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Time To Hit The Gym, Your Bones Are Calling!

Introduction

The term &quot;<a href="https://www.merisehat.pk/disease/osteoporosis-80">osteoporosis</a>&quot; literally translates to &ldquo;porous bone&rdquo;. Osteoporosis occurs when the bones lose minerals more quickly than they can be replaced. This causes the bones to become less dense, weak, and break more easily. The disease thins the bone framework. As a result, even a minor fall or bumps against furniture can cause a fracture. 
&nbsp;

For most people, the disease takes a silent course and they remain unaware of its presence until a fracture happens. Since osteoporosis generally does not present with any signs and symptoms, it is often referred to as the &ldquo;silent disease&rdquo;.&nbsp; 
&nbsp;

Osteoporosis is a common bone disease that affects both men and women, but middle- and older-aged women are more likely to have it as compared to men. In postmenopausal women, low estrogen levels increase the risk of disease. Moreover, the prevalence of the disease increases with age. 
&nbsp;

Osteoporosis typically presents with fractures and its associated complications. Spine, hip, and wrist fractures are the most common fractures in osteoporosis. Additionally, limited activity because of postural changes affects the individual&rsquo;s overall quality of life.&nbsp;&nbsp;

&nbsp;

Bones are formed by special cells in our body, called osteocytes. Similar to other parts of our body, our bones are also constantly being broken down and renewed. When we are younger, more bone is made than is broken down, which leads to bone growth. However, with age, the bone growth slows down and by the age of 25 to 30 years, it completely stops. This is the time around which peak bone mass is achieved.&nbsp; 
&nbsp;

In addition, sex hormones, such as estrogen and testosterone, play a pivotal role in maintaining bone strength in both men and women. However, during menopause, there is a significant decrease in the levels of estrogen. This triggers excessive bone loss. Women can lose as much as 10-20% of the total body bone mass during the first few years of menopause<a href="#accordion">[1]</a>. 
&nbsp;

Osteoporosis also triggers fractures of the spine that can cause pain, changes in posture, and loss of height. Similarly, when spinal fractures are compressed because of the force of gravity, it causes the spine to bend abnormally, a condition that is known as kyphosis.&nbsp; 
&nbsp;

Understanding The Importance Of Exercise in Osteoporosis

Fortunately, there are preventive measures and treatments available to combat this problem. Lifestyle changes and medical treatment can help reduce the risk of bone fractures and slow down further bone loss. Early diagnosis and fracture risk assessment can slow down the loss of bone density in people with osteoporosis. 
&nbsp;

Moreover, just like muscles gain strength from exercise, bones can also become stronger with physical activity. Exercising may be effective for the treatment of osteoporosis and the prevention of hip and spinal fractures. Studies have further shown that weight training prevents age-related decline in skeletal mass, and in some cases may also increase the mineral content of bones.&nbsp; 
&nbsp;

Exercising regularly helps with optimal improvement in bone density, even in women taking adequate dietary calcium. The skeletal benefits of exercise are not affected by hormonal status or age. Exercise programs are designed keeping in mind the individual’s physical condition, the current level of activity, their overall compliance, and objectives that need to be achieved. Generic programs that aren’t specifically designed to target the needs of the individuals and inadequate supervision will result in musculoskeletal complications and non-compliance. Moreover, exercise helps prevent osteoporosis-associated complications, irrespective of age and hormonal status.

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Each year, more than 2 million osteoporosis-related fractures are reported. What&rsquo;s more, most people are unaware of the fact that they have osteoporosis till they suffer a fracture. 
&nbsp;

While the exact cause of osteoporosis is still not known, there are many factors that contribute to osteoporosis, including:&nbsp; 
&nbsp;

<ul>
	<li>Ageing&nbsp;</li>
	<li>Lack of physical activity and an inactive lifestyle&nbsp;</li>
	<li>Decreased levels of estrogen&nbsp;</li>
	<li>Genetic predisposition&nbsp;</li>
	<li>Excessive use of thyroid hormone and cortisone&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li>Excessive intake of alcohol&nbsp;</li>
</ul>

&nbsp;

The loss of bone generally begins at the age of 35 and is more commonly seen in the lower forearm above the wrist, spine, and upper femur or thigh. Women lose 30-50% of their bone density after growth is complete, and men lose 20-30%<a href="#accordion">[1]</a>. The common osteoporosis-associated injuries in older adults include wrist fractures, spine fractures, and hip fractures.&nbsp;

During menopause, women lose calcium from the bone at a more accelerated pace compared to men. This results from the low estrogen levels during menopause.&nbsp; The hormone helps maintain bone mass and strength. Your doctor may recommend estrogen replacement therapy or other medications such as calcitonin.&nbsp;

&nbsp;

Moreover, certain medical conditions, medications, and treatments can also affect the strength of bones directly. Vitamin D deficiency, endometriosis, cancer, chronic lung disease, and an overactive thyroid or parathyroid gland can all affect bone density. Other risk factors include:&nbsp; 
&nbsp;

<ul>
	<li>Low intake of protein, potassium, vitamin D or calcium&nbsp;</li>
	<li>Inactive lifestyle&nbsp;</li>
	<li>Cigarette smoking&nbsp;</li>
	<li>Alcohol abuse&nbsp;</li>
	<li>Long-term use of medications such as some antiseizure drugs, or overuse of aluminium-containing antacids and glucocorticoids.&nbsp;</li>
	<li>Eating disorders&nbsp;</li>
	<li>Low levels of estrogen in women and testosterone in men</li>
</ul>

&nbsp;

Whether you&rsquo;re in your early 20s or late 50s, keeping the bones healthy at any age is a smart goal. However, people only realize the importance decades after they turn 50. Or when weakened bones have already led to fractures. 
&nbsp;

Fortunately, regular moderate-intensity exercise, for at least 2 hours and 30 minutes every week, can help reverse the damage. Fast walking and cycling are both examples of moderate-intensity exercise. Moreover, weight-bearing and resistance exercises help improve bone density and prevent osteoporosis. Similarly, it is also recommended for adults between the ages of 19 and 64 to do muscle-strengthening activities at least twice a week. The exercises target major muscle groups including the back, shoulders, chest, arms, hips, and legs.&nbsp; 
&nbsp;

