[Anemia Special Topic]Find out the source and don’t be careless. Anemia in men may be a precursor to cancer.

Text: He Jianxing Compiled by: Liang Yingxiu

KUALA LUMPUR: Anemia is a problem where there are not enough healthy red blood cells or hemoglobin to carry oxygen to the body’s tissues.

Hemoglobin is a protein found in red blood cells that carries oxygen from the lungs to all other organs in the body, and anemia can cause symptoms such as tiredness, weakness and shortness of breath.

Anemia refers to the reduction of red blood cells in the human blood, so that it cannot carry enough oxygen and nutrients to all parts of the body. A simple metaphor is that red blood cells are like a bus. There are many seats on the bus. These “seats” It’s called hemoglobin. When the bus comes to the lungs, oxygen will be carried on the bus by the hemoglobin and then sent to all parts of the body. If the reduction of hemoglobin means insufficient oxygen, the person will have symptoms such as easy Asthma, fatigue, dizziness, headache, palpitations and other hypoxic symptoms. The element that makes up heme is iron. In addition to being one of the hematopoietic nutrients, it is also an important cofactor when the human body generates energy.

1 in 5 adult women is anemic

Dr. Tan Sing Yee, specialist consultant in family medicine, pointed out that for adult women, the normal hemoglobin level during physical examination must be between 11.5g/dL and 16.5g/dL, and for adult men, it must be between 12.5g/dL and 16.5g/dL. 18.5g/dL, between 9g/dL and 11g/dL is considered mild anemia, between 7g/dL and 9g/dL is considered moderate anemia, and below 7g/dL is considered severe anemia.

Taking Malaysia as an example, the prevalence rate of anemia among adult women is 17% to 25%, which is about 1 in 5 people. However, if only counting pregnant women aged 18 to 45 years old, the data can increase to 1 in 3 people. One in all people is anemic.

“In addition, the probability of anemia among elderly men and women is also very high, up to 30%. Only adult men have a lower rate of about 10%. However, it is worth noting that if adult or older men develop anemia, especially those of Chinese descent, they must first Rule out the possibility of bowel cancer. A man who has never had anemia problems suddenly develops anemia, which is closely related to cancer and gastrointestinal bleeding. It is very important to further find out the source of anemia. The sudden onset of anemia in men can be regarded as one of the precursors of cancer. It must not be ignored.”

“In addition, there is a strange behavior in the children’s world, that is, some children will put mud, silt, ice cubes or wall mud into their mouths to eat, and then have no interest in eating. This kind of behavior is called abnormal in medicine. Food addiction.”

She once came into contact with a case where the patient was 7 years old, but he still often instinctively put “strange” things into his mouth. This can be regarded as one of the symptoms of anemia. However, the government has previously forced manufacturers to limit packaging to 25 kilograms and below. The flour must be added with iron and folic acid, which I believe will help improve anemia in children.

In Malaysia, the main anemia problem is Iron Deficiency Anaemia (IDA), followed by thalassemia (thalassemia), with the number of patients accounting for about 5% of the national population. As for other diseases such as vitamin B12 or Folate deficiency anemia is rare.

Anemia is treated as a symptom rather than a disease

“It is worth noting that anemia is not a disease but should be regarded as a symptom. When a person has symptoms similar to anemia, a simple full blood count can confirm that the hemoglobin is too low. Once anemia is diagnosed, the cause behind the anemia must be found out.”

For example, why does anemia occur? Find out what type of anemia it is? Because different types of anemia have different treatments, it is by no means “you need to eat iron if you have anemia”.

She reminded that in addition to IDA and thalassemia, some patients who have been taking painkillers or blood-thinning drugs for a long time, or patients with cancer and chronic diseases, as well as the male patients with gastrointestinal bleeding mentioned above, must be treated according to different situations. Sexual treatment, take gastrointestinal bleeding as an example, it is acute and needs to be treated as soon as possible. After being diagnosed with IDA or thalassemia, a ferritin test is also required to understand the true situation of iron deficiency and determine whether iron supplements are needed and the required amount.

Are there any people who can tell that they are anemic just by looking at them?

“There was a 69-year-old male elder. When he entered the clinic, he noticed that his face was pale and he also complained of dizziness. The blood test report showed that his hemoglobin level was 10.7g/dL, confirming that he had mild anemia. . In fact, the symptoms of anemia are not difficult to identify. In addition to the above-mentioned dizziness, easy tiredness, etc., the symptoms include pale eyelids, sunken nails, brittle hair and nails, and even unexplained hair loss. In addition, modern symptoms Men and women in the workplace often complain of being tired, but think it’s just work stress or lack of sleep, which is most likely caused by anemia.”

Diet is closely related to anemia

What are the risk factors for anemia?

Chen Xinyi revealed that in addition to the above-mentioned bleeding during pregnancy and cancer patients losing blood during treatment, some women with fibroids may also cause heavy menstrual bleeding and anemia. The average amount of bleeding during menstruation for women is about 80 ml does not actually cause anemia, so sisters do not need to be too anxious about this.

