ORLISTAT (XENICAL, ALLI)

Drug name: Orlistat

Brand names: Xenical, Alli

Use: Obesity management, weight loss

Orlistat is a lipase inhibitor that reduces the absorption of dietary fat -- about 30% of the fat intake from meals passes through the gut undigested.

Orlistat can help reduce weight (or maintain a lower body weight) by reducing the absorption of fat from the bowel, not by suppressing your appetite.

Xenical is licensed for sale over-the-counter in the USA & on prescription in the UK.

Alli is half the strength of xenical & may soon be available over-the-counter in the UK.

Over-the-counter anti-obesity drugs work best when combined with a reduced calorie, low-fat diet and regular exercise. When taking orlistat, each meal should contain no more than 15g of fat.

Contraindications:

- chronic malabsorption syndrome
- cholestasis
- pregnancy and breastfeeding

Side effects:

- flatulence (gas)
- increased urgency to open the bowels
- oily discharge or fatty stools
- abdominal distension (bloating) and pain
- faecal incontinence

Orlistat acts only in the gut, but it potentially inhibits the absorption of the fat-soluble vitamins A, D, E & K. Longer term this could carry risks of vitamin deficiency -- the manufacturer GlaxoSmithKline advises taking a daily multi-vitamin pill to protect against this.

Dose:

120mg at mealtime (max 3 doses per day).

If a meal is missed or contains no fat, the dose of orlistat should be omitted.

Vitamins and Minerals

What are Vitamins?

In order for you body to work properly, you will need the right amount of vitamins. Since your body can not make the vitamins themselves, except for Vitamin D, you will have to get these vitamins from other sources, particularly the food that you consume everyday. Vitamins can be classified into two main types

• water-soluble vitamins are vitamins that can not be stored in your body. They have to be replaced frequently in your diet
• fat-soluble vitamins are vitamins that can be stored in your body. Including fat-soluble vitamins in your diet is important too

You can find most water-soluble vitamins like B6, B12, C, and Folic Acid in fresh fruits and in green vegetables. It is good practice to eat the fruits and the vegetables raw because when they are boiled, the vitamins can easily be lost in the cooking process.

What are Minerals?

In order for your body to function properly, it will need a certain amount of minerals and trace elements. These minerals are important and you need to get them from the food that you eat. Some minerals that you need and why they are needed are

• calcium so that you will have strong bones
• sodium so that your fluids can be balanced and so that your nerves function properly
• iron so that oxygen is transported properly throughout the body and so that energy is metabolized properly as well
• iodine so that your thyroid glands work properly

You can find minerals and trace elements primarily in meats, fish, cereals, milk, dairy products, vegetables, nuts, and dried fruit.

How much minerals are required by your body?

There are a lot of factors that will influence the mineral requirements of your body. Factors such as a person’s gender, activity level, and age can affect the amount of mineral required by their body. According to the Department of Health of the United Kingdom, there are certain dietary reference values of DRVs that should be followed. These DRVs can be found on food and supplement packs. In order for a person to maintain good health, they will need a certain amount of energy based on the DRV.

How will you be able to get enough vitamins and minerals in your body?

Through a balanced diet, you should be able to get all the vitamins and minerals that are required by your body. As much as possible, you should have five servings of fruits and vegetables everyday. You should consume starchy foods like potatoes, pasta, and bread in order to provide energy for your body. You should have moderate amounts of protein in your diet in the form of dairy products, meat, pulses, and fish.

Should you take supplements for your body?

If your doctor or dietician does not recommend that you take supplements then there is no need to take them. Some people have to take supplements because of existing conditions. For instance, if you are anaemic then you may have to take iron supplements.

There are vitamins that can be harmful if there is too much of it in the body. Fat-soluble vitamins are particularly harmful in excessive amounts. For instance, if you have too much vitamin A in your body then you may have headaches, changes in your skin, and a damaged liver. Pregnant women may also be harmed by an overdose of vitamins.

According to the Cochrane Database of Systematic Reviews, Vitamins A, E, and Beta Carotene increase your risk of dying early. Unless advised by your doctor, you should not be taking vitamin supplements.

A look at vitamins and minerals at different stages in life

Here are some circumstances where taking vitamins and minerals change

For People over Fifty

In order to stay healthy, people must eat plenty of foods rich in iron. They must consume foods like red meat, eggs, sardines, and whole meal bread. When you consume the right amount of iron in your diet, you will lower the chances of getting anaemia. When you lack iron in your system, you may end up very tired and weak on a day to day basis. Your immune system will become weak as well. Tea is one beverage that gets in the way of iron absorption. If you like to drink tea then it is not advisable to drink it after a meal so that the absorption of iron is not hindered. You should drink fruit juices instead of tea because the fruit juices will help your body absorb the iron. Make sure that you consume five servings of fruit and vegetables everyday so that your immune system is kept strong.

One of the health issues that are faced by people over fifty, particularly women, is osteoporosis. It is important to load your body with calcium through the consumption of dairy products like milk, yoghurt, and cheese. You can also get ample amounts of calcium from canned fish with bones like sardines and pilchards.

You should consult with your doctor if you think that you need food supplements. Your doctor will check what amounts of vitamins and minerals you will need. It is important that you take the right amount of vitamins and minerals at this age.

For Women who are Pregnant

You must eat a balanced diet when you are pregnant in order to stay healthy. The supply of iron in your blood can drop significantly when you are pregnant so you must have countermeasures on how to maintain proper levels of iron in your body. Some great sources of iron for pregnant women are red meat, fortified breakfast cereals, green leafy vegetables, and pulses. In order to help your body absorb the iron, you can consume fruit juices when you eat your meals.

Eating foods that are rich in folate is important. Folate is the natural form of folic acid and it can be found in oranges, broccoli, and wholegrain foods. It is also a great idea to consume a lot of dairy foods so that your baby will have strong bones.

According to the Food Standards Agency or FSA, women must take four hundred micrograms of folic acid supplements when attempting to get pregnant and during the first trimester of pregnancy. This will lower the chances of your baby from getting disorders in their neural tube or spina bifida. The Food Standards Agency also recommends that you take a Vitamin D supplement when you are breastfeeding or when you are pregnant. You should talk to your midwife or to your general practitioner when planning to take supplements so that you can assure whether they are safe to take or not.

For Vegetarians and Vegans

It is absolutely possible to get all the needed vitamins and minerals on a vegan diet. Your goals should be to

• consume at least five portions of fruits and vegetables everyday
• get a lot of foods that are rich in iron like green leafy vegetables and fortified breakfast cereals
• make sure your main meals are based on starchy foods like bread, rice, and pasta
• make sure that you include good sources of protein in your main meals like pulses, nuts, dairy products, or soya products
• eat seeds and nuts in order to keep your selenium levels high
• drink soya milk, oat milk, or rice milk fortified with calcium in order to maintain high levels of calcium

Keys to a Great Diet

• when you have a balanced diet, you will have all the vitamins and minerals that your body requires
• always make sure that you eat five or more servings of fruits and vegetables everyday
• avoid taking vitamin supplements with vitamin A, E, and beta carotene unless your doctor tells you to do so
• if you think that you are not getting enough vitamins for your body, you should consult with a dietician or a doctor. Do not take supplements unless you have permission from your doctor

TRIGLYCERIDES

Triglycerides, as major components of very low density lipoprotein (VLDL) and chylomicrons, play an important role in metabolism as energy sources and transporters of dietary fat. They contain more than twice as much energy (9 kcal/g) as carbohydrates and proteins. In the intestine, triglycerides are split into glycerol and fatty acids (this process is called lipolysis) (with the help of lipases and bile secretions), which can then move into blood vessels. The triglycerides are rebuilt in the blood from their fragments and become constituents of lipoproteins, which deliver the fatty acids to and from fat cells among other functions. Various tissues can release the free fatty acids and take them up as a source of energy. Fat cells can synthesize and store triglycerides. When the body requires fatty acids as an energy source, the hormone glucagon signals the breakdown of the triglycerides by hormone-sensitive lipase to release free fatty acids. As the brain can not utilize fatty acids as an energy source, the glycerol component of triglycerides can be converted into glucose for brain fuel when it is broken down. Fat cells may also be broken down for that reason, if the brain's needs ever outweigh the body's.

In the human body, high levels of triglycerides in the bloodstream have been linked to atherosclerosis, and, by extension, the risk of heart disease and stroke. However, the negative impact of raised levels of triglycerides is lower than that of LDL:HDL ratios. The risk can be partly accounted for by a strong inverse relationship between triglyceride level and HDL-cholesterol level.

Another disease caused by high triglycerides is pancreatitis.

Reducing triglyceride levels

Cardiovascular exercise and lower carbohydrate diets are suggested for reducing triglyceride levels.

Omega-3 fatty acids from fish (in the order of 5 grams of omega-3 per day), one or several grams of niacin (mega-dose vitamin B-3) per day and some statins are used to reduce triglyceride levels.

Fibrates have been used in some cases as some fibrates can bring down TGs substantially. However they are not used in first line as they can have unpleasant or dangerous side effects.

Alcohol abuse can cause elevated levels of triglycerides.

SALMONELLA INFECTION

What is salmonella infection (salmonellosis)?

Salmonellosis is an infection with a bacteria called Salmonella.

Most persons infected with Salmonella develop diarrhoea, fever, and abdominal cramps 12 to 72 hours after infection. The illness usually lasts 4 to 7 days, and most persons recover without treatment.

