I am often reminded of an advertisement on television wherein the presenter asks the female audience how many of their children suffer from lethargy, weakness, irritability, repeated infections, poor concentration, and decreased capacity for work. More than 50% of the women raised their hands. Had the presenter asked the same women for these symptoms among themselves, the number of hands up would have been much more . The diagnosis in all these cases is probably anaemia which affects 40 % to 90 % of the women in developing countries like India. In women, not only is anaemia responsible for a poor quality of life but also
causes problems during pregnancy like increased urinary and genital infections, increased chances of high blood pressure and inability to tolerate routine blood loss at delivery. Babies born to such women are usually of lower weight and thrive poorly.
Anaemia is a very common problem in developing countries. The World Health Organization (WHO) defines anaemia as haemoglobin levels less than 11 g% . According to estimates, more than 500 million women in the world suffer from anaemia, and 16% of the deaths in India , related to pregnancy, are attributed to anaemia. Generally, the mortality and morbidity of any disorder is high if it’s cause or treatment is either not known or is expensive. Strangely , the cause of anaemia is known and the treatment with iron simple and cheap , yet anaemia continues to take it’s toll in such large measure especially in developing countries. The drain on women’s health is more because of increased requirements during pregnancy , especially if they are repeated in quick succession , and because of monthly loss during periods.
The most important cause of anaemia is nutritional deficiencies of iron mainly followed to some extent by lack of folic acid and vitamin B12 in the diet . Deficiencies of vitamins A and B2 also have a role to play . Iron deficiency leads to less formation of haemoglobin which is important for transporting oxygen to the tissues . Long standing lack of oxygen due to chronic anaemia can lead to weakening of the heart muscles and heart failure . Excessive breakdown of haemoglobin ( hemolysis ) due to drugs or infections can lead to haemolytic anaemia . Anaemia may also result from production of abnormal haemoglobins which are not as effective in oxygen carrying capacity as normal adult haemoglobin (haemoglobinopathies e.g. thalassaemia ).
Since the most important cause of anaemia is iron deficiency , treatment with iron should cure it . But it is not as simple as that . Treatment with iron may worsen the problems of the patient if the anaemia is due to ,say, abnormal haemoglobin . In such cases , the body cannot utilize the excess iron intake which then gets deposited in body organs leading to their damage in the long run . Iron tablets are not sweets to be consumed after self diagnosis and without a doctor’s prescription . However , what women can do for themselves and for the health of their families is to have a diet rich in iron and other nutrients – in other words , a balanced diet . Sources of iron include meat , fish , poultry , cereals , green leafy vegetables (spinach , mustard leaves , fenugreek leaves , Bengal gram leaves , and turnip greens ) , tubers and pulses . Daily intake of about 2 tablespoons of cooked green leaves provide considerable iron per day . This is not very difficult as a variety of greens and innovative methods of presentation take the boredom out of food . ‘ Saag ‘ , ‘palak’ are easily available in this part of the country . Try green coriander ( dhania), mint ( pudina), green chillies chutney for a change or just toss a handful of dried fenugreek leaves ( methi) in any vegetable or dal to enhance not only the flavour but also the nutrient value . Use jaggery instead of sugar wherever possible and go back to cooking in iron utensils . Add a source of vitamin C to the food to increase iron absorption e.g. squeezing a lemon over fish or salads is an excellent way to combine iron rich foods with vitamin C . Maybe a dash of amla pickle or chutney as a side dish is another way of sourcing vitamin C . No nutrient alone can do wonders. For building haemoglobin we need good sources of protein . So do combine all the greens on your table with protein rich foods like non vegetarian dishes , but if you queasy about this , use legumes (peas , beans, nuts and all podded plants used as food ) , pulses and cereals .
If symptoms of anaemia persist despite a good diet , it might be worthwhile to visit the doctor who is , of course , going to ask you about history suggestive of worm infestation and excessive loss of blood from haemorrhoids ( piles), ulcers and heavy bleeding during periods . Any menstrual period which lasts longer than 7 days or requires more than 10 sanitary napkins per month or if there are clots or if there is daytime embarrasement or nighttime soiling , the woman is said to have ‘heavy periods’ which will then need investigation.
However , despite the person’s best commitment to a good diet , the treatment of iron deficiency anaemia is very often required especially during times of great demand like pregnancy and convalescence . This is probably because nutrient content of foods is greatly influenced by soil conditions , use of fertilizers , pesticides , methods of preparation and processing of foods – all of which take away a large chunk of the vitamins and mineral content of food . Tablets of iron are usually prescribed in combination with folic acid and if there is adequate intake of protein and body building blocks as well , then an assured rise of haemoglobin is expected . Iron tablets are best consumed ½ to 1 hour before meals so that the absorbtion is not decreased by the phytates in food ; avoid tea , coffee , antacids and calcium tablets along with iron preparations and start with lower doses if unable to tolerate oral iron. Continue to take iron and other supplements for at least 3 months after haemoglobin levels reach normal values so as to replenish the iron stores . Deficiency of dietary iron is almost always associated with other nutritional deficiencies as well . Therefore, for overall wellbeing it might be prudent to take other nutritional supplements of minerals and vitamins also in the presence of any single nutritional deficiency .