“Some common chronic diseases such as chronic kidney disease (CKD), diabetes and hypertension can cause anemia because their bone marrow has poor hematopoietic function. This is especially true for CKD patients.”

“It is worth mentioning that diet is closely related to anemia, especially for cancer patients and the elderly. The former is due to lack of appetite during treatment, and the latter either has no appetite, or is due to different chronic diseases, such as high blood lipids or uric acid index. Advanced, you must control your diet and avoid “big fish and meat”. However, the diet that supplements iron comes from “big fish and meat”, such as red meat (pig, beef, sheep, etc.) and offal, etc. How to maintain a balanced diet to achieve this Supplementing iron can also prevent the chronic disease index from increasing. You must discuss countermeasures with your doctor.”

She said that the sources of iron that make up heme can be divided into two categories, namely animal iron and plant iron. In comparison, the former is easier to be absorbed by the body, while the latter is less absorbed. Animal-based iron is the red meat and offal mentioned above, while plant-based iron includes whole grains, dark green vegetables, seaweed, beans and nuts, etc. Therefore, it is particularly important to emphasize that vegetarians are also at high risk of iron deficiency. One of the groups.

“To avoid unnecessary anemia, you should consult a doctor or dietary therapist to learn how to get the iron your body needs, including taking regular monthly iron supplements if necessary.”

Taking iron supplements improves IDA

“The most direct and effective way to improve IDA is to take iron supplements, but you still have to pay attention to the dosage and absorption rate. According to the guidelines given by the World Health Organization (WHO), patients with IDA can People with mild, moderate and severe anemia take 100 to 200 milligrams (mg) of iron supplements, but doses that are too low will not improve the anemia problem.”

In addition, different forms of iron, such as animal-based divalent heme iron or plant-based trivalent non-heme iron, have different actual absorption levels into the human body. Generally, It may only be one-fifth of the elemental, so you need to know more about it when choosing an iron supplement. However, if men and women generally do not have anemia problems and only want to use it for health care purposes, it is enough to choose an iron supplement of 30 to 60 mg.

Enhance absorption Take iron supplements with vitamin C

Some people have complained that they experienced gastrointestinal discomfort, constipation or bloating after taking iron supplements. Therefore, it is recommended to consult a doctor or pharmacist to weigh whether it is edible.

As for taking iron supplements with vitamin C, because the reducing power of vitamin C can enhance absorption, you can choose to take it on an empty stomach in the morning, before going to bed, or 2 hours after dinner. It is also suitable to pair it with a glass of orange juice or fruit. Remember not to take it on an empty stomach. Drink tea or coffee when taking iron supplements to avoid reducing iron absorption. Generally, pregnant women will choose to take it before going to bed to avoid morning sickness.

Two-in-one iron supplements to choose from

It is worth noting that in recent years, two-in-one iron supplement products have been launched on the market, which contain iron, vitamin C and other nutrients at the same time, and can also enhance intestinal absorption and reduce the chance of constipation, etc., and also provide consumers with One more choice.

How long must IDA patients take iron supplements to see improvement? Generally speaking, as long as you follow the correct dosage, you can see an increase in hemoglobin levels in a blood test after 2 weeks to 1 month. However, to confirm that the previous loss of iron has been improved, it must be maintained for 3 months.

As for whether you need to continue taking it in the future, it depends on your individual situation. If you can already absorb enough iron from the diet, including enough animal iron, and there are no other gastrointestinal bleeding problems, then there is no need to take it.

Still tired or anemic after 8 hours of sleep

Anemia is not a disease, just a symptom. As long as it is detected in time and improved, it will be fine. As a doctor, Chen Xinyi’s advice is not to ignore the warnings from the body. If you do some housework or have slept for 8 hours, it will still be easy. If you feel tired, you should pay attention to whether you have anemia.

In fact, you can know whether you have anemia with a simple blood test.

After confirming anemia, it is necessary to identify what type of anemia it is and prescribe the right medicine according to the doctor’s advice, so that the anemia problem can be solved once and for all.

Question 1: I have a lot of blood during each menstrual period, and my hemoglobin index is 6.1g/dl. I am currently taking iron supplements. If I stop taking iron supplements if the value reaches the standard, will anemia still occur? Can excessive iron supplementation improve anemia?

Answer 1: Are you sure the hemoglobin index is 6.1g/dl? Some people will read the wrong item. I guess what you are referring to is blood flow density (RPC). If it is really the hemoglobin index, then you are already suffering from severe anemia. Iron supplements may not be able to help you in the short term. You may need a blood transfusion to improve it. If you have heavy periods, you may want to look into the cause, which may be uterine fibroids or uterine tumors. In addition to supplementing iron, you also need to find out the cause of excessive menstrual bleeding in order to solve the problem.