In some persons the diarrhoea may be so severe that the patient needs to be hospitalized. In these patients, the Salmonella infection may spread from the intestines to the blood stream, and then to other body sites and can cause death unless the person is treated promptly with antibiotics.

The elderly, infants, and those with impaired immune systems are more likely to have a severe illness.

What sort of germ is Salmonella?

The Salmonella germ is actually a group of bacteria that can cause diarrhoeal illness in humans. They are microscopic living creatures that pass from the feces of people or animals, to other people or other animals. There are many different kinds of Salmonella bacteria. Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common in the United States. Salmonella has been known to cause illness for over 100 years. They were discovered by a American scientist named Salmon, for whom they are named.

How can Salmonella infections be diagnosed?

Many different kinds of illnesses can cause diarrhoea, fever, or abdominal cramps. Determining that Salmonella is the cause of the illness depends on laboratory tests that identify Salmonella in the stools of an infected person. These tests are sometimes not performed unless the laboratory is instructed specifically to look for the organism. Once Salmonella has been identified, further testing can determine its specific type, and which antibiotics could be used to treat it.

How can Salmonella infections be treated?

Salmonella infections usually resolve in 5-7 days and often do not require treatment unless the patient becomes severely dehydrated or the infection spreads from the intestines. Persons with severe diarrhoea may require rehydration, often with intravenous fluids. Antibiotics are not usually necessary unless the infection spreads from the intestines, then it can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals.

Are there long term consequences to a Salmonella infection?

Persons with diarrhoea usually recover completely, although it may be several months before their bowel habits are entirely normal. A small number of persons who are infected with Salmonella, will go on to develop pains in their joints, irritation of the eyes, and painful urination. This is called Reiter's syndrome. It can last for months or years, and can lead to chronic arthritis which is difficult to treat. Antibiotic treatment does not make a difference in whether or not the person later develops arthritis.

How do people catch Salmonella?

Salmonella live in the intestinal tracts of humans and other animals, including birds. Salmonella are usually transmitted to humans by eating foods contaminated with animal feces. Contaminated foods usually look and smell normal. Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs, but all foods, including vegetables may become contaminated. Many raw foods of animal origin are frequently contaminated, but fortunately, thorough cooking kills Salmonella. Food may also become contaminated by the unwashed hands of an infected food handler, who forgot to wash his or her hands with soap after using the bathroom.

Salmonella may also be found in the feces of some pets, especially those with diarrhoea, and people can become infected if they do not wash their hands after contact with these feces. Reptiles are particularly likely to harbor Salmonella and people should always wash their hands immediately after handling a reptile, even if the reptile is healthy. Adults should also be careful that children wash their hands after handling a reptile.

What can a person do to prevent this illness?

There is no vaccine to prevent salmonellosis. Since foods of animal origin may be contaminated with Salmonella, people should not eat raw or undercooked eggs, poultry, or meat. Raw eggs may be unrecognised in some foods such as homemade hollandaise sauce, caesar and other homemade salad dressings, tiramisu, homemade ice cream, homemade mayonnaise, cookie dough, and frostings. Poultry and meat, including hamburgers, should be well-cooked, not pink in the middle. Persons also should not consume raw or unpasteurized milk or other dairy products. Produce should be thoroughly washed before consuming.

Cross-contamination of foods should be avoided. Uncooked meats should be keep separate from produce, cooked foods, and ready-to-eat foods. Hands, cutting boards, counters, knives, and other utensils should be washed thoroughly after handling uncooked foods. Hand should be washed before handling any food, and between handling different food items.

People who have salmonellosis should not prepare food or pour water for others until they have been shown to no longer be carrying the Salmonella bacterium.

People should wash their hands after contact with animal feces. Since reptiles are particularly likely to have Salmonella, everyone should immediately wash their hands after handling reptiles. Reptiles (including turtles) are not appropriate pets for small children and should not be in the same house as an infant.

How common is salmonellosis?

Every year, approximately 40,000 cases of salmonellosis are reported in the United States. Because many milder cases are not diagnosed or reported, the actual number of infections may be thity or more times greater. Salmonellosis is more common in the summer than winter.
Children are the most likely to get salmonellosis. Young children, the elderly, and the immunocompromised are the most likely to have severe infections. It is estimated that approximately 600 persons die each year with acute salmonellosis.

What can I do to prevent salmonellosis?

• Cook poultry, ground beef, and eggs thoroughly before eating. Do not eat or drink foods containing raw eggs, or raw unpasteurized milk.
• If you are served undercooked meat, poultry or eggs in a restaurant, don't hesitate to send it back to the kitchen for further cooking.
• Wash hands, kitchen work surfaces, and utensils with soap and water immediately after they have been in contact with raw meat or poultry.
• Be particularly careful with foods prepared for infants, the elderly, and the immunocompromised.
• Wash hands with soap after handling reptiles or birds, or after contact with pet feces.
• Avoid direct or even indirect contact between reptiles (turtles, iguanas, other lizards, snakes) and infants or immunocompromised persons.
• Don't work with raw poultry or meat, and an infant (e.g., feed, change diaper) at the same time.
• Mother's milk is the safest food for young infants. Breast-feeding prevents salmonellosis and many other health problems

REDUCTIL

DRUG NAME: Sibutramine

USE: Anti-obesity, weight loss/control

Reductil is an appetite suppressant that is used as a weight control medication. It is indicated for the management of obesity.

Reductil works by blocking the nerve cells that release and reabsorb serotonin, thus increasing serotonin levels. The increased serotonin acts in the brain and enhances feelings of fullness so that you eat less. By eating less, you consequently lose weight.

This medicine can help you reduce weight or maintain a lower weight by suppressing your appetite.

Reductil should be prescribed only for individuals who have attempted seriously to lose weight by diet, exercise, and other behavioural modification.

Cautions:

Do not use if:

- You have heart problems (eg. coronary artery disease, heart failure, arrythmias)

- You have uncontrolled high blood pressure

- You have had a stroke

- You have an overactive thyroid

- You have a psychiatric disorder

- Severely decreased kidney function

- Severely decreased liver function

- Caution is also advised if you have epilepsy or sleep apnoea.

- Pregnancy and breastfeeding (discuss with doctor).

Side effects:

Insomnia, constipation, dry mouth, increased heart rate, increased blood pressure.

Interactions:

Contraindicated if taking monoamine oxidase inhibitor antidepressants (MAOIs).

Some antifungals and some antibiotics may increase blood levels (eg.ketoconazole, erythromycin, cylclosporin).

Some antiepileptic drugs make reductil less effective by reducing blood levels (eg. phenobarbitone, phenytoin, carbamazepine).

Should not be used at the same time as other medicines that increase serotonin levels in the brain (eg. sumatriptan, some opiod pain killers).

Patient information:

Follow the instructions carefully on the label of this medicine.

Weight loss is gradual.

Arrangements should exist for appropriate healthcare professionals to offer specific advice, support, and counselling on diet, physical activity, and behavioural strategies to those receiving sibutramine.

PHENTERMINE

DRUG NAME: Phentermine

USE: Anti-obesity, weight loss/control

Phentermine is a centrally-acting appetite suppressant that is used as a weight control medication. It is indicated for the management of obesity.

Phentermine works by blocking the nerve cells that release and reabsorb serotonin, thus increasing serotonin levels. The increased serotonin acts in the brain and enhances feelings of fullness so that you eat less. By eating less, you consequently lose weight.

This medicine can help you reduce weight or maintain a lower weight by suppressing your appetite.

Cautions:

Do not use if:

You have heart problems (eg. coronary artery disease, heart failure, arrythmias)

You have uncontrolled high blood pressure

You have had a stroke

You have an overactive thyroid

You have a psychiatric disorder

Severely decreased kidney function

Severely decreased liver function

Caution is also advised if you have epilepsy or sleep apnoea.

Pregnancy and breastfeeding (discuss with doctor).

Side effects:

Insomnia, constipation, dry mouth, increased heart rate, increased blood pressure.

Phentermine has been associated with valvular heart disease and the rare but serious risk of pulmonary hypertension.

Interactions:

Contraindicated if taking monoamine oxidase inhibitor antidepressants (MAOIs).

Some antifungals and some antibiotics may increase blood levels (eg.ketoconazole, erythromycin, cylclosporin).

Some antiepileptic drugs make Phentermine less effective by reducing blood levels (eg. phenobarbitone, phenytoin, carbamazepine).

Should not be used at the same time as other medicines that increase serotonin levels in the brain (eg. sumatriptan, some opioid pain killers).

PERNICIOUS ANAEMIA

What Is Pernicious Anaemia?

Pernicious anaemia is a condition in which the body does not make enough red blood cells due to a lack of vitamin B12 in the body. It usually occurs in people whose bodies have lost the ability to absorb vitamin B12 from food.

Anaemia

Pernicious anaemia is one of many different types of anaemia. Having anaemia means you do not have enough healthy red blood cells. When a person has anaemia, the blood cannot carry enough oxygen to the cells of the body. The most common symptom of anaemia is feeling tired.

Pernicious Anaemia

In pernicious anaemia, the blood cells do not divide normally and are too large. They have trouble getting out of the bone marrow. The problem is due to a lack of vitamin B12 in the body. Vitamin B12 is one of the B vitamins; B vitamins are found in animal foods such as meat, fish, eggs, milk, and other dairy products. Vitamin B12 is necessary for the body to make red blood cells. It is also needed for the normal working of the nervous system.

