BYOL: blood

Showing posts with label blood. Show all posts

Wednesday, January 15, 2014

Iron Deficiency and Anemia

Recently a good friend of mine told me that she was diagnosed with anemia. She has been vegan for as long as I have known her (at least five years) and is the first vegan I’ve met who actually had a mineral deficiency of any kind. While I can’t go into specifics, I do know she follows a mostly health promoting lifestyle. Besides generally eating well she is also an accomplished Ironman athlete. Some of the symptoms she felt included general fatigue and dizziness but other signs of anemia include: pale skin, rapid heart beat, shortness of breath during exercise, headaches, insomnia, and muscle cramps.

She reached out to me for a little advice and happy to oblige I started doing a little more in-depth research. This is what I found.

The main function of iron in our body is to create hemoglobin, which helps facilitate red blood cell health. An adequate iron level is of paramount importance as it ensures the cells are able to deliver oxygen-rich blood throughout the body. Iron also plays a role in building blood proteins needed for food metabolism, digestion, and proper circulation.

First, while my friend is anemic, meaning she does not have enough iron in her system, having too much iron is equally dangerous – watch for a fuller post on this subject in the future. While it is relativity rare to be diagnosed, iron toxicity typically occurs in those who eat meat. This is because of the type or “quality” of iron in animal vs. plant foods. People obtain iron from either eating plants or from eating animals that have been fed plants. It is then absorbed into their bodies through the upper gastrointestional tract. Plant foods contain what is known as non-heme iron. Animal foods contain non-heme iron but also has whats known as heme iron or “blood iron.”

Traditionally, we our told that heme iron is more easily absorbed by our bodies and therefore of a higher quality, but that view is starting to be questioned as excess iron has increasingly been linked to Alzheimer’s disease, a double digit increased risk in colorectal cancer, type II diabetes, and coronary heart disease. Heme iron intake has also been associated with increased risk of stroke, gestational diabetes, gallstones, and cancers of the prostate, lung, stomach and kidneys, among others.

Our bodies are remarkable. Because the human body doesn't have a mechanism to rid itself of excess iron, we evolved a way to regulate its absorption. When our bodies have sufficient storage levels of iron approximately 5% percent of the iron present in food is absorbed, when a person is iron deficient, then the amount absorbed from the foods eaten can increase by as much as 20%. However, studies have found that the body has a much more difficult time regulating the absorption of heme iron, making iron toxicity or iron overload much more possible.

Now, back to the original topic of anemia. I want to stress that it is very possible to become anemic on any type of diet. Vegetarian’s levels of Hemoglobin, which reflects the amount of iron in the blood, are comparable to those in people who eat flesh. In a review by Craig McPherson, M.D., he stated that while iron stores may be lower in vegetarians, there is no reported increase in incidence of iron deficiency anemia. In fact, iron reduction has been shown not only to decrease the risk of getting various types of cancer by 35%, but anemia has actually been found less frequently overall in those who eat a strict vegetable based diet than those on the Standard American Diet – this is potentially caused by the consumption of large amounts of dairy in the Standard diet, which can bind and inhibit the body from absorbing iron.

Back in July when I had my blood tested, my hemoglobin levels were found to be in the ideal range so I don’t overly concern myself with iron (Hemoglobin A1C: 5.1 which also puts me at a lower risk of diabetes). That said many plant foods that I regularly consume are high in iron. Dark leafy greens and dried beans are perhaps the best sources of non-heme iron. Not only is kale, collards, and spinach all high in iron but they also contain vitamin C, which helps the absorption of non-heme, and are overall, healthy for everyone to consume. In fact, per 100 calories, cooked spinach has more than 15x the amount of iron than a steak! Soybeans, lentils, tofu are also all excellent sources - and all higher in iron than steak per 100 calories-and are accessible and affordable.

However, sometimes just eating foods high in iron won’t be enough, as my friend recently found out. The good news is just because she was diagnosed as being anemic, doesn’t mean she needs to turn to meat. Nor does it necessarily mean she should start gulping iron supplements. Dr. Michael Greger of nutritonfacts.org suggests that those who are diagnosed with anemia talk with their physician about first trying to get their blood hemogloblin levels up through diet alone, because a recent study found an increase in oxidative stress in the body when using suppliments.

Luckily, there are many things we can do to help encourage our bodies to absorb non-heme iron found in our food.

As I mentioned above, vitamin c rich foods helps our bodies absorb non-heme iron. While dark leafy greens have both iron and vitamin c, if you are eating a food that is lower in vitamin C such as chickpeas, it is best if you include a food higher in vitamin c with it such as bell pepper, citrus fruits, broccoli ect. It’s also not a bad idea to avoid taking in tea or coffee as both can block iron absorption.