Patients with iron deficiency anemia can supplement iron through food and medicine, which is enough. If you really don’t want to supplement iron through diet and oral methods, injectable iron is another option. Injectable iron supplements are also easier for the body to absorb, and the effects can be seen in a short period of time, but they require going to a clinic or hospital for treatment.

Eatable fruits to replace vitamin C

Question 2: Will adding vitamin C when supplementing iron and folic acid make the absorption better? Do I have to take vitamin C? Or just eat more fruits?

Answer 2: Yes. Vitamin C allows our gastrointestinal tract to absorb iron better. There are many iron supplements and folic acid on the market, and some of them only need one pill to cover multiple vitamins. You can also supplement them separately. Of course, you can replace vitamin C with fruits, because fruits contain vitamin C.

Anemia has no connection with blood type

Question 3: Is there a relationship between blood type and anemia? Which blood type is more likely to be anemic?

Answer 3: No correlation. Anemia can also occur with any blood type.

Thalassemia patients do not need iron supplements

Question 4: Can patients with severe alpha thalassemia trait take iron supplements? How should they supplement?

Answer 4: Patients with thalassemia do not need to supplement iron because their anemia is not caused by iron deficiency. The anemia problem in this type of patients is because the red blood cells are affected by genes, causing the red blood cells to remain at low levels, so iron supplements are useless. Iron supplementation is only effective for patients with iron deficiency anemia.

Excess iron will not cause stones

Question 5: Will supplementing too much iron food cause stones?

Answer 5: No. Even if you eat too much iron, your body will excrete it if it cannot absorb it. Kidney stones are caused by uric acid and calcium oxalate.

Take iron before bed to avoid nausea

Question 6: Elderly people generally cannot fully absorb iron from food. If they want to take iron supplements but are worried about side effects, what should they do? Especially for those who often experience stomach irritation and nausea, how can we ensure that we do not feel uncomfortable?

Answer 6: To prevent anemia, you can choose a low-dose iron supplement, only about 30 grams. If you are an anemic patient, you must take a certain dose. The side effects of taking iron supplements are constipation, gastrointestinal discomfort, Nausea, vomiting, etc., especially in the first week or two of taking it, can be overcome as long as you take it for a long time.

The best time to take iron supplements is in the morning, and on an empty stomach. However, the taste of iron will make the user’s nausea worse, so I would recommend that such users try taking it before going to bed. Another suggestion is to supplement iron every other day, such as Monday, Wednesday, Friday, Sunday, and so on. This method of taking can reduce side effects and can also effectively supplement iron. If you really hate the taste of iron supplements, you can try taking them with food, but the iron supplement will be slightly less effective.

Some iron supplements are classified as sustained release (SR). This type of iron supplement is not decomposed in the gastrointestinal tract, but in the small intestine. Therefore, this can greatly reduce the discomfort after taking it, so you can choose it when purchasing. This type of iron supplement.

When buying iron supplements, pay attention to elemental iron

Question 7: I see elemental iron in iron supplements. What is the difference between the two?

Answer 7: Iron supplements are composed of multiple prescriptions and nutrients. Elemental iron refers to the amount that our intestines and stomach can absorb. In fact, iron supplements will list the total iron content of each pill, but our intestines and stomach only absorb about 20% to 30% of the iron.

Therefore, this type of supplements will also use elemental iron as a unit to tell buyers approximately how much they can absorb. Therefore, buyers should not just look at the total iron quality when purchasing iron supplements. Elemental iron is what we should pay attention to. For patients with anemia, more than 100 grams of elemental iron is required to be effective.

Cancer affects red blood cells

Question 8: Do the early symptoms of blood cancer begin with anemia? Are anemia and blood cancer related?

Answer 8: Yes, anemia is one of the symptoms of blood cancer. Leukemia does not have such a close relationship with red blood cells. Instead, it affects white blood cells more. Patients with blood cancer will have high or low white blood cells, but the cancer can also affect red blood cells, bone marrow, etc., thus causing anemia.

High red blood cells can cause stroke

Question 9: What impact will it have on the body if hemoglobin is too high?

Answer 9: This is a congenital blood disease called polycythemia. This type of patient has high red blood cells, which is mostly related to the bone marrow. It also causes thick blood, frequent headaches, and may induce stroke and heart disease. and other diseases. Such patients must undergo blood tests and physical examinations for diagnosis, and need to be referred to a hematology department for medical treatment.

Take iron and eat high-fiber foods

Question 10: Will iron supplements cause constipation? How to improve constipation?

Answer 10: Taking iron supplements can cause constipation. Therefore, users must also consume more high-fiber foods, drink water and exercise. Most elderly people who take iron supplements have symptoms of constipation because they eat less and exercise less and drink less water. Therefore, if the condition cannot be improved, users can also take stool softeners to help with defecation.

If the bleeding is caused by hemorrhoids, you must give priority to hemorrhoids before choosing which type of supplement is suitable for you. Not every iron supplement will cause constipation in the user. If it does, the user can switch brands and choose a brand that suits you.

Text: Chen Xiaoquan

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