Weight loss is a goal for many, but sometimes it occurs unexpectedly due to underlying health issues. Anemia, characterized by a deficiency in red blood cells or hemoglobin, can be one such cause, leading to both unexplained weight loss and, paradoxically, weight gain in some instances. Understanding the relationship between anemia and weight fluctuations is crucial for proper diagnosis and management.
Understanding Anemia
Anemia is a medical condition defined by a low count of red blood cells and, consequently, reduced levels of hemoglobin. Hemoglobin, a protein within red blood cells, is responsible for carrying oxygen throughout the body. There are various types and causes of anemia, ranging from inherited conditions to those acquired due to chronic illnesses or nutrient deficiencies.
Iron Deficiency Anemia: A Common Culprit
The most common nutritional deficiency leading to anemia is low iron. Iron is essential for the proper functioning of the thyroid gland and is a vital component of hemoglobin. Insufficient iron levels can disrupt hormone regulation, potentially affecting appetite and energy levels.
Why is Iron Important?
Iron plays a vital role in the body. It is an integral component of hemoglobin, a naturally occurring protein in red blood cells. Hemoglobin helps transport oxygen throughout your body, gives blood its vibrant red color and moves carbon dioxide from your tissues to the lungs. Iron is also a component of several enzymes, including those regulating energy metabolism. That's why low iron levels in the bloodstream may cause fatigue and tiredness. This nutrient supports immune function, too.
According to a July 2014 review published in Frontiers in Pharmacology, iron promotes skin health and maintains the integrity of mucous membranes. On top of that, it influences athletic performance and post-workout recovery due to its role in energy metabolism and enzyme production.
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What Causes Iron Deficiency?
Iron occurs naturally in hundreds of foods, from beef and chicken to leafy greens and beans. Yet, more than one-third of people worldwide have iron deficiency anemia, according to a review published in the Lancet in August 2017. Certain individuals, including pregnant people, infants and people with cancer, are at greater risk. Iron deficiency also tends to be more common in people with heart failure, digestive disorders, celiac disease and women who experience heavy bleeding during menstruation. Heavy menstrual bleeding, for example, is responsible for 33 to 42 percent of causes of iron deficiency anemia. Up to 35 percent of blood donors develop this condition too. Celiac disease, inflammatory bowel disorders and other digestive ailments can affect the body's ability to absorb iron and may lead to anemia. Vegetarians also face an increased risk, particularly premenopausal women, due to the lower absorption rate of non-heme iron found in plant-based foods.
The Link Between Anemia and Weight Loss
Low iron levels in the bloodstream are a possible cause of diminished appetite. You may notice that you no longer crave your favorite foods or that you feel less hungry than usual, which can lead to weight loss.
Unexplained Weight Loss and Anemia
Low iron levels in the bloodstream are a possible cause of diminished appetite. You may notice that you no longer crave your favorite foods or that you feel less hungry than usual. This can lead to weight loss, low energy, weakness, tiredness and poor exercise performance.
Several factors contribute to weight loss in individuals with anemia:
- Reduced Appetite: Scientists speculate that iron deficiency anemia causes poor appetite because of an imbalance in the hormone ghrelin, which regulates appetite. Low iron levels in the bloodstream are a possible cause of diminished appetite.
- Fatigue and Low Energy: Low energy and fatigue caused by iron deficiency affect our ability to remain active, making it difficult to exercise.
- Underlying Medical Conditions: Patients who develop anemia because of a severe medical condition such as cancer often experience appetite loss and consequently lose weight. A chronic illness or disease such as cancer may also be associated with anemia and unexpected weight loss.
- Malabsorption of Nutrients: Anemia may sometimes lead to weight loss. This typically happens when the body experiences malabsorption of nutrients, reduced appetite due to fatigue, or increased metabolic demands as it struggles to maintain adequate oxygen levels. Conditions like iron-deficiency anemia and sickle cell anemia are more likely to result in weight loss due to these factors.
The Paradox: Anemia and Weight Gain
While weight loss is often associated with anemia, some individuals may experience weight gain. This can occur due to:
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- Reduced Physical Activity: Feeling fatigued can make you less likely to be active, which may contribute to weight gain. Anemia can contribute to weight gain if it causes significant fatigue, leading to a more sedentary lifestyle. People with anemia may feel too exhausted to engage in physical activities, which decreases the number of calories they burn.
- Treatment for Iron Deficiency: Some people also report that treatment for iron deficiency anemia has contributed to weight gain, though some research has found the opposite. If you have iron deficiency anemia, you may gain weight during treatment. However, as your iron levels return to normal, you'll regain your energy and feel like yourself again. This will allow you to work out more often and get back in shape.
- Hormonal Imbalances: Elevated ferritin levels have been linked to higher rates of metabolic syndrome, increased waist circumference and insulin resistance.
- Fluid Retention: Medication side effects like fluid retention can also be a reason for weight gain.
Iron Deficiency and Weight Gain
Iron deficiency does not cause weight gain. The problem is that you may start to pile on pounds as your iron levels return back to normal. In a July 2016 study published in the Egyptian Journal of Haematology, 60 percent of female subjects who received treatment for iron deficiency anemia gained around 6.6 pounds. Researchers state that weight gain is a common effect of iron therapy.
