Anemia: anemia and its risks

⏱ 13 min read

According to the World Health Organization (WHO), around 24.8% of the population suffers from anaemia. This corresponds to one in four people. 

Anemia is a condition in which the number of red blood cells and haemoglobin in the blood is very low. This often manifests itself in tiredness, poor concentration and palpitations. 

In this guide, you can read all about anemia, triggers, symptoms, who is particularly frequently affected and treatment options, as well as lots of other interesting information worth knowing.

What is anemia?

Anemia is the lack of red blood cells (erythrocytes) or haemoglobin in the blood. Haemoglobin is an iron-rich protein in red blood cells, which is responsible for the color of our blood. The main task of the red blood pigment is to transport oxygen from the lungs to the rest of the body. If there is too little haemoglobin in the body, the organs cannot be supplied with oxygen-rich blood. 

What triggers anemia (anemia)?

There are various reasons why you may be affected by anemia. The main causes are 

• Insufficient formation of red blood cells. This is often triggered by the bone marrow, which is normally responsible for the formation of blood cells, not functioning properly. This is life-threatening. 
• You have lost too much blood due to an injury, your period or another circumstance.
• Your body turns against its own blood cells due to changes in the immune system.

Even though anemia and iron loss are two different things, patients affected by anemia often also suffer from an iron deficiency. 

➤ Did you know that 10% of people worldwide suffer from an iron deficiency?

This is an alarming percentage, because iron plays an important role in supplying the individual body systems with oxygen. 

Caution: Anemia often goes unnoticed at the beginning because it only starts weakly. However, anemia can worsen over the years and cause symptoms. A hematocrit test can be used to determine the number of red blood cells contained in the blood, and a haemoglobin test provides information about the number of iron-rich proteins in your blood.

What are the consequences of anemia?

As you probably know, an adequate supply of oxygen is extremely important to maintain the function of the brain, tissues, muscles and cells. If this is restricted by anaemia, it can manifest itself in various symptoms: 

• Tiredness and weakness, pale skin 
• Irregular and increased heartbeat
• Breathing difficulties such as shortness of breath, poor physical condition or reduced stamina
• Chest pain
• Dizziness and loss of stability
• Concentration difficulties
• Cold hands and feet 
• Headache 

How is anemia diagnosed? Hemoglobin values and blood tests

None of these symptoms is specific to anemia, which is why the diagnosis is made with a blood test. The decisive value is hemoglobin (Hb). According to the World Health Organization (WHO), anemia is defined as a hemoglobin level below 12.0 g/dL in women and below 13.0 g/dL in men (Cappellini & Motta, 2015). In pregnancy, anemia is defined as a hemoglobin concentration below 110 g/L, which corresponds to 11.0 g/dL (Goonewardene et al., 2012).

The normal distribution of hemoglobin varies not only with sex but also with ethnicity and physiological status. For the classification and diagnosis, doctors therefore take the blood values, the underlying mechanism and the patient history into account (Cappellini & Motta, 2015).

The next step is to find the cause. If iron is suspected to be missing, serum ferritin is measured: it is the most efficient test for the diagnosis of iron deficiency (DeLoughery, 2017). Megaloblastic anemia is a macrocytic form of anemia, in which the red blood cells are enlarged. Its most common causes are a deficiency of folate (vitamin B9) and a deficiency of vitamin B12, and it can be diagnosed based on characteristic laboratory findings (Socha et al., 2020).

Who is particularly at risk of developing anemia?

Different groups of people can be increasingly affected by anemia:

• People with iron or vitamin B12 deficiency

For example, if you already have an iron deficiency or vitamin B12 deficiency. These deficiency symptoms can be triggered if you have an unbalanced diet or follow a vegan or vegetarian diet.

If you avoid animal products, you may experience these deficiency symptoms, as they are very good sources of iron and vitamin B. What may seem surprising, but can also have an impact on vitamin B absorption, is a Candida infection. This is because the infection affects the way the body can absorb nutrients. 

