Anemia comes from the Greek words "without blood," and affects 4% of men and 8% of women in the United States. That represents over 20 million people in this country. Symptoms may include fatigue, weakness, pale or yellowish skin, irregular heartbeats, shortness of breath, dizziness or lightheadedness, chest pain, cold hands and feet, and headache. 

Before discussing the most common types of anemia, let's go over some basic laboratory markers in case you have your lab results in front of you.

The most important labs to review are hemoglobin (Hg), hematocrit (Hct), and mean corpuscular volume (MCV).

• Hemoglobin is a protein that contains iron and is responsible for carrying oxygen to cells of the body. Low hemoglobin could be a sign of anemia.
• Hematocrit is the percentage of red blood cells found in the blood. Low hematocrit can be a sign of anemia.
• Mean corpuscular volume (MCV) is related to the average size of the red blood cell. Low MCV means the cells are smaller than usual and represents microcytic anemia. High MCV means the size of the cells are larger than normal and represents macrocytic anemia.

The two basic types of anemia are microcytic and macrocytic.
Microcytic anemia is when the hemoglobin, hematocrit and MCV are all low. The most common type of microcytic anemia is iron deficiency anemia.

Example of microcytic anemia (low levels in all 3 markers):

Hemoglobin 9.7 g/dL     LOW            Normal range 13.0 - 17.7 g/dL
Hematocrit 29.9 %        LOW             Normal range 37.5 - 51.0 %
MCV 69.7 fL                  LOW            Normal range 79 - 97 fL

The most common causes of iron deficiency anemia are blood loss, deficient iron in the diet, an inability to absorb iron in diet and pregnancy. If blood loss is the problem, it is important to identify the cause of the bleeding. Women are more prone to this anemia due to loss of blood during menstrual flow. If iron deficiency anemia is suspected by your physician, he or she needs to run serum iron, total iron-binding capacity (TIBC), and serum ferritin in the blood.

If you are deficient in iron, the amount you supplement should be decided on by your doctor; most people need to get between 60 and 120 mg of elemental iron a day. The best way to take the supplement so that you absorb the greatest amount of iron is to take it in two or more doses during the day. 

 

The following are general guidelines when taking iron supplements:

• Although the supplements work best on an empty stomach, you may want to take them with food so that they don't upset your stomach.
• You shouldn't take iron supplements with milk, caffeine, antacids, or calcium supplements. These can decrease the amount of iron that is absorbed.
• Try to take your iron supplement with vitamin C to increase absorption. Many high-quality iron supplements have Vitamin C in the tablet or capsule.

Iron from animal sources is better absorbed than from plant sources.
The top animal sources for iron are:

• Oysters
• Lean beef
• Chicken
• Turkey

The top plant sources for iron are:

• Beans and lentils
• Tofu
• Baked potatoes
• Cashews
• Dark green leafy vegetables such as spinach

Macrocytic anemia is when the hemoglobin and hematocrit are low but the MCV is high.

Example of macrocytic anemia:

Hemoglobin 10.6 g/dL       LOW         Normal range   13.0 - 17.7 g/dL
Hematocrit 31.6 %            LOW          Normal range   37.5 - 51.0 %
MCV 117.6 fL                    HIGH         Normal range   79 - 97 fL

The most common causes of macrocytic anemia are vitamin B12 and folate (B9) deficiency. The most common cause of vitamin B12 deficiency is inadequate intake, such as from a vegan diet, and impaired absorption from pernicious anemia (lack of intrinsic factor as a result of autoimmune damage to the gastric mucosa), gastric bypass surgery or conditions like Crohn's disease. Pregnant women are at risk for folate deficiency. In addition, the following can cause vitamin deficiencies of vitamins B12 and folate:

• Medication such as phenytoin, methotrexate, sulfasalazine and triamterene can block the absorption of folate.
• Antacids may interfere with B-12 absorption, as can medications to treat esophageal reflux. These include Prilosec, Nexium, Prevacid, Tagamet, Pepcid and Zantac. Stomach acid and digestive enzymes are required to free vitamin B12 from food.
• Alcohol can result in deficiency of certain B vitamins.
• Nicotine can reduce levels of vitamin B12.
• The diabetes medication Metformin has been associated with vitamin B12 deficiency.

Blood levels of vitamin B12 and Folate should be checked before making a diagnosis of vitamin deficiencies because both folate and vitamin B12 deficiency can cause the same symptoms. In addition, a sensitive blood marker for pernicious anemia is to test for methylmalonic acid (MMA).

The top animal sources for vitamin B12 are:

• Clams
• Mussels

Supplements:

• I recommend taking vitamin B12 and folate together. In fact, taking a good B-Complex is an excellent way to get both folate and vitamin B12.
• In a 2016 analysis of vitamin B12 absorption, regular oral B12 at 1000 mcg daily is as good as getting intramuscular injectons. Additionally, there is no scientific evidence that sublingual vitamin B12 is better that oral capsule supplementation.
• Vitamin C interferes with absorption of vitamin B12.

 (A good B-Complex found in our Medicinary is Active B-Complex by Integrative Therapeutics.)