People can develop low levels of this important vitamin in three main ways:

• From the lack of a protein in the stomach that helps the body absorb vitamin B12. The protein is called intrinsic factor. Intrinsic factor is made by special cells in the lining of the stomach. In some people, these cells are destroyed by the body's immune system or as a result of stomach surgery. When this happens, intrinsic factor is not produced and vitamin B12 cannot be absorbed. This is the most common cause of vitamin B12 deficiency.
• From not getting enough vitamin B12 in the diet. This can be the result of eating a strict vegetarian diet or a poor diet due to factors such as aging or alcoholism.
• From certain intestinal disorders that interfere with the absorption of vitamin B12, such as Crohn's disease and intestinal infections.

The condition was named �pernicious� anaemia because it was often fatal in the years before the cause was discovered to be a lack of vitamin B12, and no specific treatments were available. Now it is easy to treat with vitamin B12 pills or injections. Pernicious anaemia can be severe if it goes on for a long time without being treated. If it is not treated, it can cause permanent damage to the body. Pernicious anaemia is especially common in older adults.

Effects of Pernicious Anaemia on the Body

People who have pernicious anaemia often feel tired and weak because the body is not getting enough oxygen. Over time, if untreated, this disease can cause serious problems for the heart, nerves, and other parts of the body.

Heart. In people with anaemia, the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues. This stress on the heart can cause heart murmurs (an extra or unusual sound heard during the heartbeat), fast or irregular heartbeats, an enlarged heart, or even heart failure.

A lack of vitamin B12 or folic acid (folate) can cause extra problems for the heart because it raises the level in the body of a chemical called homocysteine (ho-mo-SIS-teen). High levels of homocysteine add to the buildup of fatty deposits in blood vessels, which in turn can lead to heart attacks and strokes.

Nerves. A lack of vitamin B12 can damage nerve cells and cause problems such as tingling and numbness in hands and feet and problems with walking and balance. A vitamin B12 deficiency can cause changes in taste, smell, and vision. Finally, it can cause mental changes, including memory loss and confusion.

Digestive tract. A lack of vitamin B12 may change the surface of the tongue and shrink or thin the stomach lining. Any changes that occur in the stomach can put a person at risk for stomach cancer.

Outlook

Pernicious anaemia is usually easy to treat with vitamin B12 pills or shots, although some people develop permanent nerve damage before they find out they have the disease and get treatment. Since pernicious anaemia does increase the risk of developing stomach cancer, doctors may do periodic cancer tests to check for it. Overall, however, people with pernicious anaemia who get proper lifelong treatment can have a normal lifespan.

Other Names for Pernicious Anaemia

• Megaloblastic anaemia
• Vitamin B12 deficiency anaemia
• Combined systems disease
• Congenital pernicious anaemia

What Causes Pernicious Anaemia?

Major Causes

Pernicious anaemia is caused by a lack of vitamin B12 in the body. The main reason for the vitamin B12 deficiency is the loss of parietal cells in the lining of the stomach. These cells make intrinsic factor, which helps the body absorb vitamin B12 in the small intestine. In some people, the body's immune system may attack and destroy the parietal cells. Doctors don't know exactly why or how this happens, or if the immune system produces antibodies in reaction to normally aging or dying parietal cells.

As a result of this immune system attack, the stomach lining shrinks, and the parietal cells in the lining of the stomach disappear. The stomach stops producing intrinsic factor. Over time, vitamin B12 deficiency develops.

Loss of intrinsic factor can also be due to removal of the stomach lining in various kinds of stomach surgery. This surgery includes removal of all or part of the stomach as well as stomach surgery for weight loss.

There is also a rare inherited disorder in which children are born without the ability to produce intrinsic factor.

Other Causes

Less common causes of pernicious anaemia include a diet low in vitamin B12, intestinal problems, and certain medicines.

Lack of Vitamin B12 in the Diet

People can develop pernicious anaemia if they don't get enough vitamin B12 in the foods that they eat. This condition takes many years to develop because it takes time to use up the vitamin B12 already stored in the body.

Some people who are strict vegetarians can develop pernicious anaemia, especially if they do not eat meat, poultry, fish, eggs, or dairy products��the best food sources of vitamin B12. Breastfed infants of strict vegetarian mothers can develop anaemia in a short time because they don't have enough vitamin B12 stored in their bodies. They can be given vitamin B12 supplements to prevent this type of anaemia.

Some people develop pernicious anaemia because of a poor diet due to conditions such as alcoholism or aging.

Disorders of the Small Intestine

Some intestinal problems can cause poor absorption of vitamin B12. These problems include:

• An infection caused by parasites or an overgrowth of bacteria in the intestine
• Coeliac disease (also known as sprue), a genetic disorder that makes a person unable to tolerate gluten
• Crohn's disease, an inflammatory bowel disease
• Not enough stomach acid to digest food�a problem that can occur in older adults

Medicines

Long-term use of certain medicines may lead to pernicious anaemia. Examples of these are medicines that reduce acid in the stomach and certain diabetes medicines (such as metformin, phenformin, and biguanides).

Who Is At Risk for Pernicious Anaemia

Populations Affected

People of all races can develop pernicious anaemia. However, people of northern European or African descent have a higher risk than other races and ethnic groups.

Men and women in the United States are equally likely to develop the disease. It is more common in older adults than younger people, and it is rare in children.

Major Risk Factors

A person's chances of developing pernicious anaemia may be higher if he or she has:

• A family history of pernicious anaemia (blood relatives with the disease)
• A disorder such as diabetes or a thyroid problem
• An intestinal disorder that keeps the body from absorbing vitamin B12 well

Pernicious anaemia is more likely to develop in people who do not eat foods high in vitamin B12 for long periods of time. This includes some vegetarians, elderly people, and people with alcoholism.

What Are the Signs and Symptoms of Pernicious Anaemia?

Major Signs and Symptoms

Major signs and symptoms of pernicious anaemia are feeling tired and weak and having a bright red, smooth tongue. Common symptoms of nerve damage caused by this disease are tingling and numbness in the hands and feet.

Symptoms most often develop slowly over time if the disease is not treated. Some people may experience mental changes and nerve problems before blood tests show that they have anaemia. This is more likely to happen in older adults than in younger people.

Other Signs and Symptoms

Other signs and symptoms of pernicious anaemia may include pale or yellowish skin, a low-grade fever, and dizziness when standing up. Infants with the condition may show unusual movements or a delayed development and failure to thrive.

Signs and Symptoms of Complications Associated With Pernicious Anaemia

Complications seen with pernicious anaemia can involve the heart, nerves and brain, and digestive tract. Some of the complications are due to the anaemia; others are the effect of a low vitamin B12 level on parts of the body.

Heart

Signs and symptoms of heart problems may include shortness of breath and chest pain. Heart murmurs, a rapid heart rate, and heart failure can develop.

Nerves and Brain

In addition to tingling or numbness in the hands and feet, signs and symptoms of problems with the nerves may include difficulty walking, unsteady movement, and loss of balance. There can be changes in vision, taste, and smell. Memory loss, confusion, depression, and even psychosis can develop.

Digestive Tract

Signs and symptoms of untreated pernicious anaemia can occur all along the digestive track. They can start with a bright red, smooth tongue and may include mouth sores or bleeding gums. The liver could be enlarged. Nausea and vomiting may occur, along with a sense of fullness, gas, or heartburn. Changes in bowel habits could include constipation or diarrhoea. A person might have a loss of appetite or weight loss.

How Is Pernicious Anaemia Diagnosed?

Pernicious anaemia is diagnosed using a person's medical history, physical exam, and tests that can determine the type and cause of anaemia. A doctor can use these methods to find out how severe the problem is, its cause, and the appropriate treatment. Mild to moderate anaemia may have no signs or symptoms. In fact, anaemia is often discovered unexpectedly on screening tests.

Specialists Involved

Primary care doctors, such as a family doctor, often diagnose and treat pernicious anaemia. Other kinds of doctors may also be involved, including:

• A neurologist (nervous system specialist)
• A cardiologist (heart specialist)
• A haematologist (blood disease specialist)
• A gastroenterologist (digestive tract disease specialist)

Medical and Family History

Your doctor may ask detailed questions about many symptoms, including feeling tired and weak and others listed in the section What Are the Signs and Symptoms of Pernicious Anaemia? The doctor may ask about any personal or family history of anaemia, diabetes, or diseases of the immune system. You may be asked about any surgery you have had, especially stomach surgery. The doctor may also ask you about your diet and about the medicines you are taking.

Physical Exam

A physical exam may include:

• Checking for pale or yellowish skin and a red, smooth tongue
• Listening to the heart to check for a rapid heartbeat or murmur
• Feeling the abdomen to check the size of the liver

Your doctor will also order a number of tests or procedures to be sure about the type of anaemia you have and how severe it is.

Diagnostic Tests and Procedures

Complete Blood Count

Usually, the first test used to diagnose anaemia is a complete blood count (CBC). The CBC tells a number of things about a person's blood, including:

• The haemoglobin level. Haemoglobin is the iron-rich protein in red blood cells that carries oxygen through the body. A low haemoglobin level means a person has anaemia.
• The haematocrit level. The haematocrit level measures how much of the blood is made up of red blood cells. Low haematocrit is another sign of anaemia.

