Lack of energy could be due to anemia

by W. Gifford-Jones M.D. and Diana Gifford-Jones
Common Sense Health

William I of Germany remarked on his death bed, “I have no time to be tired.” But often people suffer from being tired and having low energy years before they leave this planet. For some with fatigue, a prescription for 8-hours daily use of a pillow is the best treatment. But over three million Americans and one million Canadians have undiagnosed anemia, a condition due to low levels of red blood cells that carry oxygenated blood to the body’s tissues. Is it possible that anemia may lead to misdiagnosis of Alzheimer’s disease?

What should you do if you are feeling fatigued and weak for no obvious reason? A methodical approach is warranted. First, if the problem is anemia, then it is usually easy to correct, particularly if due to diet. Therefore, there is no need to panic. But you should see your doctor to rule out more serious problems.

For instance, anemia can be due to a cancer of the bowel when the malignant growth is bleeding. Other causes might be intestinal diseases, such as ulcerative colitis, Crohn’s disease, celiac disease, or peptic ulcer. Inherited conditions such as sickle cell or bone marrow disease can lead to anemia.

But the major cause of fatigue and anemia is iron deficiency, more commonly seen in women. This is not surprising since women lose blood menstruating. Pregnant women are at increased risk and should be taking a multivitamin with folic acid. Older women may be losing blood from a non-malignant fibroid in the uterus.

There’s good reason for a discussion about vitamin B12. A lack of this vitamin, or poor absorption, may cause pernicious anemia having serious consequences if not diagnosed and corrected.

Dr. Alice H. Lichtenstein, a professor at Tufts University’s Friedman School of Nutrition Science and Policy, says, “As we age many of us produce less stomach acid which is required for the absorption of vitamin B12.” Moreover, many elderly patients are taking acid suppressing medication decreasing the absorption of vitamin B12.

What is tragic is when a severe lack of B12 causes symptoms of dementia such as confusion, irritability, numbness, and tingling in the hands and feet.

This is a rare situation, but in some instances, these patients have been wrongly diagnosed as having Alzheimer’s disease. B12 would solve their confusion.

So, how can you prevent iron deficiency anemia? First, get rid of one misconception. Many people believe that red meat is the best source of iron. In fact, there are many other choices, including seafood, poultry, beans, lentils, tofu, dark green leafy vegetables, cashews, and fortified cereals.

Vitamin C increases iron absorption, so include foods rich in C such as strawberries, raspberries, and tomatoes. Enjoy a glass of orange juice.

Vegetarians should know that vitamin B12 is primarily found in animal products, so they may be at particular risk of developing this deficiency.

Be careful to include non-animal foods such as nutritional yeast and fortified cereals and plant-based milk substitutes in the diet. To ensure enough B12, consult a doctor to learn whether B12 supplements might be advisable.

Some people are tired all the time and have plenty of iron in the blood. These individuals may be suffering from another variety of fatigue – the kind due to a boss that cannot be stood, a family problem that would take a team of psychiatrists to settle, financial difficulties, or stress-related problems in these trying times. Or the key to resolving fatigue could be as simple as getting a better pillow for more restful sleep.

The weekly column by W. Gifford-Jones, MD has been published without interruption for 45 years. The same no-nonsense tradition now continues in a father-daughter collaboration. Sign-up at to receive our weekly e-newsletter. For comments,