• Women, pregnant women and senior citizens

Research shows that women are more frequently affected by anemia than men and it is particularly common during pregnancy. In addition, the risk of being affected by anemia increases from the age of 65. 

• People with a serious pre-existing condition

Other people who have an increased tendency to produce too little hemoglobin and red blood cells are those who suffer from an autoimmune disease, HIV/AIDS, rheumatoid arthritis, kidney disease or cancer.  

People who suffer from a digestive disorder, such as leaky gut syndrome or the inflammatory bowel disease Crohn's disease, are also more likely to suffer from deficiency symptoms or anemia. The reason for this is the non-intact absorption of nutrients in the intestine. In addition, taking medication, such as aspirin, can block the absorption of certain nutrients.

• Other factors that can cause anemia 

Sometimes anemia is also genetic and is not caused by lifestyle factors or diet. These include aplastic anemia (your body does not produce enough red blood cells), bone marrow diseases such as leukemia and myelofibrosis, hemolytic anemia (red blood cells are destroyed faster than the bone marrow can replace them) or sickle cell anemia (the hemoglobin produces defective red blood cells that cannot be used by the body and die prematurely).

Iron deficiency: the most common cause of anemia in figures

The Global Burden of Disease Study 2021 evaluated hemoglobin data from 204 countries and territories and arrives at a figure similar to that of the WHO: in 2021, the global prevalence of anemia across all ages was 24.3%, which corresponds to 1.92 billion people. Children younger than 5 years and women are particularly affected. Measured by the years lived with disability, the most common causes of anemia were dietary iron deficiency, hemoglobinopathies and hemolytic anemias, and other neglected tropical diseases. Together they accounted for 84.7% (GBD 2021 Anaemia Collaborators, 2023).

Iron runs low mainly through blood loss. The two main causes of iron deficiency are blood loss due to menstrual periods and blood loss due to gastrointestinal bleeding (DeLoughery, 2017). For women of reproductive age, heavy menstrual bleeding is highly prevalent and a major contributor to iron deficiency and its most severe manifestation, iron deficiency anemia (Munro et al., 2023).

Vitamin B12 is the second nutrient to keep an eye on. Vegetarians are at risk for vitamin B12 deficiency due to suboptimal intake. A review of 18 articles on vegetarians and vegans reported deficiency rates of 62% among pregnant women, 21 to 41% among adolescents and 11 to 90% among the elderly, with higher rates among vegans than among vegetarians. The authors therefore recommend the regular consumption of supplements containing B12 (Pawlak et al., 2013).

In older people, the causes are spread more evenly: in one third of patients, anemia is due to a nutritional deficiency of iron, folate or vitamin B12, and anemia of chronic disease accounts for about another third of the cases (Cappellini & Motta, 2015).

Iron and vitamin B12 are the two nutrients this article names for a vegan or vegetarian diet. The Herbano Vegan Carefree Package supplies both: iron capsules with 30 mg of iron and natural vitamin C, bioactive vitamin B12 capsules with 500 µg, and omega 3 capsules from algae oil.

View the Vegan Carefree Package  ➜

✓ Iron with natural vitamin C + vitamin B12 + omega 3 from algae oil

How dangerous is anemia (anemia)?

In the case of anemia, the side effects of palpitations and breathing difficulties are particularly dangerous. These symptoms are caused by the body trying to regulate the lack of oxygen. However, if the condition persists over a long period of time, it can lead to cardiac insufficiency. This can have serious consequences. 

We therefore recommend that you contact your doctor if you suspect or have confirmed anemia by means of a hemoglobin test and seek his or her care. 

Anemia in pregnancy: what the figures show

Anemia in pregnancy affects more than 56 million women globally. Several factors lead to it, and nutritional iron deficiency anemia is the commonest. Iron deficiency anemia in pregnancy is associated with increased maternal and perinatal morbidity and mortality and with long-term adverse effects in the newborn (Goonewardene et al., 2012).

