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Healthnotes

Anemia

Also indexed as: Hemolytic Anemia, Low Hematocrit, Low Hemoglobin, Low Red Blood Cell Count, Sideroblastic Anemia, Thalassemia

Boost your red blood cell count to a normal level by replenishing what your body may be missing. According to research or other evidence, the following self-care steps may help you treat your specific type of anemia:

Replace needed nutrients
Prevent and treat anemia with supplemental iron, vitamin B12, and folic acid; you should not take iron unless a blood test has revealed a deficiency

Get a checkup
Visit your healthcare provider for a test to determine the cause

Add L-carnitine to your routine
If you have thalassemia, take 100 mg of this nutritional supplement per 2.2 pounds of body weight each day to reduce the need for blood transfusions

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full anemia article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About anemia

Anemia is a general term for a category of blood conditions that affect the red blood cells or the oxygen-carrying hemoglobin they contain.

In anemia, there is either a reduction in the number of red blood cells in circulation or a decrease in the amount or quality of hemoglobin. There are many causes of anemia, including severe blood loss, genetic disorders, and serious diseases. (See iron-deficiency anemia, pernicious anemia [vitamin B12–related], and sickle cell anemia.) Anyone with unexplained anemia should have the cause determined by a qualified doctor.

Some athletes appear to have anemia when their blood is tested, but this may be a normal adaptation to the stress of exercise,¹ which does not need treatment. Further evaluation by a qualified doctor is necessary.

Product ratings for anemia

Science Ratings	Nutritional Supplements	Herbs
	Copper (if deficient) Iron (if deficient) Vitamin A (if deficient) Vitamin B1 (for genetic thiamine-responsive anemia) Vitamin B12 (if deficient) Vitamin B2 (if deficient) Vitamin B6 (if deficient and for genetic vitamin B6-responsive anemia) Vitamin C (if deficient) Vitamin E (if deficient)
	Folic acid (for thalassemia if deficient) L-carnitine (for thalassemia) Magnesium (for thalassemia) Taurine (if deficient in iron) Vitamin B12 (for thalassemia if deficient) Vitamin E (injections for thalassemia, orally for glucose-6-phosphate dehydrogenase deficiency [G6PD] anemia and anemia caused by kidney dialysis) Zinc (for thalassemia, if deficient)
	Antioxidants (for thalassemia) Vitamin C (for thalassemia, if deficient)	Açaí
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Some common symptoms of anemia include fatigue, lethargy, weakness, poor concentration, and frequent colds. A peculiar symptom of iron-deficiency anemia, called pica, is the desire to eat unusual things, such as ice, clay, cardboard, paint, or starch. Advanced anemia may also result in lightheadedness, headaches, ringing in the ears (tinnitus), irritability, pale skin, unpleasant sensations in the legs with an uncontrollable urge to move them, and getting out of breath easily.

Dietary changes that may be helpful

Severe protein deficiency can cause anemia because protein is required for normal production of hemoglobin and red blood cells.² However, this deficiency is uncommon in healthy people living in developed countries.

Thalassemia is an inherited type of anemia that is most common in people of Mediterranean descent. Children with severe thalassemia often have reduced growth rates that may be partially due to inadequate diets. This problem is primarily found in developing countries.³

Other therapies

Blood transfusions may be required to treat severe anemia.

Vitamins that may be helpful

Deficiencies of iron, vitamin B12, and folic acid are the most common nutritional causes of anemia.⁴ Although rare, severe deficiencies of several other vitamins and minerals, including vitamin A,⁵ ⁶ vitamin B2,⁷ vitamin B6,⁸ ⁹ vitamin C,¹⁰ and copper,¹¹ ¹² can also cause anemia by various mechanisms. Rare genetic disorders can cause anemias that may improve with large amounts of supplements such as vitamin B1.¹³ ¹⁴

Taurine has been shown, in a double-blind study, to improve the response to iron therapy in young women with iron-deficiency anemia.¹⁵ The amount of taurine used was 1,000 mg per day for 20 weeks, given in addition to iron therapy, but at a different time of the day. The mechanism by which taurine improves iron utilization is not known.

