).
- About two or three eggs a week.
- About three or four servings of dried vegetables and as many of whole grains, soaked or fermented and well cooked per week (from 80g each).
- With foods rich in vitamin C, citric acid and folic acid:
- Two portions per day of fresh medium raw sweet fruit (100-200g each).
- Two servings per day of fresh raw vegetables (100-200g each).
- Avoid the association of foods containing iron and heme with foods containing excessive amounts of phytic acid and phytates, oxalic acid and oxalates, tannins, calcium, ethyl alcohol and dietary fiber.
If one of the causes of anemia recognizes an excessively prolonged and intense aerobic physical activity (for example the endurance race), it is necessary:
- Reduce activity or try to improve diet / integration.
Medical Treatments
In addition to diet, supplements and drugs, some more challenging remedies like:
- Blood transfusions: in particularly severe cases it is possible to proceed with a blood transfusion.
- Oral contraceptives: in the case of particularly abundant menstruation the risk of iron deficiency anemia increases considerably, given the conspicuous amount of blood lost due to hypermenorrhea. By regulating menstrual flow, oral contraceptives could be a possible therapeutic option.
- Possible surgical procedures to resolve bleeding (eg for varicose veins of the digestive tract, gastric ulcer, etc.) or bleeding polyps: they are responsible for the occult or visible loss of blood in the stool and consequent anemia.
