That Tired Feeling

Tired? Uninterested in life? No energy to set about your daily activities? Feel a strange uncontrollable urge to eat bizarre non-food items like chalk, clay, bricks, dirt or even ice? You just may be part of the 220 million Indians who are anaemic.


Anaemia is defined as a haemoglobin (Hb) level less than 12 grams/decilitre (gms/dl) in women and 14gms/dl in men. Close to 70 per cent of the population in India has a Hb value around 10-11gms/dl. Although anaemia can be due to many causes, genetic or acquired, most often it is due to a deficiency of iron.

Our body needs energy to function. This is obtained by metabolising nutrients, a process requiring oxygen. Haemoglobin in the red blood cells binds oxygen and then supplies it all over the body. Iron is one of the main components of haemoglobin. If it is not available in sufficient quantities, the level of haemoglobin drops. This slows cell metabolism and functions. The person develops lethargy, sleepiness, tiredness, disinterest, inefficiency and ineffectiveness. This is eventually reflected in academic performance and earning capacity.

Iron for haemoglobin production is obtained from the diet. Absorption of iron is not very efficient even in ideal circumstances. A normal diet contains between 15 (vegetarian) and 75 (non-vegetarian) milligrams (mg) of iron. Only about 6 per cent is absorbed and the rest is excreted. Chemicals like tannates found in tea precipitate iron.

Seventy per cent of Indians are vegetarians. Vegetables contain phytates which interfere with efficient iron absorption. Non-vegetarian haem iron from meat and fish is best absorbed. Many non-vegetarians eat them only a few times in a week. Most Indian diets, therefore, barely meet the minimum daily requirement of iron of 15mg a day. This means that if there is decreased availability of iron, loss of blood or additional requirements, the person becomes anaemic.

The absorption of iron may be decreased by diseases of the stomach and intestines. Medicines which reduce stomach acidity (antacids, omeprazole, ranitidine, rabeprazole) also decrease the absorption of available iron.

Women are more prone to anaemia. They lose around 0.5mg of iron a day during menstruation — a loss that occurs every month from menarche to menopause. This is aggravated if the periods are prolonged or there is heavy bleeding. If the woman becomes pregnant, the baby requires 0.5-0.8mg of iron a day. The same amount is required during lactation. These extra losses from the body are often not replenished. This leads to a gradual fall in iron stores and anaemia.

Iron stores may become inadequate during periods of rapid growth like infancy. Infants triple their birth weight in the first year. They can become anaemic because they are not born with enough iron stores to cope with the requirements during this rapid growth. During the second growth spurt in adolescence, food faddism often makes the diet unsatisfactory from the caloric and nutrition point of view. This can eventually result in anaemia.

About 50 per cent of the population is infected with intestinal worms. There are several varieties which lay between 3,000 and 30,000 eggs a day. Each worm causes blood loss of 0.03ml a day. The anaemia can become severe, with the haemoglobin dropping to 3 gm/dl or less.

Unnoticed undiagnosed blood loss — from the stomach if there is a bleeding peptic ulcer, the intestines if there are polyps, the rectum if there are bleeding piles — can result in anaemia. If men or postmenopausal women on an adequate diet become anaemic, secondary unrecognised blood loss should be diligently searched for.

Anaemia produces a pale skin, a smooth tongue and fissuring at the angles of the mouth. The nails may become brittle. The person may complain of lethargy and difficulty in swallowing. This is because webs may form in the oesophagus. There may be a dull aching or pricking pain in the legs, relieved only by moving them rapidly, the “restless leg”.

Untreated anaemia can result in premature births. In children it may lead to growth retardation. It can eventually cause heart failure and even death.

Iron deficiency cannot be rectified by diet alone. It is necessary to take iron supplements. Iron is poorly absorbed but this can be helped by taking the tablet with an acidic drink like lemon or orange juice. If other metals, like zinc, are administered simultaneously, they compete for the same absorption sites in the intestines, decreasing availability.

So remember, if you are taking iron, zinc and calcium supplements, they need to be taken individually 12 hours apart to be effective, and not all together as a single capsule as unscientifically advertised in the media.

Sources: The Telegraph (kolkata, india)

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