A meta-analysis of 48 randomized trials with 17,793 women and 44 cohort studies with 1,851,682 women puts figures on this. Anemia in the first or second trimester was associated with a significantly higher risk of low birth weight (adjusted odds ratio 1.29) and of preterm birth (1.21). Women who took iron during pregnancy had a mean hemoglobin concentration that was 4.59 g/L higher than in the control groups. Their risk of anemia was halved (relative risk 0.50), and the risk of iron deficiency anemia (0.40) and of low birth weight (0.81) fell as well (Haider et al., 2013).

The strategies to prevent anemia in pregnancy therefore include iron and folate supplementation, taken daily during pregnancy and in the period after birth (Goonewardene et al., 2012). The Herbano Pregnancy Package combines folate, iron with natural vitamin C and omega 3 fatty acids.

How can anemia be influenced by diet?

In addition to an adequate intake of iron, vitamin B12 and folic acid, a balanced diet is particularly important:

• You should therefore eliminate ready meals and fast food from your diet as far as possible. In addition, so-called "empty" calories, such as refined grains, sugar and synthetic ingredients, should be avoided and replaced with nutritious foods.  
• Soft drinks, coffee and black tea should also be avoided, as these products inhibit iron absorption. 
• Calcium binds to iron, which can have a negative effect on iron absorption. For this reason, conventional dairy products should also only be consumed very rarely. 

How well is iron absorbed? Vitamin C, iron supplements and studies

How much iron the body takes up depends on the diet as a whole. Iron bioavailability has been estimated at 14 to 18% for mixed diets and at 5 to 12% for vegetarian diets in people with no iron stores. Phytate, polyphenols, calcium, ascorbic acid (vitamin C) and muscle tissue have been shown repeatedly to influence iron absorption (Hurrell & Egli, 2010).

Vitamin C works in favor of iron. The key role of ascorbic acid for the absorption of non-heme iron from food is generally accepted, and there are two reasons for it: vitamin C prevents the formation of insoluble iron compounds that cannot be absorbed, and it reduces ferric iron to ferrous iron, which seems to be a requirement for the uptake of iron into the cells of the intestinal lining. Meat and fish also enhance iron absorption, while phytates and tannins inhibit it (Hallberg et al., 1989).

Iron supplements have been tested in many trials. A Cochrane review evaluated 67 trials with 8,506 menstruating women. Women who took iron every day were 61% less likely to be anemic at the end of the intervention (risk ratio 0.39), had a higher hemoglobin concentration and a 38% lower risk of iron deficiency (risk ratio 0.62). The authors conclude that daily iron supplementation effectively reduces the prevalence of anemia and iron deficiency, raises hemoglobin and iron stores, improves exercise performance and reduces symptomatic fatigue (Low et al., 2016).

Iron helps even before a blood count shows anemia. In a systematic review of 18 trials with 1,170 iron-deficient adults without anemia, iron supplementation was associated with reduced self-reported fatigue and increased the hemoglobin concentration by 4.01 g/L (Houston et al., 2018).

The Herbano iron capsules combine both findings: each capsule provides 30 mg of iron together with 70 mg of natural vitamin C from acerola extract. In the Vegan Carefree Package, they come with vitamin B12 capsules and omega 3 capsules from algae oil.

View the Vegan Carefree Package  ➜

✓ Iron with natural vitamin C + vitamin B12 + omega 3 from algae oil

What natural treatments are there for anemia?

The treatment of the symptoms of anemia can be supported in a natural way. We therefore present four ways in which you can stimulate the production of haemoglobin and red blood cells. 

• Strengthen your spleen! 

It is responsible for filtering the blood system. This means that dead, defective or deformed red blood cells are filtered out of the blood and broken down in the spleen. This leaves the healthy erythrocytes in the blood. The health of your spleen is therefore important, as an enlargement of the organ can lead to too many red blood cells being filtered out. The result is an insufficient number of erythrocytes.  

