tag:theconversation.com,2011:/us/topics/anaemia-16755/articlesAnaemia – The Conversation2024-01-23T13:57:59Ztag:theconversation.com,2011:article/2203122024-01-23T13:57:59Z2024-01-23T13:57:59ZWhy your period symptoms might be worse in the winter<figure><img src="https://images.theconversation.com/files/570844/original/file-20240123-19-dn93f6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Symptoms such as fatigue, irritability, poor concentration and a weaker immune system may be pointing to iron deficiency.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-woman-lying-on-sofa-looking-2249910765">Photoroyalty/ Shutterstock</a></span></figcaption></figure><p>Period symptoms are frustrating no matter the time of year. But those who menstruate might feel like certain symptoms are worse during the winter months, when the weather is gloomy, the days are short and cold and flu seem to always be lurking. This phenomenon has even been dubbed “<a href="https://www.huffingtonpost.co.uk/entry/winter-weather-period-fatigue_uk_652fae8fe4b03b213b07e33e">winter period fatigue syndrome</a>”.</p>
<p>Unfortunately, there’s no evidence that such a thing as winter period fatigue syndrome exists. There’s also no good evidence to suggest changes in the seasons can worsen period symptoms. But that doesn’t mean there isn’t a scientific explanation for why you might feel some of your period symptoms are worse during the colder months.</p>
<p>Symptoms such as fatigue, irritability, poor concentration and a weaker immune system, may in fact be pointing to the more obvious cause of <a href="https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/signs-symptoms">iron deficiency</a>.</p>
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<em>This piece was published by <a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+R292024&utm_content=InArticleTop">The Conversation</a> as part of Taking Care, <a href="https://www.refinery29.com/en-gb/taking-care-of-health">Refinery29</a>’s health and wellness hub.</em></p>
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<p>The body needs iron in order to function. Iron helps produce red blood cells, which carry oxygen throughout the body. But many people don’t get enough iron in their diet. In fact, iron deficiency is the <a href="https://pubmed.ncbi.nlm.nih.gov/35427520">most common nutritional deficiency</a> in the world.</p>
<p>Alongside the symptoms that iron deficiency can cause, low iron can also lead to <a href="https://www.who.int/news-room/fact-sheets/detail/anaemia">anaemia</a> – a fall in <a href="https://www.who.int/health-topics/anaemia#tab=tab_1">red blood cell count</a>. While the symptoms of anaemia can be very similar to those caused by iron deficiency (including fatigue, tiredness, and cold hands and feet), symptoms can be more severe, too – leading to heart palpitations, shortness of breath and even loss of consciousness.</p>
<p>Menstruation is a leading cause of both iron deficiency and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00127-9/fulltext">anaemia</a>. People with <a href="https://www.nhs.uk/conditions/heavy-periods/">heavy or prolonged periods</a> are particularly at risk as they regularly lose more blood each month than their body can replace. Some studies even estimate that in women who experience heavy periods, 90% are iron deficient and <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12394">60% are anaemic</a>.</p>
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<img alt="A woman with her period picks up a pink pad from a table." src="https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Heavy or prolonged periods put you at greater risk of iron deficiency and anaemia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/classic-comfort-menstrual-pads-black-woman-2300535095">Prostock-studio/ Shutterstock</a></span>
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<p>Those who normally have heavy periods might not realise that this could actually be the cause of their fatigue, irritability and difficulty concentrating. This is because so many who have heavy periods just <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997654/pdf/bjgpapr-2023-73-729-e294.pdf">assume their blood loss is normal</a>. But left unchecked, heavy periods can leave women and people who menstruate trapped in a vicious cycle of progressive blood loss and iron loss, leading to anaemia, which can be difficult to break.</p>
<p>And even though <a href="https://pubmed.ncbi.nlm.nih.gov/33247314/">many clinical guidelines</a> for managing heavy menstrual bleeding recognise the importance of treating iron deficiency and anaemia caused by excessive blood loss, these conditions are still <a href="https://www.figo.org/resources/figo-statements/iron-deficiency-and-anaemia-women-and-girls">often missed</a> – despite how treatable they are.</p>
<h2>Winter symptoms</h2>
<p>Many of the symptoms of iron deficiency and anaemia overlap with other health conditions. This is why it’s important to talk to your doctor as soon as symptoms start to make sure you’re getting the right treatment.</p>
<p>For example, fatigue, lethargy and changes in mood can also be symptoms of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673349">seasonal affective disorder</a>. This is a type of depression that affects some people only in the autumn and winter.</p>
<p>So if you find your symptoms began when the shorter days and colder weather arrived, then exercise, self care (such as resting if you need to and getting plenty of sleep each night) and eating a balanced diet that contains plenty of fibre, complex carbs and protein <a href="https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/treatment">may help somewhat</a>. Your GP may also recommend talking therapy.</p>
<p>But if you find you have such symptoms all year round – and suffer from heavy or prolonged periods – this may be a sign you have iron deficiency. Certain symptoms of iron deficiency may also seem worse during the winter months. </p>
<p>Since iron deficiency affects how well your immune system functions, this could explain why you may feel you suffer from more seasonal illnesses during the colder weather. This will require a trip to the GP to be diagnosed, as well as taking an iron replacement if your doctor recommends it. This should significantly improve your quality of life and symptoms.</p><img src="https://counter.theconversation.com/content/220312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jahnavi Daru has worked as a consultant for the World Health Organization in the Department of Nutrition and Food Safety on projects related to maternal anaemia and has received grant funding from the National Institute for Health Research</span></em></p><p class="fine-print"><em><span>Ewelina Rogozinska receives funding from the National Institute for Health Research. </span></em></p><p class="fine-print"><em><span>Varsha Jain received funding from Wellbeing of Women. </span></em></p>Heavy periods are one of the leading causes of iron deficiency and anaemia.Jahnavi Daru, Senior lecturer in Women's Health, Queen Mary University of LondonEwelina Rogozinska, Research Fellow, MRC Clinical Trials Unit, UCLVarsha Jain, Clinical Research Fellow, MRC Centre for Reproductive Health, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2123552023-09-01T04:03:05Z2023-09-01T04:03:05ZFuture diets will be short of micronutrients like iron — it’s time to consider how we feed people<p>Iron deficiency is one of the <a href="https://pubmed.ncbi.nlm.nih.gov/23355536/">most common forms</a> of nutrient deficiency around the world. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/24297872/">Severe iron deficiency</a>, also known as anaemia, affects nearly 50% of women of reproductive age in regions like South Asia, Central Africa and West Africa (in contrast to 16% of women in high-income countries). </p>
<p>In <a href="https://www.health.govt.nz/publication/focus-nutrition-key-findings-2008-09-nz-adult-nutrition-survey">New Zealand</a>, 10.6% of women aged 15-18 and 12.1% of women aged 31-50 suffer from iron deficiency. The risk increases during the third trimester of pregnancy, and the iron status must be carefully monitored to ensure good health for both the mother and baby. </p>
<p>As more people consider switching to plant-based diets, the risk of iron deficiency will likely increase. </p>
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<p>We use the <a href="https://sustainablenutritioninitiative.com/login/?redirect_to=%2Fmodels-tools%2Fexplore-the-future%2F">latest version</a> of the <a href="https://sustainablenutritioninitiative.com/">Sustainable Nutrition Initiative®</a> global food mass balance model to project nutrient availability in current and future global food systems. It suggests we can expect a gap in dietary iron by 2040 if global patterns of food production and supply remain unchanged.</p>
<p>This means we’ll have to address iron shortfalls in our diet, especially in populations with higher requirements such as adolescents and women. We argue that fortifying foods with iron could provide a one-stop solution to bridge nutrient gaps caused by inadequate dietary intake.</p>
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Read more:
<a href="https://theconversation.com/low-iron-is-a-health-risk-made-worse-by-covid-how-to-get-more-without-reaching-for-supplements-185020">Low iron is a health risk made worse by COVID. How to get more without reaching for supplements</a>
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<h2>Food fortification</h2>
<p>Many foods in supermarket shelves, including common staples such as bread and cereals, already have added nutrients. </p>
<p>Unlike mandatory <a href="https://www.mpi.govt.nz/food-business/bakery-and-grain-based-products/iodine-fortification/">iodine</a> and <a href="https://www.mpi.govt.nz/food-business/bakery-and-grain-based-products/folic-acid-fortification-of-bread/">folic acid</a> fortification of bread, there is currently <a href="https://www.foodstandards.gov.au/code/Pages/default.aspx">no government initiative</a> to encourage or mandate iron fortification in New Zealand. </p>
<p>Since iron-fortification strategies have the potential to prevent deficiencies in many countries, including New Zealand, we argue that introducing iron to our foods may be a convenient and cost-effective way to provide a source of dietary iron. </p>
<h2>Shift to plant-based diets</h2>
<p>More consumers are opting for diets that include fewer animal-sourced foods in the hope of reducing environmental impacts and emissions. Recent <a href="https://www.statista.com/statistics/1306000/new-zealand-yoy-change-in-plant-based-vegetarian-or-vegan-diet/">statistics</a> show a 19% increase in the adoption of vegan and vegetarian diets among New Zealanders from 2018 to 2021. </p>
<p>Considering these plant-based diets for a sustainable food system must involve conversations about nutrient availability. Plant foods often contain high amounts of fibre and phytates, which reduce the body’s capacity to <a href="https://www.frontiersin.org/articles/10.3389/fsufs.2021.727533/full">absorb the iron</a>. </p>
<p>Iron in plant foods such as whole grains, nuts, seeds, legumes and leafy greens is known as non-heme and is less readily absorbed than heme iron in animal-sourced foods. In a mixed diet, consisting of vegetables, grains and animal-sourced foods, the <a href="https://link.springer.com/article/10.1007/s00394-012-0348-y">consumption of some red meat, fish or poultry</a> facilitates non-heme iron absorption.</p>
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Read more:
<a href="https://theconversation.com/what-to-drink-with-dinner-to-get-the-most-iron-from-your-food-and-what-to-avoid-156579">What to drink with dinner to get the most iron from your food (and what to avoid)</a>
