Hidden Hunger: Anemia

Are you iron deficient? Do you have anemia? To most people, these two questions mean the same thing. The fact is both iron deficiency and anemia can co-exist, but anemia does not just refer to iron deficiency.¹ Anemia can be caused by deficiencies of folic acid, vitamin B12, iron, other underlying health conditions or even genetic factors. Having stated this fact, half of all anemias are caused by iron deficiency.¹

Globally the statistics show an increase in percentage every year.¹ In India 67.1% of children and 59.1% adolescent girls are anemic. Three of four Indian women have low dietary iron intake.²

The diagnostic tests for anemia include Complete Blood Count (CBC), checking for specific nutrients like Iron (Serum ferritin, transferrin saturation, serum iron/TIBC; ± soluble transferrin receptor), Vitamin B12 (Serum B12; ± methylmalonic acid (MMA), homocysteine), Folate (Serum folate; ± homocysteine), Vitamin A (Serum retinol), Copper (Serum copper and ceruloplasmin). All these nutrients play a role in anemia.

Test	Result	Interpretation
CBC	Low Hb + low MCV/MCH	Possible iron deficiency, perform Ferritin (Iron stores but can increase during inflammation), hence also perform, CRP/ESR — to assess inflammation Transferrin saturation TIBC/transferrin Reticulocyte count Peripheral smear
CBC	Low Hb + high MCV	MMA and/or homocysteine OR presence of neurological manifestations
CBC	Normal	Still assess for Iron deficiency + B12/folate deficiency

All these assessments are directed towards identifying the cause of anemia and treating it by addressing the cause. While treating the cause, you may also be put on a IV regimes or supplementation regime. Few things that you can do from a diet perspective for Iron, folate and Vitamin B12:

1. Haeme Iron in Non-vegetarian sources are best absorbed. High content of haeme iron is found in organ meat (liver, brain), meat, poultry and fish.

2. Non-haeme or Vegetarian sources of Iron include pulses, green vegetables, soya, tofu, nuts and seeds. These should be paired with Vitamin C sources like lime, amla, tomato to increase Iron absorption. Pulses can be sprouted to improve the B complex availability and absorption. Avoid tea and coffee around main meals as they inhibit iron absorption.

3. Dairy, eggs, fish, meat, chicken are good sources of Vitamin B12 and if your tests still show B12 in a lower range, you can start with supplements while maintaining adequate water intake. Any additional B12 can be flushed out through urine if you are taking enough water (as B12 is a water-soluble nutrient). If you are a vegetarian or following a vegan diet, do consider supplementation.

4. Greens, beans, lentils, fortified grains, nuts and seeds are good sources of folate. If you are planning conception or are pregnant or post-natal, you should consume folate through supplements for the body’s additional needs.

Along with nutritional intervention, treating the cause of the problem will ensure a relapse of the deficiency. In India and with my own diet consult practice, my experience has been that most of us who travel frequently or eat outside food too often have stomach worms that absorb iron in spite of supplementations. Hence, a de-worming schedule planned with your family physician in otherwise healthy individuals, usually helps solve the problem. In certain cases, Vitamin D supplements also help as the blood cells are produced in the bone marrow. You are unique and identifying the issues that trouble your body is something you must invest time into.

References:

1. Nutrition and nutrition-related health and development data, Nutrition Landscape Information System (NliS), WHO, Anemia, 2008

2. India’s Fight Against Anemia. Ministry of Health and Family Welfare, Nourish, Prevent, Protect, 2025