Anaemia is one of the important public health crises, affecting almost 25 per cent of the global population. Surprisingly, in India, these statistics are even more alarming. A 2022 study published in the paper Cureus confirms that 58.6 per cent of children, 53.2 per cent of non-pregnant women, and 50.4 per cent of pregnant women in India are living with low haemoglobin. Though the major cause of anaemia is iron deficiency, other causes cannot be neglected, considering the magnitude of the problem.

We spoke to Bangaluru-based nutritionist, Dr. Nikita Suresh about the causes of haemoglobin and how to increase the haemoglobin count through nutrition.

 

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What is low haemoglobin?

Haemoglobin is a protein present in red blood cells, which is responsible for delivering oxygen throughout the body. If the body is unable to produce red blood cells due to a disease or condition, your haemoglobin levels may plunge. When your haemoglobin level drops, it means your body isn’t getting enough oxygen. This can make you feel very tired and weak.

Dr. Nikita says, “For men, a normal level ranges between 14.0 grams per deciliter (gm/dL) and 17.5 gm/dL. For women, a normal level ranges between 12.3 gm/dL and 15.3 gm/dL. A severely low haemoglobin level for men is 13.5 gm/dL or lower, and 12 gm/dL for women.”

 

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So, what happens when the body produces less haemoglobin?

Dr.Nikita explains, “when your body is producing less haemoglobin than normal, the person might experience several signs such as:

• Tiredness and fatigue
• Low energy and weakness
• Dizziness
• Craving to eat mud, chalk or ice
• Shortness of breath
• Pale skin and eyes
• Headache and low focus
• Cold hands and feet
• Brittle nails

 

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Causes of low haemoglobin

Dr. Nikita points out that there can be multiple causes of having low haemoglobin in the body.

• If the reason for low haemoglobin is insufficient iron levels, the condition is called iron deficiency anaemia. If you have aplastic anaemia, the stem cells in your bone marrow don’t create enough blood cells. Pernicious anaemia, an autoimmune disorder keeps your body from absorbing vitamin B12.
• Sometimes, heavy bleeding during menstruation can also lead to lower haemoglobin in the body.
• Internal bleeding in the gastrointestinal tract from colon cancer or an ulcer can cause low haemoglobin levels.
• You have donated a lot of blood.
• Your body recently has gone through major changes, such as a pregnancy or, in children, a growth spurt.
• When the body produces enough red blood cells, but the cells are dying rapidly before the body can replace them.
• You’re not getting enough essential nutrients like iron and vitamins B12 and B9.

There are some chronic conditions or diseases that can restrict the production of red blood cells.

• Lymphoma: Lymphoma is a phrase for cancers in your lymphatic system. Having lymphoma cells in the bone marrow can reduce the number of red blood cells.
• Leukaemia: Leukaemia is a cancer of the blood and bone marrow. Leukaemia cells in your bone marrow can confine the number of red blood cells the bone marrow creates.
• Chronic kidney disease: Chronic kidney disease affects the process of red blood cell production in the bone marrow that the kidney sends a signal to.
• Antiretroviral medications: These medications treat certain viruses. Sometimes, these medications damage your bone marrow, affecting its ability to make enough red blood cells.
• Chemotherapy: Chemotherapy may affect bone marrow cells, reducing the number of red blood cells your bone marrow produces.

 

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Who is at risk?

Anaemia or low haemoglobin can range from mild to life-threatening, depending on your haemoglobin level and the symptoms you are experiencing. Some of these symptoms are more serious than others. So, it is important to know who are or can be under the threat of low haemoglobin.

• Infants ages 6–12 months
• Children with lead in their blood (lead blocks the body's ability to make haemoglobin)
• Adults aged 65 and older
• People with cancer, celiac disease, or chronic kidney disease
• People with a genetic blood disorder
• Pregnant women
• People with heavy bleeding during their periods
• Vegetarians or vegans

 

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Foods that raise haemoglobin levels

Dr. Nikita says, “Many things can induce low haemoglobin, and most of the time you can’t manage low haemoglobin on your own. But eating a vitamin-rich diet can help maintain your red blood cells. A balanced diet centred on important nutrients is the best way to maintain healthy red blood cells and haemoglobin.” Dr. Nikita further suggests that consuming foods rich in vitamin C, such as citrus fruits, can improve iron absorption. Most people with iron deficiency need 150–200 milligrams (mg) per day of iron.

1. Consume an iron-rich diet that includes both heme (iron content found in animal food) and non-heme iron (iron found in plant foods).

2. Heme iron (meat, fish, organ meats) is better absorbed compared to non-heme (dark green leafy veggies, beans, millets, dates, beetroot, dried figs, flaxseeds)

3. When consuming non-heme/vegetarian sources, it’s best to combine them with vitamin C for better absorption. For example: A lime juice dressing with a leafy salad, Ragi pancakes with berries or citrus fruits.

4. Eat leafy green vegetables such as kale, spinach, and romaine lettuce, along with beans, and lean proteins, to get the iron and other vitamins that it needs.

 

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Treatment for low haemoglobin

To cure anaemia or low haemoglobin will depend on your age, the severity of your low haemoglobin, and the cause. To help diagnose the condition, your healthcare provider will mandate a complete blood count (CBC) test to measure your haemoglobin level.

Typically, there are a few treatments available for iron deficiency anaemia:

• Iron supplements taken orally a couple of times a day: This is the most common treatment for iron deficiency. Always check with your healthcare provider before using iron supplements.
• Iron therapy delivers iron through a blood vessel: This is more common for severe iron deficiency anaemia. It also is more commonly used in those with iron deficiency anaemia who also have chronic conditions such as celiac disease or kidney disease.
• Red blood cell transfusions: This process can help raise the number of red blood cells and iron in your blood.
• Surgery that stops the bleeding that is leading to iron deficiency anaemia: Your healthcare provider also may perform procedures like an upper endoscopy (EGD) or colonoscopy to find the cause of bleeding.

If you have a disease or condition that affects your haemoglobin levels, you should call your healthcare provider anytime your symptoms worsen.

 

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