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<p>Fortification can be a potent strategy in helping people to shift towards plant-based diets by enriching these diets with nutrients that would otherwise be lacking. </p>
<p>A recent <a href="https://www.mdpi.com/2072-6643/15/11/2473">study</a> investigating this potential revealed that fortifying foods with essential micronutrients, including iron, enables a more gradual dietary adjustment. Consumers wishing to adopt more plant-based diets without compromising nutrient adequacy may find this approach helpful.</p>
<p>However, there’s a caveat. These iron-fortified foods often contain wheat or cereal-based ingredients, which can act as iron absorption inhibitors. As these are common breakfast foods that may be consumed with a <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1301/002966402320285137">morning coffee or tea</a>, the inhibition effect may be even stronger due to the presence of phenolic compounds in these beverages.</p>
<p>One solution could be to eat iron-rich plant foods with foods high in <a href="https://sustainablenutritioninitiative.com/a-global-perspective-in-iron-awareness-week/">vitamin C</a>, such as orange juice, which helps to convert iron to a more absorbable form. </p>
<h2>Is NZ ready for iron-fortified foods?</h2>
<p>Although fortified foods can offer great benefits in tackling iron deficiency, some consumers are hesitant to include these foods in their diets. </p>
<p>Food Standards Australia New Zealand (<a href="https://www.foodstandards.govt.nz/Pages/default.aspx">FSANZ</a>), a government entity responsible for developing food regulations for both nations, found many consumers had <a href="https://www.foodstandards.gov.au/publications/documents/fortification%20report%20-%20qualitative.pdf">second thoughts about reaching for fortified foods</a>, viewing them as unnatural, processed and less healthy. </p>
<p>This hesitancy was particularly evident when it came to non-mandatory fortifications. Added vitamins and minerals in breakfast cereals or, more recently, in plant-based milks and meat alternatives, are examples of non-mandatory or “voluntary fortification”. Consumers often perceive this as a marketing tactic rather than a health-promoting intervention. </p>
<p>Given the importance of adequate dietary iron intake and the projected shortage in dietary iron, it is crucial to evaluate the benefits of fortification. Educational interventions such as <a href="https://sustainablenutritioninitiative.com/iron-awareness-week-2023/">promoting awareness of iron deficiency</a> and positive impacts of fortification may help improve consumers’ acceptance of these initiatives.</p><img src="https://counter.theconversation.com/content/212355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mahya Tavan receives funding from the Global Dairy Platform for developing a dietary optimisation model called The iOTA Model. </span></em></p><p class="fine-print"><em><span>Bi Xue Patricia Soh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many plant-based foods are rich in iron, but they also contain high amounts of fibre and phytates, which reduce the body’s capacity to absorb the essential nutrient.Mahya Tavan, Postdoctoral research fellow - Sustainable Nutrition Initiative, Massey UniversityBi Xue Patricia Soh, PhD Fellow - Sustainable Nutrition Initiative, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1624392021-06-11T08:07:53Z2021-06-11T08:07:53ZBlood donation saves lives but few South Africans are regular donors<figure><img src="https://images.theconversation.com/files/405642/original/file-20210610-15-145vawv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are many occasions when there is a shortage of blood.</span> <span class="attribution"><span class="source"> Vladimir Vladimirov/GettyImages</span></span></figcaption></figure><p><em>Blood donation is a vital therapy for a number of life threatening conditions. South Africa needs around <a href="https://www.vukuzenzele.gov.za/your-blood-can-make-difference">810,000</a> units of blood every year. People needing blood transfusions include accident victims, those with anaemia and patients undergoing surgery. But <a href="https://sanbs.org.za/">less than 1%</a> of South Africans are active blood donors, which means regular shortages of supply. Glenda Mary Davison, a medical scientist with a special interest in haematological malignancy, immunology and inflammation, unpacks the blood donation process in South Africa.</em> </p>
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<h2>What happens to the blood between donation and transfusion?</h2>
<p><a href="https://sanbs.org.za/donation-process/">Before donation</a>, donors wishing to give blood undergo a mini medical to ensure they are healthy and that it is safe for them to donate. This includes blood pressure measurements and completing a health questionnaire. Then, blood is drawn to test for HIV and other infectious diseases. The actual donation of 480ml of blood takes only 10 minutes. Once it’s complete, the blood is put on ice and taken to the blood service headquarters for processing, together with the blood tests and donor records – which are kept anonymous throughout the process. Here the donated blood is spun in a centrifuge to separate it into three components, namely red cells, platelets and plasma. </p>
<p>The red cells provide oxygen to the body’s tissues and are used to treat patients who have lost large amounts of blood due to bleeding or because of severe anaemia. After removing any residual white cells, the red cells are stored in a fridge for up to 42 days or until needed by a patient. </p>
<p>The second product is platelets. These are very small blood cells that are vital in the prevention of blood loss and to stop bleeding. They are prescribed to treat patients with extremely low platelet counts such as those on chemotherapy, or with blood cancers such as leukaemia and patients who have undergone a bone marrow transplant. After removing the white cells, the separated platelets are stored at room temperature for a maximum of five days and are constantly agitated and kept in suspension until they are required. </p>
<p>The third component is plasma, which is the straw coloured part of blood and contains no cells. Plasma is used to treat a number of disorders including burns, liver disease and infections. Plasma can be frozen and stored for up to one year before use. Another product that can be extracted from the fresh frozen plasma is cryoprecipitate, a component rich in clotting factors. It is important in the treatment of haemophilia, which often results in life threatening bleeding. </p>
<p>After processing and when blood products are required, they are distributed to hospitals which have blood banks where they are kept on standby until needed to save a life. </p>
<h2>Other than blood transfusions, what are the other uses of donated blood?</h2>
<p>Most blood is utilised in transfusion therapy. But other valuable products can be manufactured from plasma. </p>
<p>Albumin is one such product which can be used to treat individuals with shock, burns and low protein levels. Freeze dried clotting factors can also be extracted and used as life-saving treatment for patients with bleeding disorders. </p>
<p>Antibodies, which are made by the immune system to fight infections, circulate in plasma. These can be concentrated and used to treat infections or given to individuals who are unable to make their own. </p>
<h2>Why are so few South Africans donating blood?</h2>
<p>Despite the life saving properties of blood donation, which benefits over 800,000 people annually, very few South Africans are regular blood donors. Other <a href="https://www.globalcitizen.org/en/content/world-blood-donor-day-who-facts/">countries</a> such as Germany, the USA, Russia and China pay donors. But blood donation in South Africa is voluntary. This ensures that individuals donate because they want to save lives rather than for material gain. This practice reduces the risk of unsafe or infected blood products. </p>
<p>Before 2005, testing for HIV and other sexually transmitted diseases was performed using antibody and rapid antigen tests. This had the disadvantage of not detecting the virus when donors were in the <a href="https://clinicalinfo.hiv.gov/en/glossary/window-period#:%7E:text=The%20time%20period%20from%20exposure,HIV%20test%20despite%20having%20HIV.">“window” period</a> or the early stages of infection. Because of this, the criteria to become a donor were very strict. High risk groups such as those who were drug users or practised unsafe sex were discouraged from becoming donors. </p>
<p>Since then the <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/trf.14959">blood service</a> has ensured that each blood donation is analysed using nucleic acid testing, which is accurate and has dramatically improved the safety of blood donation. The <a href="https://www.spotlightnsp.co.za/2018/10/08/more-black-people-donating-blood-in-sa/">numbers</a> of African blood donors, in particular, have increased since then. But there is still a long way to go. There are many occasions, particularly over holiday periods when there are more traffic accidents and donors go on holiday, when there is a shortage of blood.</p>
<p>The <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/tme.12218">reasons</a> for the hesitancy to donate are complex and include a fear of needles, fear of discovering a hidden disease and lack of awareness. What is however unique to South Africa is a perception of mistrust and racial discrimination, resulting in the donor pool not being representative of the population. Most <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/tme.12218">donors</a> are of European descent. </p>
<p>Previous policies to prevent HIV infected donations profiled donors according to sex and ethnicity. These policies have changed. But the negative perceptions linger. Many <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/tme.12218">believe</a> that blood products from African donors, particularly products containing cells, are discarded and not used. </p>
<h2>What can be done to get more South Africans to become regular donors?</h2>
<p>For South Africa to provide a safe, efficient and well resourced blood service, blood donors representative of the entire population must be recruited. Awareness and education drives to dispel the fear of donating are important. Campaigns must aim to regain the trust of previously alienated groups. </p>
<p>The South African National Blood Service and Western Cape Blood Service have embarked on <a href="https://www.westerncape.gov.za/general-publication/donating-blood-you-can-save-life">marketing campaigns</a> which have targeted young people on various platforms. </p>
<p>Although a lot of work must still be done, these have seen an <a href="https://www.spotlightnsp.co.za/2018/10/08/more-black-people-donating-blood-in-sa/">increase</a> in blood donors across all demographic groups. Blood donation is a way of making a difference and saving a life should be the most important motivator.</p><img src="https://counter.theconversation.com/content/162439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Glenda Mary Davison does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The reasons for the hesitancy to donate blood are complex and include a fear of needles and lack of awareness. Awareness and education drives to dispel the fear of donating are important.Glenda Mary Davison, Associate Professor, Cape Peninsula University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1253892019-10-25T12:23:44Z2019-10-25T12:23:44ZVitamin B12 deficiency: what is pernicious anaemia, and why can it be so dangerous?<figure><img src="https://images.theconversation.com/files/298591/original/file-20191024-170467-sbfioq.jpg?ixlib=rb-1.1.0&rect=70%2C10%2C6639%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Typical symptoms include extreme tiredness, lack of energy, muscle weakness, and even problems with memory. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/tired-woman-touching-her-eyes-694175920?src=8wvRDoVdLZvpWkTVM2arpw-1-63">sebra/ Shutterstock</a></span></figcaption></figure><p>An estimated <a href="https://www.bmj.com/content/349/bmj.g5226">6% of people</a> in the US and UK suffer from vitamin B12 deficiency. The condition is recognised by the World Health Organisation as a <a href="https://www.who.int/nutrition/publications/micronutrients/FNBvol29N2supjun08.pdf">global health problem</a> that could impact millions of lives. B12 deficiency is <a href="https://www.nhs.uk/conditions/vitamin-b12-or-folate-deficiency-anaemia/">typically characterised</a> by symptoms such as extreme tiredness, lack of energy, muscle weakness, and even problems with memory. Not only that, but it can cause a number of serious health problems, such as irreversible nerve damage, anxiety or depression, or disorders which <a href="https://www.nhs.uk/conditions/ataxia/">affect coordination, balance, and speech</a>. </p>
