Friday, April 30, 2010

Why is Anemia More Common in Some Ethnicities?

There are many, many types of anemia with iron deficiency anemia the most common. And, anemia isn't really one of those nutrient deficiencies that is tied to certain ethnicities (the way vitamin D is for instance; where ethnicities with darker skin have a greater risk of deficiency). But, a study published a few years ago made me re-think the fact that some ethnicities may have an increased risk.

Among women, there's been a decline in the prevalence of iron deficiency anemia and folate deficiency related anemia. However, there's a tremendous difference by ethnicity: 3.3% for whites, 24.4% for blacks and 8.7% for Mexican Americans. Unfortunately, I'm left wondering and trying to figure out what is going on. According to this study, patient demographics, lab testing methods and known causes of anemia can't account for the differences. So, what's left? Is the data wrong? Have studies misinterpreted the prevalence data or have other factors contributed to this data? One potential factor mentioned is lack of adherence. For all the clinicians out there, we know this all too well. You can give someone a prescription or supplement and instructions, but, this doesn't mean they will indeed follow-through and take it as prescribed. Follow-up and monitoring are absolutely crucial with any deficiency.

Right now we have more questions than answers but hopefully future research will tell us why some populations have a higher incidence of anemia. Right now though, public health interventions can at the very least, target these groups to make them aware of iron deficiency anemia and increase testing in those who are displaying signs and symptoms of deficiency.

Am J Clin Nutr 2008;88(6): 1457-1458.

Monday, April 26, 2010

Top Vegetarian Sources of Iron

The best sources of iron are from meat, poultry and fish – all of which contain heme iron. Heme iron is absorbed better than the type of iron found in plants – non-heme iron. For vegetarians of course, this is a moot point since animal foods aren’t an option. Therefore, you’ll need to be extra aware of your iron intake.



The top vegetarian sources of iron include:
Fortified cereals (look for 100% DV for iron)
Instant oatmeal
Lentils
Lima, navy, lima, black, pinto
Molasses
Spinach
Black-eyed peas

Be sure to include several of these foods in your diet and consume them with vitamin C to enhance the absorption of non-heme iron. And, take your calcium supplements and antacids separately since they can inhibit the absorption of non-heme iron.

Wednesday, April 21, 2010

Heavy Period? The Top Causes of Debilitating Menstrual Cycles Uncovered

Some people share a little TMI (too much information). As one of my good friends said, as a dietitian, you are part nutrition expert, part behavioral expert and part therapist. And granted, I’d expect my female clients to ask me questions about their bodily functions (from constipation to the color of pee). But when random girls I don't know well start telling me about their heavy menstrual cycles and asking about herbal remedies, it’s TMI. I’m not a doctor, you’re okay and it's Friday night and we are at a bar for crying out loud. But, naturally curious, I began to wonder why some women complain about abnormally long periods, debilitating cramping, bloating and a 1-week a month total meltdown.

So I went searching and found some common causes of heavy periods include:

- Hormone imbalances - the pill can help, sometimes.
- Uterine fibroid tumors - these are typically benign (non-cancerous). The causes are not known but these tumors rely on estrogen for growth.
- Cervical polyps - small growths on around the cervix
- Pelvic Inflammatory Disease (PID) - typically caused by a STD though some women get PID after childbirth or a gynecological procedure.
- Cervical cancer - yearly pap smears are vital for catching this cancer early!
- Endometrial cancer
- Bleeding disorders
- Diseases such as lupus, cirrhosis of the liver, diabetes, thyroid and pituitary disorders

If you have heavy bleeding and/or cramping and pain, don’t just wait it out while popping Advil. Instead, talk to your physician to rule out any medical conditions that may be causing changes to your cycle. In addition, may sure your physician runs lab tests including CBC, thyroid functioning and an iron panel.

Sunday, April 18, 2010

China Girl Eats Pounds of Dirt Daily



This morning I found myself drawn in to a rather odd, yet interesting story my good friend Joey Antonio posted on facebook this morning. Joey has a knack for finding the strangest of strange news. And this story was no different.

A 19 year old Chinese girl named Bao Bao, tried eating soil, aka dirt, at age 7 and hasn't been able to stop since. In the brief article, she said "It gives me energy. I can live without rice but not soil." She only eats a yellowish, soft powdery soil and consumes about 1/2 to 2 pounds of dirt daily to "keep going." And apparently her boyfriend doesn't mind since she is a cheap date.

As odd as it sounds, Bao Bao is not alone in her dirt eating habit. She has what is callled pica, a pattern of eating non-food materials such as dirt, clay, animal feces, paint, sand or paper. If you are starting to have clear memories of the strange little kid from your pre-K who ate mudpies, you aren't alone, pica is most common in children than young adults like Bao Bao. In fact, an estimated 10-32% of kids aged 1-6 eat dirt. Pica can also occur in pregnant women or adults who crave a certain texture that they apparently can't get from food.

Aside from the obvious issues with eating non-fresh dirt, people with pica often have iron deficiency anemia and zinc deficiency. If you or someone you know has pica, it's time to visit a doctor and get tested for blood levels of iron and zinc and also check for other medical problems such as lead exposure.

Munching on dirt is a cheap habit but could be a sign of other medical issues and of course, it may result shame or at the least, odd stares from your friends and family.

Thursday, April 8, 2010

Pregnant? Are you Consuming Enough Iron?

Anemia can increase the risk of preterm delivery. Yet many women don’t consume enough iron while pregnant. In fact, the National Institutes of Health indicates that up to 50% of pregnant women do not have enough iron in their body. That’s why prenatal multivitamins are so important. They contain more iron (and other nutrients) than regular multivitamins. Pregnant women should also get their iron levels tested at least twice while they are pregnant (more often if necessary). However, you still need to be aware of the signs of iron deficiency (though some people have few or no symptoms from iron deficiency). They include:

• Fatigue
• Weakness
• Feeling cold, low body temperature
• Feeling out of breath easily
• Irritability
• Headache

Many women complain of side effects related to their prenatal supplement. You can minimize some of these side effects by consuming your supplement with food. If you are still having problems, talk to your physician about switching brands. Some women do better on name brand versus generic. And finally, consuming a prenatal multivitamin with heme iron will decrease the likelihood that your supplement will make you constipated (because you need less heme iron in comparison to non-heme, to raise your iron stores).

References
J of Nutr 2000;130:443S-447S.
NIH: http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm

Wednesday, April 7, 2010

Anemia - There are Several Kinds!

The word anemia typically makes people think of iron. However, there are actually over 400 kinds of anemia. Anemia is a condition characterized by a lack of healthy red blood cells. Because red blood cells transport iron to your body’s tissues, anemia will often lead to fatigue. The most common types of anemia related to dietary deficiencies are:

Iron deficiency – over time, inadequate iron intake will hamper the body’s production of hemoglobin, a protein in red blood cells that carries oxygen. Iron deficiency can result from inadequate dietary intake (especially in vegetarians, children and teenagers), increased demand for iron (pregnancy and breastfeeding), heavy menstrual periods and digestive diseases such as Crohn’s and ulcerative colitis.

B-12 or folate (folic acid) deficiency – both of these vitamins play an important role in the production of red blood cells. Folate is found in food and folic acid is the syntheic form of this vitamin. Megaloblastic anemia is due to a deficiency in vitamin B12 or folate or both. Pernicious anemia results from inadequate B12 absorption.

Vitamin E deficiency – hemolytic anemia, from a vitamin E deficiency, is rare but can occur in newborns and people who have problems absorbing fat.