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Dr. Elena Koles, MD

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Anemia

         Anemia, or literally «bloodlessness», in former time was indeed developing mainly due to blood loss and, consequently, iron deficiency. In the sixteenth trough the nineteenths centuries sluggish girls from wealthy families who suffered from it were called pale sluggishness, and the actual sickness was called «chlorosis» or, in the English version, "green sickness" because of the greenish tint of skin, accompanied by severe weakness, palpitation, edema of the feet, thrombophlebitis and digestive disorders. In the nineteenths century in Europe, Dr. Pierre Blaud became famous for treating chlorosis with iron sulfate and potassium carbonate salts.
         From 1890 to 1920 the number of cases of iron deficient anemia declined sharply, but not  because of metal-therapy, but because ... tight corsets came into fashion, squeezing the liver and internal organs of the ladies and causing, among others, the difficulty of their liver function and an impairment of gastric secretion that in turn caused another type of anemia.. 
         Presently, despite the known causes of iron deficiency anemia, worldwide there are about 2 billion of patients, which in third world countries, is primarily due to poor quality of food and parasitic diseases.
        In the U.S. anemia affects 52% of pregnant women and 39% of preschoolers. Fifteen percent of adolescent girls have iron deficiency. The most frequent causes of illness in adults in developed countries is bleeding, that often goes unknown to patients. For example, a long-term intake of aspirin-like drugs, that causes elevated bleeding of the mucosa of gastrointestinal tract (GIT), or the presence of bleeding polyps in the intestines, etc. The cause of anemia may be a subtle long-term loss of blood in urine [microhematurea], observed in several renal diseases, stones, neoplasm. For many, especially children and adolescents, a lack of iron in foods or the inability to utilize iron is observed.

Iron accumulates in the body.  Its daily requirement (22-24 mg) is brought about by dissipated red blood cells. It major physiological losses (0,6-1,2 mg / day for males and 1,5-2 mg / day for women) should be supplied by the iron coming from food. Iron absorption is regulated by the stomach and the bowel walls: it increases during its deficit and inefficient formation of red blood cells and should be blocked when in surplus. The transport of iron from the intestinal wall to the bone marrow and cell-depot, called macrophages, is made possible by the blood plasma proteins - transferrin. Any malfunction of the gastrointestinal tract due to reduced secretion of digestive juices, enzymes and damage to the mucous membrane, for instance the presence of food allergies, celiac disease, dysbiosis, gastric resection, etc., leads to an impairment of absorption and transport of iron. American Academy of Pediatrics released a warning in 1992 that states that intake of cow's milk by young children is accompanied by damage to mucosal GIT and hidden bleeding, which, consequently, leads to anemia.    

Symptoms of anemia are a result of insufficient supply of oxygen to the tissues, as low levels of iron cause impairment in the development of hemoglobin [hem], which should deliver oxygen and to ensure full function of the organs.      

Adults become sluggish, experiencing dizziness, difficulty swallowing, increased heart rate, shortness of breath, muscle weakness, fainting, numbness, and various neurological symptoms which is explained by the overall oxygen-starved tissues. Unfortunately, the memory loss, decreased concentration, confusion, and poor sleep accompanied by anemia is considered a «natural» process of aging, not requiring treatment.      

 Iron deficiency is sometimes «written» on the patient’s appearance: pale puffy face, «polished» inflamed tongue, «a spoon-shaped» bulged nails, depressed nail phalanges of the thumb, usually on the right hand.  

Children with iron deficiency lag behind their peers in the physical and intellectual development, are irritable, have difficulty concentrating, which is often mistakenly regarded as having attention deficit hyperactivity disorder (ADHD). In the best scenario, these children are treated by natural therapy, in the worst - with psychotropic drugs ...According to Dr. Oski (1993), for the healthy development of the child, assessment of iron levels, (I would say, all the indicators of blood formula), should be done as early as infancy.