The CBC also checks:

• The number of red blood cells. Too few red blood cells means a person has anaemia. A low number of red blood cells is usually seen with either a low haemoglobin or a low haematocrit level, or both.
• The number of white blood cells. White blood cells are involved in fighting infection.
• The number of platelets in the blood. Platelets are small cells that are involved in blood clotting.
• Red blood cell size. The mean cell volume is the name of a test that measures the average size (volume) of red blood cells. In pernicious anaemia, the red blood cells are usually larger than normal. This is called macrocytosis (MAK-ro-si-TO-sis).

Tests To Check the Vitamin B12 Level

• Vitamin B12. The level of vitamin B12 in the bloodstream may be normal or borderline even when the total amount of B12 in the body is low.
• Folic acid (folate). This is another B vitamin that can be low when the B12 level is low. A lack of folic acid can also cause anaemia.
• Homocysteine. Homocysteine is high in anaemia due to the lack of vitamin B12 or folic acid. Folate deficiency is more common because this vitamin is used up more quickly and the dietary need is greater. In this case, the blood's B12 level can be normal.
• Methylmalonic acid. The level of methylmalonic acid is high in anaemia due to a lack of vitamin B12 or folic acid. Methylmalonic acid can also be checked with a urine test.

Other Blood Tests

Other blood tests check for:

• The presence of intrinsic factor antibodies and parietal cell antibodies. These antibodies in the blood may mean that they are destroying the intrinsic factor or parietal cells.
• Levels of bilirubin, potassium, or cholesterol in the blood.
• Serum iron and iron binding capacity.
• The number of reticulocytes. Reticulocytes are young, red blood cells. The reticulocyte test is used to see if the bone marrow is producing red blood cells at the proper rate. A lower than average number of reticulocytes can mean that the bone marrow is not making enough red blood cells. The reticulocyte number is low in people with pernicious anaemia.

Schilling Test

The Schilling test is a urine test that measures how well the body absorbs vitamin B12. It is not used as much now as it was in the past.

Bone Marrow Tests

In some cases, a doctor may want to do a bone marrow biopsy or aspiration. A bone marrow biopsy is a minor surgical procedure to remove a small amount of bone marrow tissue. In a bone marrow aspiration, the doctor removes a small amount of bone marrow fluid through a needle. Bone marrow biopsy or aspiration tests whether the bone marrow is healthy and can show whether the bone marrow is making enough blood cells.

How Is Pernicious Anaemia Treated?

Doctors treat pernicious anaemia by replacing the missing vitamin B12 in the body. People who have pernicious anaemia need treatment, usually for the rest of their lives. Without treatment, pernicious anaemia can cause serious problems and can even be fatal.

Goals of Treatment

The goals of treating pernicious anaemia are to:

• Stop the anaemia and symptoms through vitamin B12 treatment
• Prevent complications, such as heart or nerve damage
• Provide ongoing followup to make sure that the treatment is working
• Treat the underlying cause, if one can be found

Specific Types of Treatment

Fortunately, pernicious anaemia is usually easy to treat with either vitamin shots (injections) or pills. Symptoms may begin to improve within a few days after the start of treatment.

• Vitamin B12 shots. People with pernicious anaemia may get daily or weekly shots at first, then one shot every month. Some people get vitamin B12 shots and also take vitamin B12 pills.
• Vitamin B12 pills. Many people with pernicious anaemia can be treated successfully with vitamin B12 pills. Often, the pills work as well as the shots. Because only a small amount of vitamin B12 is absorbed by the body, high doses are given.

Vitamin B12 can also be given in a gel or spray for the nose.

Treatment for the underlying causes of vitamin B12 deficiency may be needed. To help the body absorb vitamin B12, for example, a person might need antibiotics to treat stomach infections or surgery to treat intestinal problems. If the vitamin B12 level is due to a poor diet, then a person can learn how to correct the diet.

The doctor may also recommend limiting physical activity until anaemia symptoms have improved.

How Can Pernicious Anaemia Be Prevented?

Doctors do not know how to prevent pernicious anaemia that occurs from the immune system destroying parietal cells in the stomach. The most common cause of pernicious anaemia is the loss of stomach cells that make intrinsic factor.

Pernicious anaemia due to a diet low in vitamin B12 is not common. But some people who are strict vegetarians or who have a poor diet for a long time can develop this condition. Eating foods high in vitamin B12 and folic acid can help prevent low vitamin B12 levels. Some of these foods are:

• Eggs, meat, poultry, or shellfish
• Milk, orange juice, or oranges
• Fortified cereals, wheat germ, rice, or barley
• Romaine lettuce, spinach, and other green leafy vegetables
• Sprouts, broccoli, asparagus
• Peas, peanuts, beans, lentils, soy beans, and chickpeas

Vitamin B12 also can be found in multivitamins and in B-complex vitamin supplements.

Doctors may recommend supplements for people at risk of developing vitamin B12 deficiency, such as infants and children of strict vegetarians.

Living With Pernicious Anaemia

People treated for pernicious anaemia can recover, feel well, and live normal lives, although they must be sure to receive enough vitamin B12 throughout their lives. If a person has developed health problems caused by pernicious anaemia, such as nerve damage, treatment may reverse the damage.

Ongoing Health Care Needs

People with pernicious anaemia usually need to see a doctor regularly for checkups and ongoing treatment with vitamin B12. If you are being treated for pernicious anaemia, you will need to take vitamin B12 supplements as directed by your doctor to prevent the return of symptoms.

Visits to the doctor will focus on monitoring for signs of vitamin B12 deficiency in your body, making treatment changes as needed, and checking for the possible development of stomach cancer.

Doctor visits will also focus on the foods that you eat and whether you are eating enough foods that contain vitamin B12. A paediatrician may prescribe vitamin B12 supplements for infants and children of strict vegetarians.

Continued treatment may be needed for any ongoing problems due to nerve damage.

Family Members

If you have been diagnosed with pernicious anaemia, you should tell your family members about the disease�especially your children and your siblings. Because pernicious anaemia runs in families, they may be more likely to develop the disease.

Key Points

• Pernicious anaemia is a condition caused by too little vitamin B12 in the body. It is also called vitamin B12 deficiency anaemia.
• Vitamin B12 helps the body make healthy red blood cells and helps keep nerve cells healthy. It is found in animal foods, including meat, fish, eggs, milk, and other dairy products.
• The most common cause of pernicious anaemia is the loss of stomach cells that make intrinsic factor. Intrinsic factor helps the body absorb vitamin B12 in the intestine. The loss of parietal cells may be due to destruction by the body's own immune system.
• Pernicious anaemia can cause permanent damage to nerves and other organs if it goes on for a long time without being treated. It also raises the risk for developing stomach cancer.
• Common signs and symptoms of pernicious anaemia are:
  • Feeling tired and weak
  • Tingling and numbness in hands and feet
  • A bright red, smooth tongue
• Pernicious anaemia is diagnosed using family history and medical history, a physical exam, and diagnostic tests and procedures.
• Pernicious anaemia is easy to treat with vitamin B12 pills or shots as well as diet changes. Lifelong treatment is needed.
• Complications caused by untreated pernicious anaemia may be reversible with treatment.
• Doctors don't know how to prevent pernicious anaemia that is caused by the immune system destroying stomach cells.
• Eating foods high in vitamin B12 and folic acid can help prevent vitamin B12 deficiency caused by a poor diet.

OBESITY

Obesity is one of the biggest threats facing the human race. It is a major problem here in the UK and the West in general. In fact, obesity is now becoming a problem in parts of the world we would never have imagined such as China, Japan and the Middle East. Even parts of Africa are reporting cases of obesity.

This may sound overly dramatic but consider these facts:

• By 2010 nearly 1 in 4 adults in the UK will be classed as obese.
• By 2050 nine out of ten adults will be classed as obese.
• By 2050 nearly two thirds of children will be classified as obese.

At present 17% of men and 21% of women are classed as obese. And by 2010 around 33% of men and 28% of women will be classed as obese.

It has been suggested that this current generation of children is likely to be outlived by its parents. We are seeing increasing levels of obesity amongst children and teenagers which is not only blighting their lives but can even reduce their life expectancy levels. Being obese can mean losing as much as 9 years off your life expectancy.

Medical experts are seeing an increasing number of children and teenagers with Type 2 diabetes and other obesity-related conditions which they would normally expect to see in people who are middle aged or older. These are chronic conditions which are also potentially life threatening as well.

Obesity is never out of the media and is one of the most critical issues facing our government. Yesterday’s newspapers (26th February 2009) reported that the numbers of people undergoing obesity surgery had risen by 40%. The number of obesity related conditions which required admission to hospital has risen by 30% and 1.2 million people in the UK are on weight loss medication.

Experts state that the UK, especially the NHS if facing an obesity epidemic and unless steps are taken to tackle this problem then the country as a whole is storing up serious, long term health problems. This will impact upon not only the NHS but our very lives.

This problem is not just confined to the UK: in the US they have reported that 72 million Americans are clinically obese. And, the WHO (World Health Organisation) states that globally, there are at least 300 million adults who are classed as obese. These figures are for levels of obesity: they do not include the number of overweight people, here in the UK and around the world.

So, as we can see levels of obesity are rising everywhere and unless measures are taken will carry on doing so.

What is obesity?