Symptoms of Iron Deficiency Anemia
Iron deficiency develops gradually and takes time to reveal symptoms. Weight fluctuations often indicate an underlying health issue, especially when paired with other uncomfortable symptoms. Anemia makes it challenging to maintain optimal weight. Patients report unexplainable weight loss or weight gain accompanied by fatigue, weakness, and other symptoms.
According to the National Heart, Lung, and Blood Institute (NHLBI), symptoms can range from mild to severe and may include:
- Low energy and unexplained fatigue
- Hair loss
- Brittle nails
- Headache, especially during physical activity
- Poor mental focus
- Cold hands and feet
- Cravings for clay, ice and other non-food items
- Diminished appetite
- Rapid heartbeat
- Pale skin
- Overall weakness
- Breathing problems
Without adequate treatment, this condition may increase your risk of infections and affect cardiovascular health. It also has a direct impact on mental health and may contribute to depression. Pregnant people with iron deficiency anemia are at risk for preterm birth. If you have a chronic disease, anemia can worsen your symptoms.
Treatment and Management
To treat anemia, a healthcare professional will first need to determine the underlying cause. Once your doctor identifies the cause, they can develop a treatment plan. This may involve treatments such as iron or B12 supplements or injections. In severe cases, they may recommend medications to boost red blood cell production. If you’ve gained or lost weight as a result of anemia, there are several things to focus on alongside appropriate anemia treatment.
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Depending on the severity of your condition, there are several ways to address unexplained weight loss and anemia. If you have only mild symptoms, your doctor may recommend simple lifestyle changes to boost your iron intake. The NHLBI recommends eating foods rich in vitamin C to help your body absorb this mineral more efficiently.
Dietary Changes
- Iron-Rich Foods: To keep infants from having iron deficiency anemia, feed your baby breast milk or iron-fortified formula for the first year. Breastfed children need iron supplements starting at 4 months. Cow's milk is not a good source of iron for infants. It isn't suggested for children younger than 1 year old. After 6 months, babies can eat cereals with added iron or pureed meats at least twice a day to boost iron intake. Children older than 1 year shouldn't drink more than 24 fluid ounces (720 milliliters) of milk a day. Too much milk often takes the place of other foods, including those that are rich in iron.
- Animal proteins: Beef, poultry, eggs, liver and fish
- Breads and cereals: Whole wheat bread, enriched white bread, rye bread, bran cereals and cereals with wheat
- Fruits: Figs, dates and raisins
- Legumes: Peas, beans, tofu and tempeh
- Vegetables: Spinach, broccoli, string beans, dark leafy greens, potatoes, cabbage and tomatoes
- Vitamin C: Vitamin C can improve your body's ability to absorb iron. If you're deficient in this mineral, eat plenty of citrus fruits, leafy greens, tomatoes, broccoli, berries and other foods rich in vitamin C.
Iron Supplements
Iron supplements can help, too. However, too much iron can be harmful. That's why iron supplements should be taken only under medical supervision.
Medical Interventions
In severe cases, doctors may recommend injectable iron or blood transfusions. If iron deficiency anemia is due to internal bleeding, surgery may be needed.
Lifestyle Adjustments
- Exercise: “Speak with a healthcare provider you trust about what types of exercise are safe and appropriate for you,” says Gans. Low-intensity exercises like walking, yoga, or light stretching can help improve energy and prevent weight gain without overwhelming your body.
- Nutrition: “If you’re experiencing unintended weight loss with anemia, it’s important to consume enough calories to meet your body’s energy needs.“Speak with a health and nutrition professional to develop a meal plan that provides enough calories and nutrients to support your health.”
Prevention
You can lower your risk of iron deficiency anemia by choosing foods rich in iron. While many types of anemia cannot be prevented, eating healthy foods can help you avoid both iron-and vitamin-deficiency anemia. Foods to include in your diet include those with high levels of iron (beef, dark green leafy vegetables, dried fruits, and nuts), vitamin B-12 (meat and dairy), and folic acid (citrus juices, dark green leafy vegetables, legumes, and fortified cereals).
Recent Research on Weight Loss and Iron Status
A study was conducted to evaluate the effect of diet-induced weight loss on iron status, chronic inflammation, and serum hepcidin level among overweight or obese young women with IDA. The study design was a single-blinded, randomized controlled trial with two parallel arms (weight loss intervention vs control). The intervention group received individual consultation sessions with the dietitian and tailored energy-restricted diets.
The results showed that there was a significant decrease (p < 0.001) in body weight of the intervention group (-7.4 ± 2.7 kg) that was associated with significant improvements in iron status and its markers (p < 0.01). These results suggest that diet-induced weight loss among young women with overweight or obesity was associated with an improvement in iron indicators including a decrease in chronic inflammation and serum hepcidin level.
When to Seek Medical Advice
Weight can fluctuate slightly, but persistently losing or gaining weight when you haven’t changed your diet or activity levels can be a cause for concern.“If you or a loved one are experiencing unexplained weight changes or other symptoms, it’s important to speak with a physician for a proper diagnosis and treatment plan,” says Gans. This is also true if you have any other potential anemia symptoms, such as fatigue or dizziness.