Hemolytic anemia refers to a category of anemia in which red blood cells become fragile and undergo premature death. Vitamin E deficiency, though quite rare, can cause hemolytic anemia because vitamin E protects the red blood cell membrane from oxidative damage. Vitamin E deficiency anemia usually affects only premature infants and children with cystic fibrosis.¹⁶ ¹⁷ Preliminary studies have reported that large amounts (typically 800 IU per day) of vitamin E improve hemolytic anemia caused by a genetic deficiency of the enzyme glucose-6-phosphate dehydrogenase (G6PD)¹⁸ ¹⁹ ²⁰ and anemia caused by kidney dialysis.²¹ ²²

People with severe thalassemia who receive regular blood transfusions become overloaded with iron, which increases damaging free radical activity and lowers antioxidant levels in their bodies.²³ ²⁴ ²⁵ ²⁶ Some people with milder forms of thalassemia may also have iron overload.²⁷ Iron supplements should be avoided by people with thalassemia unless iron deficiency is diagnosed. Preliminary studies have found that oral supplements of 200 to 600 IU per day of vitamin E reduce free radical damage to red blood cells in thalassemia patients.²⁸ ²⁹ ³⁰ However, only injections of vitamin E have reduced the need for blood transfusions caused by thalassemia.³¹ ³²

Test tube studies have shown that propionyl-L-carnitine (a form of L-carnitine) protects red blood cells of people with thalassemia against free radical damage.³³ In a preliminary study, children with beta thalassemia major who took 100 mg of L-carnitine per 2.2 pounds of body weight per day for three months had a significantly decreased need for blood transfusions.³⁴ Some studies have found people with thalassemia to be frequently deficient in folic acid, vitamin B12,³⁵ and zinc.³⁶ ³⁷ Researchers have reported improved growth rates in zinc-deficient thalassemic children who were given zinc supplements of 22.5 to 90 mg per day, depending on age.³⁸ ³⁹ Magnesium has been reported to be low in thalassemia patients in some,⁴⁰ ⁴¹ but not all,⁴² studies. A small, preliminary study reported that oral supplements of magnesium, 7.2 mg per 2.2 pounds of body weight per day, improved some red blood cell abnormalities in thalassemia patients.⁴³

Sideroblastic anemia refers to a category of anemia featuring a buildup of iron-containing immature red blood cells (sideroblasts). One type of sideroblastic anemia is due to a genetic defect in an enzyme that uses vitamin B6 as a cofactor.⁴⁴ ⁴⁵ Vitamin B6 supplements of 50 to 200 mg per day partially correct the anemia, but must be taken for life.⁴⁶

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Açaí contains iron (approximately 1.5 to 5 mg per 3.5 ounces of fruit).⁴⁷ Although it has been traditionally used to help treat anemia, the amount of iron in açaí is not likely to be abundant or absorbable enough to have a significant effect.

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References
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2. Torun B, Chew F. Protein-energy malnutrition. In Shils ME, Olsen JA, Shike M, Ross AC, eds. Modern Nutrition in Health and Disease, 9th ed. Baltimore: Williams & Wilkins, 1999, 963–88 [review].

3. Fuchs GJ, Tienboon P, Linpisarn S, et al. Nutritional factors and thalassaemia major. Arch Dis Child 1996;74:224–7.

4. Little DR. Ambulatory management of common forms of anemia. Am Fam Physician 1999;59:1598–604 [review].

5. Hodges RE, Sauberlich HE, Canham JE, et al. Hematopoietic studies in vitamin A deficiency. Am J Clin Nutr 1978;31:876–85 [review].

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8. Orehek AJ, Kollas CD. Refractory postpartum anemia due to vitamin B6 deficiency. Ann Intern Med 1997;126(10):834–5 [letter].

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14. Neufeld EJ, Mandel H, Raz T, et al. Localization of the gene for thiamine-responsive megaloblastic anemia syndrome, on the long arm of chromosome 1, by homozygosity mapping. Am J Hum Genet 1997;61:1335–41.

