Anemia in the general population and in heart patients

What is anemia?

Anemia is a condition in which your body does not have enough healthy red blood cells to carry adequate oxygen to your body’s tissues. Having anemia, also referred to as low hemoglobin, can make you feel tired and weak and is often associated with pale skin and nails, and hair fall.

Anemia widely affects people of all age groups and genders. In India, the prevalence of anemia is as high as 38% in women, 22% in men and 40% in pregnant women.

Anemia is diagnosed by a blood test called complete blood count that looks at the hemoglobin level along with cell counts in the blood. The normal value of hemoglobin for women is 12-15.5 g/dl and for men it is 13-17.5 g/dl. Anything below this hemoglobin level is considered to be anemia.

What are the types of anemia?

Nutritional anemia is the commonest type of anemia and is divided into iron deficiency anemia, vitamin B12 deficiency anemia and folic acid deficiency anemia. The lack of the desired amount of vitamins and minerals, also known as micronutrients, in our diet is the main reason why nutritional anemia develops.

The other less common types of anemia may be due to genetic factors, abnormal red blood cells, chronic illnesses and disease of the bone marrow.

Who is at risk of developing anemia?

The following groups of people are at a high risk of developing anemia:

1. Lack of a balanced healthy diet leads to nutritional anemia. People may not be consuming a healthy diet due to lack of knowledge about healthy food choices, lack of financial means to procure healthy food, or due to poorly informed dietary practices such as avoidance diets, crash diets etc.

2. Chronic blood loss such as women in the reproductive age group with heavy menstrual bleeding, individuals with undiagnosed occult blood loss from the gut, and medication-induced bleeding in those who take pain medication for prolonged periods of time.

3. Acute blood loss such as during surgical procedures and road traffic accidents.

4.  Elderly individuals are at a higher risk of developing anemia due to a combination of factors such as poor appetite, dentition related issues, reduced absorption of nutrients from the gut, associated co-morbidities and lack of access to fresh and nutritionally wholesome foods.

5. Pregnant women are susceptible to anemia because of the increased demand posed by the developing fetus.

6. Adolescent girls are prone to anemia due to the alterations in their body physiology and the hormonal changes associated with menstruation.

7. Individuals with any chronic conditions such as chronic kidney disease, liver disease, heart failure and malabsorption syndromes are at high risk for developing anemia.

Why should heart patients be extra vigilant about anemia?

From the above discussion, it is clear that anemia may occur in heart patients who have undergone cardiac surgeries such as bypass surgery or valve surgery, in individuals with heart failure and in almost any cardiac patient with poor nutritional habits. As the heart is the pumping organ responsible for circulating blood to all parts of the body, whenever there is anemia your heart has to work much harder than normal to ensure that the rest of the body gets sufficient oxygen and energy. This means that the wear and tear on the heart muscle is higher when you are anemic and therefore the possibility of the heart becoming weak or failing is also much higher than in normal individuals. In fact, anemia, heart failure and renal failure are a deadly combination as they form a vicious cycle where one worsens the other and leads to rapid deterioration of overall health. Hence, it is very important to diagnose anemia in a timely manner and to treat it at the earliest to avoid further complications. 

What should you do if you have symptoms of anemia or are at risk?

If you are experiencing symptoms such as undue tiredness or fatigue, breathlessness while doing routine activities, or have had a history of surgery or excessive and prolonged bleeding, visiting your physician should be the first step. After running a battery of tests, your doctor will be able to come to a conclusion about what type of anemia you have and advise you on the appropriate interventions to overcome the problem. While dietary modifications and supplemental iron pills are the most commonly employed solutions, intravenous iron infusion and blood transfusion may be necessary in severe deficiency.

What are the nutritional strategies to overcome anemia?

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As a cardiopulmonary dietician, I often guide individuals with anemia on how to improve their hemoglobin level through dietary modifications. Let me walk you through some tips about consuming a diet rich in iron and ensuring that the dietary iron is efficiently absorbed into your bloodstream

There are two types of iron in your food: heme iron that is present in animal sources and non-heme iron that is present in plant sources.

Animal sources of iron – lean meat, chicken breast, meat liver, sardine, oyster, crab, tuna, mackerel, salmon

Plant sources of iron

Nuts and seeds – Nuts, seeds and dried fruits such as figs, dates, pistachios, hemp seeds, pumpkin seeds

Green leafy vegetables – Dark green leaves such as drumstick leaves, spinach, kale

Beans – Chickpeas, kidney beans, soy beans, black beans

Whole grains and millets – such as oats, whole wheat, ragi

Fortified foods – There are a variety of foods that are fortified with iron such as fortified pasta, fortified white rice, fortified orange juice, fortified cereals etc.