If you have been diagnosed with osteoporosis, speak with your doctor before starting any new exercise regimen to ensure that it&rsquo;s the right fit for you.&nbsp; 
&nbsp;

<h5>1. Weight-Bearing Exercises&nbsp;</h5>

Weight-bearing exercises are tailored for your feet and legs to support your weight. High-impact weight-bearing exercises, for example, aerobics, dancing, skipping, running, and jumping up and down on the spot will help in strengthening your muscles, joints, and ligaments. Though, while exercising it is essential to wear footwear that provides your ankles and feet with adequate support. Moreover, weight-bearing exercises are also the perfect fit for people over the age of 60. The exercises can include brisk walking or a game of tennis.&nbsp; 
&nbsp;

<h5>2. Resistance Exercises&nbsp;</h5>

Resistance exercises are designed to strengthen muscles and improve bone density. Examples of resistance exercises include weightlifting, press-ups or exercise using other weight training equipment at the gym. If you have never exercised at a gym before, always ask for help from an instructor to ensure correct use and prevent any injuries.

&nbsp;

Conclusion

Ageing and declining hormone levels are normal physiological phenomena. But that should not be used as an excuse to live an unhealthy or sedentary lifestyle. While you may not feel as physically fit as when you were in your 20s, it’s never too late to hit the gym and reverse the damage. Studies have shown that exercising regularly can help improve bone density and prevent fractures.&nbsp;

[1].Ji, M.X. and Yu, Q., 2015. Primary osteoporosis in postmenopausal women. Chronic diseases and translational medicine, 1(01), pp.9-13.

Staff Writer

To Meat Or Not To Meat?

Research over the years has shown that a strict vegetarian diet excluding all animal fats can lead to vitamin B12 deficiency. Thus, increasing the risk of developing anemia. Newer research also suggests that a more lenient diet puts people at risk of developing <a href="https://www.merisehat.pk/disease/anemia">anemia </a>and heart disease.

There are various reasons behind people giving up eating meat and animal products (milk, cheese, and eggs). However, doing so might increase their risk of anemia, which is a potentially serious condition in which the body does not make enough red blood cells. For vegetarians, vitamin B12 deficiency anemia is typically caused because of eliminating meat from their diet. Similarly, for vegans, giving up all animal products including dairy, eggs, and even honey increases the risk of developing anemia.&nbsp; 
&nbsp;

Understanding Ways To Diversify Iron Sources In Vegetarian And Vegan Diets

A lack of vitamin B12 in your diet can cause pernicious anemia. The body needs vitamin B12 from foods such as meat, poultry, fish and eggs to make red blood cells. Pernicious anemia is a rare type of anemia in which the body is unable to absorb vitamin B12. The vitamin is only available in meat and animal products. While vegetarians who eat dairy and eggs are getting enough vitamin B12 through these sources, vegans must find other ways to include it in their diets, for example, through vitamin B12 supplements. 
&nbsp;

Vitamin B12 deficiency can boost the levels of homocysteine in the blood, a common amino acid that is associated with a higher risk of heart disease. Studies also suggest that the level of this amino acid can over time cause blockages in arteries and lead to heart disease or stroke. Vitamin B12, unlike B vitamins, is not found in any plant derived foods and fortified cereals. However, many types of meat and fish are abundant in vitamin B12. Thus, making it difficult for people following a strict vegetarian diet to get the necessary amount of vitamin B12. The answer is to eat a well-balanced diet and get the needed B12 from other sources, such as vitamin B12 supplementation, to prevent anemia.&nbsp; 
&nbsp;

Look for foods fortified with vitamin B12. Read the nutrition label on packaged foods. Some examples of processed foods that contain vitamin B12 are:&nbsp;

<ul>
	<li>Fortified rice&nbsp;</li>
	<li>Soy milk&nbsp;</li>
	<li>Grain products and cereal&nbsp;</li>
	<li>Meat substitutes</li>
	<li>Dietary supplements containing B complex&nbsp;</li>
	<li>Nutritional yeast&nbsp; 
	&nbsp;</li>
</ul>

Whether you are on a vegan or vegetarian diet, you need to create a healthy and balanced diet that includes enough vitamin B12 to prevent anemia. While fortified cereals are a good choice because of their good bioavailability, meaning it doesn&rsquo;t need to break down before the body absorbs them, vegetarians should consume the following foods on a regular basis:&nbsp;

<ul>
	<li>8 ounces (oz) of yogurt contains about 1.1 mcg of vitamin B12</li>
	<li>1 cup of low-fat milk can provide 1.2 mcg of vitamin B12</li>
	<li>1 oz of Swiss cheese can contain 0.95 mcg of vitamin B12</li>
	<li>1 large egg contains 0.6 mcg of vitamin B12</li>
</ul>

Nutritional yeast is also popular among vegetarians because of its rich, cheesy, and nutty flavor. The yeast can either be added to cooked meals or sprinkled on foods and snacks.

<div>
Since vegans avoid all animal-derived products, they may rely on vitamin B12 fortified breakfast cereals and nutritional yeast, as an alternative source of vitamin B12. For example, fortified non-dairy milk, meat substitutes, breakfast cereals, nutritional yeast, and vegan spreads. However, it is essential to read the labels of the foods as some may not be fortified in vitamin B12.&nbsp;

For those who are deficient in vitamin B12, supplemental vitamins in the form of capsules may be required.&nbsp; 
&nbsp;
</div>

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If you decide on taking a dietary supplement, there are some ground rules. A healthy body does not readily absorb all the vitamin B12 in a supplement. Food supplements should never be used as a substitute for a balanced diet and healthy lifestyle. Therefore, it is essential that you talk to your doctor or nutritionist to know the amount of vitamin B12 supplement that is right for you.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Vegetarians and vegans need to take steps to make sure that they are including an adequate amount of vitamin B12 in their diet. Not maintaining proper levels of vitamin B12 increases the risk of developing anemia.</li>
	<li>Similarly, since there are no plant-derived foods that contain vitamin B12, it is essential to look into alternative sources, for example, fortified foods and vitamin B12 supplements.</li>
	<li>Speak with a healthcare provider for advice on how much you need to take and where to find sources of vitamin B12.</li>
</ul>

[1] Pawlak, R., Parrott, S.J., Raj, S., Cullum-Dugan, D. and Lucus, D., 2013. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition reviews, 71(2), pp.110-117.