This is the name given to the condition of chronic or excessive weight gain. It means that you are carrying excess amounts of body fat which can cause long term health problems.

How is obesity defined?

Obesity can be defined as:

“An excess of body fat that frequently results in a significant impairment of health”.

(Ref: Weight.com
Michael D. Myers MD)

There are numerous definitions of obesity but they all deal with the same thing; namely that of very high levels of body fat.

There are different levels of obesity which along with being overweight are measured using a BMI (Body Mass Index) calculator. This tool performs a series of calculations based upon a person’s height, sex and weight. For example, weight in kilograms x height in metres. This enables your doctor or healthcare professional to assess whether you fall into one of the following categories:

• Below 18.5 – classed as underweight
• 18.5 to 24.9 – classed as a healthy weight (normal)
• 25 to 29.9 – classed as overweight
• 30 to 34.9 – classed as obese
• 35 to 45 – classed as severely obese
• 45 to 50 – classed as morbidly obese
• 50 to 60 – classed as super obese
• 60 upwards – classed as super-super obese

It is important to remember that BMI is a guide only. These definitions apply to many people but are not suitable for the very young, very old and sportspeople.

There are also a great many people who are overweight. Whilst this is not an ideal state it is not as serious as being obese and is easier to address. Being overweight can mean carrying a few extra pounds, namely around the abdomen for men and the hips and thighs for women. It can be more of an irritant than a health problem, for example, when clothes shopping but if left unchecked it can develop into obesity.

It is all too easy to think that obesity is something that only happens to a certain group of people. That it is due to a lack of self-control, education or is simply ignorance. It does appear to be the case that it is more likely to be found in lower socio-economic groups who for a variety of reasons end up making poor lifestyle choices. And one of the side effects of that is obesity.

Why has obesity become such a problem?

There is no easy answer to that question: there are a wide variety of factors which have all contributed to the worrying levels we are now seeing. The most obvious one is that of lifestyle: we have become much more sedentary than we used to be and this coupled with a greater amount and choice of food has meant that people are generally bigger and heavier than they used to be.

Other factors include genetic predisposition, family traits, our metabolisms, lack of sleep even the type of bacteria we carry in our gut can all contribute to this problem.

LISTERIA

What is listeriosis (Listeria infection)?

Listeriosis, a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes, is an important public health problem. The disease primarily affects pregnant women, newborns, and adults with weakened immune systems. It can be avoided by following a few simple recommendations.

What are the symptoms of listeriosis?

A person with listeriosis (listeria infection) has fever, muscle aches, and sometimes gastrintestinal symptoms such as nausea or diarrhoea. If infection spreads to the nervous system, symptoms such as headache, stiff neck, confusion, loss of balance, or convulsions can occur.

Infected pregnant women may experience only a mild, flu-like illness; however, infections during pregnancy can lead to miscarraige or stillbirth, premature delivery, or infection of the newborn.

How great is the risk for listeriosis?

In the United States, an estimated 2,500 persons become seriously ill with listeriosis each year. Of these, 500 die. At increased risk are:

• Pregnant women - They are about 20 times more likely than other healthy adults to get listeriosis. About one-third of listeriosis cases happen during pregnancy.
• Newborns - Newborns rather than the pregnant women themselves suffer the serious effects of infection in pregnancy.
• Persons with weakened immune systems
• Persons with cancer, diabetes, or kidney disease
• Persons with AIDS - They are almost 300 times more likely to get listeriosis than people with normal immune systems.
• Persons who take glucocorticosteroid medications
• The elderly

Healthy adults and children occasionally get infected with Listeria, but they rarely become seriously ill.

How does Listeria get into food?

Listeria monocytogenes is found in soil and water. Vegetables can become contaminated from the soil or from manure used as fertilizer.
Animals can carry the bacterium without appearing ill and can contaminate foods of animal origin such as meats and dairy products. The bacterium has been found in a variety of raw foods, such as uncooked meats and vegetables, as well as in processed foods that become contaminated after processing, such as soft cheeses and cold cuts at the deli counter. Unpasteurized (raw) milk or foods made from unpasteurized milk may contain the bacterium.

Listeria is killed by pasteurization and cooking; however, in certain ready-to-eat foods such as hot dogs and deli meats, contamination may occur after cooking but before packaging.

How do you get listeriosis?

You get listeriosis by eating food contaminated with Listeria. Babies can be born with listeriosis if their mothers eat contaminated food during pregnancy. Although healthy persons may consume contaminated foods without becoming ill, those at increased risk for infection can probably get listeriosis after eating food contaminated with even a few bacteria. Persons at risk can prevent Listeria infection by avoiding certain high-risk foods and by handling food properly.

Can listeriosis be prevented?

The general guidelines recommended for the prevention of listeriosis are similar to those used to help prevent other foodborne illnesses, such as salmonellosis.

How can you reduce your risk for listeriosis?

General recommendations:

• Thoroughly cook raw food from animal sources, such as beef, pork, or poultry.
• Wash raw vegetables thoroughly before eating.
• Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods.
• Avoid unpasteurized (raw) milk or foods made from unpasteurized milk.
• Wash hands, knives, and cutting boards after handling uncooked foods.
• Consume perishable and ready-to-eat foods as soon as possible.

Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above:

• Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
• Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
• Do not eat soft cheeses such as feta, Brie, and Camembert, blue-veined cheeses, or Mexican-style cheeses such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pastuerized milk.
• Do not eat refrigerated p�t�s or meat spreads. Canned or shelf-stable p�t�s and meat spreads may be eaten.
• Do not eat refrigerated smoked seafood, unless it is contained in acooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as "nova-style," "lox," "kippered," "smoked," or "jerky." The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

How do you know if you have listeriosis?

There is no routine screening test for susceptibility to listeriosis during pregnancy, as there is for rubella and some other congenital infections. If you have symptoms such as fever or stiff neck, consult your doctor. A blood or spinal fluid test (to cultivate the bacteria) will show if you have listeriosis. During pregnancy, a blood test is the most reliable way to find out if your symptoms are due to listeriosis.

What should you do if you've eaten a food recalled because of Listeria contamination?

The risk of an individual person developing Listeria infection after consumption of a contaminated product is very small. If you have eaten a contaminated product and do not have any symptoms, we do not recommend that you have any tests or treatment, even if you are in a high-risk group. However, if you are in a high-risk group, have eaten the contaminated product, and within 2 months become ill with fever or signs of serious illness, you should contact your physician and inform him or her about this exposure.

Can listeriosis be treated?

When infection occurs during pregnancy, antibiotics given promptly to the pregnant woman can often prevent infection of the foetus or newborn.

Babies with listeriosis receive the same antibiotics as adults, although a combination of antibiotics is often used until physicians are certain of the diagnosis. Even with prompt treatment, some infections result in death. This is particularly likely in the elderly and in persons with other serious medical problems.

LACTOSE INTOLERANCE

What is lactose intolerance?

People with lactose intolerance have trouble digesting lactose, the natural sugar found in dairy foods. This is because their bodies do not have enough of the enzyme lactase.

Lactose intolerance is not common in young children because most people are born with enough lactase. However, in some people, the amount of lactase in their body drops over their lifetime.

This is especially common in non-Caucasians and other populations that don't traditionally include dairy products in their diets.

What are the symptoms of lactose intolerance?

Symptoms of lactose intolerance can include:

• abdominal pain
  
• diarrhoea
  
• flatulence
  
• bloating

Symptoms can be mild or severe, usually depending on how much lactose a person has eaten or drank, and how much lactase is in their body.

Can people with lactose intolerance still have dairy products?

Most people with lactose intolerance do not require a completely lactose-free diet.

Studies show that there are some things people with lactose intolerance can do to have fewer symptoms of lactose intolerance:

• Drink low-fat or fat-free milk in servings of 1 cup or less.
  
• Drink low-fat or fat-free milk with other food, such as with breakfast cereal, instead of by itself.
  
• Eat dairy products other than milk, such as low-fat or fat-free hard cheeses or cottage cheese, or low-fat or fat-free ice cream or yogurt. These foods contain a lower amount of lactose per serving compared with milk and may cause fewer symptoms.
  
• Choose lactose-free milk and milk products, which have the same amount of calcium as regular milk.
  
• Use over-the-counter pills or drops that contain lactase, which can eliminate symptoms altogether.

IRRITABLE BOWEL SYNDROME What is irritable bowel syndrome (IBS)?

Irritable bowel syndrome (IBS) is a collection of symptoms that occur when the nerves and muscles in a person's bowel (the colon, or large intestine) do not work like they should. With IBS, a person's bowel is extra sensitive, causing discomfort and changes in bowel activity. IBS is a chronic condition, meaning it lasts a long time.

Symptoms of IBS may include:

• cramping
• pain in the stomach area
• bloating
• gas
• mucus in the stool
• changes in bowel habits

Some people with IBS have constipation--infrequent stools that may be hard, dry, and painful. Others have diarrhoea--frequent loose stools. Some people have both. Sometimes a person with IBS has a crampy urge to empty the bowels but cannot do so.

IBS is not a disease and it does not cause cancer. IBS is a "functional" disorder, which means that the bowel doesn't work as it should. The cause of IBS is not known, and there is no cure for IBS. But, there are things you can do to feel better.

For some people, IBS is simply a bother. For others, it keeps them from going out, going to work, or even traveling short distances. Most people with IBS, however, can ease their symptoms by eating better, reducing stress, or taking medicine.

