Anemia treatment, iron, supplement, vitamins, herbs and diet by Ray Sahelian, M.D.
April 21 2014

Anemia is one of the more common blood disorders. It an be defined as having less than the normal number of red blood cells or less hemoglobin than normal in the blood. Hemoglobin helps red blood cells carry oxygen from your lungs to all parts of your body. If anemia is left untreated, it could cause stress on body organs. Causes vary widely, but often include inherited disorders, nutritional deficiencies, infections, or exposure to a drug or toxic substance. Anemia is common with certain forms of kidney disease, especially once a patient is on dialysis, and when cancer patients take chemotherapy. Treatment depends on the cause and type of anemia. It could include iron pills or vitamin supplements. Symptoms range from mild skin paleness and fatigue to dizziness and lightheadedness.

Diet and food selection
The type of diet for anemia depends on the cause. In case of iron deficiency anemia, the diet should include foods that have a high iron content or a person can take an Iron pill supplement. Foods with high iron content include beef, turkey, seafood, chicken, and liver. IF the anemia is due to vitamin B12 deficiency, the diet above still applies since B12 is mostly found in meats. Consider a Vitamin-B12 supplement. On the other hand, if the anemia is due to folic acid deficiency, dietary sources of folic acid would include dark green, leafy vegetables, whole grains, beans and peas, nuts and seed, many types of fruits, liver and organ meats.

Symptom and sign
Symptoms of anemia vary depending on the severity of the condition. Anemia may occur without symptoms and be detected only during a medical examination that includes a blood test. When they occur, symptoms may include weakness and fatigue. These are the most common symptoms of even mild anemia; shortness of breath on exertion; rapid heartbeat, lightheadedness or dizziness, headache, ringing in the ears (tinnitus), irritability and other mood disturbances.

Types
There are several types of anemia each with its own cause:

Iron deficiency anemia
This is the most common type. Iron deficiency anemia happens when there is a deficiency of iron in the body. Iron is needed to make hemoglobin which can occur when a person loses blood from problems such as heavy periods, ulcers, colon polyps, or colon cancer. A diet that doesn't have enough iron in it can also cause iron deficiency anemia. Pregnancy can also cause iron deficiency anemia if there's not enough iron for the mother and fetus.
     Helicobacter pylori infection, which affects about one third of adults in the US, is associated with an increased risk of iron deficiency and related anemia. Moreover, this relationship holds true even in the absence of peptic ulcer disease, which can cause iron-deficiency anemia through hemorrhage. H. pylori infection has previously been found to cause stomach inflammation and most ulcers. The bacterium also increases the risk of stomach cancer. The presence of H. pylori infection raises the risk of iron deficiency and iron-deficiency anemia by 1.4- and 2.6-fold, respectively. H. pylori infection was also tied to other types of anemia, but to a much lesser extent. American Journal of Epidemiology, January 15, 2006.

Megaloblastic anemia
Also known as vitamin deficiency anemia. This most often happens when your body doesn't get enough folic acid or vitamin B-12. These vitamins help your body keep healthy blood and a healthy nervous system. With this type of anemia, your body makes red blood cells that can't deliver oxygen right. Folic acid supplements (pills) can treat this type of anemia. Sometimes, with this disease, your health care provider may not realize you're not getting enough B-12. This usually happens to someone with pernicious anemia, a type of autoimmune disease. B-12 deficiency may also be more common in people with other autoimmune diseases, like Crohn's disease. See Pernicious anemia below.

Pernicious anemia
This is caused by an inability to absorb vitamin B12 (cobalamin) that is naturally found in certain foods. These foods are all of animal origin and include meat, milk and dairy products, and eggs. Vitamin B12 is not found in plants. Although bacteria in the large intestine produce vitamin B12, it is not absorbed into the blood stream from this site. Most people need at least 3 micrograms of vitamin B12 daily. The average diet provides about 5 to 30 micrograms a day.

Is methylcobalamin appropriate for someone who has anemia and is vegetarian?
   Yes, methylcobalamin is a good form of this B supplement.

Anemia from chronic diseases
Certain diseases can hurt the body's ability to make red blood cells. For example, people with kidney disease, especially those getting dialysis (takes out wastes from your blood if your kidneys can't), are at higher risk for developing anemia. Their kidneys can't create enough hormones to make blood cells, and iron is lost in dialysis.