[2] Walsh, S., Appleby, P., Baron, L., Dallas-Chapman, G., Davis, B. and Harris, W., 2001. What every vegan should know about vitamin B12. Birmingham: Vegan Society.

[3] Watanabe, F., Yabuta, Y., Bito, T. and Teng, F., 2014. Vitamin B12-containing plant food sources for vegetarians. Nutrients, 6(5), pp.1861-1873.

How Do I Boost My Iron Levels?

Iron is an essential mineral that your body uses to make hemoglobin. Iron is also an essential mineral for growth and development. There are two types of iron in food: animal-derived and plant-derived. While there is enough iron available in our food sources, it can also be taken as a supplement.

Understanding Ways To Treat Iron Deficiency Anemia

Studies have shown that the average amount of iron is 8.7 milligrams per day for men and 14.8 milligrams per day for women. The requirement for iron in vegetarians and vegans is 1.8 times more than in people who eat meat.&nbsp;

&nbsp;

You need iron to function properly. A lack of iron in your diet will lead to iron deficiency. Iron plays an important role in different bodily functions; it is an essential nutrient needed to form hemoglobin and carry oxygen in your blood to organs and tissues. This is important for optimal heart health, immune function, and respiratory functions.

&nbsp;

<a href="https://www.merisehat.pk/disease/anemia">Anemia</a> occurs when the body does not have enough red blood cells to carry oxygen to the body&rsquo;s organs and tissues. There are different types of anemia, but iron-deficiency anemia is the most common type of anemia in developing countries. According to the World Health Organization, 1.62 billion people are estimated to be affected by anemia worldwide.&nbsp;

&nbsp;

Low levels of iron can further lead to iron deficiency anemia. The symptoms of anemia include:&nbsp;

<ul>
	<li>Fatigue&nbsp;</li>
	<li>Weakness&nbsp;</li>
	<li>Pale and yellow skin&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Lightheadedness&nbsp;</li>
	<li>Chest pain&nbsp;</li>
	<li>Cold hands and feet&nbsp;</li>
	<li>Headaches&nbsp;</li>
</ul>

&nbsp;

There are some types of anemia that are inherited and cannot be prevented, for example, sickle cell anemia, hemolytic anemia, and aplastic anemia.&nbsp;

However, anemia caused because of iron deficiency, vitamin B12, and vitamin B9 deficiency, can be prevented by eating well. This includes eating foods that provide enough iron and vitamins, in addition to vitamin C food sources, because it helps with the absorption of iron. Studies have also shown that drinking enough water helps keep hemoglobin levels up.

Moreover, daily iron supplementation may increase hemoglobin levels, and decrease the risk of anemia in infants, school-aged children, and pregnant and non-pregnant women. Foods fortified with iron and improving overall diet also have benefits in reducing the risk of developing iron-deficiency anemia.

There are some types of anemia that are short-term and mild. However, others can affect you throughout your life. There are several ways to manage anemia, including:

<ul>
	<li><a href="https://www.merisehat.pk/article/anemia-best-meals-for-boosting-iron">A healthy, well-balanced diet</a></li>
	<li>Stay hydrated</li>
	<li>Regular exercise</li>
	<li>Avoid&nbsp;exposure to chemicals that trigger anemia</li>
	<li>Visiting the dentist regularly because anemia increases the risk of tooth decay and gum disease</li>
	<li>Keep track of your symptoms and talk to your doctor about any changing symptoms</li>
</ul>

&nbsp;

If you have anemia, it is important to make good food choices. For example, avoid junk foods because it means adding calories to your diet without getting any essential nutrients. In addition, some foods impair the absorption of iron. Therefore, it is important to make the right food choices.

Here are some foods you should avoid:&nbsp;

<ul>
	<li>Coffee, tea, and other tannin-containing products, such as some spices</li>
	<li>Egg whites</li>
	<li>Fiber, but not all of it because some iron supplements may cause constipation</li>
	<li>Soy protein</li>
	<li>You should not be taking calcium with iron supplements because it impairs its absorption</li>
</ul>

&nbsp;

Here are some foods you should eat:

<ul>
	<li>Whether you eat meat or not, you should generally eat iron-rich foods, such as lentils, spinach, and pistachios.&nbsp;</li>
	<li>You can also get protein from different kinds of meat, like lean beef and turkey. There are some iron-fortified foods also available for vegans and vegetarians.&nbsp;</li>
	<li>It is also important to incorporate citrus fruits, berries, and other vitamin C-containing foods such as peppers and tomatoes in your diet to improve iron consumption.</li>
</ul>

&nbsp;

Consult with a healthcare provider to help with your iron intake, and do what works best for you.&nbsp;

&nbsp;

Iqra Mazhar

Anemia: Best Meals For Boosting Iron

Iron deficiency anemia is the most common nutritional disorder in the world according to the World Health Organization. A deficiency in the mineral i.e. iron leads to a deficiency in red blood cells, which causes anemia. Oxygen binds to the hemoglobin in the red blood cells and is transported to the organs and tissues. In anemia, the blood is not carrying enough oxygen to the cells of the body. Thus, causing you to feel weak and tired.