Another slick trick to help improve the bioavailability of non-heme iron is to prepare your dish with foods such as garlic and onion. The allium family of vegetables foods have phytonutrients that help promote iron absorption. Also steaming your dark leafy greens before eating them can also help improve your bodies iron absorption.

While cooking with cast iron has also been shown to increase the amount of iron content in foods, our bodies are less able to manage the absorption of that type of iron - making it less than ideal for those already with healthy storages of iron.

Below is a chart of plant foods high in iron:

Food Amount Iron (mg)

Soybeans, cooked 1 cup 8.8

Lentils, cooked 1 cup 6.6

Spinach, cooked 1 cup 6.4

Tofu 4 oz 4.7

Chickpeas, cooked 1 cup 4.7

Swiss Chard, cooked 1 cup 4.0

White Potato 1 large 3.2

Quinoa, cooked 1 cup 2.8
Pumpkin Seeds 1 cup 2.1

Raisins ½ cup 1.6

Kale, cooked 1 cup 1.2

Broccoli, cooked 1 cup 1.1

Source: USDA Nutrient Database for Standard Reference.

Saturday, July 13, 2013

Blood Test Results: Blood pressure, Cholesterol, and HDL

Yesterday I went to the Doctor’s for the results of the blood work I had drawn last week. After first telling me I had Chlamydia, the Doctor pulled up the correct chart (Thankfully, I don’t have Chlamydia, unfortunately there is an Anthony in Harlem who does.) the Doc began going over my numbers.

After being vegan for 6 years, my B-12 levels were perfect. The healthy range is between 200-900 pg/mL. I scored a 695. I did this by consuming a few fortified foods once in a while such as soy and almond milk but I also take a B-12 supplement every few days. It is the only supplement I take and I don’t take it every day.

In America, heart disease is currently our number one killer, but as Dr. Esselstyne boldly states in the documentary, Forks Over Knives, “if the truth be known coronary artery disease is a toothless paper tiger that need never, ever exist and if it does exist, it need never, ever progress.” Now if you’ve read Dr. Esselstyne’s book How to Prevent and Reverse Heart Disease (BYOL review pending), or Rip’s Engine 2 Diet, you’ll remember that there are a few magic numbers when it comes to blood pressure and cholesterol that nearly guarantee you’ll stand apart of the majority of Americans who currently suffer from the disease (many of whom won’t know they even have the disease until after they have died of a serious heart attack!).

First, blood pressure. Unfortunately, according to the CDC, one in three Americans have high blood pressure, many of whom are told to take medicine for the rest of their lives to artificially lower it. We consider high blood pressure, or hypertension, to be a natural part of the aging process, but this is not true. Rather it is a natural part of the Standard American Diet. Adults who consume a mostly plant-based diet typically have blood pressure levels similar to their children. I’m happy to use my Mom as a shinning example of this. She has had high blood pressure my entire life and for the last several years was on medication to control it. Last August I convinced her to switch to a plant-based vegan diet. Since the beginning of April, she has been completely off her medications!

Blood pressure is expressed in two numbers. The first number is called the systolic blood pressure and this represents the force your heart exerts on your arteries when your heart squeezes. You want your systolic pressure to be 120 or below. Mine was 106.

Next is the diastolic blood pressure, and this represents the force the blood exerts on your arteries when your heart relaxes. This number should be below 80. Mine was 60.

Cholesterol is, perhaps, America’s real greatest killer! And to think most people willing put extra cholesterol into their bodies whenever they chose to eat an animal based food! The average American’s cholesterol, again according to the CDC is around 200 mg/dL. This, by their standards is borderline risky, however the research shows that even this number is too high. Heck, just common sense can tell you that! Currently ¼ of the population will die from heart disease… something is clearly off with our numbers. Rather, Dr. Esselstyne argues from his research that to be “heart attack proof,” our total cholesterol levels should be below 150. Among others, Dr. Campbell’s The China Study concurs with this number. Mine was 88 mg/dL.

Now besides the total number, cholesterol is also made up of a few numbers. The two most commonly discussed are LDL, or low-density lipoprotein, and HDL, or high-density lipoprotein. We traditionally refer to LDL as bad, and HDL as good because LDL sticks to our arties, while HDL tends to clear them.

If LDL is bad, we obviously want our LDL reading to be low. Most people’s LDL is around 100, but according to Dr. Esselstyne that number is still too high, and can put one at risk of heart disease, and several other chronic degenerative diseases. Instead, he recommends we should aim for 80 or below. Mine was 34.

Now HDL is a bit more tricky. Because it is the “good” cholesterol, we assume we want that number to be high; however, according to several research studies, what is far more important is to have your total cholesterol and LDL levels in check.