Vitamin C helps the absorption of iron in the body and is also essential for cell growth, development and repair of all body tissues, proper functioning of the immune system, and wound healing. Dietary sources of Vitamin C are gooseberry, orange, lemon,  guava, strawberries, papaya, capsicum and broccoli.

Vitamin B12 and folic acid are also important in order for our body to produce healthy red blood cells. Sources of Vitamin B12 for vegetarians are bananas, melons, sprouts, soy milk and tofu.

Folic acid is present in green leafy vegetables, dried beans and peas, nuts, enriched bread, cereals and other grains.

Poultry, fish, dairy products and eggs also contain both these micronutrients.

In summary, anemia is a common medical condition that should be diagnosed and managed early. Regular routine health checks are very useful in picking up the condition in otherwise well individuals. Eating a balanced diet with a focus on locally available iron-rich foods along with vitamin C, vitamin B12 and folic acid containing foods is the ideal way to prevent and manage nutritional anemias.


A colourful plate for a healthy heart

Fruits and vegetables are high in vitamins, minerals and fiber – and they’re low in calories. Eating a variety of fruits and vegetables may help you control your weight and blood pressure. Fresh, filling and heart-healthy, fruits and vegetables are an important part of your overall healthy eating plan. The American Heart Association recommends eating five or more fruit and vegetable servings every day. Also variety matters, so try a wide range of fruits and veggies.

Keep it colorful

Challenge yourself to try fruits and vegetables of different colors. Make it a red/green/orange day (apple, green leafy vegetables, carrot), or see if you can consume a rainbow of fruits and vegetables during the week.


Fruit and vegetables

Antioxidants in fruit and vegetables offer protection against heart disease. Fruit and vegetables are also important sources of folate, which helps lower the blood levels of the amino acid homocysteine, which appears to be linked to an increased risk of heart disease.

Foods containing vitamin E 

Some studies indicate that vitamin E acts as an antioxidant, helping to protect against ‘bad’ cholesterol. Good sources of vitamin E include almonds, dark green vegetables, vegetable oils and wholegrain products. It is better to eat foods containing vitamin E rather than take supplements, which do not have the same protective nature.

Fruits containing Iron

Fruits and vegetables are rich sources of iron. Watermelon is a fruit that contains 1.5g of iron in 1/8 of a medium sized fruit. Watermelon is also rich in vitamin C which helps your body to absorb iron efficiently. Raisins are a good addition to oat meal or Payasam (Indian milk-based dessert) which can increase your iron intake. Mushrooms, dark green leafy vegetables, beans, peas are also good sources of iron.

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Citrus Fruits

Women who consume high amounts of the flavonoids found in oranges and grapefruits have a 19% lower risk of ischemic stroke(caused by a clot) than women who don’t get as much of these compounds, a recent study found. Citrus fruits are also high in vitamin C, which has been linked with a lower risk of heart disease. Oranges are an excellent source of vitamin C. They are also a very good source of dietary fibre. In addition, oranges are a good source of B vitamins including vitamin B1, pantothenic acid and folate as well as vitamin A, calcium, copper and potassium. An orange has over 170 different phytonutrients and more than 60 flavonoids, many of which have been shown to have anti-inflammatory, anti-tumour and blood clot inhibiting properties, as well as strong antioxidant effects.


Papaya may be beneficial to your heart health as it contains lycopene and vitamin C. The antioxidants in papaya may protect your heart and enhance the protective effects of HDL, the good cholesterol.


Pomegranates contain numerous antioxidants, including heart-promoting polyphenols and anthocyanins which may help stave off hardening of the arteries.


Creamy, rich and sweet bananas are a favourite food for everyone from infants to elders. Bananas are a good source of potassium an essential nutrient in maintaining blood pressure. Since one medium sized banana contains whopping 400mg of potassium the inclusion of bananas in your routine meal plan may help to prevent high blood pressure and protect again atherosclerosis. While bananas are a very low-fat food, one type of fat that they do contain is small amounts of sterols like sitosterol.  As these sterols look structurally similar to cholesterol, they can block the absorption of dietary cholesterol. By blocking absorption, they help us keep our blood cholesterol levels in check. They are good sources of vitamins, minerals and fibre.

Green leafy vegetables

A generous portion of green veggies in your daily diet can benefit your body .Greens make up a significant source vitamins A, C, E and K as well as several B vitamins. They are rich sources of minerals such as calcium, magnesium, iron and potassium. They are rich in fiber, extremely low in fat and carbohydrates and provide an excellent source of protein. Winter is the best time to enjoy leafy, green vegetables as they are fresh and can be consumed in a variety of ways. Add them to salads, have a green soup, make gravy or simply stuff  them in your sandwich. Whatever you choose, make sure you eat them.