There are several causes of iron deficiency anemia, but inadequate dietary intake and a loss of blood are the two most common causes. Doctors typically prescribe oral iron supplements and intravenous (IV) iron to treat iron deficiency.&nbsp;

Similarly, people with iron deficiency anemia are also encouraged to follow a diet plan specifically designed for iron deficiency. The diet includes animal- and plant-based iron-rich foods, such as poultry, meat, seafood, nuts, seeds, and beans. While an iron-rich diet is necessary, you also need to include foods in your diet that improve the body&rsquo;s absorption of iron, in addition to avoiding foods that may interfere with the process.&nbsp;

&nbsp;

Understanding Ways To Increase Dietary Iron

Adding iron-rich foods to your diet and foods that increase the absorption of iron is the best way to curb iron-deficiency anemia. Iron-fortified cereals, bread products, orange juice, rice, and bread help with bringing iron levels back up. Below is a diet plan that a person with anemia may follow:&nbsp;

&nbsp;

<h5 dir="ltr">Breakfast&nbsp;</h5>

<ul>
	<li>
	Option 1: Unsweetened, iron-fortified oatmeal topped with either almonds, cashews, or walnuts, and a glass (8 ounces) of 100% orange juice which may help increase the absorption of iron in your body.&nbsp;
	</li>
	<li>Option 2: Brown bread, eggs, and apples, with a hand full of iron-rich nuts. Avoid tea and coffee with your meals as it inhibits the absorption of iron.&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Lunch&nbsp;</h5>

<ul>
	<li>
	Option 1: Boiled rice, chickpeas, or lentils with beef, chicken, or fish.&nbsp;
	</li>
	<li>Option 2: Chapati, leafy green vegetables, for example, spinach, or any other iron-rich vegetables, such as potatoes, beef, chicken, or fish curry.&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Dinner&nbsp;</h5>

<ul>
	<li>
	Option 1: Mutton curry or chops with chapati, or boiled rice with a leafy green vegetable on the side.&nbsp;
	</li>
	<li>Option 2: Stew any kind of meat with <a href="https://www.merisehat.pk/disease/chronic-kidney-disease">kidney</a> beans, chickpeas, and tomatoes with either boiled rice or chapati.</li>
</ul>

&nbsp;

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There are many foods that contain high levels of iron and can be combined to make nutritious meals to help with the intake of iron. Foods rich in vitamin C, such as tomatoes, cauliflower, apples, and oranges should also be added to your diet because they help with the absorption of iron. Below is a list of foods that you can add to your diet to help with iron-deficiency anemia:

&nbsp;

<h5 dir="ltr">Fruits And Vegetables&nbsp;</h5>

<ul>
	<li>Spinach&nbsp;</li>
	<li>Beetroot&nbsp;</li>
	<li>Soybean&nbsp;</li>
	<li>Kale&nbsp;</li>
	<li>Broccoli&nbsp;</li>
	<li>Citrus fruits, oranges, grapefruit&nbsp;</li>
	<li>Pomegranate&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Nuts&nbsp;</h5>

<ul>
</ul>

<ul>
	<li>Cashews&nbsp;</li>
	<li>Pistachios&nbsp;</li>
	<li>Almonds&nbsp;</li>
	<li>Walnuts</li>
</ul>

&nbsp;

<h5 dir="ltr">Meat And Fish&nbsp;</h5>

<ul>
</ul>

<ul>
	<li>Beef&nbsp;</li>
	<li>Lamb&nbsp;</li>
	<li>Venison&nbsp;</li>
	<li>Liver&nbsp;</li>
	<li>Shrimp&nbsp;</li>
	<li>Salmon&nbsp;</li>
	<li>Tuna&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Beans And Pulses&nbsp;</h5>

<ul>
	<li>Kidney beans&nbsp;</li>
	<li>Chickpeas&nbsp;</li>
	<li>Soybeans&nbsp;</li>
	<li>Black beans&nbsp;</li>
	<li>Pinto beans&nbsp;</li>
	<li>Peas&nbsp;</li>
</ul>

&nbsp;

If you have been diagnosed with iron deficiency anemia, there are a few foods and drinks you should avoid because they can keep your body from absorbing iron into your system.&nbsp;

<ul>
	<li>Black and green teas make the iron from plant sources indigestible.&nbsp;</li>
	<li>Coffee also prevents iron from being absorbed&nbsp;into your system. If you are taking iron-rich supplements or an iron-rich meal, avoid drinking coffee an hour before and after.&nbsp;</li>
	<li>Calcium-rich foods, for example, milk, yogurt, bananas, and some nuts interfere with the absorption of iron in the body.</li>
	<li>Gluten-containing foods such as pasta, barley, rye, wheat products, and oats, damage the intestinal walls and prevent the absorption of iron.&nbsp;</li>
	<li>Foods that contain phytates, such as legumes, whole-grain wheat, and brown rice should also be avoided because they prevent the absorption of iron.&nbsp;</li>
	<li>Foods containing oxalic acids, such as peanuts, parsley, chocolates, and spinach should also be eaten in a limited quantity if you are on iron medication.&nbsp;</li>
	<li>Tannins containing foods, such as grapes and corn should also be avoided.</li>
</ul>

&nbsp;

Although iron-rich foods help raise the levels of iron in the blood, to achieve a healthy iron status, most people also need to take supplements alongside following a healthy diet. Some people also do not absorb iron well and may need IV iron treatments. Your doctor will best advise treatment based on your needs. However, the following tips can help with increasing the absorption of iron:

<ul>
	<li>Avoid tea and coffee with meals.</li>
	<li>Avoid calcium-rich foods.</li>
	<li>Have iron-rich foods with those rich in vitamin C.</li>
	<li>Cook food for shorter periods on a cast-iron skillet.</li>
</ul>

&nbsp;

Following an iron-rich meal is perhaps the easiest way to recover from anemia. All the foods mentioned on the list are easily available at well-stocked grocery stores. If you&rsquo;ve tried changing your diet, but failed at bringing your iron levels back to normal, you should speak with a doctor or dietician. They will recommend a supplement that is most effective for you, based on your needs.&nbsp;

&nbsp;

Medilink Consultant clinic

Saad Ullah Siddiqui

Rare Types of Anemia

If you&#39;ve ever felt like a deflated balloon after climbing a flight of stairs or found yourself nodding off during an important meeting, you might be familiar with the telltale signs of anemia. But don&#39;t worry, there&#39;s no need to break out the iron supplements just yet!

There are several different forms of anemia and there are many possible causes and treatments for this condition. 
&nbsp;

Anemic refers to the state of being affected by anemia, which is a medical condition characterized by a deficiency in red blood cells or hemoglobin. When you have anemia, your body doesn&#39;t produce enough healthy red blood cells to supply your tissues with enough oxygen. Being anemic, or having low hemoglobin, can make you feel exhausted and frail.&nbsp; 
&nbsp;

According to WHO statistics, 40% of pregnant women and 42% of children under the age of 5 worldwide are particularly affected by anemia<a href="#accordion">[4]</a>.