15. Sirdah MM, El-Agouza IMA, Abu Shahla ANK. Possible ameliorative effect of taurine in the treatment of iron-deficiency anaemia in female university students of Gaza, Palestine. Eur J Haematol 2002;69:236–2.

16. Mino M. Clinical uses and abuses of vitamin E in children. Proc Soc Exp Biol Med 1992;200:266–70 [review].

17. Swann IL, Kendra JR. Anaemia, vitamin E deficiency and failure to thrive in an infant. Clin Lab Haematol 1998;20:61–3.

18. Hafez M, Amar ES, Zedan M, et al. Improved erythrocyte survival with combined vitamin E and selenium therapy in children with glucose-6-phosphate dehydrogenase deficiency and mild chronic hemolysis. J Pediatr 1986;108:558–61.

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20. Eldamhougy S, Elhelw Z, Yamamah G, et al. The vitamin E status among glucose-6 phosphate dehydrogenase deficient patients and effectiveness of oral vitamin E. Int J Vitam Nutr Res 1988;58:184–8.

21. Ono K. Reduction of osmotic haemolysis and anaemia by high dose vitamin E supplementation in regular haemodialysis patients. Proc Eur Dial Transplant Assoc Eur Ren Assoc 1985;21:296–9.

22. Ono K. Effects of large dose vitamin E supplementation on anemia in hemodialysis patients. Nephron 1985;40:440–5.

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26. De Luca C, Filosa A, Grandinetti M, et al. Blood antioxidant status and urinary levels of catecholamine metabolites in beta-thalassemia. Free Radic Res 1999;30:453–62.

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28. Miniero R, Canducci E, Ghigo D, et al. Vitamin E in beta-thalassemia. Acta Vitaminol Enzymol 1982;4:21–5.

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35. Saraya AK, Kumar R, Kailash S, Sehgal AK. Vitamin B12 and folic acid deficiency in b-heterozygous thalassemia. Indian J Med Res 1984;79:783–8.

36. Silprasert A, Laokuldilok T, Kulapongs P. Zinc deficiency in b-thalassemic children. In Fucharoen S, Rowley PT, Paul NW, eds. Thalassemia: pathophysiology and management, part A. New York: Alan R Liss, 1988 [review].

37. Bashir NA. Serum zinc and copper levels in sickle cell anaemia and beta-thalassaemia in North Jordan. Ann Trop Paediatr 1995;15:291–3.

38. Arcasoy A, Cavdar AO, Cin S, et al. Effects of zinc supplementation on linear growth in beta thalassemia. Am J Hematol 1987;24:127–36.

39. Akar N, Berberoglu M, Arcasoy A. Effects of zinc supplementation on somatomedin-C level, in beta-thalassemia. Am J Hematol 1992;41:142–3 [letter].

40. Cohen L, Bitterman H, Froom P, Aghai E. Decreased bone magnesium in beta thalassemia with spinal osteoporosis. Magnesium 1986;5:43–6.

41. Hyman CB, Ortega JA, Costin G, Takahashi M. The clinical significance of magnesium depletion in thalassemia. Ann N Y Acad Sci 1980;344:436–43.

42. Arcasoy A, Cavdar AO. Changes of trace minerals (serum iron, zinc, copper and magnesium) in thalassemia. Acta Haematol 1975;53:341–6.

43. De Franceschi L, Cappellini MD, Graziadei G, et al. The effect of dietary magnesium supplementation on the cellular abnormalities of erythrocytes in patients with beta thalassemia intermedia. Haematologica 1998;83:118–25.

44. May A, Bishop DF. The molecular biology and pyridoxine responsiveness of X-linked sideroblastic anaemia. Haematologica 1998;83:56–70 [review].

45. May A, Fitzsimons E. Sideroblastic anaemia. Baillieres Clin Haematol 1994;7:851–79 [review].

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47. Yuyama LKO, Dias RR, Nagahama D, et al. Acai ( Euterpe oleracea Mart.) and camu-camu (Myrciaria dubia (H.B.K.) Mc Vaugh), do they possess anti-anemic action? Acta Amazonica 2002;32:625–33.

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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

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