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August 7, 2015

What does anemia, malabsorption and Allergies have in common ?

by Helene van den Berg

ANEMIA

Anemia is a condition in which the oxygen-carrying capacity of the blood is reduced, due to reduced numbers of RBC’s or a decreased amount of hemoglobin (iron consisting protein, transports oxygen). The person feels fatigued, is intolerant of cold and the skin appears pale.

TYPES OF ANEMIA:

  • Iron-deficiency anemia = MALABSORPTION of iron, excessive loss of iron, or insufficient intake of iron. It is the most common type of anemia.
  • Megaloblastic anemia = inadequate intake of vitamin B12 or folic acid. The red bone marrow produces large , abnormal red blood cells (megaloblasts).
  • Pernicious anemia = insufficient making of blood (hemopoiesis). It results from an inability of the stomach to produce intrinsic factor, which is needed for the absorption of vitamin B12 in the small intestines.
  • Hemorrhagic anemia = excessive loss of RBC’s through bleeding, due to heavy menstruation, stomach ulcers or wounds.
  • Hemolytic anemia = RBC plasma membranes rupture prematurely. Damages the filtering units (glomeruli) in the kidneys. Results from inherited defects or could be from parasites, toxins or antibodies from incompatible transfused blood.
  • Thalassemia = deficient synthesis of hemoglobin. It is hereditary. The RBC’s are small (microcytic), pale (hypochromic) and short-lived. Occurs primarily in populations from countries bordering the Mediterranean Sea.
  • Aplastic anemia- destruction of red bone marrow. Caused by toxins, radiation and certain medications, that inhibit enzymes needed for hemopoiesis.
  • Sickle-cell disease = Inherited disease. RBC’s contain an abnormal kind of hemoglobin, have a sickle shape and die prematurely, which leads to anemia. Symptoms are shortness of breath, paleness, fatigue, delayed growth in children, pain in bones and abdomen, serious infections, fever, rapid heart rate, leg ulcers, organ damage etc.
MALABSORPTION SYNDROME:Malabsorption syndrome (MS) refers to a number of disorders in which the small intestine’s ability to absorb certain nutrients, such as vitamin B12 and iron, into the bloodstream is negatively affected.Causes of Malabsorption Syndrome (MS):

Any defect in the functioning of the digestive system – e.g. inadequate production of bile salts by the liver or digestive enzymes by the pancreas, or cells lining the intestine, or damage to the intestinal absorptive cells, can prevent the proper breakdown of foods and the absorption of adequate amounts of nutrients.

Factors that may cause MS:

  • Tapeworm and other parasites.
  • Diseases such as celiac disease, AIDS (damages immune defenses against secondary infections, biliary atresia, diabetes mellitus, hyper and hypothyroidism etc.
  • Dairy protein allergies.
  • Inflammation (Crohn’s disease, Amyloidosis) in the mucous membrane that lines the intestine may prevent nutrients from being absorbed through the intestinal wall. Infections (acute infectious enteritis). Some infections may result in an overgrowth of intestinal bacteria;
  • Soy milk protein intolerance
  • Certain medications (cholestyramine – cholesterol lowering drug); neomycin – an antibiotic; laxatives; colchicines – an antigout drug.
  • Cardiovascular problems (congestive heart failure and Pericarditis)
  • Chronic pancreatitis (alcohol abuse) – decreased secretion of pancreatic enzymes that digest food – especially fats and protein.
  • Any obstruction of the lymphatic system (lymphomas, tuberculosis)
  • Birth (congenital) defects.
  • Radiation therapy
  • Cholestasis
  • Chronic liver disease
  • Surgery (gastrectomy, surgical treatments for obesity)
  • Short bowel syndrome – birth defect or due to surgery. Surface area for nutrient absorption is reduced.
  • Tropical sprue – related to environmental factors such as parasites, toxins in food, infections. Symptoms may include anemia, sore tongue, diarrhea and weight loss.
  • Whipple’s disease – bacterial infection that affects mostly middle-aged men.