The condition affects different people in different ways.<a href="#accordion">[1]</a> 
&nbsp;

<ul>
	<li>Newborns: Some newborns have low red blood cell count at birth. Most newborns with anemia don&#39;t require medical attention, but others may require blood transfusions if their anemia is severe.</li>
	<li>Infants: When infants begin eating solid food, they do not get as much iron as they require. This is due to the fact that iron in solid food isn&#39;t as quickly absorbed as iron in breast milk or infant formula. Infants with anemia&nbsp;will be lethargic.</li>
	<li>Children: From birth until age 2, children grow significantly and hence mothers&nbsp; prioritize drinking milk and also increasing the quantity of milk as their children grow. Although milk is a beneficial source of calcium and vitamin D, excessive consumption can lead to a potential risk of iron deficiency anemia in children, as milk lacks sufficient iron content and hampers the absorption of iron from other food sources. However growing children do require extra iron. If they have anemia, they&nbsp;may experience growth-related challenges, such as&nbsp;delayed motor skill development and learning difficulties. Hence the best option is to consult your local health care provider to understand the correct amounts of milk and iron required in the different developing stages by your little one.</li>
	<li>Pregnant Women: Iron-deficiency anemia can occur in pregnant women, which can increase the risk of issues, including premature birth or giving birth to babies who are underweight. Iron deficiency anemia is different from physiological anemia of pregnancy. In a typical pregnancy, the plasma volume expands more significantly compared to the increase in the red cell mass. This leads to a condition known as the physiological anemia of pregnancy, where there is dilution of blood, resulting in anemia.</li>
	<li>Females: Anemia can result from blood loss in women who experience heavy menstrual bleeding or medical disorders like uterine fibroids.</li>
	<li>Elderly People: Adults who are 65 and above are more prone to anemia because they are more likely to have iron-deficient diets. Moreover, they suffer from certain chronic conditions. As a result, they can experience heart problems or weakness that makes it difficult for them to move around if they develop anemia. </li>
	<li>People With Chronic Illnesses: Anemia may be more common in people with certain long-term illnesses, like cancer or autoimmune diseases. This is known as anemia of chronic disease ( also known as Anemia of inflammation). 
	&nbsp;</li>
</ul>

Understanding  Rare Types of Anemia

<ol>
	<li>
	<h5>Aplastic (Or Hypoplastic) Anemia</h5>
	</li>
</ol>

Aplastic anemia occurs when the stem cells in your bone marrow are damaged and cannot produce sufficient blood cells. You can either inherit it or acquire it; the acquired type is more common but potentially temporary.

Causes

<ul>
	<li>Autoimmune conditions, like rheumatoid arthritis or lupus</li>
	<li>Exposure to chemicals, such as arsenic, pesticides, and benzene</li>
	<li>Infections, such as HIV, Epstein-Barr virus, and hepatitis</li>
	<li>Chemotherapy and radiation for cancer</li>
	<li>Fanconi anemia </li>
	<li>Shwachman-Diamond syndrome</li>
	<li>Diamond Blackfan anemia</li>
</ul>

Symptoms

<ul>
	<li>Dizziness</li>
	<li>Shortness of breath</li>
	<li>Headache</li>
	<li>Chest pain</li>
	<li>Pale skin</li>
	<li>Fast heart rate</li>
	<li>Cold feet and hands</li>
</ul>

Treatment: Blood transfusion is one method of treating aplastic anemia. Aplastic anemia can also be treated with a stem cell transplant, which replaces your bone marrow&#39;s damaged stem cells with healthy ones. 
&nbsp;

<ol start="2">
	<li>
	<h5>Sideroblastic Anemia </h5>
	</li>
</ol>

Your body is unable to utilize iron to produce hemoglobin, the protein that transports oxygen throughout your body. Sideroblasts, which are abnormal red blood cells, are produced as a result of iron accumulation.

Causes

<ul>
	<li>Exposure to drugs or certain chemicals</li>
	<li>Normal hemoglobin production is disrupted by mutation of the gene responsible for producing &ldquo;heme&rdquo; that is part of hemoglobin </li>
</ul>

Symptoms

<ul>
	<li>Headache</li>
	<li>Chest pain</li>
	<li>Fast heartbeat</li>
	<li>Trouble breathing</li>
	<li>Fatigue and weakness</li>
</ul>

Treatment: &nbsp;Depending on the etiology, sideroblastic anemia requires different treatments. Additionally, bone marrow or stem cell transplants and vitamin B6 therapy are available as treatments. 
&nbsp;

<ol start="3">
	<li>
	<h5>Myelodysplastic Syndromes</h5>
	</li>
</ol>

Myelodysplastic syndromes (MDS) are conditions brought on by damaged bone marrow. MDS is a form of cancer.

Causes

<ul>
	<li>It&rsquo;s congenital, especially if you have certain genetic syndromes, such as Fanconi anemia, Shwachman-Diamond syndrome, Diamond Blackfan anemia, familial platelet disease, and severe congenital neutropenia</li>
	<li>Prior treatment with chemotherapy or radiation therapy</li>
	<li>Exposure to compounds like benzene, which is present in cigarette smoke</li>
</ul>

Symptoms

<ul>
	<li>Bleeding or bruising</li>
	<li>Fever</li>
	<li>Infection</li>
	<li>Fatigue and weakness</li>
	<li>Weight loss</li>
	<li>Shortness of breath</li>
</ul>

Treatment: Hematologists (blood doctors) and oncologists (cancer doctors) will treat your MDS using chemotherapy, hematopoietic growth factor, bone marrow, or stem cell transplants. 
&nbsp;

<ol start="4">
	<li>
	<h5>Autoimmune Hemolytic Anemia</h5>
	</li>
</ol>

The condition is known as autoimmune hemolytic anemia when your body&#39;s immune system attacks and eliminates red blood cells more quickly than it can produce new ones. 

