Doctors are terrible patients.  Five years ago, I found myself dizzy, unsteady, headachy and exhausted beyond my usual 9 pm bedtime.  After a visit to the ear nose and throat specialist, an MRI of my brain and neck, and eight weeks of general suffering, I had a blood count that showed profound iron deficiency anemia.  Duh.

Iron deficiency is the most common cause of anemia worldwide.  There are other less common causes such as vitamin B12 deficiency and folic acid deficiency, neither of which will be discussed here!  Dietary iron is absorbed in the intestines and the body uses it to make hemoglobin.  Hemoglobin is essential for transferring oxygen in your blood from the lungs to the tissues.  Anemia is simply low hemoglobin levels, roughly less than 12 for adult women and 14 for adult men.

Causes of Anemia

Iron deficiency anemia is very common and can be divided into two categories: not enough coming in (poor dietary intake, poor absorption, or increased needs) or too much going out (bleeding from the gastrointestinal tract or other sources).   Often there are multiple factors.

Symptoms of Anemia

Most people’s iron levels will gradually diminish, therefore the symptoms can be confusing.  Patients will often present with fatigue, weakness, pallor, dizziness, lightheadedness and depression.  Less commonly, they can have tongue irritation, ice craving or restless leg syndrome.  A rapidly developing anemia can also cause fainting and low blood pressure.

How Anemia is Diagnosed

A simple blood test can diagnose low hemoglobin and iron studies can give your doctor an idea of the levels of iron in your body.  Once a low level is found, the source must be determined.  Most patients will need a test for microscopic blood in the stool and a urinalysis.  If these are positive, referral to a specialist may be necessary.

Ways to Increase Iron Intake

Regardless of the cause, once iron deficiency is diagnosed, you’ll need to change your diet to include iron rich foods.  Animal based foods are rich in heme iron, which is better absorbed than plant based foods containing non-heme iron.  Cooking these foods in an iron skillet can boost iron content as well.

Multiple factors affect your ability to absorb iron.  Make certain you’re not swigging back your iron supplement with black tea!

Anemia is a sneaky one.  If you’re feeling sluggish, ask your doctor to check some labs.  Iron intake is part of a well-balanced diet.  Do as I say, not as I do!

Human beings emit an average of 14 farts per day.  Considering that most of mine occur while in a business meeting or on a dinner date, I began to wonder exactly what causes gas and how it can be prevented.  Call me superficial, but this week I’ve chosen to enlighten my readers on the mysteries of intestinal emissions.

Gas occurs as a result of the breakdown of food products (usually carbohydrates).   As food passes through the large intestine, hydrogen, carbon dioxide and methane are produced.  The amount of food and trigger type for gas varies widely from person to person.  It is also related to the natural bacterial balance in each person’s colon.

Causes of Gut Busting Gas

1.     Lactose

Lactose is the main sugar in milk products.  Adults are commonly deficient in the enzyme necessary to break down lactose, so when the sugar enters the colon, it is broken down into gas-forming elements.  This causes cramping, diarrhea and gas.

2.     Sorbitol

This is a natural sugar found in apples, pears, peaches and prunes.  It is a sugar alcohol and is commonly used as an artificial sweetener in gum and candy.

3.     Raffinose

Beans contain large amounts of this sugar, as do cabbage, brussel sprouts and broccoli.  The resulting flatulence is the most odiferous around.

4.     Fiber

Too much insoluble fiber (the kind found in supplements) causes gas.   In order to make their food labels appear healthy, processed foods contain undigestible fiber and artificial sweeteners.  That’s why a Fiber One bar is fart city.

Fart Fixers

1.     Eliminate Dairy Products

Try this for two weeks.  You may indeed be lactose intolerant.  While technically not an allergy, this problem is life-long and can be quite a nuisance.  You can either avoid lactose or take an enzyme supplement (Lactaid), at mealtime.  For more information on lactose intolerance, check out http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001321/

2.     Skip Sweeteners

Avoid sugar free gum and beverages (sorbitol, lactitol, maltitol, erythritol and xylitol, to name a few).  Gum also causes you to swallow air; leading to belching and farting.  Pretty soon, you’ll be sitting on the couch in a wife-beater tee and watching professional wrestling.

3.     Probiotics

Available at every drugstore, these capsules contain millions of healthy bacteria.   These bacteria reset the colon, promoting healthier digestion.  Try them daily for 2-3 months and then stop.