<p>While some B12 deficiencies are caused by diet, the most common reason for low B12 levels worldwide is an <a href="https://www.hammersmithbooks.co.uk/product/what-you-really-need-to-know-about-vitamin-b12-deficiency-and-pernicious-anaemia/">autoimmune disorder called pernicious anaemia</a>. This is a chronic form of low B12 that can have serious consequences on health if left untreated long-term. However, because symptoms of the condition typically look like other common conditions, it’s often misdiagnosed as depression or anxiety. Not only does the condition cause physical distress, the stigma of living with this chronic condition can also <a href="https://www.sciencedirect.com/science/article/pii/S0022399918306111?via%3Dihub">cause serious psychological harm</a>, as I’ve shown in my research. </p>
<p>Vitamin B12 – otherwise known as <em>cobalamin</em> – is a water-soluble vitamin found in animal by-products, such as meat, fish and dairy. Other sources include fortified cereal, breads and plant milks. People who don’t regularly consume animal products are at risk of becoming deficient in B12. To reduce this risk, vegans are recommended to consume at least three micrograms of B12 daily through fortified foods, or by <a href="https://www.vegansociety.com/resources/nutrition-and-health/nutrients/vitamin-b12/what-every-vegan-should-know-about-vitamin-b12">taking a regular B12 supplement</a>.</p>
<p>However, most low B12 levels are more caused by pernicious anaemia. The condition makes it difficult for people to process vitamin B12 because the immune system impacts on the functioning of important parietal cells within the stomach. These cells produce a protein called “intrinsic factor” which is <a href="https://www.ncbi.nlm.nih.gov/pubmed/9358143">essential for vitamin absorption</a>. People with pernicious anaemia will produce an antibody to Intrinsic Factor that destroys any Intrinsic Factor that has been produced. And so, without any Intrinsic Factor to bind to food, they are unable to extract any B12. Without B12, the body isn’t able to produce enough healthy red blood cells. The condition can also be caused by a <a href="https://www.emjreviews.com/gastroenterology/article/atrophic-body-gastritis-clinical-presentation-diagnosis-and-outcome/">weakened stomach lining</a>. This may happen because of atrophic gastritis, chronic inflammation in the stomach that eventually weakens the lining. </p>
<h2>A lifelong condition</h2>
<p>An estimated five in every 100,000 people in the UK have pernicious anaemia. It <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/bjh.12959">effects people of all ages</a>, and symptoms can start at any time. However, the condition is <a href="https://www.ncbi.nlm.nih.gov/pubmed/25189324">more common in people over 60</a>, as older adults are more likely to develop atrophic gastritis, which increases the risk of B12 deficiency. The number of people with the condition worldwide might be higher than estimated. However, it’s difficult to reliably estimate levels of B12 deficiency because there’s no agreed definition of how low B12 levels must be to be classified as deficient. </p>
<p>New guidelines have been made to address problems with <a href="https://b-s-h.org.uk/guidelines/guidelines/diagnosis-of-b12-and-folate-deficiency/">current diagnosis methods</a>. They state that a patient’s symptoms are the best indicator of any deficiency. It also states that if there’s inconsistency with the test result and the patient’s reported symptoms, the patient should still be treated with replacement B12 to prevent any potential irreversible damage. </p>
<p>B12 deficiency causes a wide range of debilitating neurological and physical symptoms. The <a href="https://www.ncbi.nlm.nih.gov/pubmed/24732991">most common symptoms</a> of pernicious anaemia are fatigue, memory loss and problems with concentration. However, the subtle, nonspecific nature of the condition’s initial symptoms can make it difficult to properly diagnose people. One study interviewing members of the Pernicious Anaemia Society found that nearly <a href="https://www.ncbi.nlm.nih.gov/pubmed/24732991">half had been misdiagnosed</a>. A further 20% had waited two years or more for a proper diagnosis. For many, symptoms were initially attributed to a hectic lifestyle or <a href="https://repository.cardiffmet.ac.uk/handle/10369/10769?locale-attribute=cy">diagnosed as anxiety or depression</a>.</p>
<p>Low levels of B12 can lead to nerve damage, as the vitamin is essential to producing myelin, which protects nerve cells from damage. Symptoms of low B12 might initially feel like tingling or numbness in hands and feet, or difficulty with balance. If pernicious anaemia is left untreated, symptoms can become debilitating and nerve damage irreversible. The term “pernicious” was used to describe the condition as historically it resulted in death. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=427&fit=crop&dpr=1 600w, https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=427&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=427&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=537&fit=crop&dpr=1 754w, https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=537&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/298595/original/file-20191024-170449-863v7x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=537&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Regular injections or B12 tablets are essential for managing the condition.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-needle-vials-preparing-inject-vitamin-1083680702?src=ErAAnKRbbKg5LW-HamKy_A-1-1">Kristen Prahl/ Shutterstock</a></span>
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<p>When Vitamin B12 deficiency is caused by poor diet, it’s treated by <a href="https://cks.nice.org.uk/anaemia-b12-and-folate-deficiency">prescribing B12 tablets or injections of hydroxocobalamin</a>. Once the deficiency has been corrected, levels can be managed by changing diet or regularly taking a supplement. </p>
<p>However, treatment is lifelong for people with pernicious anaemia. In the UK, many need frequent injections every 8 to 12 weeks to replace the vitamin. Despite this, many people continue experiencing debilitating symptoms, or find their symptoms return before their next scheduled injection because their treatment hasn’t been sufficient. </p>
<p>When patients raised concerns about insufficient treatment or requested more frequent injections, <a href="https://repository.cardiffmet.ac.uk/handle/10369/10769?locale-attribute=cy">our research found</a> that many health care professionals responded negatively, even questioning the legitimacy of the patient’s illness. These kinds of questions can increase psychological distress and <a href="https://www.ncbi.nlm.nih.gov/pubmed/21977499">impact on quality of life</a>.</p>
<p>Patients with pernicious anaemia also anticipated high levels of health-related stigma. Many people with chronic health conditions fear that their health
status will lead them to be devalued by wider society, or be a source of discrimination. Stigma not only impacts on relationships with health care providers, but can cause <a href="https://www.sciencedirect.com/science/article/pii/S0022399918306111?via%3Dihub">increased incidence of anxiety and depression</a>.</p>
<p>The lack of appropriate guidelines for diagnosis and treatment of pernicious anaemia is problematic and there is an urgent need for this to be reviewed. It is important that both the general public and health professionals have increased awareness of the symptoms that arise from inadequate levels of B12 so that the condition can be diagnosed before long term damage occurs.</p><img src="https://counter.theconversation.com/content/125389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heidi Seage is affiliated with Pernicious Anaemia Society (Research Group Member)</span></em></p>Pernicious anaemia is a lifelong condition that affects nearly 5 in 100,000 people in the UK.Heidi Seage, Senior Lecturer in Psychology, Cardiff Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/947822018-04-13T13:40:02Z2018-04-13T13:40:02ZHarmful genetic mutations may be less common than we thought<figure><img src="https://images.theconversation.com/files/214745/original/file-20180413-566-xfmc1r.jpg?ixlib=rb-1.1.0&rect=844%2C215%2C4868%2C2730&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Vchal / www.shutterstock.com</span></span></figcaption></figure><p>We are all mutants. Every characteristic that defines our species is the result of a genetic mutation somewhere in the <a href="https://theconversation.com/would-standing-on-the-first-butterfly-really-change-the-history-of-evolution-93517">history of evolution</a>. And the same is true for every other organism on the planet. Yet more often than not we think about mutations as bad, leading to disability or disease. So how often are these changes to DNA harmful and how many of them are potentially helpful? A new study suggests that lethal mutations may be much less common than we once thought, at least in bacteria.</p>
<p>Most DNA mutations are caused by mistakes that happen when a cell makes a copy of all its genetic information so it can divide into two new cells. Bacteria such as <em>E. coli</em> have to copy around five million letters of DNA code. For humans, it’s around 3.2 billion DNA letters in eggs and sperm, and double that number in other body cells.</p>
<p>Despite sophisticated systems to detect and repair copying errors as they occur, some occasionally slip through the net. Most result in what are called <a href="https://www.yourgenome.org/facts/what-types-of-mutation-are-there">“point mutations”</a>, as they involve just a single DNA letter change. Yet even these can sometimes lead to big changes, altering genes and the proteins they produce. This in turn can affect the way the body grows or works. </p>
<p>Mutations can drive evolution, if they give an individual <a href="https://theconversation.com/natural-selection-in-black-and-white-how-industrial-pollution-changed-moths-43061">an advantage</a> that means they are more likely to survive to have children and pass on the mutated gene. The chances of random mutations in millions or billions of letters of code being beneficial may seem small. But life on Earth has been around for four billion years so evolutionary timescales are vast.</p>
<p>Yet mutations can also cause serious health problems, some of which may also be inherited. Researchers in France recently tried to work out how often mutations were actually harmful, using <em>E. coli</em> bacteria as a model. Lydia Roberts and her colleagues used an ingenious technique that allowed them to visualise DNA changes that happened while the bacteria were actually dividing.</p>