Causes

<ul>
	<li>Autoimmune disorders, like lupus</li>
	<li>Medications, including quinine (Qualaquin), penicillin, and methyldopa (Aldomet)</li>
</ul>

Symptoms

<ul>
	<li>Pale skin</li>
	<li>Fast heartbeat</li>
	<li>Backache</li>
	<li>Trouble breathing</li>
	<li>Yellow skin (jaundice)</li>
	<li>Chills</li>
</ul>

Treatment: Treating the underlying condition that led to your anemia can help stop the damage to your red blood cells. Your doctor may also prescribe steroids to suppress your immune system if you have an autoimmune condition. 
&nbsp;

<ol start="5">
	<li>
	<h5>Congenital Dyserythropoietic Anemia (CDA)</h5>
	</li>
</ol>

A group of hereditary anemias known as CDA lowers your body&#39;s supply of healthy red blood cells. Types 1, 2, and 3 of CDA are the three different types. Type 2 is the most prevalent, while type 3 is the least common.

Causes

Every CDA is inherited.

Symptoms

<ul>
	<li>Fatigue</li>
	<li>Anemia</li>
	<li>Yellow eyes and skin (jaundice)</li>
	<li>Chronic anemia</li>
	<li>Pale skin</li>
	<li>Missing toes and fingers at birth</li>
</ul>

Treatment: Some patients never require medical care. However, depending on the severity of your disease, your doctor may advise a blood transfusion, stem cell transplant, medications to lower iron levels, or interferon alfa-2A (a medication normally used to treat leukemia and melanoma). 
&nbsp;

<ol start="6">
	<li>
	<h5>Diamond-Blackfan Anemia&nbsp; </h5>
	</li>
</ol>

In Diamond-Blackfan anemia (DBA), your bone marrow does not produce enough red blood cells. DBA can manifest with various physical characteristics or features, such as facial abnormalities, delays in growth, and abnormalities in the upper limbs.

Causes 

<ul>
	<li>Doctors think that a change in your genes is what causes this anemia.</li>
</ul>

Symptoms

<ul>
	<li>Fatigue</li>
	<li>Fast heartbeat</li>
	<li>Heart murmur</li>
	<li>Pale skin</li>
	<li>Irritability</li>
	<li>Short height</li>
	<li>Weak bones</li>
	<li>Sleepiness </li>
</ul>

Treatment: Everything from steroids, which can help in the production of more red blood cells, to red blood cell transfusions and bone marrow transplants can be used to treat Diamond-Blackfan anemia. 
&nbsp;

<ol start="7">
	<li>
	<h5>Megaloblastic Anemia</h5>
	</li>
</ol>

Your bone marrow creates improperly formed red blood cells that are too big and too immature when you have megaloblastic anemia. They can&#39;t effectively transport oxygen throughout your body since they aren&#39;t fully developed or healthy.

Causes

<ul>
	<li>Deficiency in vitamin B9 (folate) or vitamin B12 (cobalamin)</li>
</ul>

Symptoms

People with megaloblastic anemia may not have symptoms for years. However, symptoms which people with the condition might experience are :

<ul>
	<li>Fatigue or dizziness</li>
	<li>Nausea</li>
	<li>Diarrhea</li>
	<li>Irregular or fast heartbeat</li>
	<li>Pale skin</li>
	<li>Muscle weakness or pain</li>
	<li>Trouble breathing</li>
</ul>

Treatment: Vitamin B12 and vitamin B9 supplements are used to replenish your body. An underlying condition, such as Crohn&rsquo;s, would also need to be treated if it caused the vitamin deficiency in your body. 
&nbsp;

<ol start="8">
	<li>
	<h5>Fanconi Anemia </h5>
	</li>
</ol>

Fanconi anemia makes your bone marrow produce fewer blood cells than required.Diagnostic features may include physical abnormalities such as the absence of a thumb and other deformities. 

Causes

<ul>
	<li>Gene mutation</li>
</ul>

Symptoms

<ul>
	<li>Fatigue</li>
	<li>Abnormal thumbs</li>
	<li>Easy bleeding and bruising</li>
	<li>Skin color changes</li>
	<li>Small head, body, and eyes</li>
	<li>Frequent infections</li>
	<li>Bone, kidney, and heart problems</li>
</ul>

Treatment: The severity of the physical consequences and the stage of the disease will both influence the course of your treatment. Hormone therapy and growth factors can be used as treatments to promote blood cell growth. Your doctor may also advise a bone marrow stem cell transplant if your symptoms worsen. A bone marrow transplant frequently eliminates all issues. 
&nbsp;

Diagnosing rare types of anemia can be challenging&nbsp; and will require multiple testing for a conclusive diagnosis.

Some steps that can be taken to diagnose rare types of anemia are: 
&nbsp;

<ul>
	<li>Obtain A Detailed Medical History: This can help identify potential underlying causes of anemia, such as genetic disorders or other medical conditions.</li>
	<li>Perform A Physical Exam: Your healthcare provider will look for signs of anemia, such as pale skin or mucous membranes, and listen for abnormal heart sounds. While these are general examination findings that can be associated with any type of anemia, healthcare providers also assess specific signs related to different types of anemia during the examination. For instance, they may look for signs such as the absence of a thumb or other specific indicators to help identify the particular type of anemia.</li>
	<li>Conduct Laboratory Tests: These may include a complete blood count (CBC), which measures the number and types of blood cells, and a peripheral blood smear, which can help identify abnormal cell shapes or sizes. </li>
</ul>

Additional tests, including endoscopy, colonoscopy, and ultrasound, may be needed if your doctor suspects any underlying condition to be the cause of anemia.

<ul>
	<li>Consider Genetic Testing: In some cases, rare forms of anemia may be caused by genetic mutations. Genetic testing can help identify these mutations and provide more information about the underlying condition.</li>
	<li>Consult With a Hematologist: Hematologists are specialists in blood disorders and may have more experience with rare forms of anemia. They can help diagnose your condition and recommend appropriate treatment options. 
	&nbsp;</li>
</ul>

It&#39;s important to note that diagnosis of rare types of anemia may require consultation with multiple healthcare professionals and may involve more advanced testing methods. Therefore, it&#39;s crucial to seek medical attention and work closely with your healthcare provider to identify the underlying cause of your anemia. 
&nbsp;

<h5>Can I Prevent Anemia?</h5>

Some types of anemia, like sickle cell, hemolytic, and aplastic anemia, cannot be prevented. If you have a chronic illness that makes you susceptible to anemia, then you should keep an eye out for its symptoms.

