According to the National Heart, Lung, and Blood Institute, anemia is the most common blood disorder and it affects more than 3 million Americans.
Here to speak with us today about anemia, is Dr. Syed Shahid Mahmood. He is a hematologist, oncologist with Meritus Health.
Selected Podcast
Anemia is Not a Normal Part of Aging
Featured Speaker:
S. Shahid Mahmood, MD
Dr. Mahmood earned his medical degree from the University of Miami Miller School of Medicine. He completed his internal medicine residency at the Boston University Medical Center and completed his fellowship in hematology and oncology at the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center in Baltimore, Md. Dr. Mahmood is board certified in internal medicine. Transcription:
Anemia is Not a Normal Part of Aging
Melanie Cole (Host): According to the National Heart, Lung and Blood Institute, anemia is the most common blood disorder and affects more than three million Americans. Here to speak with us today about anemia is Dr. Syed Shahid Mahmood. He’s a hematologist and medical oncologist with Meritus Health. Welcome to the show. Tell us a little bit about anemia. What is it?
Dr. Syed Shahid Mahmood (Guest): Thank you for having me. Anemia is characterized by a low hemoglobin count in your blood. Red blood cells carry hemoglobin, which is an iron-rich protein, that attaches to oxygen in our lungs and carries it to tissues throughout the body. Anemia occurs when you don't have enough red blood cells or when they don't function properly. Again, the red blood cells carry the hemoglobin. It is diagnosed through a blood test called a complete blood count, which shows your hemoglobin level and your total red blood cell count. In men, a normal hemoglobin is generally over 13.5 grams/dl, and in women, generally greater than 12. It is often developed slowly, and their signs and symptoms are often and frequently overlooked. Some of the symptoms that you could have if you are anemic would be generalized weakness, dizziness, headache, shortness of breath, you could feel a fast or irregular heartbeat, pounding or whishing in your ears, generally feeling cold in your hands or feet, possibly even having chest pain. Commonly when someone is anemic, they look very pale, so that’s a very common finding when you see someone who’s very anemic.
Melanie: Is it a normal part of aging?
Dr. Mahmood: This is a common myth. I'm glad you asked. Many people, especially when they come in, they were told either by some other doctor or family member that it’s a normal process of aging – ‘I'm old, they told me it’s common for me to be old when you're anemic’ – however, this is not normal. It’s not a normal process. It is usually due to something else that’s causing it. There are many elderly men and women in their 80s to 90s who have a normal hemoglobin, and that’s a normal physiologic state. If you're less than that or you are anemic, that is abnormal and is usually due to another reason. It's a very common finding so I think that's where people get confused because that's very common, but it's not normal.
Melanie: Is there a genetic component to it?
Dr. Mahmood: There can be in some states that lead to anemia or that cause anemia. They can be a hereditary component. For example, thalassemia, which is a genetic abnormality in your hemoglobin molecule, that can lead to a slightly anemic, or even in some cases very anemic states. That is a genetic component. There are other conditions such as sickle cell anemia. There are other genetic causes of anemia that could be the case. However, it is not the majority of the situation. The vast majority of people who are anemic in this country and globally are due to non-genetic causes.
Melanie: If someone is diagnosed with anemia, whether it’s slight or full on, what do you do as the first line of defense?
Dr. Mahmood: First, you need to have a diagnosis. That requires going to see the doctor and getting the appropriate blood tests. The second main determination is the cause of the anemia. That’s where a lot of people can get confused. They say ‘I was told I was anemic; I need to go on iron.’ You really need to get to the bottom of why you have anemia. Again, there are many different causes and the specific treatments depend on the exact cause of anemia. For example, an adult, in men in general and in postmenopausal women, if you are iron deficient, that is not a normal state. Yes, you can go on iron to treat that, but what’s more important medically speaking is why are you iron deficient. You should not be losing iron in men and you should not be losing iron in a postmenopausal woman. That requires additional testing. You need to get to see a gastroenterologist to look through the GI tract because that's a very common place to be losing iron. We lose iron by losing blood. That's why getting to the exact reason why you're anemic is very important. Your general practitioner, your primary care doctor, can do a lot of the workup. They are the first line of defense in general. When you come in with complaints that are concerning for anemia or if you initially are found to be anemic, they do a lot of the initial diagnostic workup and they may decide that you need to see a specialist such as a hematologist as myself, or other doctors to further work up the cause of the anemia.