<p>The usual way to estimate mutation rates in bacteria involves <a href="https://www.the-scientist.com/?articles.view/articleNo/52065/title/Monitoring-Mutations-with-Microfluidics/">growing them on agar plates</a>, plastic dishes containing a nutrient-rich jelly for microbes. But the problem with this approach is that any bacteria that acquire a lethal mutation obviously die, so information about these genetic changes is permanently lost.</p>
<p>To get round this, the French researchers used a tiny chip containing 1,000 microscopic channels, into which liquid nutrient broth is delivered. New cells produced after every cell division remain in the channels, regardless of any harmful mutations that might affect their survival.</p>
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<p>The team then used time-lapse imaging, combined with a fluorescent marker that flashed every time a mutation occurred. This produced impressive <a href="http://www.sciencemag.org/news/2018/03/mutating-dna-caught-film">videos of the multiplying, mutating bacteria</a> reminiscent of the lines of code portrayed in the sci-fi film The Matrix.</p>
<p>The results, <a href="http://science.sciencemag.org/content/359/6381/1283">published in Science</a>, suggest point mutations in bacteria arise at a constant rate of about <a href="http://science.sciencemag.org/content/359/6381/1283">one every 600 hours</a>. To the researchers’ surprise, they also discovered that only around 1% of these DNA changes were lethal to the bacteria – far fewer than previously thought.</p>
<p>It seems that, in bacteria at least, most mutations may not have any effect on survival at all. They are neither “bad” nor “good”, but simply evolutionary bystanders. Researchers working to understand how genetic mutations cause disease in humans are asking similar questions. Results from large projects such as the <a href="https://www.genomicsengland.co.uk/the-100000-genomes-project/">UK’s 100,000 Genomes project</a> should help reveal which mutations cause disease and which are of no consequence. </p>
<h2>Beyond good and bad</h2>
<p>But we also know that categorising mutations as good or bad can sometimes be very difficult. Often it depends on context, for example whether the mutation helps the organism use a particular food source or fight off a disease present during its lifetime. And some mutations can be beneficial if just one copy is inherited, but harmful if two copies are inherited. One example of a gene mutation subject to this kind of “balancing selection” is <a href="https://ghr.nlm.nih.gov/condition/sickle-cell-disease">sickle cell disease</a>.</p>
<p>People with sickle-cell disease have a gene mutation that produces an altered form of haemoglobin, the protein in red blood cells that carries oxygen around the body. The altered haemoglobin produces long sickle-shaped blood cells that can get stuck in small blood vessels. This causes pain in the chest and joints, as well as anaemia, an increased risk of infections and <a href="https://www.nhs.uk/conditions/sickle-cell-disease/">other problems</a>.</p>
<p>Yet despite these potentially devastating health effects, the disease is relatively common in certain countries. An estimated 300,000 infants who inherit two copies of the sickle-cell gene mutation (one from each parent) are born with the disease <a href="http://www.nejm.org/doi/full/10.1056/NEJMra1510865">every year</a>, mostly in Nigeria, the Democratic Republic of the Congo, and India.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214751/original/file-20180413-570-1px4t8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sickle-shaped blood cells.</span>
<span class="attribution"><span class="source">Kateryna Kon / www.shutterstock.com</span></span>
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</figure>
<p>This is because people with one copy of the mutation are <a href="https://www.sciencedirect.com/science/article/pii/S2352304215000239">resistant to malaria</a>, and so are more likely to survive to adulthood and pass the mutated gene on to their children. So even though having sickle disease is an evolutionary disadvantage, unaffected carriers of the gene mutation have a survival advantage in countries where malaria was (or still is) rife.</p>
<p>A recent US study suggests that all people living with the condition today are descended from <a href="http://www.cell.com/ajhg/fulltext/S0002-9297(18)30048-X">a single ancestor who lived around 7,300 years ago</a> in either Sahara or west-central Africa. This shows how a single mutation can spread to many, many individuals in a population if it bestows a significant benefit, even if it also has the potential to do harm. Similarly, <a href="https://www.sciencedirect.com/science/article/pii/S2352304215000239">there is evidence</a> that a single copy of the cystic fibrosis gene mutation may have provided our ancestors with resistance to cholera, and that carriers of Tay-Sachs disease have tuberculosis resistance.</p>
<p>Better understanding of the effects of mutations could play a big role in treating disease. For example, studying mutation rates in different cell types could shed light on how cancer arises in different body tissues. And understanding bacterial mutation rates could help scientists fighting microbes that have evolved <a href="https://theconversation.com/next-time-you-ask-the-doctor-for-some-antibiotics-consider-whether-youre-being-immoral-61100">resistance to antibiotics</a>. This will eventually help usher in a new era of medicine, in which many diseases will be diagnosed and treated with the help of genetic information. And that’s got to be good.</p><img src="https://counter.theconversation.com/content/94782/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jess Buxton is a Trustee of Progress Educational Trust, a UK charity that aims to educate and debate the responsible application of reproductive and genetic science (UK charity number 1139856).</span></em></p>New research shows just 1% of E. coli bacteria’s genetic mutations are lethal.Jess Buxton, Senior Lecturer in Medical Genetics, Kingston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/769812017-05-02T22:01:37Z2017-05-02T22:01:37ZFeeling worn out? You could have iron overload<figure><img src="https://images.theconversation.com/files/167448/original/file-20170502-26313-zixla5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No, not that type of iron overload – haemochromatosis, when your body absorbs too much iron.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/442118806?src=_STvjoIZMwVdZZezu0Copw-1-5&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Feeling a bit tired and worn out? Vague symptoms like these are common in iron deficiency and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anaemia">anaemia</a>. But before you reach for the iron supplements or chow down on steak, these symptoms are common in another condition related to iron. This time the trouble is <em>too much</em> iron, not too little, because of the iron overload disorder called <a href="http://haemochromatosis.org.au/explanation/">haemochromatosis</a>.</p>
<h2>What is haemochromatosis?</h2>
<p>Haemochromatosis is the most common iron storage disease in Australia, the US and most European countries and occurs in about <a href="https://www.ncbi.nlm.nih.gov/pubmed/9138148">one person in 200</a>. It is <a href="https://www.ncbi.nlm.nih.gov/pubmed/23577916">rare in people of Asian descent</a>. </p>
<p>It is a recessive genetic condition, meaning you have to <a href="https://www.niddk.nih.gov/health-information/liver-disease/hemochromatosis">inherited two copies of the haemochromatosis gene</a> (one from each parent). The defect is in the gene that regulates how much iron you absorb from food and supplements. This means that more iron gets into your system than you <a href="https://en.wikipedia.org/wiki/Human_iron_metabolism">need to make red blood cells or to perform other functions</a>. The excess iron ends up in your organs and <a href="https://www.niddk.nih.gov/health-information/liver-disease/hemochromatosis">can damage your heart, liver, pancreas, joint and glands that make hormones</a>. If left untreated, you are at a higher <a href="http://haemochromatosis.org.au/">risk of heart and liver disease, diabetes and arthritis</a>. </p>
<h2>Signs and symptoms</h2>
<p>Symptoms commonly appear in men aged 40-60 years, but appear later in women due to blood loss from menstruation and childbirth.</p>
<p>The most common symptoms are fatigue and joint pain. More advanced symptoms include osteoarthritis, hormonal changes with loss of libido, skin that has a bronze or slate grey colour, heart problems, diabetes (including <a href="http://www.diabetes.co.uk/hemochromatotis-bronze-diabetes.html">bronze diabetes</a>) and liver diseases such as cirrhosis and liver cancer.</p>
<p>It seems confusing that absorbing <em>more iron</em> could lead to fatigue. Iron is needed to make red blood cells that carry oxygen around the body. However, <em>too much</em> iron is toxic. <a href="http://www.mayoclinic.org/diseases-conditions/hemochromatosis/symptoms-causes/dxc-20167290">Excess iron gets deposited in your organs, and this then interferes with normal body functions</a>, as well as the production of hormones that regulate your metabolism and sex drive. Not surprisingly, you don’t feel well. </p>
<h2>Diagnosis and treatment</h2>
<p>Your GP can order a simple blood test to check your iron status. This includes <a href="https://en.wikipedia.org/wiki/Transferrin_saturation">transferrin saturation</a> and <a href="https://en.wikipedia.org/wiki/Ferritin">serum ferritin</a>. If these suggest you could have an iron overload disorder then a gene test will confirm the diagnosis. Once diagnosed, close relatives would also need to be checked for the condition. </p>
<p>The good news is that treatment for haemochromatosis is straight forward and effective. The <a href="https://en.wikipedia.org/wiki/Venipuncture">venipuncture</a> process (similar to becoming a regular blood donor) removes excess iron from the body.</p>
<h2>What do I need to avoid eating and drinking?</h2>
<p>Avoiding eating meat, chicken and fish or becoming a <a href="https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/vegetarian-diets-the-basics/">vegetarian</a> will help reduce the amount of iron you eat and can therefore potentially reduce what your body absorbs.</p>
<p>Other things to avoid are vitamin C supplements and juices high in, or supplemented with, vitamin C. Vitamin C converts the iron from legumes, eggs, nuts, seeds, grains and breakfast cereals into a form that is more easily absorbed, increasing your iron load.</p>
<p>There are many reasons why you could feel fatigued. If you have a lethargy that just won’t lift, see your GP for a check up.</p><img src="https://counter.theconversation.com/content/76981/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p>Feeling tired and out of energy? Talk to your GP about checking your iron level.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/717602017-01-26T13:45:43Z2017-01-26T13:45:43ZNew insights into the complex link between iron supplements and malaria<figure><img src="https://images.theconversation.com/files/154239/original/image-20170125-23838-i2ftr0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Public health campaigns in malaria prone areas should increase.</span> <span class="attribution"><span class="source">Stephen Morrison/EPA</span></span></figcaption></figure><p>Children under five years in Africa are at a higher risk of anaemia as well as being <a href="http://www.ajtmh.org/content/71/2_suppl/25.full">exposed to malaria</a> than children in other parts of the world. Most of this anaemia is due to <a href="http://www.webmd.com/a-to-z-guides/understanding-anemia-basics">iron deficiency</a>.</p>