Meanwhile, a nutritious diet can help prevent&nbsp;nutritional anemias. Some iron-rich foods are<a href="#accordion">[3]</a>:

<ul>
	<li>Beans</li>
	<li>Peas</li>
	<li>Seafood</li>
	<li>Red meat</li>
	<li>Iron-fortified bread, cereals, and pasta</li>
	<li>Dry fruits, like apricots and raisins</li>
	<li>Dark green leafy vegetables, like spinach</li>
</ul>

A Quick Tip: Iron is better absorbed in the presence of vitamin C! You can pair up an iron-rich meal with a glass of orange juice for better results. 
&nbsp;

<h5>Preventing Anemia in Babies</h5>

Breast milk or iron-fortified formula can prevent iron deficiency anemia in your baby. However, cow&rsquo;s milk is not a good source of iron for newborns. Hence, it is not recommended for them.

To increase iron consumption, you can give your baby iron-fortified cereals or pureed meals after 6 months of age. Make sure they don&#39;t consume more than 20 ounces (591 ml) of milk per day after the age of 1. Too much milk frequently replaces other foods, such as those high in iron<a href="#accordion">[3]</a>. 
&nbsp;

In conclusion, rare types of anemia may sound intimidating, but don&#39;t worry you&#39;re not alone! With the help of early intervention, modern medicine, and the support of loved ones, many people with rare forms of anemia are able to live happy and fulfilling lives. 
&nbsp;

Key Takeaways

<ul>
	<li>When you have anemia, your body doesn&#39;t produce enough healthy red blood cells to supply your tissues with enough oxygen.</li>
	<li>Diagnosing rare types of anemia can be challenging.</li>
	<li>Aplastic anemia occurs when the stem cells in the bone marrow are damaged and cannot produce sufficient blood cells</li>
	<li>Sideroblasts, which are abnormal red blood cells, are produced as a result of iron accumulation.</li>
	<li>Myelodysplastic syndromes (MDS) are conditions brought on by damaged bone marrow.</li>
	<li>A group of hereditary anemias known as CDA lowers your body&#39;s supply of healthy red blood cells. </li>
	<li>In Diamond-Blackfan Anemia, your bone marrow does not produce enough red blood cells.</li>
	<li>Your bone marrow creates improperly formed red blood cells that are too big and too immature when you have megaloblastic anemia.</li>
	<li>Fanconi anemia makes your bone marrow produce fewer blood cells than required.</li>
	<li>Iron is better absorbed in the presence of vitamin C! You can pair up an iron-rich meal with a glass of orange juice for better results.</li>
</ul>

[1] Anemia: Causes, symptoms & treatment. Cleveland Clinic.

[2] 8 rare types of anemia: Symptoms, causes, and treatment explained. WebMD.

[3] Iron deficiency anemia. Mayo Clinic.

[4] Anaemia. World Health Organization.

Mariam Chughtai

تعارف

انسانی جسم کے لئے آئرن ایک لازمی معدنیات میں سے ہے،جو ہیموگلوبن تیار کرنے میں مدد دیتا ہے۔ آئرن انسان کی نشوونما کے لئے بھی ضروری ہے۔خوراک میں آئرن دَو ذرائع سے حاصل ہوتا ہےیعنی حیوانی ذرائع اور نباتاتی ذرائع سےحاصل ہونے والا آئرن۔اگرچہ خوراک کےذریعے کافی آئرن حاصل کیا جاسکتا ہےتاہم اسےسپلیمنٹ کےطورپربھی لیا جاسکتا ہے۔ 
&nbsp;

سائنسی مطالعات سےظاہر ہوتا ہےکہ مَردوں کے لئےاوسطاً،یومیہ8.7 ملی گرام اور عورتوں کےلئےاوسطاً،یومیہ14.8ملی گرام کی ضرورت ہوتی ہے۔گوشت کھانے والےافراد کی نسبت سبزی کھانے والےافراد،اورحیوانی ذرائع سےحاصل ہونے والی کوئی بھی چیزاستعمال نہ کرنے والے افراد کو1.8گنا آئرن کی ضرورت ہوتی ہے۔&nbsp; 
&nbsp;

خون کی کمی: انیمیا کے علاج کے طریقوں کی وضاحت

انسانی جسم کے افعال کو درست طورپرسرانجام دینے کے لئےآئرن کی ضرورت ہوتی ہے۔خوارک میں آئرن کی کمی کی وجہ سےجسم میں آئرن کی قِلّت پیدا ہوجاتی ہے۔آئرن جسم کےمختلف افعال میں اہم کردار ادا کرتا ہےاوریہ ہیموگلوبن بنانے کےلئے&nbsp; اہم غذائی جُزہے،جو آکسیجن کوخون کےذریعےاعضاء اورعضلات تک پہنچانے کے کام آتا ہے۔یہ دِل کی صحت،مدافعتی نظام کےافعال،اورسانس لینےعمل کے لئےاہم ہے۔ 
&nbsp;

جب جسم میں خون کےسُرخ ذرّات&nbsp; کافی تعداد میں نہ ہوں تو آکسیجن کی مطلوبہ مقدار جسم کےاعضاء اورعضلات تک نہیں پہنچ سکتی۔خون کی قِلّت کی مختلف قِسمیں ہوتی ہیں تاہم ترقی پذیرممالک میں آئرن کی کمی والی خون کی کمی سب سے زیادہ عام قِسم ہے۔عالمی ادارہ صحت(WHO) کےمطابق،دُنیا بھرمیں خون کی قِلّت والے افراد کی تعداد کا تخمینہ1.62بلین افراد ہیں۔ 
&nbsp;

آئرن کی کمی کی وجہ سےآئرن کی کمی والی خون کی قِلّت پیدا ہوتی ہےجس کی علامات میں درج ذیل شامل ہیں:

<ul>
	<li dir="rtl" style="text-align: right;">تھکن</li>
	<li dir="rtl" style="text-align: right;">کمزوری</li>
	<li dir="rtl" style="text-align: right;">جِلد کی زرد رنگت&nbsp;</li>
	<li dir="rtl" style="text-align: right;">چھوٹےسانس لینا</li>
	<li dir="rtl" style="text-align: right;">سَرچکرانا</li>
	<li dir="rtl" style="text-align: right;">سینےمیں درد</li>
	<li dir="rtl" style="text-align: right;">ہاتھ،پَیروں کا ٹھنڈا ہونا</li>
	<li dir="rtl" style="text-align: right;">سَردرد ہونا 
	&nbsp;</li>
</ul>