Inherited blood disease
If you have a blood disease in your family, there is a higher risk that you will also have this disease. One type of inherited blood disease is sickle cell anemia. Instead of having normal red blood cells that move through blood vessels easily, sickle cells are hard and have a curved edge. These cells cannot squeeze through small blood vessels and block the organs from getting blood. Your body destroys sickle red cells quickly, but it can't make new red blood cells fast enough. This causes anemia. Another inherited blood disease is thalassemia. It happens when the body is missing certain genes or when variant (different from normal) genes are passed down from parents that affect how the body makes hemoglobin.

Aplastic anemia
This rare problem happens when your body doesn't make enough red blood cells. Since this affects the white blood cells too, there is a higher risk for infections and bleeding that can't be stopped. This can be caused by many things.

Chin J Integr Med. 2007. Clinical study on effect of Astragalus Injection and its immuno-regulation action in treating chronic aplastic anemia. Sixty patients with CAA were randomly assigned to two groups equally, both were treated with Stanozolol three times a day, 2 mg each time through oral intake, but AI was given additionally to the patients in the treated group once a day via intravenous dripping. All were treated for 15 days as one therapeutic course and the whole medication lasted for more than 4 months totally, with follow-up adopted. The clinical efficacy was estimated and the changes of T-lymphocyte subsets in peripheral blood as well as the serum levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-2 (IL-2) were observed. Astragalus Injection could promote the recovery of hemopoietic function, which might be through improving T-lymphocyte subsets and reducing the release of negative regulatory factors such as TNF-alpha and IL-2 to alleviate the inhibition on hemopoietic function.

Anemia and heart failure
Many patients with chronic heart failure also have anemia, an association that has been increasingly recognized in recent years. Whether treating anemia will improve outcomes in patients with heart failure has yet to be determined, however. The decision to use an agent to treat anemia in heart failure should be made on a case-by-case basis.
     Anemia is found in about one-third of all cases of congestive heart failure (CHF). The most likely common cause is chronic renal insufficiency, which is present in about half of all CHF cases. However, anemia can occur in CHF without renal insufficiency and is likely to be due to excessive cytokine production. The anemia itself can worsen cardiac function, both because it causes cardiac stress through tachycardia and increased stroke volume, and because it can cause a reduced renal blood flow and fluid retention, adding further stress to the heart. Long-standing anemia of any cause can cause left ventricular hypertrophy, which can lead to cardiac cell death through apoptosis and worsen CHF. Therefore, a vicious circle, cardio-renal anemia syndrome, is set up wherein CHF causes anemia, and the anemia causes more CHF and both damage the kidneys worsening the anemia and the CHF further and increasing mortality. There is now evidence that early correction of the CHF anemia with subcutaneous erythropoietin and intravenous iron improves shortness of breath and fatigue, cardiac function, renal function and exercise capacity, reducing the need for hospitalization and improving quality of life. In the present review we discuss the data on current clinical use of erythropoietin in cardiovascular disease, with the main focus on the treatment of congestive heart failure, and summarize the advances and progress made in the understanding of the hematopoietic and pleiotropic effects of erythropoietin in the cardiovascular system.

Hemolytic anemia
This condition is caused by premature destruction of red blood cells. There are a number of specific types of hemolytic anemia, which are described individually. Causes include infection, some prescription medications, autoimmune disorders, and inherited disorders. It is defined as destruction of red cells in the bloodstream by a disease process. The list includes:

hemolytic disease of the newborn, usually caused by blood group incompatibility between mother and baby (ABO incompatibility, Rh factor incompatibility)
caused by abnormal red cell membranes, chiefly hereditary spherocytosis and hereditary elliptocytosis
caused by abnormal hemoglobin (the oxygen carrying molecule that fills the red cell); for example sickle cell anemia and thallassemia

Microcytic anemia
This is a result of insufficient hemoglobin synthesis. This type of anemia has many causes. Some of them are:

* Heme synthesis defect due to Iron deficiency or anemia of chronic disease
* Globin synthesis defect due to alpha-, and beta-thalassemia
* Sideroblastic defect from sideroblastic anemia.

Treatment
The treatment of anemia depends of the cause of anemia. It could be as simple as change in diet, iron supplements in case of iron deficiency anemia, or folic acid, or vitamin B12. If anemia is caused by a chronic underlying condition, the cause of that disease needs to be found and corrected.