<p>But treating children for anaemia by giving them iron supplements is fraught with problems. This is because it can lead to children becoming more susceptible to malaria. This is a controversial contention and studies looking at iron supplementation and malaria risk have produced <a href="https://www.ncbi.nlm.nih.gov/pubmed/27566983">conflicting results</a>. </p>
<p>But a new study done at the University of North Carolina’s School of Medicine <a href="https://www.sciencedaily.com/releases/2017/01/170105160212.htm">validates</a> observations about the effect of iron supplements on children’s susceptibility to malaria. It found that children with iron deficiency anaemia who were given iron supplements were at increased risk of malaria. But this effect is transient.</p>
<p>There are <a href="http://www.nhs.uk/Conditions/Anaemia-iron-deficiency-/Pages/Causes.aspx">different causes of anaemia</a>. Iron deficiency anaemia occurs when the body doesn’t have enough iron leading to a decreased number of red blood cells. </p>
<p>Iron supplements, the main treatment regime for iron deficient anaemia, leads to <a href="https://www.nhlbi.nih.gov/health/health-topics/topics/ida/treatment">renewed production</a> of red blood cells. Malaria parasites prefer younger red blood cells and so attack them. This increases malaria parasite multiplication and thus the risk of disease.</p>
<p>The results of the research underscore the fact that children should be offered preventative treatment against malaria if they are being given iron supplements.</p>
<h2>Iron supplementation trials</h2>
<p>These results provide an explanation to findings from a field study by Sunil Sazawal in Pemba Island, Tanzania, involving over 16,000 <a href="https://www.ncbi.nlm.nih.gov/pubmed/16413877">children</a>. The study compared malaria deaths among children with iron deficiency anaemia who were receiving iron supplements and those who weren’t. The study reported a 15% increase in deaths among those who received supplementation and was stopped early.</p>
<p>A number of studies have looked at iron supplementation and malaria risk. A highly respected <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006589.pub4/abstract;jsessionid=3AE771EE49EF3FA859A4ABE10B66F48E.f02t03">Cochrane review</a> published last year by Ami Neuberger and colleagues provided a comprehensive view of the issue after considering over 35 trials that involved 31,955 children. They concluded that in areas where malaria prevention and management are in place, iron supplementation does not affect occurrence of severe malaria disease or death. </p>
<p>Iron supplementation alongside malaria prevention resulted in a 50% drop in clinical malaria.</p>
<p>But in areas with no malaria prevention and management, as in the Sazawal study, iron supplementation may lead to a transient increase in malaria. </p>
<h2>Reducing the malaria burden</h2>
<p>The latest <a href="http://www.who.int/malaria/media/world-malaria-report-2016/en/">World Health Organisation data</a> shows that in 2015, there were about 212 million cases of malaria in the world. About 292,000 children under five years of age died from the disease in sub-Saharan Africa. </p>
<p>It’s estimated that in Kenya there are 6.7 million cases of malaria each year and about 4000 deaths. </p>
<p>But there has been progress. Between 2000 and 2015 cases of malaria in Africa dropped by 42% and mortality by 66%. Effective treatments and <a href="http://www.who.int/malaria/areas/high_risk_groups/children/en/">wider access</a> to treated bed nets are thought to be the main drivers of this reduction.</p>
<p>Better economic growth also plays a part. Wealthier countries are closer to <a href="http://www.scidev.net/global/malaria/news/global-wealth-primed-curb-malaria.html">eliminating malaria</a> than poorer countries.</p>
<p>There is no vaccine available although the RTS,S vaccine is close to being <a href="http://www.malariavaccine.org/malaria-and-vaccines/first-generation-vaccine/rtss">licensed</a>. The World Health Organisation expects it to be rolled out in some African countries <a href="http://www.who.int/immunization/research/development/malaria_vaccine_qa/en/">in 2018</a>.
In the meantime, the race continues for a more efficacious vaccine. Professor Adrian Hill and his team at the University of Oxford are working to improve on RTS,S. </p>
<p>There are likely to be quite a number of vaccine trials in the future and an improved RTS,S is just one of them.</p>
<h2>The way forward</h2>
<p>There is still a lot of work that is needed from the scientific world to bring malaria to its knees.</p>
<p>Researchers continue to gather data on trends in malaria as well as <a href="http://www.who.int/malaria/areas/vector_control/insecticide_resistance/en/">drug and insecticide resistance</a>. Malaria parasites and mosquitoes adapt quickly to whatever control measures are thrown at them so scientists must be <a href="https://www.fic.nih.gov/News/GlobalHealthMatters/january-february-2014/Pages/malaria-drug-resistance-mutation-niaid.aspx">a step ahead</a>.</p>
<p>Scientists continue to conduct research to improve on the insecticides used on bed nets and indoor house spraying. They also have to continue looking for new treatments to ensure that, should resistance to current anti malaria drugs emerge, the world is prepared.</p>
<p>On top of the efforts by scientists there must also be more effort put into awareness campaigns in malaria prone areas. When the RTS,S vaccine is rolled out, parents need to be reminded that the vaccine will not fully protect their children from malaria.</p>
<p>They need to ensure that children continue to sleep under insecticide treated bed nets and that malaria fevers are treated on time. If this is not done, progress in malaria control on the continent may be lost. </p>
<p>And special consideration must be given to the fact that preventative measures are particularly important if iron supplements are being given to children to treat anaemia.</p><img src="https://counter.theconversation.com/content/71760/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tabitha Mwangi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The link between taking iron supplements and the increased risk of contracting malaria is a complex one.Tabitha Mwangi, Senior Lecturer, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/699742016-12-08T02:29:26Z2016-12-08T02:29:26ZWhy iron is such an important part of your diet<figure><img src="https://images.theconversation.com/files/148984/original/image-20161207-25753-1lmyqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Iron is contained in many vegetarian foods, and there are yummy ways to enhance how much you absorb. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/516747673?src=SP9vbt4Ziya_qzzBMJHH1w-3-25&id=516747673&size=huge_jpg">Shutterstock/Uber Images</a></span></figcaption></figure><p>According to the <a href="http://www.who.int/nutrition/topics/ida/en/">World Health Organisation</a>, iron deficiency – a condition where your body doesn’t have enough of the mineral iron – is a global public health problem of “epidemic proportions”. It is the single most prevalent nutrient deficiency in developing and industrialised countries, and the most common cause of anaemia. </p>
<p><a href="http://link.springer.com/article/10.1007%2Fs00277-010-1144-5">Anaemia</a> occurs when our red blood cell count and/or haemoglobin levels are too low, resulting in an inability to transport sufficient oxygen throughout the body. Iron is required in order for haemoglobin to transport oxygen. </p>
<p>This week <a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">Australian Prescriber</a> published an update on the problem of iron deficiency in Australia. Young women, children and disadvantaged groups are at <a href="http://europepmc.org/abstract/med/9076267">highest risk</a>. Around 12-15% of women who are pregnant or of reproductive age and 8% of preschool children in Australia are estimated to have <a href="https://www.mja.com.au/journal/2010/193/9/diagnosis-and-management-iron-deficiency-anaemia-clinical-update?0=ip_login_no_cache%3D5b5ca34fad730a23f7740f2b74d0b0e4">iron deficiency anaemia</a>. Iron deficiency without clinical anaemia is <a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pd">even more widespread</a>. </p>
<p>Although vegetarians and vegans are broadly thought of as being at high risk of iron deficiency due to an absence of red meat in the diet, there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/8172127">little evidence</a> to <a href="https://www.mja.com.au/journal/2013/199/4/iron-and-vegetarian-diets">support</a> this. However restricted diets can confer higher risk if not well balanced, for instance in <a href="https://www.mja.com.au/open/2012/1/2/iron-and-vegetarian-diets">young overweight women</a> who are trying to lose weight.</p>
<h2>Why is iron important?</h2>
<p>Iron has an <a href="http://www.sciencedirect.com/science/article/pii/S0098299700000066">essential role</a> in numerous <a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">metabolic pathways</a> in the body, including transport of oxygen in the blood, DNA synthesis, breathing, immune function and energy production. </p>
<p><a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">Symptoms</a> of iron deficiency include tiredness, neurobehavioural disorders like <a href="http://nutritionreviews.oxfordjournals.org/content/66/10/558.long">attention deficit hyperactivity disorder</a> and <a href="http://www.webmd.com/brain/restless-legs-syndrome/restless-legs-syndrome-rls#1">restless leg syndrome</a> (a nervous system disorder that creates an irresistible and sometimes unbearable urge to move the legs), and cognitive impairment in children. Iron deficiency can have a <a href="http://www.who.int/nutrition/topics/ida/en/">serious impact</a> on health and productivity. </p>
<p>Iron is essential for the developing <a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pdf">brain</a>. Iron deficiency with and without anaemia in infancy can have long term negative impacts on brain function and behaviour, and even when levels are corrected, those effects may not be completely reversed.</p>
<p>Maternal anaemia can result in <a href="http://ajcn.nutrition.org/content/71/5/1280s.short">preterm birth</a>, and along with high blood pressure or diabetes can compromise <a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pdf">fetal iron levels</a> in pre-term or term infants. </p>
<p><a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pdf">Breastfeeding</a> provides adequate iron to meet infant needs up to the age of six months. However from seven to 12 months the requirement for iron increases significantly (up to 11 milligrams per day), and must be provided via solid food in addition to breast milk.</p>
<p>It’s important to understand problems can be caused by both too little as well as too much iron. Hence iron concentrations in the body are <a href="http://www.sciencedirect.com/science/article/pii/S0098299700000066">carefully regulated</a> and professional advice must be sought before supplementing with iron. </p>
<h2>Causes of iron deficiency</h2>
<p>There are <a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">lots</a> of <a href="https://www.mja.com.au/journal/2010/193/9/diagnosis-and-management-iron-deficiency-anaemia-clinical-update?0=ip_login_no_cache%3D5b5ca34fad730a23f7740f2b74d0b0e4">complex</a> causes of iron deficiency and anaemia, and they should be carefully investigated before being addressed.</p>
<p>Poor dietary intake is an important cause of iron deficiency, particularly when requirements are increased during infancy, menstruation and pregnancy.</p>
<p>Iron is one of a number of essential nutrients we need to get through our diet. Iron deficiency is therefore one of <a href="http://www.abc.net.au/news/2016-11-29/resurgence-of-the-rare-condition-of-scurvy-among-diabetics/8073136">several casualties</a> of <a href="http://www.aihw.gov.au/publication-detail/?id=10737422319">poor dietary patterns</a> in Australia and other westernised countries, characterised by excessive intake of highly processed foods and inadequate intake of nutritious whole foods.</p>
