Q-I've been diagnosed with anaemia, and my doctor has given me iron pills. Do you think that's enough? GC, Bristol.......
A-Largely because of their training, doctors often fixate on a single cause of illness and attempt to cure it with a single magic bullet. Because iron deficiency causes simple anaemia, doctors believe that taking iron pills will cure you.
However, as with most conditions, the cause is complex. For iron to be effective, it must work synergistically with a number of other nutrients. But, if you're low in iron, it's likely you are low in other vitamins and minerals which may help prevent anaemia.
Low levels of folic acid are a well known cause of various types of anaemia, says Dr Werbach. The other B vitamins, such as riboflavin, thiamine, pantothenic acid, and vitamins B6 and B12 are vital in protecting you from various types of anaemias.
Another unappreciated vital nutrient in anaemia is vitamin A. Without enough vitamin A and many people are afraid to take 'too much' the ability of red blood cells (RBCs) to make haemoglobin is impaired. In one study, patients on a diet low in vitamin A gradually developed anaemia (Am J Clin Nutr, 1978; 31: 876-85). Another study of 148 patients found that low blood levels of vitamin A corresponded to reduced haemoglobin levels (Am J Clin Nutr, 1987; 46: 531). Vitamin A taken with iron produces a better take up of iron in the blood and improvement in anaemia than either nutrient taken alone (Am J Clin Nutr, 1988; 48: 595-600).
Low levels of vitamin E can also contribute to anaemia (N Engl J Med, 1980; 303: 416-20). In a study of patients with sickle cell anaemia (in which RBCs are deformed in shape), 450 IU of vitamin E per day decreased the number of sickle shaped cells in the blood by an average of 44 per cent (Am J Clin Nutr, 1980; 33: 968-71).
Make sure your copper levels are checked as low levels can produce anaemia (Semin Hematol, 1983: 20: 118-28). Dr Werbach warns that too high levels of supplemental zinc can often lead to copper deficiency.
Another common cause of simple anaemia is coeliac diease (allergy to gluten in certain grains). Coeliacs are often deficient in iron (Hepatogastro-enterology, 1990; 37: 90-1).
Finally, says Dr Werbach, make sure your stomach acid isn't too low [test this at Biolab in London (0207 636 5959) or Smokie Mountain Laboratories in the US (001 800 522 4762)].
In one study he cites, the number of RBCs increased significantly when patients were given glutamic acid (which increases stomach acid) compared with when they were given iron (Am J Dig Dis, 1949; 16: 322-32). Other studies have shown that patients with low stomach acid given hydrochloric acid absorb iron supplements better (J Appl Physiol, 1964; 19: 187-8).