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Anemia

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Anemia is when a person does have enough red blood cells or the proper concentration of hemoglobin (iron-containing portions of red blood cells). These deficiencies occur when the body either does not make enough red blood cells or destroys too many red blood cells. One of the major functions of red blood cells is to carry oxygen throughout the body,. A decrease in red blood cells means the body's tissues don't get enough oxygen, causing the symptoms of anemia. There are several different types of anemia. The most common are iron deficiency anemia, megaloblastic anemia (caused by lack of some B vitamins), and anemia of chronic disease.

Signs and Symptoms

Symptoms of anemia can be mild, at first, and can be mistaken for other symptoms of other conditions.

• Tiredness
• Weakness
• Shortness of breath
• Pale skin
• Lightheadedness
• Headache
• Feeling cold
• Rapid heartbeat and chest pain

What Causes It?

Anemia may have the following causes.

• Blood loss, including gastrointestinal blood loss (caused by ulcers, cancer, parasites), genitourinary blood loss (such as from heavy menstruation), or blood loss after surgery or regular blood donations
• Diseases and conditions, such as congenital diseases (for example, sickle-cell anemia), malabsorption syndromes (for example, celiac disease), and other chronic conditions
• Side effect of medication
• Malnutrition
• Iron, folic acid, vitamin B12, or other vitamin deficiencies
• Pregnancy and breast-feeding
• Excessive alcohol or drug use

What to Expect at Your Provider's Office

Anemia is often the result of an underlying disease. Your health care provider will have you blood examined in laboratory tests. If you are anemic, your health care provider will try to determine the cause to begin treatment.

Treatment Options

Treatment depends on the cause and severity of the anemia. Your health care provider may recommend changes in your diet to make sure you receive all of the nutrients you need for healthy blood formation, such as vitamin B12, iron, and folic acid. Your health care provider may also suggest nutritional supplements or medication. If your anemia is the result of an underlying disease, that disease must first be successfully treated.

Drug Therapies

• Erythropoietin plus iron -- for anemia caused by chronic kidney failure
• Corticosteroid medications (such as prednisone)
• Immunosuppressant medications (such as azathioprine) -- for aplastic anemia

Surgical and Other Procedures

• Removal of the spleen (splenectomy) -- may be necessary in cases of hereditary spherocytosis
• Transfusions -- may help treat certain types of anemia, including anemia of chronic disease

Complementary and Alternative Therapies

Most cases of anemia will respond well to nutritional therapy. You should, however, already have the underlying cause of anemia diagnosed so you can begin the right treatment. For example, excess iron is toxic, and you should not take supplements unless you have iron deficiency anemia and your health care provider recommends them. Herbal and nutritional treatments may be helpful when used along with medical treatment.

Nutrition and Supplements

• Ferrous fumerate, glycerate, or sulfate (50 mg three times per day for 3 - 6 months, or as prescribed) are the most absorbable forms of iron. All iron supplements can cause nausea, constipation, and heartburn. Taking a smaller dose three times a day may reduce side effects, as can taking iron with meals. If you miss a dose, don't take an extra dose the next time. Never take a double dose of iron. Keep iron supplements away from children. Even a little excess iron can be fatal.
• Dietary sources of iron include red meat (especially calf liver), beans, beet greens, blackstrap molasses, almonds, and brewer's yeast. Green leafy vegetables contain both iron and folic acid (see below).
• Vitamin C -- 250 - 500 mg twice a day to aid in absorption of iron. Dietary sources include citrus fruits and juices, tomatoes, broccoli, and cauliflower.
• Vitamin B12 -- cyanocobalamine, 1,000 mcg via injection once a day for 1 - 2 weeks, then every 1 - 3 months; or orally, 1,000 - 2,000 mcg per day. Dietary sources include liver, meats, eggs, tuna, and cheese.
• Folic acid (400 mcg - 1,000 mcg per day) -- for folic acid deficiency, which can cause anemia. Good food sources include green leafy vegetables, orange juice, and grains. Folic acid supplementation can mask vitamin B12 deficiency, so always take vitamin B12 when taking folic acid.

Herbs

Herbs can strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should avoid using tinctures. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures singly or in combination as noted.

You may be treated with the following herbal therapies for 1 -3 months and then reassessed.

• Blackstrap molasses, also known as pregnancy tea (1 tbs. per day in a cup of hot water), is a good source of iron, B vitamins, and minerals. Blackstrap molasses is also a very gentle laxative.
• Spirulina, or blue-green algae, may treat both microcytic and macrocytic anemias. Dose is 1 heaping tsp. per day.
• Alfalfa (Medicago sativa), dandelion (Taraxacum officinale) root or leaf, burdock (Arctium lappa), and yellowdock (Rumex crispus) have long been used to fortify and cleanse the blood. For mild cases of anemia, they may help bring levels of hemoglobin into normal range. Dosage is 1 tbs. per cup of water. Simmer roots for 20 minutes and leaves for 5 minutes. You may use a single herb, or a combination of these four herbs.
• Gentian ( Gentiana lutea) is often used in Europe to treat anemia by stimulating the digestive system to more easily absorb iron and other nutrients. Add 1 tsp. powdered dried rhizome to 3 cups of water. Take 1 tbs. about a half hour before eating.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of anemia based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

A homeopath will usually consider anemia as symptomatic of an underlying condition, and treat that condition.

• Ferrum phosphoricum -- for iron deficiency
• Calcarea phosphorica -- particularly for children with nighttime bone aches, cool hands and feet, lack of energy, or poor digestion

Following Up

Maintaining a normal balanced diet is very important if a nutrition problem is causing your anemia. In addition, you should avoid both drugs that can cause stomach problems and too much alcohol if they are causing your anemia.

Special Considerations

Complications from anemia can range from loss of productivity due to weakness and fatigue to coma and death. Some neurologic changes caused by anemia are irreversible. Pregnant women need three or four times as much iron as normal. A folic acid deficiency during pregnancy can result in infants being born with neural-tube defects, such as spina bifida.

Supporting Research

Branch WT Jr. Office Practice of Medicine. Philadelphia, Pa: WB Saunders Company; 1994.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

CDC Recommendations to prevent and control iron deficiency in the United States. Centers for Disease Control and Prevention. MMWR Recomm Rep 1998;47:1-29.

Elia M. Oral or parenteral therapy for B12 deficiency. Lancet . 1998;352:1721-22.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kelley WN, ed. Textbook of Internal Medicine. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1997.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Tyler VE. The Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. 3rd ed. Binghamton, NY: Pharmaceutical Products Press; 1993.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995:181.

• Review Date: 6/15/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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