Don't Be Afraid to See Red

Strictly speaking, an anemia is a decrease in red blood cells or the amount of hemoglobin that they carry. If you lose blood, have a condition that destroys red blood cells, or have deficiencies or other conditions that change the hemoglobin concentration of your blood, you may be classified as anemic. There are two main classifications of anemia that HIVers need to be aware of: nutrientdeficiency anemia and anemia caused by chronic disease. B vitamins, such as folate and vitamin B12, are both important in red blood cell function. A deficiency of these vitamins can cause megaloblastic anemia (or, larger than normal red blood cells being formed in bone marrow). Severely reduced availability of vitamin B12 in the body can lead to progressive and very destructive pernicious anemia. Lab results will show high mean corpuscular volume and mean corpuscular hemoglobin concentration. In cases of iron deficiency both the size and the number of red blood cells are lower than expected. Lab values will show a low mean corpuscular volume and mean corpuscular hemoglobin concentration, which means that the red pigment that is provided by hemoglobin is lacking and cells are small. Anemia of chronic disease is related to inflammation. HIV infection causes a chronic inflammation that can lead to fewer red blood cells in the circulation, and their size tends to be smaller than normal. In this type the storage form of iron, called ferritin, may be normal or even high while levels of iron and total iron binding capacity are low. What is typically done nutritionally for anemia? In the case of vitamin B deficiency, the B vitamin in question can usually be supplemented. For instance, vitamin B12 can be given in injection form'usually administered as 100 micrograms weekly until the problem is resolved. Also, oral supplementation of 1,000 micrograms daily can get around malabsorption problems. Nasal gels and tablets absorbed under the tongue are available as well. Reversal of vitamin B12 deficiency usually improves cognitive function and appetite. As appetite increases, such foods as yogurt, hamburger, and salmon will help restore vitamin B12 reserves. Liver is a particularly potent source of vitamin B12. For folate deficiency, supplementation must be taken with caution since it can mask a vitamin B12 deficiency'a dangerous situation. Supplementation may include one milligram of folate per day for two to three weeks. After that, folate intake should remain in the 50- to 100-microgram range to maintain folate levels in the body. Liver is an amazing source of folate'with over 600 micrograms in three ounces of chicken liver. Other folate-rich foods include beans, soybean nuts, orange juice, spinach, and good old Grape-Nuts cereal. For iron-deficiency anemia, iron is often supplemented. But this can be a problem in chronic inflammatory conditions, where iron is diverted to a storage form that renders it unavailable to make the hemoglobin the body needs. It's important to get enough dietary iron in a form that is absorbable and usable by the body. Here again, liver pops up as an excellent source of iron. Dark poultry meat, beans, lentils, raisins, soy milk, Cream of Wheat cereal, and oatmeal have good supplies of iron as well. Keep in mind that the body can absorb around 15% of the iron in animal foods but only about 3% of the iron in plant foods. Except, and we love this exception, you can make the iron in plant foods more available to the body by including a source of vitamin C. So cook those beans, and put the tomatoes in for only the last few minutes to retain their vitamin C and unlock the iron. For anemia of chronic disease, be sure to make enough iron and other nutrients available for the body to use'although nutrition alone might not fully solve the problem. Often a hormonal treatment will be used to improve the production of red blood cells in this type of anemia. The bottom line is that it is a wise thing to eat well to stay well and energetic! Fields-Gardner is the director of services for the HIV nutrition company Cutting Edge and is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS. E-mail her at cade@hivplusmag.com.