What causes IBS?

The cause of IBS is not known, and there is no cure for IBS. But, there are things you can do to feel better.

Who gets IBS?

Up to one in five Americans has IBS. IBS often begins before the age of 35, but it can start at any age. IBS seems to run in families--people with IBS often report having a family member with IBS. Most people diagnosed with IBS (up to 75 percent) are women. But, it is not known for sure that IBS affects more women than men. It may be that women are more likely to talk to their doctors about their symptoms.

What are the symptoms of IBS?

The main symptoms of IBS include:

• crampy pain in the stomach area
• painful constipation - infrequent stools that may be hard and dry
• painful diarrhoea - frequent loose stools

Most people have either diarrhoea or constipation, but some people have both.

Other symptoms include:

• mucus in the stool
• swollen or bloated stomach area
• feeling like you haven't finished a bowel movement
• gas
• heartburn
• discomfort in the upper stomach area or feeling uncomfortably full or nauseous after eating a normal size meal

Some women with IBS have more or different symptoms during their menstrual periods. Constipation may be relieved or diarrhoea may occur in the day or two before or when their period starts.

How is IBS diagnosed?

If you think you may have IBS, see your doctor. Your doctor will take a medical history and ask about your symptoms. Then your doctor will perform some medical tests.

There are no tests that can show for sure that you have IBS. But your doctor may do some medical tests to make sure you don't have any other diseases that could cause your symptoms. Other possible causes include polyps, inflammation, or intolerance of foods containing a protein called gluten. Medical tests that may be done include:

• physical exam
• blood tests
• x-ray of the bowel: This x-ray test is called a barium enema or lower GI (gastrointestinal) series. Barium is a thick liquid that makes the bowel show up better on the x-ray. Before taking the x-ray, the doctor will put barium into your bowel through the anus.
• endoscopy: The doctor inserts a thin tube into your bowel. The tube has a camera in it, so the doctor can look at the inside of the bowel to check for problems.

Sometimes other tests need to be done to check how fast or slow content moves through the colon, or to check to see if the anal muscles are working right.

What is the treatment for IBS?

There is no cure for IBS, but there are things you can do to feel better. Treatment may include:

Diet changes

Some foods make IBS worse:

• milk products, like cheese or ice cream (people who have trouble digesting lactose, or milk sugar could be extra sensitive)
• chocolate
• alcohol
• caffeine (found in coffee, tea, and some sodas)
• carbonated drinks like soda
• Sorbitol, a sweetener found in dietetic foods and in some chewing gums
• gas-producing foods including beans and certain vegetables like broccoli or cabbage

="margin-left: 2em;">To find out which foods are causing your symptoms, write down:

• what you eat during the day
• what symptoms you have
• when symptoms occur
• what foods always make you feel bad

="margin-left: 2em;">Try not to eat foods that cause IBS symptoms. Or try eating less of those foods.

Some foods make IBS better:

Fiber lessens IBS symptoms--mainly constipation because it makes stool soft, bulky, and easier to pass. Fiber is found in bran, bread, cereal, beans, fruits, and vegetables.

Here are some examples of foods with fiber:

Fruits	Vegetables	Breads, cereals, and beans
Apples Peaches	Broccoli, raw Cabbage Carrots, raw Peas	Kidney beans Lima beans Whole-grain bread Whole-grain cereal

Add foods with fiber to your diet a little at a time to let your body get used to them. Too much fiber all at once might cause gas, which can trigger symptoms in a person with IBS. If you have constipation, start by adding 12 grams of fiber per day. You may have to raise or lower the amount of fiber to a maximum of 30 grams per day, based on how fiber affects your bowel function and gas production.

Besides telling you to eat more foods with fiber, your doctor might also tell you to get more fiber by taking a fiber pill or drinking water mixed with a special high-fiber powder.

How much you eat matters, too.

Large meals can cause cramping and diarrhoea in people with IBS. If this happens to you, try eating four or five small meals a day. Or, have your usual three meals, but eat less at each meal.

Medicine

If necessary, your doctor may give you medicine to help with symptoms:

• laxatives: to treat constipation
• antispasmodics: to slow contractions in the bowel, which may help with diarrhoea and pain
• antidepressants: to help with severe pain

Take your medicine exactly as your doctor tells you to. Some medicines, including laxatives, can be habit-forming, and all drugs have side effects. Remember to tell your doctor about any over-the-counter medicines you are taking.

Stress relief

Stress does not cause IBS, but it can worsen your symptoms. Learning to reduce stress can help. With less stress, you may find that you have less cramping and pain.

Meditation, yoga, massage, exercise, hypnotherapy, and counseling are some things that might help. You may need to try different activities to see what works best for you.

Other things that may help:

• Drink 6 to 8 glasses of water each day.
• Exercise can help with constipation and improve your overall health. Exercise helps relieve stress and depression and helps your bowel function as it should.

IRON DEFICIENCY AND IRON DEFICIENCY ANAEMIA

Iron-deficiency anaemia is a common and easily treated condition that occurs when there is not enough iron in the body. It is the most common type of anaemia. A lack of iron in the body can come from bleeding, not eating enough foods that contain iron, or not absorbing enough iron from food that is eaten.

Anaemia

The term "anaemia" is used for a group of conditions in which the number of red blood cells in the blood is lower than normal, or the red blood cells don't have enough haemoglobin. Haemoglobin�an iron-rich protein that gives the red colour to blood�carries the oxygen from the lungs to the rest of the body. In people with anaemia, the blood does not carry enough oxygen to the rest of the body. Red blood cells also remove carbon dioxide, a waste product, from cells and carry it to the lungs to be exhaled.

Red blood cells also are called RBCs or erythrocytes. Normal red blood cells are all about the same size and look like doughnuts without a hole in the center. They are produced by the spongy marrow inside the large bones of the body. Healthy red blood cells have an average lifespan of 120 days. When they die, the iron from the haemoglobin is recycled to make new red blood cells.

There are many types of anaemia. The three major causes of anaemia are blood loss, decreased production of red blood cells, or increased destruction of red blood cells. White blood cells and platelets are the two other kinds of blood cells. White blood cells help fight infection. Platelets help blood to clot. In some kinds of anaemia, there are low amounts of all three types of blood cells. The most common symptom of all types of anaemia is feeling tired because the body is not receiving enough oxygen.

Iron-Deficiency Anaemia

In iron-deficiency anaemia, the body does not have enough iron to form haemoglobin, which means there is not enough haemoglobin to carry oxygen to the whole body. The body gets its iron from food. The main foods that contain iron are meat and shellfish as well as iron-fortified foods (that is, foods that have iron added). A steady supply of iron is needed to form haemoglobin and healthy red blood cells.

A person can have low iron levels for three reasons:

• Blood loss, either from disease or injury
• Not getting enough iron in the diet
• Not being able to absorb the iron in the diet

Iron-deficiency anaemia also can develop when the body needs higher levels of iron, such as during pregnancy.

Effects of Iron-Deficiency Anaemia on the Body

Iron-deficiency anaemia can range from mild to severe. A mild case usually causes no symptoms or problems. However, a severe case can cause extreme fatigue (tiredness) and weakness. Severe iron-deficiency anaemia can lead to serious problems for young children and pregnant women, and it can affect the heart.

In young children, iron-deficiency anaemia can cause a heart murmur and delays in growth and development. It puts a child at greater risk for lead poisoning and infections, and it can cause behaviour problems.

In pregnant women, iron-deficiency anaemia can increase the risk of a premature delivery and a low-birth-weight baby.

The heart is affected when there is a lack of oxygen in the body. The heart has to work harder to get enough oxygen throughout the body. Over time, this stress on the heart can lead to a fast or irregular heartbeat, chest pain, an enlarged heart, and even heart failure.

Important General Information

A lack of iron in the body is the most common nutritional problem. Iron-deficiency anaemia is the most common form of anaemia. It is most often found in young children, pregnant women, and women of childbearing age. In fact, it affects half of all pregnant women and 1 out of 5 women of childbearing age.

Outlook

Iron-deficiency anaemia can be treated successfully. The causes of iron-deficiency anaemia can most often be treated successfully as well. However, if not treated, it can lead to severe symptoms and serious problems.

What Causes Iron-Deficiency Anaemia?

Iron-deficiency anaemia occurs when there is too little iron in the body. A person can have a low iron level for three reasons:

• Blood loss, either from disease or injury
• Not getting enough iron in the diet
• Not being able to absorb the iron in the diet

Iron-deficiency anaemia also can develop when the body needs higher levels of iron, such as during pregnancy.

Loss of Iron Through Blood Loss

In general, when blood is lost, iron is lost. If the body does not have enough iron reserves to make up for the iron loss, a person will develop iron-deficiency anaemia.

Blood is lost in a number of ways. In women, iron and red blood cells are lost when bleeding occurs from very long or heavy menstrual periods as well as from childbirth. Women also can lose iron and red blood cells from slowly bleeding fibroids in the uterus.