خون کی&nbsp; کمی&nbsp; کی بعض اقسام موروثی ہوتی&nbsp; ہیں اوراِن سےبچا نہیں جاسکتا،مثلاً sickle cell anemia، hemolytic anemia،اورaplastic anemia۔

تاہم،آئرن،وٹامنB12 اورB9کی کمی کی وجہ سے پیدا ہونےوالی خون کی قِلّت&nbsp; سے بہترخوراک کےذریعے بچا جاسکتا ہے۔یعنی کافی آئرن کی حامل اوروٹامن &quot;سی&quot;اوردیگروٹامنز پرمشتمل خوراک کوکھانا کیوں کہ اس طرح آئرن کوجذب کرنےمیں مدد ملتی ہے۔مطالعات سےیہ بھی ظاہر ہوتا ہےکہ کافی پانی پینے سے بھی ہیموگلوبن کا لیول بہتررہتا ہے۔

مطالعات سےیہ بھی ظاہر ہوتا ہے کہ روزانہ آئرن سپلیمنٹ لینےبھی ہیموگلوبن کا لیول بہترہوسکتا ہےاورشیرخواربچّوں،اسکول جانےکی عمر والےبچّوں حاملہ اور غیرحاملہ عورتوں کےلئےخون کی قِلّت کا خطرہ کم کرتا ہے۔آئرن والی خوراک اوربہترطورپرکھانے کے ذریعےآئرن کی کمی والی خون کی قِلّت کا خطرہ کم ہوجاتا ہے۔ 
&nbsp;

خون کی قِلّت کی بعض اقسام مختصر مدّت اور ہلکےدرجے کی ہوتی ہیں،تاہم اس کی بعض اقسام زندگی بھر چلتی ہیں۔خون کی قِلّت کی دیکھ بھال کئی طریقوں سے کی جاتی ہےجن میں درج ذیل شامل ہیں:

<ul>
	<li dir="rtl" style="text-align: right;">صحت بخش ورمتوازن غذا</li>
	<li dir="rtl" style="text-align: right;">وافر مقدارمیں پانی پینا</li>
	<li dir="rtl" style="text-align: right;">باقاعدگی سےورزش کرنا</li>
	<li dir="rtl" style="text-align: right;">خون کی قِلّت پیدا کرنے والےکیمیکلز سے گریزکرنا</li>
	<li dir="rtl" style="text-align: right;">خون کی قِلّت کی وجہ سےدانتوں کے خراب ہونےاور مسوڑحوں کی بیماری کا خطرہ بڑھ جاتا ہےلہٰذا،ڈینٹل ڈاکٹرسےباقاعدگی سےمشورہ لیتےرہئے&nbsp;</li>
	<li dir="rtl" style="text-align: right;">اپنی علامات کا دھیان رکھئےاوران علامات میں کوئی تبدیلی آنےپراپنےڈاکٹر سےمشورہ لیجئے 
	&nbsp;</li>
</ul>

خون کی قِلّت کی صورت میں،کھانے پینے کےحوالے سےبہتر انتخاب کیجئے۔ مثلاً&quot;جنک فوڈ&quot;استعمال نہ کیجئےکیوں کہ اس میں کیلوریززیادہ ہوتی ہیں جب کہ اس میں کوئی غذائیت نہیں ہوتی۔اس کےعلاوہ،بعض خوراک ایسی ہوتی ہیں جو آئرن کےجذب ہونے میں رُکاوٹ بنتی ہیں۔ لہٰذا،درست خوراک کا انتخاب ایک اہم بات ہے۔ 
 
ذیل میں خوراک کی چند اقسام ہیں جن سے گریز کرنا چاہئے:

<ul>
	<li dir="rtl" style="text-align: right;">کافی، چائےاوردیگرtannin&nbsp;والی اشیاء،مثلاًبعض مصالحے</li>
	<li dir="rtl" style="text-align: right;">انڈوں کی سفیدی&nbsp;</li>
	<li dir="rtl" style="text-align: right;">ریشہ دار خوراک لیکن تمام اقسام نہیں کیوں کہ آئرن کےبعض سپلیمنٹ کی وجہ سےقبض ہوسکتا ہے</li>
	<li dir="rtl" style="text-align: right;">سویا پروٹین</li>
	<li dir="rtl" style="text-align: right;">کیلشیم اورآئرن سپلیمنٹ ایک ساتھ نہیں لینا چاہئیں کیوں کہ اس سےآئرن کےجذب ہونے میں رُکاوٹ پیداہوتی ہے 
	&nbsp;</li>
</ul>

ذیل میں خوراک کی چند اقسام درج ہیں جو کھانی چاہئیں:

<ul>
	<li dir="rtl" style="text-align:right">آپ خواہ گوشت کھاتےہوں یا نہ کھاتے ہوں،آپ کوعام طور پر آئرن والی خوراک کھانی چاہئےمثلاًدالیں،پالک،میتھی،کلفہ،اور پستے۔</li>
	<li dir="rtl" style="text-align:right">مختلف قسم کےگوشت سےبھی پروٹین حاصل کیا جاسکتا ہے مثلاً گائےاورپرندوں کا پتلا گوشت۔بعض خوراکوں میں آئرن شامل کیا جاتا ہےجسےسبزی کھانےوالےاورحیوانی ذرائع سے حاصل ہونےوالی غذا نہ کھانے والےافراد استعمال کر سکتے&nbsp; ہیں۔</li>
	<li dir="rtl" style="text-align:right">سِٹرس فروٹ،بیریز،اور وٹامن&quot;سی&quot;والی دیگرخوراک مثلاً مرچیں اور ٹماٹرکو آپنی خوراک میں شامل کرکےہتربنایا جاسکتا ہے۔ 
	&nbsp;</li>
</ul>

خلاصہ

آئرن لینے کےحوالےسےاپنےمعالج سےمشورہ کیجئےاورمعلوم کیجئےکہ آپ کے لئےکیا بہتر رہے گا۔