Anemia is the most common blood disorder where the blood’s ability to carry oxygen is impaired. It is a problem with the red blood cells – either there are too few red blood cells or the oxygen-carrying ability of these cells are lower than normal. When it is associated with insufficient iron, an essential mineral required for red blood cell formation, then it is known as iron-deficiency anemia. This is the most common type of anemia and is mainly seen in females for several gender-specific reasons. However, iron-deficiency anemia can also occur in men and is sometimes due to common reasons that many people do not know.
Iron Deficiency Anemia in Women
It is important to understand why iron-deficiency anemia is more common in women. Females of reproductive age are more likely to have iron deficiency anemia because of menstrual bleeding. However, this does not mean that every menstruating female will experience this problem. Women who tend to experience heavy menstrual bleeding are obviously at greater risk of iron deficiency anemia. But there are also other factors at play in may instances, particularly for younger females. An inadequate diet with low iron intake, extreme dieting and even eating disorders are some of the lifestyle factors that are also contribute to iron deficiency anemia along with monthly menstrual blood loss.
However, men are also at risk. But why would iron deficiency occur in men? There are actually many reasons why this may happen. One of the most common is internal bleeding. Menstruation is the only type of long term bleeding that is considered as ‘normal’. Although this is not an issue for men, there are many other sites and reasons for persistent or recurrent internal bleeding among males. The other common reasons include diet, digestive and chronic conditions, apart from the same dietary and lifestyle factor mentioned above.
Internal Bleeding in Men
There are several reasons for internal bleeding which may never be noticed until iron deficiency anemia is diagnosed. Some of the causes can be very serious and even due to life threatening illness. Although massive blood loss can cause anemia, usually it will be clearly evident if it occurs internally and typically follows trauma to the body. Instead internal bleeding leading to iron deficiency is slow and prolonged. One of the most common sites is from the gastrointestinal lining usually due to bleeding ulcers. Regular aspirin use is a major risk factor for bleeding peptic ulcers. Ulcerative colitis is one of the many conditions that may present with bleeding ulcers in the lower bowels. Iron-deficiency anemia should not be taken lightly as sometimes the bleeding may be from malignant (cancerous) tumors despite the lack of other symptoms.
Hemorrhoids (piles) is a common condition that affects both men and women. Bleeding can occur in both internal and external hemorrhoids and be the source of prolonged albeit mostly minor blood loss for long periods of time. Most people with hemorrhoids will notice the bleeding – in severe cases it may stain the stool and toilet water or more frequently be seen on the toilet paper when wiping. However, sometimes bleeding may not be as obvious and can be masked in the stool. A fecal occult blood test (FOBT) is always advisable as it will indicate bleeding in the gut, be it as high up as the stomach or lower down in the colon or rectum.
Insufficient Dietary Iron
Iron is abundant in many foods – both plant and animal. However, not all dietary iron is the same. Heme iron found in red meat, poultry and fish is more readily absorbed than non-heme iron found in plants. While meat-eating is not necessary to ensure sufficient dietary iron absorption, vegetarians and vegans should also take other dietary measures like increasing vitamin C intake and avoiding tea/coffee around meal times to maximize iron absorption. Many common processed foods are also fortified with iron. However, poor dietary intake of iron is also a problem in the backdrop of eating disorders like anorexia nervosa, extreme dieting and fasting and malnutrition due to other causes.
Iron Absorption Problems
Even if there is sufficient dietary intake of iron, the gastrointestinal system has to be capable of absorbing it. Malabsorption of iron is seen in many gastrointestinal conditions and iron may not be the only nutrient that is not absorbed properly. Celiac disease is one such condition. It may also occur when a portion of the stomach or small intestine is removed due to bariatric (weight loss) surgery, severe inflammatory bowel disease and in the treatment of cancers of the gastrointestinal tract. Men are just as prone to these conditions as women and absorption problems may therefore be the cause of iron deficiency anemia even without any blood loss.
Excessive Tea Drinking
Tannins in tea can bind to iron in the gut and prevent it from being absorbed. However, it may not be as significant a cause to iron deficiency anemia as is often thought. Instead tea drinking, especially when excessive, may be a contributing factor that co-exists with other causes to lead to iron-deficiency anemia. A study on the effects of different drinks on iron absorption showed that tea was indeed a contributor to impaired iron absorption as well as coffee, but it was primarily non-heme iron (the type found in plants) that was affected. The same study also found that drinking orange juice almost doubled iron absorption. High vitamin C intake is known to be helpful in iron absorption.
Anemia of Chronic Disease
People suffering with certain chronic diseases are more likely to develop anemia. It closely resembles iron-deficiency anemia and may be difficult to distinguish between each type. But anemia of chronic disease is different from iron-deficiency anemia. It occurs in certain chronic inflammatory conditions and is believed to be due to the some of the inflammatory chemicals affecting the utilization of iron and shifting bone marrow activity to producing more white blood cells at the expense of red blood cells. Some of the conditions that may lead to anemia of chronic disease includes autoimmune conditions (rheumatoid arthritis, IBD, SLE), cancers (even without internal bleeding), chronic liver and kidney diseases and long term infections like HIV and hepatitis B.