Anemia is a condition with low levels of red blood cells, or hemoglobin in the blood. Hemoglobin is the part of red blood cells which contains iron. Red blood cells carry oxygen from the lungs to the body tissues, and then carry carbon dioxide back to the lungs where it is exhaled, therefore fatigue is a common symptom of various types of anemia. Other common symptoms are pallor and weakness.
Iron Deficiency Anemia
Anemia can occur when there has been excessive blood loss, for example during an operation or with heavy menstruation or conditions such as hemorrhoids. However, the most common factor leading to anemia is a deficiency of one or more specific nutrients including iron, vitamin B12 and folate/folic acid.
Iron deficiency anemia is one of the most common [i], and it is easily diagnosed through a serum ferritin blood test. To get optimal absorption of iron through food, it is best consumed with vitamin C, as they work synergistically together.
Vitamin B12 Deficiency Anemia
A vitamin B12 deficiency is usually due to an issue with absorbing B12, rather than a lack of B12 in the diet. B12 needs sufficient hydrochloric acid in the stomach and the efficient production of a compound called the intrinsic factor produced by the parietal cells in the stomach, which then binds with B12 for absorption at a site further down the small intestine. This type of vitamin B12 deficiency anemia is called Pernicious Anemia and is a subgroup of a Megaloblastic anemia producing enlarged red blood cells. All well as extreme fatigue, people may experience lack of concentration or focus and problems with memory and recall. Even though it is a water-soluble vitamin, vitamin B12 can be stored in the body for some time[ii], which is why it can take a while for symptoms to occur. Vegan diets are typically low in vitamin B12 and so either consumption of food choices such as algaes or supplementation may be helpful as a preventative measure.
Folate/folic acid (vitamin B9) deficiency is fairly common if there are not sufficient amounts consumed in food or if there is high alcohol consumption[iii]. Alcohol consumption often leads to a folic acid deficiency because it prevents proper absorption and metabolism of this nutrient amongst others and also causes the body to excrete more of it. Pregnant women also need higher levels of folic acid especially during the first trimester as it is imperative for healthy foetus development and prevention of neural tube defects[iv].
If a deficiency has been diagnosed, then addressing the diet is advised. This can be through additions of specific foods or food combinations in the diet and supplementation can be helpful in the interim to support this.
In relation to Iron Deficiency anemia, we need to consider intake of what is called heme and non-heme food intake, which are foods that contain iron whilst taking into account the food choices made by the individual. For example, foods high in heme iron which has the highest bioavailability are organic calf or lamb liver, various seafoods and lean meats which wouldn’t be on the menu for some. Examples of non heme iron which is less bioavailable but has lots of other nutritional properties include green leafy vegetables, white beans, lentils and organic tofu. As mentioned above, vitamin C greatly improves the bioavailability of non heme iron[v], so when consuming these foods, it can be helpful to include a little vitamin C alongside such as a little dash of lemon too. Good formulas of supplemental iron will include vitamin C for that reason and also include a non-constipating form of iron. Calcium and tannins from tea are another worthy consideration here as they can hinder the absorption of iron so keep these separate from your iron food sources if you are addressing low iron, or iron deficiency issues.
When it comes to vitamin B12 deficiency, food sources include animal meats, especially liver and kidney, eggs, cheese, fish are also good sources. Vitamin B12 found in sea vegetables is not utilized by the body well and therefore shouldn’t be used as an alternative for supplementing B12 if there is a deficiency. It might be necessary for someone with a B12 deficiency to have regular B12 injections and this will be decided by a medical professional. It is generally recommended that vegans supplement with vitamin B12 to prevent any deficiencies.
Food sources of folate/folic acid are organic liver (again), lentils, dark green leafy vegetables and whole grains. You can also supplement folate/folic acid. Its most bioavailable form is folate, so this would be more beneficial to get levels up if there is a deficiency. It is also worth noting that for some people, their genetics will disable them from converting folic acid effectively so these people should also supplement with folate/methyl folate.
Vitamin B12 should always be supplemented along with folic acid as the folic acid supplement can mask a B12 deficiency[vi].
[i] DeLoughery TG. Iron Deficiency Anemia. Med Clin North Am. 2017;101(2):319‐332. doi:10.1016/j.mcna.2016.09.004
[ii] Jansen EH, Beekhof PK, Cremers JW, Schenk E. Long-term (in)stability of folate and vitamin B12 in human serum. Clin Chem Lab Med. 2012;50(10):1761‐1763. doi:10.1515/cclm-2012-0108
[iii] Hoyumpa AM. Mechanisms of vitamin deficiencies in alcoholism. Alcohol Clin Exp Res. 1986;10(6):573‐581. doi:10.1111/j.1530-0277.1986.tb05147.x
[iv] Chitayat D, Matsui D, Amitai Y, et al. Folic acid supplementation for pregnant women and those planning pregnancy: 2015 update. J Clin Pharmacol. 2016;56(2):170‐175. doi:10.1002/jcph.616
[v] Hallberg L, Brune M, Rossander L. The role of vitamin C in iron absorption. Int J Vitam Nutr Res Suppl. 1989;30:103‐108.
[vi] Scaglione F, Panzavolta G. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014;44(5):480‐488. doi:10.3109/00498254.2013.845705
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