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Are you exhausted, unfocused, and pale? you may have anemia. Supplements and a simple change in diet can help

aNEMIA IS a sneaky condition. Mild symptoms can feel like stress: You're fatigued even when you get enough sleep. You're unable to concentrate or think clearly. Your skin may become pale due to the lack of oxygenated blood that would normally give it a healthy color. And you may find yourself craving things like ice, clay, or even dirt. (Medical experts have no idea why pica, the desire for nonfood substances, is a symptom of anemia.)

act quickly
If left undiagnosed, anemia can start to feel like a heart attack: rapid breathing, irregular heartbeat, and chest pain from an overworked, oxygen-deprived heart. It's no wonder, says Lloyd Van Winkle, M.D., clinical associate professor at the University of Texas Health Center. "You're already tired from the lack of oxygen in your blood," he explains, "plus, your body is working overtime with a shortage of blood to try to get oxygen into your cells, which is wearing you out even more." That lack of oxygen stresses every part of your body and can, in fact, lead to heart failure.

While serious anemia can indeed be dire, the condition can very often be easily treated and managed with iron pills and a diet filled with foods high in iron.

take supplements
If you're diagnosed with anemia, the first thing you'll get is a prescription for supplements to bring your iron levels up to normal. Once you start taking them, you should see improvement within a couple of weeks. It's important to continue taking supplements as long as they are prescribed, often for up to six months, in order to increase your body's store. The most common side effects are stomach discomfort and constipation, which can usually be relieved with high-fiber foods, lots of water, and exercise.

eat iron-rich foods
In the "old days," most doctors and nutritionists advised their anemic patients to eat more liver. Carla Weisberg, 45, a textile and surface designer in New York City, remembers hearing that as a college student in the 1980s, when she became anemic shortly after being hit by a car. She didn't lose a lot of blood in the accident, but she was bruised from head to toe. A few weeks later she noticed she was becoming more and more fatigued. When she went back to the doctor, tests showed she was anemic, A nutritionist recommended homemade "liver shakes" — an unpalatable combination of pureed frozen liver and orange juice. "I drank one and it was so vile, I couldn't swallow anything else for 24 hours," recalls Weisberg.

Although organ meats (beef, lamb, and dark-meat poultry) do contain the highest concentration of iron and are more readily absorbed by the body than other sources, it's found in significant amounts in many additional foods, too. In fact, legumes and other plant foods often contain more iron than most animal-derived products. Tasty foods like leafy green vegetables, legumes, dried fruit, nuts, whole grains, enriched rice, pastas, or cereals, and shellfish are also excellent sources of the nutrient, so you can forget about those liver shakes. (See "Top Ten Food Sources of Iron," page 54.)

Weisberg's nutritionist also recommended cooking with a cast-iron skillet to get more iron from a mostly vegetarian diet. This is an effective method and a smart thing to do, agrees Ashley Koff, R.D., founder of The HealthXchange nutrition counseling services in Beverly Hills and Santa Monica, Calif. Many foods, especially those with acidic ingredients such as tomatoes, absorb significant amounts of the mineral from a cast-iron skillet, she says.

If you have mild or borderline anemia, you might respond well to getting more B vitamins, which your body uses to produce red blood cells, and vitamin C, which aids in absorption of dietary iron.

avoid iron blockers
Certain substances in foods can negatively affect iron's bioavail-ability, or the amount that is actually absorbed and used by the body. These "iron blockers" include phosphates in milk and egg whites, calcium in dairy products, phytates in high-fiber foods, and tannins and polyphenols in coffee and tea. Some foods, like spinach and soybeans, are high in iron, but they also contain substances that block iron absorption. "You don't have to avoid these foods," Koff says. "But it's best not to eat them at the same time you're eating foods high in iron. And be sure to eat soy and spinach with foods that are filled with vitamin C to help increase iron absorption." If you are using both calcium and iron supplements, Koff adds, take them separately, at different times of the day.

try TCM
Reduced life force energy (known as qi) in the blood causes anemia, according to the principles of Traditional Chinese Medicine (TCM). Acupuncture is thought to not only regulate menstrual periods, but also to stir up energy and promote movement of stagnant blood, says licensed acupuncturist and nationally board-certified herbologist Greg Ruvolo of Sound Body & Soul healthcare center in New York City. "We treat anemia problems with acupuncture, herbal medicine, and diet to help nourish the blood," he adds. "In general, the more severe the problem, the longer it takes to correct, but I have seen patients respond very well when they are diligent about their treatment." For serious cases, Ruvolo recommends staying under the supervision and care of a medical doctor while also using TCM methods.

One of the herb formulas Ruvolo prescribes routinely is Four Substance Decoction (Si Wu Tang). It consists of the herbs Rehmannia glutinosa (shu di huang), Paeonia lactiflora (bai shao), Angelica sinensis (dang qui), and Ligusticum wallichii (chuan xiong), and it can be used alone or in combination with other herbs, depending on your needs.