4.     Beano

IT REALLY WORKS!  This over-the-counter supplement contains enzymes that help break down sugars.  It must be taken with meals in order to prevent gas.  Beano won’t relieve gas once it’s started or if it’s related to Lactose deficiency or fiber overload.

5.     Gas-X

Once gas strikes, this is your only option.  Simethicone, the active ingredient in Gas-X, is like soap.  It enters the intestine, coating the gas with surfactant, and breaking it up into tiny bubbles.   Theoretically, it should reduce bloating and gas.  The truth is, it doesn’t work very well.

6.     Add Fiber Gradually

Don’t decide to turn over a new leaf by eating 30 grams of fiber.  You’ll be miserable (and so will your family).  Your colon needs some time to get used to dietary fiber.  Begin with 5 grams daily for the first week.  As each week passes, increase your intake by 5 grams, until you reach a goal of 25-30 grams per day.

7.     Charcoal

Believe it or not, the same stuff that makes your babyback ribs taste delicious can reduce your flatulence.  Activated charcoal is available on the internet and in health food stores.  Talk to your doctor before considering this; it has side effects and drug interactions.

Do your best to identify and avoid your flatulence-inducing foods.  If you’re like me, the realization is always too late.  Worst case scenario?  Blame it on the dog.

What’s the most important information on a food label?

I’ve asked this questions hundreds of times.  It’s my best material.  And nobody ever gets the answer correct.  It doesn’t matter how knowledgeable you are, you’re missing the boat.  When I head down the grocery aisle, I see confused, uniformed shoppers searching for information.  They select the prettiest package of cookies, flip it over to look at the label, pretend to understand what the hell it says, and throw it in the cart to join the rest of the processed slop.

Food labels were introduced in 1994 as part of the Nutrition Education Labeling Act.  They are an attempt by the FDA to inform consumers in a clear, standardized way about the foods they eat.  David Kessler, the director of the FDA at the time (and author of “The End of Overeating”), was prescient enough to know that the processed food industry would expand in the coming years.  The food label now graces over 6.5 billion packaged foods.

SO, WHAT IS THE MOST IMPORTANT INFORMATION ON A FOOD LABEL?

SERVING SIZE

You must know the serving size to understand how much of the food you are supposed to eat.  All of the remaining information depends on it.  Many times I’ve wolfed down a half box of Cheez-Its, only to realize the serving size is ten measly crackers.  That’s ridiculous!

Beyond serving size, how you read a food label is based upon your dietary preferences.   I don’t want to inundate you with nitty-gritty.  Life’s hard enough, so here’s how I break it down:

1.     Ignore all adjectives on a package. Food companies use cute words to attract you to their products.  Read only the nutrition label and the ingredients.

2.     SERVING SIZE!

3.     If you’re watching your weight, next, look at the calories.

4.     I never care how much fat is in an item.  Fat has 9 calories per gram.  If a food is high in fat, it will be high in calories.  I do, however look for items that are low in saturated fat (because these raise your cardiovascular risk).  You should eat about 50 grams of fat per day and no more than 15 grams of saturated fat.

5.     If a food label lists trans fats (like the one above), don’t buy the product.  Trans fats are horrible.  See my blog, http://emilyfrankmd.com/hydrogenated-fat-heart-attack/

6.     I personally believe that % Recommended Daily Allowance (RDA) is bunk.  These were established in the 1940’s at a time of famine and food rationing.  Today, we are fighting an epidemic of obesity so nutritional deficiencies are practically unheard of.   The vast majority of processed foods are chemically fortified with vitamins and minerals, basically amping up the processed crap so it looks nutritionally sound.  I prefer to get my nutrients from Mother Nature.

7.     Read the ingredients.  They are listed in order of amount.  The more things you can’t pronounce, the worse an item is for you.

8.     I look at fiber content next.  You need 25 grams of fiber daily.  Try to get it from fruits and vegetables.  If you’re eating breakfast bars and processed grains, know that the food manufacturer has beaten, whipped and morphed the ingredients into something palatable, taking away all nutritive value, subsequently adding fiber at the end to make it look healthier.   In processed foods, aim for 2 grams of fiber for every 90 calories.

And finally, a general recommendation.  Try to think like a marketing team.  What are glamorous keywords?  If a product boasts “New” or “Heart Healthy”, what does that really mean?  Are you going to be a sucker or a savvy consumer?