My HDL level was 27 mg/dL. My Doctor told me that it was way too low and it could potentially put me at risk for heart disease; however, I believe - and the science supports me - that there is an error in his thinking. Yes, 27 mg/dL is very low, however, my total cholesterol is over 100 points below average. So obviously my other levels will also be low. According to Dr. John McDougall, “When total cholesterol is lowered, all fractions of cholesterol are reduced, including HDL-cholesterol. This is not bad, but expected, and actually of no harm.”

In a study done on the Indian population, Tarahumara, a population that thrives off of a nearly complete plant-based diet and has almost zero accounts of heart disease help prove this. The researchers subbed the Tarahumara plant-based diet with an “affluent” diet high in fat, animal protein, and cholesterol, the natives total cholesterol raised 31% from an average of 121 to 159 in just five weeks. At the start of the study their HDL levels were around 32 mg/dL. Over the five weeks, those levels, on average, also jumped by 31% to 42. The study concluded they were at significantly higher risks for contracting heart disease at the end of the study then they were at the beginning even though their “good” cholesterol level rose. Essentially, labeling one form of cholesterol as “good” and one as “bad” is a classic example of the reductionist thinking that is too common when it comes to health and nutrition. A certain amount of both forms of cholesterol are needed for the body to function properly- and our bodies make both so there is no reason to increase our consumption of it with animal foods.

Worldwide (comparing people who eat different diets) those who have the lowest HDL levels (like people in rural Japan, China, and Africa) have the lowest rate of heart disease – and also the lowest total cholesterol. Those with the highest HDL levels (like people in the USA and Western Europe) have the highest rates of heart disease.

As Dr. McDougall notes, when total cholesterol drops so too will HDL. In fact, in a study of over 500 of his patients, he found that, on average, people reduce their overall HDL levels by 19 percent (8 mg/dl – from 41 mg/dl to 33 mg/dl) in 11 days.

The Doctor told me that I should try and raise my HDL by consuming more Omega-3 fatty acids. At first he suggested fish, but then remembering that I was vegan he then offered I consume nuts and some seeds. He never specifically said walnuts, chia or flax, but those were the foods he was groping for. (As a side note, studies on cows and fish have both shown these animals get their Omega-3s from eating greens- It is not implausible to suggests humans do the same.)

Now, you might think, well, that doesn’t seem unreasonable, and until just a few days ago, I might have agreed. But we have to remember there are two essentially fatty acids that our bodies need to get through food. The first is Alpha-linolenic acid or Omega-3, which the doctor said would help raise my HDL- the second is Linoleic acid or Omega-6. According to recent studies, the ideal ratio between these two EFAs is a 1:1. A whole food, plant-based diet typically provides exactly that, a 1:1 to 3:1 (still within the safe realm) Omega 6 to Omega-3 ratio (for comparison, SAD is a 20:1 – 50:1 ratio). For someone eating the Standard American Diet, increasing their consumption of Omega-3 foods is a good idea, however for someone eating a plant-based diet it may not be. By increasing the Omega-3 intake, you could disrupt the ratio between Omega-6 to Omega-3, and this can lead to increase risk of heart disease as well as type-2 diabetes among other aliments. Both of these outcomes would be very rare with the numbers that I am dealing with, but why take the chance?

Finally, one cannot die of low HDL just as you cannot die from having a high HDL number. That said, far more people go to their graves from heart attacks believing their high cholesterol is safe because they have a lot of “good” cholesterol. We need to stop thinking about these matters in such reductionist ways.

I hope you all have a great weekend filled with healthy foods!

As always, I am not a medically trained Doctor and this blog should not be taken as medical advice. Consult your doctor about any changes you make to your diet and all of your health concerns.

References:

Brinton EA. “A low-fat diet decreases high density lipoprotein (HDL) cholesterol levels by decreasing HDL apolipoprotein transport rates.” Journal of Clinical Investigation. 1990 Jan;85(1):144-51.

Kausik, et al. “Long- Chain Omega-3 Fats, Fish and Type 2 Diabetes,” American Journal of Clinical Nutrition 90, 613, 2009.

Esselstyn, C. Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure, New York, Penguin Group, 2007.

Esselstyn, R. The Engine 2 Diet: The Texas Firefighter's 28-Day Saver-Your-Life Plan that Lowers Cholesterol and Burns Away the Pounds, New York, Wellness Central, 2009.

Knuiman JT. HDL cholesterol in men from thirteen countries. Lancet. 1981 Aug 15;2(8242):367-8.

McDougall J. “Rapid reduction of serum cholesterol and blood pressure by a twelve-day, very low fat, strictly vegetarian diet.” Journal American College Nutrition. 1995 Oct;14(5):491-6.

McDougall J. “Good Cholesterol “Worstens” with McDougall?” McDougall News Letter September 2003.

McMurry MP. “Changes in lipid and lipoprotein levels and body weight in Tarahumara Indians after consumption of an affluent diet.” New England Journal of Medicine. 1991 Dec 12; 325 (24):1704-8.