Ruvulo also recommends cooking with herbs that contain iron, like parsley, dandelion, yellow dock root, watercress, nettle, and roots of burdock, sarsaparilla, and the seaweed dulse — and adding Chinese Rehmannia and Chinese wild yam herbs to your diet to increase the assimilation of iron.

choose energy drinks
In place of coffee and regular tea, Ruvolo suggests drinking teas made from anise, caraway, cumin, mint, or linden flowers daily to improve iron absorption. Or you can gulp down drinks made from powdered green foods such as seaweeds, cereal grasses (wheat and barley grass), and micro-algae (wild blue green and chlorella), which provide many nutrients and aid iron absorption, he adds.

exercise with care
Physically active women, especially runners, often have low iron stores, so if you exercise frequently, it's especially important to have your blood checked annually.

Researchers at Purdue University found that even moderate exercise can lead to anemia in women who have low levels of iron to begin with. This type of "sports anemia" is often due to a combination of the breakdown of red blood cells from the physical force of exercise (blood cells literally squashed from physical pressure), a dietary deficiency of iron, and regular use of aspirin and other painkillers that can cause gastrointestinal bleeding.

FIRST PERSON: LIVING WITH ANEMIA
Eleven years ago, I was rushed to the emergency room with shortness of breath, chest pain, and a rapid heartbeat — symptoms, I believed, of an impending heart attack. At age 42, I thought my number was up. As it turned out, my numbers were down; my lab numbers, that is. What I had actually experienced were symptoms typical of iron-deficiency anemia, a shortage of the red blood cells that carry oxygen throughout the body. Working with my doctor, we figured out uterine fibroids and adenomyosis (a condition similar to endometriosis) were causing excessive menstrual bleeding that led to my anemia. In addition to a regimen of iron supplements, my doctor prescribed birth control pills to reduce the severity of my periods. I was also told to start eating foods high in iron on a daily basis.

Although my condition has been chronic and required regular attention, I've learned that it's easy to handle and won't become life-threatening as long as I eat lots of iron-rich foods and remember to take iron supplements during the weeks when I have my period. Like many conditions, iron-deficiency anemia is completely manageable if you get an early diagnosis. I pay much more attention to my own body signals now — especially feelings of fatigue that don't stem from tack of sleep — and I try to get my blood tested every six to eight months, two surefire measures of prevention.

In the "old days," most doctors advised their anemic patients to eat more liver. Now foods like leafy green vegetables, legumes, dried fruit, nuts, and enriched grains or pastas get the nod.

Drinking teas mode from anise, caraway, cumin, mint, or linden flowers daily may help to improve iron absorption.

"Anemia is easy to handle as long as I eat lots of iron-rich foods."

ARE YOU ANEMIC?
If you have symptoms of iron-deficiency anemia, ask your doctor for a complete blood count — to get a reading on your levels of red blood cells, hemoglobin (the protein that contains iron and helps the cells carry oxygen), and hematocrit, which determines the blood's ability to carry oxygen. The lower these numbers get, the more likely you are to experience symptoms of anemia.

Find the cause "If you're anemic, the first step is to figure out why," says hematologist Bruce Dezube, M.D., associate professor of medicine at Beth Israel Deaconess Medical Center, Harvard Medical School. In most cases, it results from abnormal bleeding due to frequent or heavy menstrual periods. Other medical conditions can lead to anemia, and although it's much more common in women, it can happen to men, too. An intestinal disorder such as celiac or Crohn's disease can affect the body's ability to absorb nutrients including iron, as can a class of drugs known as proton pump inhibitors, used to block stomach acid. Internal bleeding from chronic conditions such as stomach ulcers, hemorrhoids, and even nosebleeds can lead to iron deficiency. Blood loss from childbirth, an injury, or surgery can also bring on an acute case.

Get treated According to the Centers for Disease Control, 12 percent of women ages 12 to 49 have iron-deficiency anemia. If you think you're one of them, don't self-diagnose or self-treat. There's a chance you'll take the wrong kind of supplement. While deficiency conditions (from a shortage of iron, folic acid, or vitamin B12 — a condition also known as pernicious anemia) are most common, there are actually more than 400 different types of anemia. — S.M.

For shopping information, see Buyer's Guide, page 104.

TOP TEN FOOD SOURCES OF IRON
The recommended daily intake of iron for women ages 19 to 50 is 18 milligrams. Pregnant women need significantly more (27 mg); men and postmenopausal women need much less (8 mg). Here's how these iron-filled foods stack up:

FOOD (amount) IRON (mg)
Clams, canned, drained (3 oz.) 23.8
Oysters, cooked (3 oz.) 10.2
Soybeans, mature, cooked (½ cup) 4.4
Pumpkin seed kernels, roasted (1 oz.) 4.2
White beans, canned (½ cup) 3.9
Blackstrap molasses (1 tbsp) 3.5
Lentils, cooked (½ cup) 3.3
Beef bottom round, lean, cooked (3 oz.) 2.8
Prune juice (¾cup) 2.3
Tomato puree (½ cup) 2.2
PHOTO (COLOR): Get even more energy out of iron-rich pumpkin seeds by roasting them in a cast-iron skillet.

PHOTO (COLOR): Pump up your iron intake by cooking with (clockwise from top left) dandelion, watercress, dulse seaweed, and parsley.

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By Susan McQuillan

Photography by Levi Brown

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