Anemia drug warning
Doctors need to be more careful when prescribing anemia drugs since can increase the risk of death and other serious problems in patients with cancer and kidney disease. At issue are drugs sold under the brand names Procrit, Epogen and Aranesp. These anemia drugs are genetically engineered versions of a natural protein, erythropoietin, that increases the number of red blood cells. Recent studies that found using too much of the anemia medications increases the risk of death, blood clots, strokes and heart attacks in patients with chronic kidney failure. In other studies, patients with head and neck cancer had more rapid tumor growth if they used higher-than-recommended doses. Even when the anemia drugs were used at FDA-recommended doses, giving them to cancer patients not on chemotherapy increased the risk of death. Moreover, some doctors have begun giving the anemia drugs to patients following orthopedic surgery, also increasing the risk of blood clots. Amgen Inc. and Johnson & Johnson, companies that manufacture and market the drugs, both said they would work to inform doctors about the new warnings, outlined in a so-called "black box." The warnings are the most serious a drug label can bear. The FDA also said it would take a new look at how the anemia medication are marketed, including claims they can improve the quality of life of cancer patients. The Web site for Procrit, for example, says the drug "helps you find the strength you need."

Sickle cell anemia treatment
See sickle cell anemia information.

Questions
Have you heard anything about carao fruit also known as cassia grandis fruit extract for anemia and general vigor? Do herbs help?
   See cassia grandis web page. Herbs usually do not have a manor influence as a treatment for most cases of anemia.

Q. I've been getting your newsletter for the past few months, enjoy it and am quite impressed w/ your approach. I'm wondering about links between insomnia and anemia. I've had the kind of insomnia were I wake up around 5am all my life. I follow all the good sleeping habits, take light sleeping pills and not much makes a dent in this insomnia. Actually, I've had the best result w/ sitting meditation, tho my practice comes and goes. I've not been meditating every day lately and insomnia is flaring up. Today, I was unable to give blood at a blood bank because I am slightly anemic. They always say something to me about iron deficiency, so my iron levels are probably always on the low side. I've been eating liver several times a week for the last 2 months or so, so thought my iron levels would be ok. So, I started wondering if insomnia and anemia are linked. I'm looking on the web and sometimes see anemia listed as a cause of insomnia but don't see any more detail than that. I wonder if you could offer some insight.
   A. Insomnia may be caused by anemia, but this usually happens in those who have chronic kidney disease and have severe anemia. It is not likely that a mild case of iron deficiency anemia would be a cause of insomnia.

Do you have any supplements that improve hemoglobin without causing constipation?
    Before resorting to supplements, one has to determine the cause of the anemia, whether it is due to iron deficiency, vitamin deficiency, or other causes.

Can you talk about anemia because my husband's blood test came back showing he was anemic. He went to a hematologist who said it was from taking Nexium. He was told taking nexium reduces the benefits of vitamin intake and that could be one of the problems he was anemic, that was an interesting comment. I would imagine a lot of prescribed drugs also reduce vitamin intake not only from vitamins but vitamins from the foods we eat as well.
    There are many factors that cause anemia, and the use of medications is only one possible factor.

I am wondering if any of these supplements are likely to cause anemia (that is NOT due to an iron, B-12, or folic acid deficiency). EGCG 5-HTP chamomile scullcap white willow Revitalizing Sleep supplement that contains Valerian, Passionflower, L-Theanine, Hops, Wild Lettuce, and Jamaica Dogwood. I developed a low RBC, hematocrit, and hemoglobin, but a high MCV, MCH, and MPV. B-12 and folic acid are normal. The only supplements that I take that are different are the EGCG and the various other ones to help me sleep. I generally have 2 g. scullcap and 15. g chamomile every night, and I alternate small doses of the 5-HTP (50 mg) and Revitalizing sleep (1/2-1 capsule) every night. I sometimes use 2. g of white willow also. I realize that you cannot know my situation, but I am wondering if any of these supplements are likely to cause the low blood count. I really appreciate your knowledge and information.
   I am not aware of any studies that show this effect, but sometimes unusual reactions can occur in some people due to herbal product ingestion and the only way to find out for sure is to stop them for a few weeks and check to see if the blood count has improved.