Melanie: Do you have any recommendations for prophylactic iron supplementation for perimenopausal women or menopausal women or even adolescent girls?
Dr. Mahmood: Iron is a very cost effective and cheap method to help prevent iron deficiency, and I think what you're getting at are people who are perimenopausal or who have heavy bleeds are at greater risk for getting an iron deficiency. In general, I would not say that there's not a general recommendation, especially if you're perimenopausal, to go on iron. We do know that in adolescents and in young females where your body need for iron greatly increases as there's the rapid pace of growth, also in young females or starting with their menstrual period, so they have a greater need for iron and they're losing iron at a fast pace. There, it is generally recommended to at least talk to your doctor and maybe even going on iron supplementation for several months to help reduce the risk of iron deficiency.
In adolescents, it's very important because you have increased fatigue. Studies have been shown that you have a decreased ability to concentrate in schools, you have a decreased mood and an impaired cognitive function. That's why it's more important to be at a higher concerned and maybe even go on iron supplementation in that age group. For perimenopausal women, it’s not generally recommended, but it is not normal to be iron deficient in a postmenopausal state. You are not losing iron on a monthly basis at that point, and if you are iron deficient, that is a cause for further workup and to see the doctor.
Melanie: Where does dietary changes and supplements come into this picture? What do you want the listeners to know about diet and really keeping iron-rich fortified foods?
Dr. Mahmood: Majority of the supplements – any over the counter multivitamin – will include iron, and many foods such as cereals and greens are enriched or fortified with iron supplements in general in the United States. What I would say is that people who are very strict in their diet – let’s say, vegans who are not eating red meat – they need to be more keenly aware of how much iron they intake because that's where you could get into the situation of maybe not intake enough iron. Leafy green vegetables also are a good source of iron. It’s just to keep in mind that having a well-balanced diet and not doing anything that’s too strict or abnormal can help prevent getting into trouble.
The other thing is you can be eating a normal, regular diet and still become iron deficient, and again, that is either due to commonly GI blood loss – and that's why it's important that if you notice bleeding in your stool or bleeding in your urine that you need to go see the doctor; that is not normal and that could predispose you to become iron deficient. There are some conditions where your body loses the ability to absorb iron and you become iron deficient. Again, no fault to yourself – it's just medical conditions that can develop that lead to that. I will say bariatric surgery is becoming more common in this county and more common across the United States. When you do bariatric surgery, the most common bariatric surgery does take out a portion of the stomach, and that portion is very important for the body's ability to absorb iron. Those are the situations where I see people who have become iron deficient and they either forgot about being counseling about that or we're not counseled in general. You just need to be aware of that situation as well.
Melanie: Wrap it up for us with your best advice about anemia, prevention of anemia, and what you want the listeners to know.
Dr. Mahmood: I do want to say that anemia is a very common medical condition. It is an insidious process and people feel fine and they don’t realize how fatigued they are before they become diagnosed this medical problem. I will also say that some of the signs and symptoms of fatigue, dizziness or a headache are very common, but it should at least be evaluated by their doctor for evidence of anemia. Anemia can be treated. A very common cause of anemia is iron deficiency, but it's not the only cause. Finally, they should seek the advice of a specialist. If someone was diagnosed with an iron deficiency and they were put on iron and it's not helping after several months, then it could be another cause other than iron deficiency. That’s where most of the situations where I see patients are where they were told they were iron deficient and it’s not really helping, and now we’re asking what else could it be. Just don’t be fooled to think that it’s only iron that’s the cause of anemia.