Blood also is lost through internal bleeding. Most often this loss of blood occurs slowly and can be due to:

• A bleeding ulcer, colon polyp, or colon cancer
• Regular use of aspirin or other pain medicine such as nonsteroidal anti-inflammatory drugs (for example, ibuprofen and naproxen)
• Hookworm infection
• Urinary tract bleeding

A more rapid loss or removal of blood that can cause iron-deficiency anaemia occurs in situations such as:

• Severe injuries
• Surgery
• Frequent blood drawing

Lack of Iron in the Diet

Meat, poultry, fish, eggs, dairy products, or iron-fortified foods (that is, foods that have iron added) are the best sources of iron found in food. Eating patterns that exclude these foods or food supplements may lead to iron-deficiency anaemia. For example, some vegetarians do not eat enough foods with iron. Other people get iron-deficiency anaemia because of eating poorly due to alcoholism or aging. Following a diet that has an imbalance of food groups also can lead to this type of anaemia. Examples of diets that can lead to iron-deficiency anaemia include:

• Low-fat diets. Following a low-fat diet over a long period of time may limit sources of iron from animal foods.
• Diets high in sugars. These types of diets are often low in iron.
• High-fiber diets. These types of diets can slow the absorption of iron.

Infants who are fed cow's milk in the first year are at risk for iron-deficiency anaemia because cow's milk is low in iron. The same is true for infants who are breastfed after 4 months of age. These infants need iron supplements.

An Increased Need for Iron

People may need more iron at some periods in their lives. If they do not get more iron at these times, they may develop iron-deficiency anaemia. Periods of rapid growth or growth spurts in children and teens are a good example of an increased need for iron. Pregnancy also is an example. The need for iron doubles during pregnancy due to an increased blood volume, the growth of the foetus, and the blood loss that occurs during childbirth.

Inability To Absorb Enough Iron From Food

Certain factors make it hard for the body to absorb enough iron from food. These factors include:

• Intestinal surgery or diseases of the intestine, such as Crohn's disease or coeliac disease
• Prescription medicines that reduce acid in the stomach
• Low levels of folate, vitamin B12, or vitamin C in the diet

How Iron-Deficiency Anaemia Develops

First, iron is lost from the body by one of the ways listed above. Usually, this happens slowly over a period of time. Most often, the person is not taking in enough iron to meet the needs of the body.

Next, the body starts to use iron that it has stored. When the stored iron is used up, new red blood cells have less haemoglobin than normal, and fewer red blood cells are produced. Finally, when the number of red cells is too low, iron-deficiency anaemia develops.

Who Is At Risk for Iron-Deficiency Anaemia?

The major risk factors for iron-deficiency anaemia are blood loss and a diet low in iron. Three of the highest risk groups are women, young children, and adults with intestinal bleeding.

Populations Affected

Women

Women who lose a lot of blood during their monthly periods are at higher risk of developing iron-deficiency anaemia. About 1 in 5 women of childbearing age has iron-deficiency anaemia.

Pregnant women need twice as much iron in their diet than women who are not pregnant. If a pregnant woman doesn't get enough iron for herself and the growing baby, she can develop iron-deficiency anaemia. About half of all pregnant women have this type of anaemia.

Young Children

Infants and toddlers 6�24 months of age need a lot of iron to grow and develop. The iron that full-term infants have stored in their bodies is used up in the first 4�6 months of life. After that, infants need to get iron from food or supplements. Premature and low-birth-weight babies are at even greater risk for iron-deficiency anaemia because they don't have as much iron stored in their bodies.

Other children at risk for anaemia are:

• Children with poor nutrition, including low-income children
• Children with lead in their blood
• Infants fed cow's milk before 1 year of age
• Breastfed infants older than 4 months who are not receiving iron-rich solid foods or iron supplements

Adults With Intestinal Bleeding

Adults who bleed in their intestinal tract are at risk for iron-deficiency anaemia. This includes people who have bleeding ulcers or colon cancer. It also includes people who use medicines that can cause intestinal bleeding (for example, aspirin).

Other Adults

Other adults who are at risk for iron-deficiency anaemia include those who are on kidney dialysis, vegetarians, and older adults who have poor diets.

What Are the Signs and Symptoms of Iron-Deficiency Anaemia?

Signs and symptoms of anaemia depend on the severity of the condition. People with mild anaemia or anaemia that has come on very slowly may have no symptoms at all. However, if the anaemia is severe, the symptoms increase and become more serious. Many of the signs and symptoms of iron-deficiency anaemia are true for all kinds of anaemia.

Major Signs and Symptoms of Anaemia

The major symptom of all types of anaemia, including iron-deficiency anaemia, is fatigue (feeling tired). Fatigue is caused by having too few red blood cells to carry oxygen to the body. This lack of oxygen in the body can cause people to feel weak or dizzy, have a headache, or even pass out when changing position (for example, standing up).

Since the heart must work harder to move the reduced amount of oxygen, signs and symptoms may include shortness of breath and chest pain. This can lead to a fast or irregular heartbeat or a heart murmur.

In anaemia, the red blood cells don't have enough haemoglobin. Common signs of lack of haemoglobin include pale skin, tongue, gums, and nail beds.

Other Signs and Symptoms of Anaemia

Other signs and symptoms of anaemia can include:

• Cold hands and feet as well as brittle nails
• Swelling or soreness of the tongue and cracks in the sides of the mouth
• An enlarged spleen
• Frequent infections

Signs and Symptoms of Iron-Deficiency Anaemia

Symptoms of iron-deficiency anaemia include unusual cravings for nonfood items such as ice, dirt, paint, or starch. This craving for nonfood items is called pica.

Another symptom of iron-deficiency anaemia is developing restless legs syndrome (RLS). RLS is a disorder that causes an uncomfortable feeling in the legs that can only be relieved by movement. Sleep is difficult for people with RLS.

In infants and young children, signs and symptoms include a poor appetite, being irritable, and a slower rate of growth and development.

Some of the signs and symptoms of iron-deficiency anaemia are related to its causes, such as blood loss. Blood loss is most often seen with very heavy or long lasting menstrual bleeding or vaginal bleeding in women after menopause. Other signs of internal bleeding are bright red blood in the stool or black, tarry-looking stools.

How Is Iron-Deficiency Anaemia Diagnosed?

Iron-deficiency anaemia is diagnosed using a person's medical history, a physical exam, and diagnostic tests and procedures. A doctor can use these methods to determine how severe the anaemia is, its cause, and appropriate treatment. Mild to moderate anaemia may have no signs or symptoms. In fact, anaemia is often discovered unexpectedly on screening tests and when doctors are checking for other problems.

Specialists Involved

Primary care doctors often diagnose and treat iron-deficiency anaemia. These doctors include paediatricians, family doctors, obstetricians, or internal medicine specialists. Other doctors may be consulted, such as experts on diseases of the blood (haematologists) or experts on diseases of the digestive system (gastroenterologists).

Medical and Family History

To find the cause of the anaemia and how severe it is, the doctor may ask detailed questions about symptoms. The doctor may ask whether the person or a family member has ever had problems with anaemia. The doctor will ask about things that may cause anaemia, including illnesses, conditions (such as pregnancy), and medicines. The doctor also may ask about the person's diet and eating habits.

Physical Exam

A physical exam may include:

• Checking for pale or yellowish skin, gums, or nail beds
• Listening to the heart for a rapid or irregular heartbeat
• Listening to the lungs for rapid or uneven breathing
• Feeling the abdomen to check the size of the liver and spleen
• Checking for signs of bleeding, including a pelvic and rectal exam (these areas are common sources of blood loss)

The doctor also will order a number of tests or procedures to be sure about the type of anaemia and how severe it is.

Diagnostic Tests and Procedures

Your doctor may order various tests or procedures to determine the type and severity of anaemia you have. Usually, the first test used to diagnose anaemia is a complete blood count (CBC). The CBC tells a number of things about a person's blood, including:

• The haemoglobin level. Haemoglobin is the iron-rich protein in red blood cells that carries oxygen through the body. The normal range of haemoglobin levels for the general population is 11.1�15.0 g/dL. A low haemoglobin level means a person has anaemia.
• The haematocrit (hee-MAT-oh-crit) level. The haematocrit level measures how much of the blood is made up of red blood cells. The normal range for haematocrit levels for the general population is 32�43 percent. A low haematocrit level is another sign of anaemia.

The normal range of these levels may be lower in certain racial and ethnic populations. Your doctor can explain your individual test results.

The CBC also checks:

• The numbers of red blood cells. Too few red blood cells means a person has anaemia. A low number of red blood cells is usually seen with either a low haemoglobin or a low haematocrit level, or both.
• The numbers of white blood cells. White blood cells are involved in fighting infection.
• The number of platelets in the blood. Platelets are small cells that are involved in blood clotting.
• Red blood cell size. The mean cell volume measures the average size (volume) of red blood cells. In iron-deficiency anaemia, the red blood cells are often smaller than normal.

If the CBC results confirm that you have anaemia, your doctor may order additional tests to determine the cause, severity, and correct treatment for your condition. For example, the doctor may order a reticulocyte count. Reticulocytes are young red blood cells. This test measures the number of new red blood cells in your blood. The reticulocyte test is used to determine whether your bone marrow is producing red blood cells at the proper rate.