<h2>Iron requirements</h2>
<p><a href="https://www.mja.com.au/journal/2013/199/4/iron-and-vegetarian-diets">Dietary iron requirements</a> vary by age and gender. The recommended daily intake (average daily intake that is sufficient to meet the needs of the majority of people) for males varies from eight to 11 milligrams a day for ages one to 18 years, and eight milligrams for all other ages. </p>
<p>Women have higher requirements. For ages 14-50 years, recommended daily intakes range from 15 milligrams (14-18 years) to 18 milligrams a day. Needs are higher during pregnancy, jumping to 27 milligrams per day. However during lactation they are slightly less, at nine to ten milligrams a day.</p>
<p>Iron requirements for vegetarians have been estimated as 1.8 times more than non-vegetarians, however this conclusion was based on <a href="https://www.mja.com.au/open/2012/1/2/iron-and-vegetarian-diets#0_CBBJFGAA">limited research</a>.</p>
<h2>Dietary sources of iron</h2>
<p><a href="http://ajcn.nutrition.org/content/59/5/1233S.long">Dietary iron</a> is obtained in the form of <a href="https://www.mja.com.au/journal/2013/199/4/iron-and-vegetarian-diets">haem iron or non-haem iron</a>. Haem iron sources include red meat, poultry and fish, while non-haem iron comes from a variety of plant foods such as legumes, wholegrains, green leafy vegetables, nuts, seeds, fresh and dried fruit. These plant sources are core components of both vegetarian and vegan diets.</p>
<p>Non-haem iron is believed to be <a href="http://ajcn.nutrition.org/content/59/5/1233S.long">less available</a> than haem iron. This is because plant foods contain substances that can inhibit absorption of iron.</p>
<p>However, vitamin C can enhance non-haem iron absorption thereby counteracting these inhibitory effects. To address this in your diet, you might like to try:</p>
<ul>
<li>eating hummus that contains chickpeas and lemon juice </li>
<li>lemon juice drizzled over Indian dal or <a href="http://helfimed.org/recipes/red-lentil-soup/">lentil soup</a></li>
<li>salads containing high vitamin C sources such as red capsicum or tomato as a side dish</li>
<li>kiwi fruit, strawberries, papaya or a glass of freshly squeezed orange juice with muesli</li>
<li>a side dish of <a href="http://helfimed.org/recipes/steamed-vegies/">lightly steamed</a> broccoli, cauliflower and/or brussel sprouts - good sources of vitamin C – which can be boosted with lemon juice (plus extra virgin olive oil, garlic and salt for ultimate flavour and nutrition)</li>
<li>mixing baby spinach in salads - green leafy vegetables contain iron and vitamin C, a complete package.</li>
</ul>
<p><a href="https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sau11494_fm.pdf">Soaking and sprouting</a> legumes, wholegrains and seeds makes the iron more available from these foods. </p>
<p>It is important to note the absorption of non-haem iron varies considerably, and has been shown to be <a href="http://www.andjrnl.org/article/S2212-2672(16)31192-3/pdf">higher</a> in people who have greater iron requirements. This suggests the body adapts to low iron by increasing its absorption. </p>
<p><a href="http://ajcn.nutrition.org/content/59/5/1233S.long">Vegetarians</a> who follow a balanced diet have been shown to have higher iron intake than that of non-vegetarians and there is <a href="https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sau11494_fm.pdf">little evidence</a> of lower iron status.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Foods such as red meat, spinach, nuts, seeds and legumes are good sources of dietary iron.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/527187667?src=7zaxtIY4FJYErFDQGkGrtw-1-0&id=527187667&size=medium_jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>A table of the iron content of foods commonly available in Australia is provided <a href="https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sau11494_fm.pdf">here</a>.</p>
<p>Iron is an essential nutrient with a range of critically important functions in the body and brain. Assessing iron stores and causes of anaemia is complex and should be performed by a professional. </p>
<p>We can ensure adequate intake of iron by eating a healthy balanced diet with a variety of whole foods including (but not limited to) meat as well as plant sources.</p><img src="https://counter.theconversation.com/content/69974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Parletta (formerly Sinn) has received funding from the Australian Research Council and is currently employed by a National Health & Medical Research Council Program Grant. </span></em></p>Iron deficiency affects more than one in ten Australian women before they reach menopause. Better dietary choices can be part of the solution.Natalie Parletta, Adjunct Senior Research Fellow, Freelance Science Writer, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/671312016-10-19T03:38:57Z2016-10-19T03:38:57ZThe slow climb from innovation to cure: treating anaemia with gene editing<figure><img src="https://images.theconversation.com/files/142099/original/image-20161018-12440-153fy3h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Gene editing technology may soon prevent the formation of sickle-shaped red blood cells in a common and deadly form of anaemia. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-404084629/stock-photo-sickle-cell-anemia-3d-illustration-showing-blood-vessel-with-normal-and-deformated-red-blood-cells.html?src=h15EzG6U1E3CTHGS_nEB4w-1-3">Shutterstock/Uber Images</a></span></figcaption></figure><p>The ability to precisely edit DNA via <a href="https://theconversation.com/explainer-what-is-genome-editing-25072">CRISPR</a> technology has emerged as one of the most powerful advances in biology. A <a href="http://stm.sciencemag.org/content/8/360/360ra134">new paper</a> showing repair of a genetic mutation in human blood cells represents an important step towards treating the common, debilitating and expensive-to-treat blood disease known as <a href="http://www.who.int/mediacentre/factsheets/fs308/en/">sickle cell anaemia</a>. </p>
<p>Gene therapy has been a long time coming. </p>
<p>Other breakthroughs – such as vitamins, antibiotics, and vaccines – were translated into medical remedies very quickly. Advances in diagnosis and the combination of different therapies have gradually improved cancer <a href="http://www.aihw.gov.au/media-release-detail/?id=10737422964">survival rates</a>, and <a href="https://www.eurekalert.org/pub_releases/2015-06/idso-tyo060215.php">HIV</a> can often be controlled with combination therapy.</p>
<p>But inherited genetic mutations that lead to unrelenting and life-long disease have stumped us. It has proved much harder than expected to put replacement genes into cells. Too often our genome seems to recognise the new DNA as foreign and shuts it down. </p>
<p>But <a href="https://theconversation.com/explainer-what-is-genome-editing-25072">CRISPR</a> technology offers a completely new approach. We can now repair a gene, whereas in the past gene therapy involved adding a replacement gene.</p>
<h2>A common, debilitating and expensive disease</h2>
<p><a href="http://www.who.int/mediacentre/factsheets/fs308/en/">Sickle cell anaemia</a> results from a mutation in a gene that encodes haemoglobin – the protein in red blood cells that carries oxygen around our bodies. The mutation not only impairs the function of the protein, but also causes it to aggregate and distort cell shape. This leads to clumps of cells that block blood vessels, with devastating effects. Vital organs are damaged, strokes and episodes of great pain occur, and life span is reduced by around 30 years.</p>
<p>Blood transfusions can help but ultimately excess iron – a key component of haemoglobin – accumulates and tissues are further damaged. Life-long treatments are estimated to cost a <a href="http://science.sciencemag.org/content/352/6289/1059.full.pdf+html">million</a> dollars per patient.</p>
<p>Sadly, this disease is common. Mutations in globin genes are the most prevalent of all single gene disorders. In the US there are around <a href="http://science.sciencemag.org/content/352/6289/1059.full.pdf+html">70,000</a> patients at any given time, and across the world about <a href="http://perspectivesinmedicine.cshlp.org/content/2/9/a011692.full">200,000</a> children with sickle cell anaemia are born each year. The total costs in terms of human suffering and the ultimately ineffective spending on health care is colossal.</p>
<h2>Targeting the mutation</h2>
<p>Researchers led by <a href="http://stemcellcenter.berkeley.edu/JacobCorn.html">Jacob Corn</a> at Berkeley – the home of <a href="http://mcb.berkeley.edu/faculty/all/doudnaj">Jennifer Doudna</a>, a CRISPR pioneer – have introduced several innovations to bring CRISPR therapy for sickle cell anaemia closer to the clinic.</p>
<p>As described in their <a href="http://stm.sciencemag.org/content/8/360/360ra134">newest paper</a>, their basic strategy was to purify immature blood cells (before they lose their nucleus, a normal part of red <a href="https://en.wikipedia.org/wiki/Haematopoiesis">blood cell development</a>), correct the mutation using a CRISPR system, and then graft the cells back into a recipient – in this case a laboratory mouse.</p>
<p>The team developed a number of innovations. They first synthesised all the components of the CRISPR machinery in the lab, then assembled them and delivered the parcel into cells using an electric shock process termed “electroporation”. The parcel contained bespoke molecular tools to find, cut and replace the target mutation in the haemoglobin gene.</p>
<p>The authors targeted the gene-editing parcel to blood cells that subsequently divide and give rise to many generations of blood cells. This feature is essential for long-term treatment, since red blood cells quickly wear out as they are being pumped around our bodies.</p>
<p>Using their technique, the team was able to successfully correct the target gene mutation in about 10% of cells. This might not sound much, but should be enough to have very real clinical benefits for patients.</p>
<h2>How far off is use in the clinic?</h2>
<p>While this work most certainly advances the use of CRISPR for editing human cells, a number of factors limit immediate applicability. </p>
<p>First, this paper concerned the correction of human blood cells that were grafted into laboratory mice. Although the same cells could be re-introduced into human patients, a lot more cells would be required to treat a human, since humans are much bigger than mice. </p>
<p>Also, the choice of “blood progenitor cells” to target is interesting. <a href="https://en.wikipedia.org/wiki/Haematopoiesis">Blood progenitor cells</a> are cells that have begun to develop down the pathway that forms blood. They aren’t self-renewing in the same way immortal <a href="https://theconversation.com/explainer-what-are-stem-cells-14391">stem cells</a> are, so the supply of corrected blood will eventually run out.</p>
<p>It would have been better to use actual blood stem cells and sustain the cell renewal for longer, but those cells are much rarer and are difficult to recover in large numbers from patients. Also, some researchers have struggled to achieve gene correction in blood stem cells, and they wonder if these cells have all the required repair pathways.</p>
<p>Nevertheless, even corrected progenitor blood cells could be effective over reasonable periods, so this could represent a new treatment if not a cure.</p>
<h2>Ethical and political factors</h2>