            Because people have high compensatory ability and hemoglobin decreases slowly, the child’s body adapts to live in a perpetual state of hypoxemia (reduced oxygen levels in the blood), which undoubtedly has a negative impact on the child’s development. Iron deficiency, with or without the presence of anemia in the test results, leads to mental and physical retardation. If the treatment is not begun in time, the process may take an irreversible turn. Such children usually have developmental delay or mental retardation, and faster heart rate because the heart tries to compensate for the lack of oxygen.
            In fact, recent studies show that the function of hem in the blood and in the brain is different. If in the blood it causes the tissues to be enriched by oxygen, in the brain it inhibits amyloid formation in neural cells. The accumulation of amyloid appears as a manifestation of aging, and one of the signs of Alzheimer's disease and dementia.
          Children with anemia, drag in mouth inedible things (dirt, chalk, charcoal, clay, toothpaste), chew ice, have as addiction to raw products (dough, grains, ground meat), and to unusual odors (gasoline, acetone, shoe polish, naphthalene, exhaust, etc.)
          Typically, an overall analysis of the blood is done in children from the ages of 6-18 months, but in my practice, it would not be an unusual case where a doctor would never perform an overall analysis of the blood for children 4-12 years old, who already have a wax paleness of skin. I see anemic children more and more often which may be due to the fact that the American style of eating “lifeless” food out of boxes, bags and cans, «from the cradle» does not give the body everything necessary for full growth and proper circulation.  
           Anemia caused by iron deficiency is such a well-known disease that many do not even suspect that there could be other reasons for the reduced hemoglobin and lowered red blood cell count. The prescription of iron drugs in such cases not only will fail to improve the condition of the patient, but also can lead to severe and irreversible consequences.
          For example, one of the causes of anemia unknown to public, but one that is increasingly common in men, children and especially pregnant women, is a deficiency of vitamin B6. Method of taking drugs with iron does not normalize the levels of hemoglobin. Rather, iron absorption is increased, which leads to its accumulation in internal organs (iron is a heavy metal). This state, by manifestations, is compared with fatal hemosiderosis - once rare, but now is seen with increasing frequency.
        

      Another unknown form of anemia occurs as part of vitamin E deficiency, which is not only characterized by an impairment of hemoglobin synthesis, but also a shortened lifespan of erythrocytes. This disease often occurs in newborns, whose mothers had a deficit of vitamin E during pregnancy.
When red blood cells «contact» with inspired oxygen in lungs, they are destroyed rapidly and a pigment forms, giving the skin a yellowish color, as newborn kidneys cannot timely expel the pigment out of the body.
       By the way, the human kidney is one of the regulating organs in the generation of red blood cells - erythropoesis. During hypoxemia, they produce a hormone called erythropoietin (EP) which stimulates the production of bone marrow. ET also stimulates the production of platelets, sometimes up to high numbers (700 000), which can be explained by a defense response: even a drop of blood lost by an anemic person may cost him his life; therefore the blood should clot faster, which is ensured by the platelets.
        In young children, the elderly and in the presence of kidney disease, PE is not formed in sufficient quantities which can serve as one of the reasons for the development of anemia. Unfortunately, the costly pharmaceutical drug PE (Epogen, Procrit, Aranesp), applied in the form of injections in cancer patients and in renal insufficiency, has not fulfilled the hopes of doctors and, as demonstrated by recent studies, may accelerate the fatality of patients by eliciting an enhanced growth of tumors and their metastases and an increased thrombosis in the legs and lungs. This has prompted the FDA to administer a special warning for this drug (Washington Post, 2007).
     

