Anemia is defined by a deficiency of red blood cells. anemic red blood cells

In this section we will be looking at chronic anemia - the kind that lingers and is hard to treat. This is not the kind of anemia that develops suddenly after an accident or heavy blood loss. Nor is it the kind of anemia that comes from hemolysis, a condition which develops, sometimes suddenly, and in which the red blood cells suddenly begin to break up and disappear from circulation.

There are a number of causes of anemia which are slower in onset. These range from women who have heavy menstrual periods or in people with blood losses from intestinal bleeding caused by polyps, ulcers or parasites.

Other cause of anemia can come from people with chronic diseases like renal failure, inflammatory illnesses like inflammatory bowel disease or autoimmune illness like lupus. Chronic viral illnesses like HIV/AIDS can cause anemia as can various cancers. For most of these conditions, in order to treat the anemia, it is necessary to deal with the underlying illnesses.

Occasionally, there are people who just don't have enough iron in their diet. Some vegans could fit in this group as could many elderly people who live alone or those who eat poorly - alcoholics or drug users. Often however, anemia is not cause by any of these conditions but is due to poor iron absorption.

Anemia Caused by Poor Absorption

Poor iron absorption causes microcytic - (small red blood cells), hypochromic - (red blood cells low in hemoglobin) anemia. The miscroscopic slide above illustrates this type of anemia in which the red cells, usually full of pink pigment and larger than you see here, have been replaced with "anemic" little cells.

Most people with this type of anemia have a low hemoglobin because they can't absorb the iron from the foods in their diet. These are the people who may complain of fatigue, go to the doctor and get blood tests which reveal mild to moderate anemia. The physician will likely want to do tests to rule our some of the causes mentioned above. When this is done and all is well, they will likely be instructed to take an iron supplement.

On iron supplements, usually something like ferrous sulfate (often leading to almost instant constipation), or perhaps something easier to tolerate like ferrous fumerate or ferrous citrate, some people will improve. Others will not. Most non-responders have anemia because of altered absorption.

What is the basis of reduced iron absorption?

Iron (and most other minerals) are absorbed in the small intestine. When the small intestine is healthy, it has a number of features which make iron absorption possible. One of the most important of these is the probiotic bacteria which live on the mucus layer. In the small intestine, the most prominent type of these friendly bacteria is acidophilus (Lactobacillus acidophilus) which has many virtues. In addition to helping enormously with the immune defenses of the intestine, it secretes an acidic fluid which is critical to mineral absorption.

These secretions produce a thin layer of acid which takes iron from a ferrous (mostly insoluble) to ferric state so it can be absorbed. The acid requirement makes reasonable the suggestion to take iron with vitamin C or take it in an acidic state (ferrous citrate) or as a chelate of amino acids.

Dealing with anemia

I suggest starting with a diet change. Because wheat can cause a number of people to have problems, one approach is to experimentally eliminate wheat from the diet. This includes most of the commercial foods like breads, muffins, crackers, noodles, cereals, etc. The good news is that the health food sections of many supermarkets have abundant selections of wheat free or gluten free products.

If you add iron rich foods like kale, eggs, red meat, or herbs like yellow dock, stringing nettle etc., this may help. Iron containing supplements can be constipating, so those which enhance absorption, and thus deliver iron better, may be taken in smaller doses. Ferrous citrate or other ferrous chelates are a better choice. The strength of iron which is optimal will depend on your situation, but many people do well on 35 - 50 mg./day. Often health food stores are the best source of easily assimilability iron. In my experience, the iron supplements which contain 300 mg. or so, of iron often cause constipation and can cause abdominal pain.

Adding Acidophilus will, in my opinion, help. It does this by producing a thin layer of acidic fluid in the small intestine which helps the iron to transform to an absorbable form. For most people, 2 - 4 capsules daily, taken at mealtime, will not only improve their anemia but also promote better immunity.