Melanie: Thank you so much for being with us today. You're listening to Your Health Matters with Meritus Health. For more information, please visit meritushealth.com. That’s meritushealth.com. I'm Melanie Cole. Thanks so much for listening.
Anemia is Not a Normal Part of Aging
Melanie Cole (Host): According to the National Heart, Lung and Blood Institute, anemia is the most common blood disorder and affects more than three million Americans. Here to speak with us today about anemia is Dr. Syed Shahid Mahmood. He’s a hematologist and medical oncologist with Meritus Health. Welcome to the show. Tell us a little bit about anemia. What is it?
Dr. Syed Shahid Mahmood (Guest): Thank you for having me. Anemia is characterized by a low hemoglobin count in your blood. Red blood cells carry hemoglobin, which is an iron-rich protein, that attaches to oxygen in our lungs and carries it to tissues throughout the body. Anemia occurs when you don't have enough red blood cells or when they don't function properly. Again, the red blood cells carry the hemoglobin. It is diagnosed through a blood test called a complete blood count, which shows your hemoglobin level and your total red blood cell count. In men, a normal hemoglobin is generally over 13.5 grams/dl, and in women, generally greater than 12. It is often developed slowly, and their signs and symptoms are often and frequently overlooked. Some of the symptoms that you could have if you are anemic would be generalized weakness, dizziness, headache, shortness of breath, you could feel a fast or irregular heartbeat, pounding or whishing in your ears, generally feeling cold in your hands or feet, possibly even having chest pain. Commonly when someone is anemic, they look very pale, so that’s a very common finding when you see someone who’s very anemic.
Melanie: Is it a normal part of aging?
Dr. Mahmood: This is a common myth. I'm glad you asked. Many people, especially when they come in, they were told either by some other doctor or family member that it’s a normal process of aging – ‘I'm old, they told me it’s common for me to be old when you're anemic’ – however, this is not normal. It’s not a normal process. It is usually due to something else that’s causing it. There are many elderly men and women in their 80s to 90s who have a normal hemoglobin, and that’s a normal physiologic state. If you're less than that or you are anemic, that is abnormal and is usually due to another reason. It's a very common finding so I think that's where people get confused because that's very common, but it's not normal.
Melanie: Is there a genetic component to it?
Dr. Mahmood: There can be in some states that lead to anemia or that cause anemia. They can be a hereditary component. For example, thalassemia, which is a genetic abnormality in your hemoglobin molecule, that can lead to a slightly anemic, or even in some cases very anemic states. That is a genetic component. There are other conditions such as sickle cell anemia. There are other genetic causes of anemia that could be the case. However, it is not the majority of the situation. The vast majority of people who are anemic in this country and globally are due to non-genetic causes.
Melanie: If someone is diagnosed with anemia, whether it’s slight or full on, what do you do as the first line of defense?
Dr. Mahmood: First, you need to have a diagnosis. That requires going to see the doctor and getting the appropriate blood tests. The second main determination is the cause of the anemia. That’s where a lot of people can get confused. They say ‘I was told I was anemic; I need to go on iron.’ You really need to get to the bottom of why you have anemia. Again, there are many different causes and the specific treatments depend on the exact cause of anemia. For example, an adult, in men in general and in postmenopausal women, if you are iron deficient, that is not a normal state. Yes, you can go on iron to treat that, but what’s more important medically speaking is why are you iron deficient. You should not be losing iron in men and you should not be losing iron in a postmenopausal woman. That requires additional testing. You need to get to see a gastroenterologist to look through the GI tract because that's a very common place to be losing iron. We lose iron by losing blood. That's why getting to the exact reason why you're anemic is very important. Your general practitioner, your primary care doctor, can do a lot of the workup. They are the first line of defense in general. When you come in with complaints that are concerning for anemia or if you initially are found to be anemic, they do a lot of the initial diagnostic workup and they may decide that you need to see a specialist such as a hematologist as myself, or other doctors to further work up the cause of the anemia.