Vitamin B12 malabsorption may be due to :

  • Pernicious anemia
  • Bowel resection
  • Tapeworm infection

SYMPTOMS OF MS:

Symptoms of MS will be different depending on the nutrients that are not properly absorbed. Symptoms include:

  • Stools that float and are bulky, greasy and have an unusually bad odor
  • Abdominal discomfort or cramps, especially after eating
  • Diarrhea
  • Excessive gas
  • fatigue
  • weight loss
  • muscle wasting
  • vomiting
  • easy bruising (vitamin K malabsorption)
  • bone pain and painful muscle contractions (calcium malabsorption)
  • night blindness ( vitamin A malabsorption)
  • paleness and other symptoms of anemia
  • high susceptibility to infection

RISK FACTORS for MS:

  • Family history of malabsorption or cystic fibrosis.
  • Excessive alcohol consumption
  • Intestinal surgery
  • Use of laxatives/mineral oil

DIAGNOSING MS:

MS is suspected if the patient suffers nutrient deficiencies, chronic diarrhea, or significant weight loss, despite eating a healthy diet.

Tests:

  • Blood and urine tests (anemia and other nutritional deficiencies)
  • Hydrogen breath test (detect lactose intolerance or bacterial overgrowth in the small intestine).
  • Schilling test for vitamin B12 deficiency.
  • Secretin stimulation test (enzyme to digest foods).
  • Stool samples looking for undigested fat.
  • Culture of the microorganisms inhabiting the intestines.
  • Small intestine biopsy with an endoscope.
  • CT scan of the abdomen

POSSIBLE COMPLICATIONS:

Long-term malabsorption can result in:

  • Anemia
  • Gallstones
  • Kidney stones
  • Osteoporosis and bone disease
  • Malnutrition and vitamin deficiencies

TREATMENT:

  • In some cases the only treatment necessary is to avoid certain foods (potential allergens) that trigger or exacerbate symptoms e.g. those with lactose intolerance should avoid milk products (cheese and butter); those with nontropical sprue (celiac disease) may be cure by avoiding all foods containing gluten (protein found in wheat, rye, oats and barley); avoid sugar and foods rich in sugar; avoid eggs.
  • The underlying disorder causing malabsorption must be diagnosed and treated.
  • Nutritional supplements may be prescribed.
  • Pancreatic enzymes may be prescribed.
  • Corticosteroids may improve absorption in some cases of inflammatory diseases.
  • In many cases a high carbohydrate, low-fat diet is recommended – easier to digest and absorb.
  • A sweat test ( to check for cystic fibrosis).
INFLAMMATION/ALLERGIES:

Inflammation is your body’s way of responding to injury. Prolonged, maladaptive inflammation is a common thread in many diseases, including:

  • Allergies
  • Digestive disorders
  • Eczema
  • Psoriasis
  • Asthma
  • Arthritis
  • Autoimmune conditions
  • Cardiovascular disease
  • Cancer
  • depression
  • Neurodegenerative diseases
  • Obesity

Anti-inflammatory medications are often prescribed, but they cause unpleasant side effects and don’t address the underlying cause of the symptoms that are related to inflammation. That is why an anti-inflammatory diet can be a great place to start.

HOW DOES INFLAMMATION BECOME CHRONIC?

Genetics certainly play a role in chronic inflammation e.g. people with a family history of rheumatoid arthritis or cardiovascular disease, may be predisposed to chronic inflammation. Genetics loads the gun, but diet and lifestyle pull the trigger.

Even without genetic predisposition, an environment of chronic inflammation could be created by:

  • Pro-inflammatory dietary choices – reliance on processed foods and refined carbohydrates, excess sugar, too much meat , pork, poultry eggs and dairy, not enough anti-inflammatory foods like vegetables, avocados, olives, nuts, seeds and legumes
  • Elevated stress
  • Smoking
  • Physical activity extremes – lack of exercise/overexercising
  • An undiagnosed condition that’s causing chronic inflammation e.g. food allergies, irritable bowel syndrome, autoimmune disorder.