<p>When considering this work it is worth noting that we are talking about correcting blood cells. This is quite different from <a href="http://link.springer.com/article/10.1007/s13238-015-0153-5">earlier work</a> by a separate team that used donated, non-viable human embryos for their research. </p>
<p>Previous CRISPR experiments focused on the use of gene editing to change the genome of the entire body, which would be included in the eggs or sperm of any offspring if it came to fruition. Such gene therapy remains <a href="https://ghr.nlm.nih.gov/primer/therapy/ethics">highly controversial</a> and is considered unethical by many – partly because it could affect future generations who cannot consent to the treatment. </p>
<p>The work on blood progenitor cells is called “somatic” gene therapy, because only somatic or body cells are altered, and this is widely accepted as appropriate. </p>
<p>Beyond the important ethical considerations, will expensive treatments like this actually enter the clinic? </p>
<p>In America, yes they may. With strong investment in medical companies and health care insurance processes it could be <a href="http://science.sciencemag.org/content/352/6289/1059.full.pdf+html">cost effective</a> in the USA. </p>
<p>In other developing countries it could be much harder. Consequently, a great many laboratories – including <a href="http://www.crossleylab.unsw.edu.au/">my own</a> – continue to work on understanding the fundamental biology of the haemoglobin gene. The goal is to find affordable drugs that could treat the disease and could be made available throughout the world.</p><img src="https://counter.theconversation.com/content/67131/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merlin Crossley for the University of New South Wales (UNSW) and receives funding from the National Health and Medical Research Council for work related to Sickle Cell Disease, and also receives funding from the Australian Research Council. He is a Trust Member of the Australian Museum, Board Member of the Sydney Institute of Marine Science, the Australian Science Media Centre (AusSMC) and on the Editorial Board of The Conversation in Australia.</span></em></p>A new study has advanced the use of a technique known as ‘CRISPR’ to treat a common inherited form of anaemia.Merlin Crossley, Deputy Vice-Chancellor Education and Professor of Molecular Biology, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/666862016-10-09T17:11:09Z2016-10-09T17:11:09ZPeople in Africa are living longer but lifestyle diseases are rising<figure><img src="https://images.theconversation.com/files/140886/original/image-20161007-21433-gtd4oc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The age profile of people living in Africa is changing - they are living longer.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Malaria, HIV, pneumonia, and diarrhoea are the leading killers on the African continent, according to a recently <a href="http://www.thelancet.com/gbd">released study</a> looking at the burden of diseases across the world. In 1980 the list looked different. Then the leading killer diseases were also diarrhoea, pneumonia and malaria, but tuberculosis and measles were up there with them. </p>
<p>The good news is that people in Africa are living longer. The bad news is that non-communicable diseases like diabetes, cardiovascular disease and cancer are wreaking havoc. </p>
<p>Our study on the <a href="http://www.thelancet.com/gbd">Global Burden of Disease</a> measured which health problems have had an impact on populations. The information was collected by more than 1800 researchers from more than 120 countries.</p>
<p>It shows that sub-Saharan Africa is going through an epidemiological transition. This means that as countries increase their levels of development, their communicable disease burdens are declining and their life expectancies are rising – but that the burden of non-communicable diseases and injuries are rising.</p>
<p>There are more than <a href="http://www.worldometers.info/world-population/africa-population/">1.2 billion people</a> living in Africa. The continent makes up 16% of the world’s population. Just under 40% of the population live in urban areas and the average age is about 19.</p>
<p>Just over 8 million people died in sub-Saharan Africa in 2015. More than half of these deaths was due to malaria, HIV/AIDS, maternal and child diseases, anaemia and malnutrition. And more than a third of the deaths were due to cardiovascular diseases and cancer. </p>
<h2>Improvements in life expectancy</h2>
<p>Compared to 15 years ago, people on the continent are now living longer.
Life expectancy for both men and women has increased from 52 years in 1980 to <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31012-1/fulltext">62 years in 2015</a>. Life expectancy is a measure of the average time people are expected to live, based on the year of their birth and other factors such as their sex.</p>
<p>These gains were largely as a result of decreases in deaths caused by malaria, HIV/AIDS, and childhood vaccine-preventable diseases such as measles, pneumonia and diarrhoeal diseases.</p>
<p>Women still have a longer life expectancy than men and gains in life expectancy have generally been gradual but steady. There are wide variations between regions on the continent. In southern Africa, for example, the life expectancy dropped from 57.3 years in 1980 to 50.8 years in 2005 but bounced back to 60.4 years in 2015. By comparison, in both west and east Africa, the life expectancy has consistently increased from 1980 to 2015. </p>
<p>Dramatic events such as the Ethiopian drought and famine in 1983/1984, the Rwandan genocide in 1994, and the HIV epidemic – especially in southern Africa – had catastrophic effects on longevity in Africa.</p>
<h2>Top 10 killers</h2>
<p>Looking at the sub-regions more specifically there are some similarities and differences.</p>
<p>For example, HIV/Aids was the leading killer in both South Africa and Kenya. In Nigeria the leading killer was malaria.</p>
<p>In South Africa, ischemic heart disease and tuberculosis were also major killers. But in Nigeria and Kenya, diarrhoeal diseases and pneumonia were among the top killers. </p>
<p>What our study shows, however, is that the diseases that kill people are not typically those that make them sick. This differed by region. For example, in South Africa diabetes was highest on the list of diseases that made people sick, in the other countries iron-deficiency anaemia, neglected tropical diseases and depression were responsible.</p>
<p>The 10 leading causes of health loss, which is measured in years lived with disability, were iron-deficiency anaemia, low back and neck pain, depression, sense organ diseases (including hearing loss and vision loss), skin and subcutaneous diseases, neglected tropical diseases, headaches, HIV, asthma, and malaria. </p>
<h2>Child deaths</h2>
<p>Another important focus over the last 15 years has been a reduction in the number of child deaths across the globe where great progress was made between 1990 to 2015.</p>
<p>This was partly due to the focus on child survival interventions such as <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001405">immunisation</a> which have started to reap rewards.</p>
<p>By 2015, child mortality in many countries in sub-Saharan Africa was lower than expected given the current levels of development. It was reduced from over 850 000 deaths in 1990. In some parts of the continent the gains have been significant but in others it’s been slow. </p>
<p>Between 1990 and 2015 South Africa nearly halved the number of children under five that died. But Kenya only managed to reduce deaths by a tenth while Nigeria brought down the number by a quarter. In Kenya the reduction reveals some progress but the country still falls behind many other East African nations.</p>
<h2>Making informed health decisions</h2>
<p>The study’s observations are important in the context of achieving the <a href="https://theconversation.com/a-novel-global-scoring-system-shows-africa-falling-behind-on-health-goals-65861">sustainable development goals</a>.</p>
<p>Policy-makers need the <a href="http://www.panafrican-med-journal.com/content/article/24/180/full/#.V_a_uclInM4">best available evidence</a> to make informed health policy decisions and to determine how to allocate resources.</p>
<p>Some countries in sub-Saharan Africa face significant health challenges despite improvements in income and education, while other countries further behind in terms of development are seeing strong progress. </p>
<p>Policymakers in all nations – from Senegal to South Africa and Equatorial Guinea to Eritrea – need to align spending to target the things that will make their communities healthier faster.</p><img src="https://counter.theconversation.com/content/66686/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Charles Shey Wiysonge does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The burden of communicable disease is declining in Africa and life expectancy is increasing. But non-communicable diseases like diabetes, cardiovascular disease and cancer are wreaking havoc.Charles Shey Wiysonge, Professor of Clinical Epidemiology at the Faculty of Medicine and Health Sciences, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/660752016-10-04T19:15:38Z2016-10-04T19:15:38ZMaternal malnutrition affects future generations. Kenya must break the cycle<figure><img src="https://images.theconversation.com/files/140275/original/image-20161004-20213-18d7eqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A mother and her son at a nutrition clinic in Kenya. Adequate nutrition for mothers is important for the health of their children.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/kuap-pandipieri/17055944318/in/album-72157649672274083/">KUAP Pandipieri</a></span></figcaption></figure><p>Nutrition of women before and during pregnancy and when breastfeeding is critical in determining the health and survival of the mother and of her unborn baby. </p>
<p>Undernourished pregnant women have higher reproductive risks. They are more likely to experience <a href="http://www.care.org/sites/default/files/documents/MH-2013-Maternal-Nutrition-Maternal-and-Child-Health.pdf">obstructed labour</a>, or to die during or after childbirth. Poor nutrition in pregnancy also results in babies growing poorly in the womb and being born underweight and susceptible to diseases. These mothers also invariably produce <a href="http://www.care.org/sites/default/files/documents/MH-2013-Maternal-Nutrition-Maternal-and-Child-Health.pdf">low quality breast milk</a>.</p>
<p>Maternal malnutrition has inter-generational consequences because it is cyclical. Poor nutrition in pregnancy is linked to undernourishment in-utero which results in low birth weight, pre-maturity, and low nutrient stores in infants. These babies end up stunted and, in turn, give birth to low birth weight babies. Optimal maternal nutrition is therefore vital to break this inter-generational cycle. </p>
<p>In Kenya, women’s nutritional needs during pregnancy has not received much attention. This has exposed a gap in efforts to improve maternal and child health. </p>
<p>Our <a href="http://kemri.org/dmdocuments/KEMRI%20Study%20Brief.pdf">study</a> at the Kenya Medical Research Institute looked at micronutrient deficiencies among pregnant women in Nairobi. The study found that close to 20% of women had anaemia and just over a third had iron deficiency. </p>
<p>Nearly a third of women had zinc deficiency. About 21% of the women had a combination of two to three deficiencies. The most common - in two thirds of the women - was the combination of iron and zinc deficiencies. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23661841">Studies</a> show that women with zinc deficiency are more likely to develop anaemia during pregnancy. Anaemia contributes to <a href="http://www.who.int/nutrition/topics/ida/en/">20% of all maternal deaths</a>, poor pregnancy outcomes and impaired physical and cognitive development in children.</p>