Therefore, choose foods that support your spleen! For example, foods that contain a lot of bitter substances, such as rocket, grapefruit and turmeric. 

• Strengthen your gut!

To improve the absorption of nutrients, you can use probiotics capsules or probiotics powder. A healthy gut is essential for the absorption of nutrients. Therefore, the motto is not: "You are what you eat." Rather, the motto should be: "You are what you digest."

If digestion is impaired, nutrients are not properly absorbed and assimilated. This means that you can take as many iron and vitamin B supplements as you like, but if your gut is not healthy and cannot absorb them properly, they are useless. 

A medical study from Stanford has shown that vitamin B levels and iron levels often increase when probiotics are taken.

• Make sure you eat iron-rich foods!

The next step in overcoming your anemia symptoms is to eat iron-rich foods. You can do this by eating the following products: 

• Lean meat 
• Seafood
• Nuts
• Beans

The best iron-rich foods include beef and chicken liver.

➤ Liver? This may seem strange, but if you buy organic chicken liver from your trusted farmer or organic food store, it's no problem. Liver is not only rich in iron, but also provides valuable B vitamins, making it an extremely nutritious food.

But be careful: pregnant women should definitely avoid eating liver. The reason for this is the extremely high vitamin A content, which can harm the unborn child in the womb. 

• Take the right food supplements! 

Of course, there are also helpful dietary supplements for anemia that you can take to support a healthy diet. However, as we have already mentioned, the functioning of your intestines is paramount, which is why taking probiotics tablets is recommended. A list of additional supplements that can be used to support the treatment of anemia symptoms are: 

• Vitamin B complex capsules
• Iron capsules 
• Folate capsules: Is also very important for the formation of blood in the body. However, folate and not the synthetic form, folic acid, should be used. 

Conclusion

Anemia means that too few red blood cells or haemoglobin are produced and present in the blood. This can lead to various symptoms, which can have serious consequences, especially over a longer period of time. As symptoms such as tiredness, lack of concentration, cold hands and feet and dizziness are not definite complaints and can also be triggered by a variety of other illnesses, it is not advisable to make a self-diagnosis. It is therefore very important to be examined by a doctor if anemia is suspected.

Frequently asked questions

What are 5 symptoms of anemia?

Five typical symptoms of anemia are tiredness and weakness, pale skin, an irregular and increased heartbeat, shortness of breath and dizziness. Chest pain, concentration difficulties, cold hands and feet and headaches can also occur. They arise because too little hemoglobin means that the organs are not supplied with enough oxygen-rich blood.

What is the main cause of anemia?

Worldwide, dietary iron deficiency is the most common cause of anemia, followed by hemoglobinopathies and hemolytic anemias. Iron deficiency itself mainly results from blood loss due to menstrual periods and from gastrointestinal bleeding. Other causes are an insufficient formation of red blood cells in the bone marrow, a deficiency of vitamin B12 or folate, and an immune system that turns against its own blood cells.

What are normal hemoglobin levels?

According to the World Health Organization, anemia is defined as a hemoglobin level below 12.0 g/dL in women and below 13.0 g/dL in men. In pregnancy, the limit is 110 g/L, which corresponds to 11.0 g/dL. The normal distribution of hemoglobin also varies with ethnicity and physiological status.

Can heavy periods cause anemia?

Yes. Blood loss during the period is one of the main causes named in this article, and blood loss due to menstrual periods is one of the two main causes of iron deficiency. For women of reproductive age, heavy menstrual bleeding is a major contributor to iron deficiency and to iron deficiency anemia.

How do you fix anemia?

The first step is a hemoglobin test and care from a doctor, because the treatment depends on the cause. An adequate intake of iron, vitamin B12 and folate, iron-rich foods, a healthy gut and suitable food supplements support the formation of hemoglobin and red blood cells. In a Cochrane review of 67 trials, daily iron supplementation reduced the prevalence of anemia and iron deficiency and raised hemoglobin and iron stores.

Sources (in English):

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