        Severe anemia, sometimes with irreversible neurological disorders is observed during a deficit of vitamin B12 and folic acid. The complexity of detecting B12-deficiency anemia arises from the fact that normal blood levels are not a valid indicator. The numbers in the «normal range» or above, tell us nothing. 
        Indirect signs of B12-anemia that mimic coronary heart disease are increased heartbeat, shortness of breath during physical activity, pain in the chest and edema. Patients are usually bloated, with a puffy face. Some patients may experience a change in psyche: anxiety, depression, psychosis. Intake of food and medicines can cause a burning sensation and a feeling of heaviness in the stomach, which provokes the doctor to prescribe «gastric» treatment. Acute pain, abnormal urination, changes in vision, hearing, taste, smell and behavior are consequences of the destruction of nerves and brain during B12 deficiency, additionally, the neurological symptoms may occur without anemia in the blood. Typically, these patients have elevated levels of «bad» cholesterol (LDL), at 35-50%, and the dysfunction of the thyroid gland. Treatment is also complicated, because the B12-cyanocobalamin, which is most often prescribed to such patients, in many cases, especially in elderly and children, is not absorbed well in a tablet form, or does not enter the cells with injection – where it is directly needed. Other more active forms of vitamins are needed.
         The increased reduction of gastric juices with age, the utilization of a variety of medications against heartburn, laxatives, and calcium supplementation leads to a reduced absorption of iron and vitamin B12, with all its consequences.
   

         In many cases, toxic environmental factors and the accumulation of heavy metals (mercury, lead, strontium, cadmium, etc.) from the exhaust and cigarette smoke, dental fillings (amalgam), food (in cans, fish, etc.), drugs (vaccines, antacids), pesticides and etc. lead to the development of anemia. For example, mercury, that has entered the body from different sources, often causes symptoms similar to the manifestations of iron deficiency anemia, because it reduces the bonding effectiveness of hemoglobin with oxygen by 25% (Hal Huggins, DDS). There appears a paradox: the test result is normal, yet the patient is sick... Lead intoxication also often accompanies iron deficiency (Nicholls and McLachlan, 1990).
    

         In recent times, as paradoxically as it may sound, a growing number of Americans have parasite infestation of the digestive tract, which obviously is as much due to the large number of traveling as to the growing number of immigrants  arriving and carrying along their parasites from the most exotic countries. Taking into consideration that Americans not very often wash their hands before eating (as the statistics show - only 45%), the quantity of worms they host should not come as a surprise. But many of these uncalled for "guests" may cause anemia (Necator, Ancylostoma, Trichuris). Thus, for an anemic patient, even one who has not traveled the world, stool analysis is mandatory.

       

          We know that aging is related to the systemic decline of all of the functions of the body, which also explains the accumulation of toxins in the body, and a decrease in the number of physiologically active cells in tissues. Circulation of blood also slows down. The amount of bone marrow decreases and blood cells become more vulnerable to damage.

The developing anemia contributes to the development of chronic diseases. It is a constant companion of many deficits and various pathological processes occurring in humans. And, as a rule, evolving slowly and often unrecognized in time, it exacerbates the duration of illness or appears as a «normal process» of aging. However, if the body is well supported by all the necessary metabolic components, among which vitamins and minerals play a primary role, biochemical processes occur within the normal range of ageing.    

 In the so-called «anemia of chronic illness», found in various autoimmune, inflammatory, infectious and oncology- related processes, the patient does not have iron deficiency, rather, the intake of iron as a supplement is ineffective and dangerous.
This type of anemia was first "recognized" 50 years ago, but only in the last 10 years its causes were studied.  The chief  trigger among which is the reduction in production of PE by the kidneys and the synthesis of recently discovered protein gepsidin by the liver, which stops the absorption of iron in digestive tract. Interestingly, in the presence of this anemia, the life of erythrocytes is shorter by half, but if these erythrocytes are transferred to a healthy human, the period of their lives is restored. This shows that despite the changed «biochemical environment» the of the patient’s body (changed acidity, vitamin deficiency, etc), the blood cells are undamaged.

 

   Interesting also the fact that the rate of absorption of iron is affected by the mood of the patient, and medicine that is taken for treatment of psychosis (Zyprexa, Seroquel), are able to increase the level of hemoglobin. At the same time, some psychotropic drugs (Ritalin, Carbamazepine, Felbamate, Ticlopidine, etc.) can cause severe anemia.
      

   Thus, the identification of the causes of anemia, its form, and good nutrition with adequate intake of the necessary vitamins can help to regain health. The main thing to know is what to do, when and in what form should food supplements by used. This is the core of my medical practice.