SYMPTOMS OF CHRONIC INFLAMMATION:

  • Joint pain
  • Ongoing digestive problems – bloating, abdominal pain, bowel irregularity
  • Overweight/obesity
  • High cholesterol
  • High blood pressure

The combination of high cholesterol with inflammation, increases the risk of heart disease.

TESTS FOR INFLAMMATION:

  • Blood test for C-reactive protein (produced in liver in response to inflammation).
  • Sedimentation rate – blood more sticky and takes more time to settle, in presence of inflammatory proteins.

WHAT IS AN ANTI-INFLAMMATORY DIET:

It is based on a Mediterranean-style eating plan that includes plenty of vegetables, fruit, legumes, nuts seeds, healthy oils and fish (Pescatarian diet) with the following most important components:

  • Omega-3 fatty acids – seafood, walnuts, flaxseeds, leafy greens
  • Fiber – fruit, vegetables, whole grains, legumes. It is important for healthy digestion, blood sugar balance and cholesterol management.
  • Carotenoids –e.g. beta-carotene found in carrots, squash.
  • Vitamin K – leafy greens (kale, brussel sprouts, broccoli,cabbage, seafood. Regulate the body’s anti-inflammatory processes and a powerful antioxidant, reducing oxidative stress that can lead to inflammation.
  • Magnesium – green leafy vegetables, nuts, seeds, legumes, whole grains. This is the most important mineral for protection against inflammation.

Another important aspect of an anti-inflammatory diet, is a low glycemic way of eating . Excess sugar in the blood over a long period of time, leads to insulin insensitivity and an inflammatory response.

Other lifestyle factors like moderate physical activity, meditation, good sleep reduce inflammation as well.

An anti-inflammatory diet will help to combat the following diseases:

  • Metabolic syndrome (precursor to diabetes and cardiovascular disease) – a person is diagnosed with this disease if 3/5 of the following symptoms are present: high blood glucose, high blood pressure, high triglycerides, low HDL, excess abdominal fat. A Mediterranean diet will reduce metabolic syndrome with 25%!.
  • Alzheimer’s disease – a Mediterranean diet had a 48% lower risk of mental degeneration progressing to Alzheimer’s.
  • Cancer – a Mediterranean diet was associated with a 6% reduction in cancer
  • Cardiovascular disease – 9% reduction through a Mediterranean diet.
  • Parkinson’s disease – 13% reduction

To conclude: Most widely feared diseases share a common inflammatory component, which could largely be prevented by an anti-inflammatory diet.

THE ANTI-INFLAMMATORY PLATE: (estimated)

  • 40% VEGETABLES – kale, spinach, broccoli, asparagus, cauliflower, mushrooms, carrots, celery, radishes
  • 20% FRUIT – apples, pears, berries, grapes, melons, mangoes, kiwi
  • 20% PROTEIN – wild caught fish, beans, nuts, seeds, (grass–fed beef/lamb/chicken – 1-2x/ wk)
  • 10-15% COMPLEX CARBS – Quinoa, brown rice, squash, beets, carrots, sweet potatoes
  • 5 -10% FATS AND OILS – avocado, olives, extra virgin olive oil, flaxseed oil, coconut oil

Vegetables occupy most of your plate. It will supply most of your vitamins, minerals, antioxidants, and other phytonutrients.

A variety of colored, antioxidant-rich fruits, will supply the fiber, to slow down your blood sugar. Eat twice as many vegetables as fruits in a day.

The portion of complex carbohydrates includes some of the starchier vegetables, like sweet potatoes, carrots, beets etc as well as whole grains like brown rice and quinoa for energy. When eating a more plant-based diet, include whole grains in combination with beans to get your protein needs met.

The best anti-inflammatory protein is fish, but grass-fed beef, lamb and free range poultry are acceptable in small amounts. Vegetarian protein sources include legumes, nuts and seeds. Note: soy is one of the top food allergens!.

The fats and oils are those that contain omega-3’s and other phytosterols that are part of the anti-inflammatory pathways in the body. Fat can help you to feel satiated and decrease overeating.

 
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