Melanie: Do you have any recommendations for prophylactic iron supplementation for perimenopausal women or menopausal women or even adolescent girls?
Dr. Mahmood: Iron is a very cost effective and cheap method to help prevent iron deficiency, and I think what you're getting at are people who are perimenopausal or who have heavy bleeds are at greater risk for getting an iron deficiency. In general, I would not say that there's not a general recommendation, especially if you're perimenopausal, to go on iron. We do know that in adolescents and in young females where your body need for iron greatly increases as there's the rapid pace of growth, also in young females or starting with their menstrual period, so they have a greater need for iron and they're losing iron at a fast pace. There, it is generally recommended to at least talk to your doctor and maybe even going on iron supplementation for several months to help reduce the risk of iron deficiency.
In adolescents, it's very important because you have increased fatigue. Studies have been shown that you have a decreased ability to concentrate in schools, you have a decreased mood and an impaired cognitive function. That's why it's more important to be at a higher concerned and maybe even go on iron supplementation in that age group. For perimenopausal women, it’s not generally recommended, but it is not normal to be iron deficient in a postmenopausal state. You are not losing iron on a monthly basis at that point, and if you are iron deficient, that is a cause for further workup and to see the doctor.
Melanie: Where does dietary changes and supplements come into this picture? What do you want the listeners to know about diet and really keeping iron-rich fortified foods?
Dr. Mahmood: Majority of the supplements – any over the counter multivitamin – will include iron, and many foods such as cereals and greens are enriched or fortified with iron supplements in general in the United States. What I would say is that people who are very strict in their diet – let’s say, vegans who are not eating red meat – they need to be more keenly aware of how much iron they intake because that's where you could get into the situation of maybe not intake enough iron. Leafy green vegetables also are a good source of iron. It’s just to keep in mind that having a well-balanced diet and not doing anything that’s too strict or abnormal can help prevent getting into trouble.
The other thing is you can be eating a normal, regular diet and still become iron deficient, and again, that is either due to commonly GI blood loss – and that's why it's important that if you notice bleeding in your stool or bleeding in your urine that you need to go see the doctor; that is not normal and that could predispose you to become iron deficient. There are some conditions where your body loses the ability to absorb iron and you become iron deficient. Again, no fault to yourself – it's just medical conditions that can develop that lead to that. I will say bariatric surgery is becoming more common in this county and more common across the United States. When you do bariatric surgery, the most common bariatric surgery does take out a portion of the stomach, and that portion is very important for the body's ability to absorb iron. Those are the situations where I see people who have become iron deficient and they either forgot about being counseling about that or we're not counseled in general. You just need to be aware of that situation as well.
Melanie: Wrap it up for us with your best advice about anemia, prevention of anemia, and what you want the listeners to know.
Dr. Mahmood: I do want to say that anemia is a very common medical condition. It is an insidious process and people feel fine and they don’t realize how fatigued they are before they become diagnosed this medical problem. I will also say that some of the signs and symptoms of fatigue, dizziness or a headache are very common, but it should at least be evaluated by their doctor for evidence of anemia. Anemia can be treated. A very common cause of anemia is iron deficiency, but it's not the only cause. Finally, they should seek the advice of a specialist. If someone was diagnosed with an iron deficiency and they were put on iron and it's not helping after several months, then it could be another cause other than iron deficiency. That’s where most of the situations where I see patients are where they were told they were iron deficient and it’s not really helping, and now we’re asking what else could it be. Just don’t be fooled to think that it’s only iron that’s the cause of anemia.
Melanie: Thank you so much for being with us today. You're listening to Your Health Matters with Meritus Health. For more information, please visit meritushealth.com. That’s meritushealth.com. I'm Melanie Cole. Thanks so much for listening.