Tests That Measure Iron Levels in the Body

Iron is needed to make haemoglobin�the protein in red blood cells that gives them their colour and carries oxygen. Several tests can be used to check the level of iron in the blood and in the body:

• Serum iron. This test measures the amount of iron in the blood. The level of iron in the blood can be normal even when the total amount of iron in the body is low. For this reason, other iron tests are done.
• Serum ferritin. Ferritin is a protein that helps store iron in the body. Results of this test give doctors a good idea of how much of the body's stored iron has been used up.
• Transferrin level or total iron-binding capacity. Transferrin is a protein that carries iron in the blood. Total iron-binding capacity measures how much of the transferrin in the blood is not carrying iron. People with iron-deficiency anaemia have a high level of transferrin that has no iron.
• Other blood tests. Other tests the doctor may order include tests that check hormone levels, especially the thyroid hormone. Blood tests also may be ordered to check the level of a chemical used by the body to make haemoglobin. It is called erythrocyte protoporphyrin.

Tests That Diagnose Gastrointestinal Bleeding

If your doctor suspects anaemia because of internal bleeding in the stomach or intestines, several tests may be used to discover the source of the bleeding.

One of the first tests ordered is the faecal occult blood test. This test checks the stool for signs of blood. It can detect even small amounts of bleeding anywhere in the intestines. If blood is found in the stool, further tests may be used to find the source of the bleeding, including:

• Colonoscopy. In this test, a thin, flexible tube attached to a video camera is used to examine the rectum and colon for sources of bleeding.
• Upper GI endoscopy. In this test, a thin, flexible tube attached to a video camera is used to examine the stomach and upper intestines. The doctor looks for signs of bleeding.
• Pelvic ultrasound. This test uses sound waves to look at the uterus and other pelvic organs. It checks for causes of heavy vaginal bleeding, such as fibroids.

How Is Iron-Deficiency Anaemia Treated?

Goals of Treatment

The goals of treating iron-deficiency anaemia are to restore normal levels of red blood cells, haemoglobin, and iron as well as to treat the condition causing the anaemia.

Specific Types of Treatment

Treatment for iron-deficiency anaemia is based on the cause and the severity of the condition. It will include treatment to stop any bleeding, as well as changes in diet and iron supplements as needed. Severe anaemia may require more emergency measures.

Treatment To Stop Bleeding

Treatment will depend on why the body is bleeding and where it is bleeding. Anaemia will not improve until the bleeding is stopped.

Treatment To Increase Iron in the Diet

Your doctor may recommend a diet rich in iron, folic acid, and vitamin C to treat the anaemia. Iron in meats is more easily absorbed by the body than iron in vegetables and other foods. The best source of iron is red meat, especially beef and liver. Chicken, turkey, pork, fish, and shellfish also are good sources of iron.

Other foods high in iron are:

• Eggs
• Cereals, breads, or pastas that are fortified with iron
• Beans and nuts, including peanut butter, almonds, peas, lentils, and white, red, and baked beans
• Dried fruits (for example, raisins, apricots, and peaches), prune juice
• Vegetables such as spinach and other dark green, leafy vegetables
• Iron-fortified infant formula and cereals

Sources of vitamin C in foods include many fruits and vegetables such as:

• Citrus fruits (for example, oranges, grapefruits, and lemons) and their juices
• Kiwi fruit, mangos, apricots, strawberries, cantaloupes, and watermelons
• Broccoli, peppers, tomatoes, cabbage, potatoes, and leafy greens (for example, romaine lettuce, turnip greens, spinach)

The doctor may prescribe supplements to treat anaemia. Supplements can correct low iron levels within months if taken as ordered. They include iron supplements in pill form and vitamin C to help the body absorb the iron. Iron supplements also come in drops for children. But iron supplements are very dangerous if taken in overdose, so it is important to keep them away from children.

Iron and vitamin C supplements can cause side effects, including dark stools and stomach irritation or heart burn. Iron also can cause constipation, and a stool softener may be needed.

Treatment for Severe and Life-Threatening Anaemia

Severe anaemia may need to be treated with hospitalization, blood transfusions, and iron injections.

How Can Iron-Deficiency Anaemia Be Prevented?

Eating a well-balanced diet rich in iron and vitamins can help prevent iron-deficiency anaemia. Red meat is the best source of iron, but other meats, including poultry and seafood, are good sources of iron as well. Besides meat, foods high in iron are:

• Eggs
• Cereals, breads, or pastas that are fortified with iron
• Beans and nuts, including peanut butter, almonds, peas, lentils, and white, red, and baked beans
• Dried fruits (for example, raisins, apricots, and peaches), prune juice
• Vegetables such as spinach and other dark green, leafy vegetables
• Iron-fortified infant formula and cereals

Food fads and dieting can sometimes lead to iron deficiency. Weight loss diets that stress low-fat foods can mean that a person will avoid animal foods that are good sources of iron. High-fiber diets can make it hard for iron to be absorbed. High-sugar diets are often low in iron.

Adults who eat a balanced diet usually don't need iron supplements. However, people who don't absorb iron well and those who are strict vegetarians may need them.

Preventing Anaemia in Infants and Young Children

Anaemia can be prevented in infants and young children by testing, especially in the following three age groups:

• Premature and low-birth-weight babies less than 6 months of age
• Babies who are 9�12 months of age
• Babies who are 15�18 months of age

Infants absorb iron best from breast milk. They can absorb more than 50 percent of the iron in breast milk but only about 12 percent of the iron in infant formula.

Doctors usually recommend not giving cow's milk to babies for the first year. Cow's milk is low in iron. The doctor may suggest limiting cow's milk for children up to age 3 to no more than 24 ounces a day�about three full baby bottles each day. A child who is drinking a lot of milk may not be eating other foods that are better sources of iron. Drinking a lot of milk also can lead to bleeding in the intestines.

Babies need more iron as they grow and begin to eat solid foods. To help them get enough iron:

• Infants under age 1 who are not breastfed or who are partially breastfed can be given iron-fortified infant formula. Iron fortified means that each liter of formula has 4�12 milligrams of iron.
• Babies older than 4 months can be given iron-rich or iron-fortified solid foods such as cereal.

The child's doctor can give advice on the best diet for the infant. The doctor may recommend iron drops if the child needs an iron supplement. Giving a child too much iron can be dangerous, so it is important to be careful and follow the doctor's instructions. Parents and caregivers should keep all iron supplements and vitamins away from children. They should ask for child-proof packages for supplements.

Preventing Anaemia in Adolescents and Women of Childbearing Age

Teenaged girls and women of childbearing age are at higher risk for iron-deficiency anaemia due to blood loss from menstrual bleeding. They should be tested for anaemia every 5�10 years starting in their teens. Girls and women at higher risk for anaemia should be checked yearly. This includes women who have a history of anaemia, do not eat foods high in iron, or have heavy blood loss from menstruation or other causes.

Preventing Anaemia in Pregnant Women

Half of all pregnant women develop iron-deficiency anaemia because their volume of blood increases and because the growing foetus needs iron. Anaemia during pregnancy can lead to an increased risk of premature delivery and a low-birth-weight baby.

To prevent these problems, pregnant women need twice as much iron as women who are not pregnant. Pregnant women can get more iron from eating more iron-rich foods, from supplements, or from both. Medical care during pregnancy should include screening for anaemia.

The doctor giving prenatal care may prescribe iron supplements, which should be taken as directed. Pregnant women should notify their doctors if they have uncomfortable side effects such as constipation. The doctor also may give advice on how to get higher levels of iron through eating iron-rich foods.

Preventing Anaemia in Older Adults

Older adults may be at risk for iron deficiency due to poor diet or illnesses that reduce iron absorption. Iron deficiency can take away their sense of well-being, strength, and activeness. It also can make symptoms of other conditions worse. Doctors can advise older adults about eating iron-rich foods and how to use iron supplements to prevent iron-deficiency anaemia.

Living With Iron-Deficiency Anaemia

If you have iron-deficiency anaemia, you need to see a doctor for treatment but you can recover, feel well, and live a normal life.

Ongoing Health Care Needs

You will need regular medical checkups to make sure your iron levels are going up. At your checkups you may have changes made to your medicines or supplements, or you may get further advice on a healthy diet.

During treatment for anaemia, you may feel fatigue (tiredness) and have other symptoms until your iron levels return to normal. This can take months. Tell your doctor if you get any new symptoms or if your symptoms get worse.

Take iron supplements only with your doctor's approval. Don't decide to take them on your own. It is possible to get too high a level of iron in your body and cause a condition called iron overload.

A pregnant woman with iron-deficiency anaemia is usually tested for anaemia at 4�6 weeks after delivery, if she:

• Was anemic during the third trimester of pregnancy
• Lost a lot of blood during childbirth
• Had a multiple birth (such as twins)

Key Points

• Iron-deficiency anaemia is an illness that occurs when there is not enough iron in the body.
• Iron helps the body make haemoglobin and healthy red blood cells. Haemoglobin is needed to carry oxygen throughout the body.
• A person can have low iron levels for three reasons: blood loss, either from disease or injury; not getting enough iron in the diet; and not being able to absorb the iron in the diet. Iron-deficiency anaemia also can develop when the body needs higher levels of iron, such as during pregnancy.
• One in five women of childbearing age and half of all pregnant women have iron-deficiency anaemia.
• Infants and toddlers can be at risk for iron-deficiency anaemia.
• The most common symptoms of iron-deficiency anaemia are fatigue (tiredness) and weakness.
• Iron-deficiency anaemia is treated by stopping the bleeding (if the cause of the anaemia is bleeding), increasing iron in the diet, and giving iron supplements.
• Eating a well-balanced diet rich in iron and vitamins can help prevent iron deficiency anaemia.
• Iron-deficiency anaemia can be successfully treated