<h2>A continental problem</h2>
<p>Micronutrient deficiencies are common across sub-Saharan Africa.</p>
<p>About <a href="http://www.who.int/nutrition/topics/ida/en/">2 billion people</a> – or more than 30% of the world’s population – are anaemic due to iron deficiency. In developing countries, this translates into every second pregnant woman. About <a href="http://www.who.int/nutrition/topics/ida/en/">40% of preschool children</a> are anaemic. In resource-poor areas, anaemia is exacerbated by infectious diseases such as malaria, HIV/AIDS, hookworm infestation, schistosomiasis (snail fever) and other infections like tuberculosis.</p>
<p>The continent also has the highest prevalence of vitamin A deficiency globally with about <a href="https://data.unicef.org/topic/nutrition/vitamin-a-deficiency/">48% of children</a> between the ages of six months and five years affected. Vitamin A can be found in foods such as sweet potatoes, carrots and dark leafy green vegetables. But food insecurity and problems of bio-availability have resulted in vitamin A deficiency. This often leads to preventable childhood blindness. </p>
<p>Vitamin D deficiency is also <a href="http://www.samj.org.za/index.php/samj/article/view/10070/6859">extremely common</a> despite the fact that Africa has a great deal of sunlight. This results in bone pain and muscle weakness. Insufficient vitamin D affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/">almost half</a> of the world’s population. </p>
<p>From the study, more than half of the women had vitamin D deficiency while only 1% had vitamin A deficiency. </p>
<h2>Lacking the essential micronutrients</h2>
<p>Being undernourished in the womb increases the risk of death in the early months and years of a child’s life. While a baby’s weight at birth is a strong indicator of maternal and newborn health and nutrition, <a href="http://data.unicef.org/topic/nutrition/low-birthweight/">about 13% of infants</a> in sub-Saharan Africa are born with low birth weight. </p>
<p>Those who survive tend to have increased risk of disease. They are likely to remain undernourished, with reduced muscle strength and cognitive abilities throughout their lives. As adults, they suffer a <a href="http://data.unicef.org/topic/nutrition/low-birthweight/">higher incidence of diabetes and heart disease</a>.</p>
<p>It’s crucial that pregnant women get adequate micronutrients. If it is not addressed, there will be little progress made in promoting maternal and child health in Kenya. </p>
<h2>Changing the cycle</h2>
<p>Women in Nairobi have some access to resources and are likely to attend antenatal care. It is therefore possible that the micronutrient deficiency burden may be higher in rural areas where the health system infrastructure and capacity is limited. </p>
<p>What is clear is that there is an urgent need to address the issue of micronutrient deficiencies in pregnancy. We suggest the scaling-up of proven interventions that promote healthy pregnancies and improved pregnancy outcomes. This includes enhanced nutrition education and services in antenatal care. </p>
<p>These efforts should be complemented by other supporting interventions such as reduction of malaria infection; reduction of hookworm infection; birth spacing; decreased workload or rest during pregnancy. </p>
<p>Efforts geared at addressing maternal nutrition must be broad enough to encompass the pre-conception period, the pregnancy and after pregnancy – including the period of breastfeeding – to ensure safer and more optimal birth outcomes.</p><img src="https://counter.theconversation.com/content/66075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Echoka receives funding from Kenya Medical Research Institute. </span></em></p><p class="fine-print"><em><span>Lydia Kaduka receives funding from Kenya Medical Research Institute. </span></em></p>In Kenya, not much attention has been paid to addressing pregnant women’s nutritional needs. This has exposed a gap in efforts to improve maternal and child health.Elizabeth Echoka, Senior Researcher, Kenya Medical Research InstituteLydia Kaduka, Senior Research Officer at Centre for Public Health Research , Kenya Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/639642016-08-23T19:18:22Z2016-08-23T19:18:22ZHow Vitamin A, iodine and iron play a part in beating malnutrition<figure><img src="https://images.theconversation.com/files/135194/original/image-20160823-30231-cuouzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As incomes in developing countries rise people have moved towards eating food that is easy and fast to prepare – convenience foods. This processed food is often energy-dense and high in saturated and trans fats, sugars, salt and cholesterol. </p>
<p>This change in eating habits is known as a nutrition transition and it’s leading to increased health challenges, particularly in developed countries. As a result nutritionists and food system analysts across the globe are paying special attention to changes in the types and amounts of food that people consume, their exercise patterns and the affects of these lifestyles on their health.</p>
<p>What’s emerged is a focus on the “triple burden” of malnutrition – an energy deficiency from consuming too little food, the nutrient deficiencies from consuming food that doesn’t have essential micronutrients and an excessive net energy intake resulting in overweight and obese people.</p>
<p>While energy deficiency is a topic that gets most attention, and over-nutrition has also been <a href="https://theconversation.com/nutrition-may-be-as-big-a-challenge-today-as-hiv-aids-was-15-years-ago-64208">discussed</a> deficiencies in micronutrients are often less well understood. This is a problem because micronutrient deficiencies in vitamin A, iron, zinc, folate and iodine remain high, increasing a range of health risks. These include:</p>
<ul>
<li><p>dying during childbirth;</p></li>
<li><p>children having an increased risk of dying from common childhood illnesses such as diarrhoea; </p></li>
<li><p>childhood blindness; and,</p></li>
<li><p>the impairment of children’s physical and cognitive development.</p></li>
</ul>
<h2>Sub-Saharan Africa: worst in the world</h2>
<p>Sub-Saharan Africa has the highest prevalence of vitamin A deficiency in the world. About 48% of children between the ages of six months and five years suffer from this deficiency. Vitamin A deficiency is the leading cause of preventable childhood blindness. Vitamin A can be found in foods such as sweet potatoes, carrots and dark leafy green vegetables. </p>
<p>Iodine deficiency is easily preventable through the fortification of food, including salt. But in 2011 <a href="http://kan-kaz.org/english/files/J.Nutr_2012.pdf">321 million people in Africa</a> had an insufficient iodine intake, and seven of the top 10 iodine-deficient countries with the greatest numbers of school age children with insufficient iodine intake were from Africa.</p>
<p>In addition iron deficiency, which is the most common and widespread nutritional disorder in the world, affects a large number of children and women in developing countries. It is also significantly prevalent in the developed world. About 2 billion people – more than 30% of the world’s population – are anaemic. Many of these cases are due to iron deficiency. </p>
<p>In resource-poor areas, it is exacerbated by infectious diseases such as malaria, HIV/AIDS, hookworm infestation, <a href="http://www.who.int/mediacentre/factsheets/fs115/en/">schistosomiasis (snail fever)</a>, and other infections such as tuberculosis.</p>
<p>According to the World Health Organisation, in developing countries every second pregnant woman and about <a href="http://www.who.int/nutrition/topics/ida/en/">40% of preschool children</a> are estimated to be anaemic.</p>
<p>Anaemia contributes to 20% of all maternal deaths. Other major health consequences include poor pregnancy outcomes, impaired physical and cognitive development in children and increased risk of dying as well as reduced work productivity in adults. </p>
<h2>Its not all bad</h2>
<p>Some progress has been made in developed as well as developing countries.</p>
<p>Changes in technology, better diets and improved access to food has resulted in <a href="http://www.scidev.net/global/r-d/feature/can-technology-rescue-women-farm-workers-from-drudgery--1.html">many benefits</a>. This includes improved maternal and child health, the reduction of drudgery in the preparation of food, greater time for work or for leisure, and growth in both the food processing and distribution sectors. </p>
<p>In Africa the prevalence of under-nutrition, where people have a level of food intake that is insufficient to meet dietary energy requirements, has declined from 33% in 1990-1992 to 23% in <a href="http://www.fao.org/3/a-i4635e.pdf">2014-2016</a>. </p>
<p>Although food availability in sub-Saharan Africa has increased by nearly 12% over the past <a href="http://www.fao.org/3/a-i4635e.pdf">two decades</a> implying that more people have more food on their plates, the total number of undernourished people continues to increase. The figure sits at <a href="http://www.fao.org/3/a-i4635e.pdf">an estimated 220 million</a>. </p>
<p>In South Africa the situation is better than the rest of the continent. Only about 5% of the population is under-nourished. But this hasn’t improved since 1991, suggesting there is plateau that may need more than increases in food availability if under-nutrition is to be eliminated.</p>
<p>One way to gauge under-nutrition is to look at the rates of stunting. Children who are stunted are shorter than the expected height for their age by the time they are five. The prevalence of stunting has reduced only marginally in sub-Saharan Africa from 41% in 1990 to 35% in <a href="https://www.aho.afro.who.int/en/publication/1786/african-regional-health-report-2014-health-people-what-works">2012</a>. </p>
<p>There are countries on the continent that are doing well in terms of reducing under-nutrition. For example, Ethiopia reduced the prevalence of stunting from 57% in 2000 to 44% in <a href="https://www.aho.afro.who.int/en/publication/1786/african-regional-health-report-2014-health-people-what-works">2011</a>. Similarly in Ghana stunting has fallen from 35% in 2003 to 28% in 2011.</p>
<p>South Africa’s challenge is that although its stunting rate is lower, at 25%, the prevalence is nearly double what’s expected from a country with its economic wealth.</p>
<h2>Solving the problems</h2>
<p>Improving access to food is obviously key. But trends in childhood malnutrition suggest that more is needed than simply increasing the quantity of food consumed.</p>
<p>The challenge is that food has moved from being mostly produced on family farms and sold through fresh produce markets and small business to industrialised production, ultra-processing, mass distribution and globalised trade. This points to the need to fix flaws across the board, from how food is manufactured and distributed, to nutrition and health systems. </p>
<p>Addressing micronutrient deficiencies needs specific interventions. These include the fortification of food and promoting greater dietary diversity.</p><img src="https://counter.theconversation.com/content/63964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian May receives funding from the National Research Foundation for the DST-NRF Centre of Excellence</span></em></p>Micronutrient deficiencies are not well understood as an aspect of malnutrition. The problem is that such deficiencies increase a range of health risks.Julian May, Director DST-NRF Centre of Excellence in Food Security, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/499212015-10-30T04:20:01Z2015-10-30T04:20:01ZLessons other countries can learn from Kenya’s ambitious nutrition plan<figure><img src="https://images.theconversation.com/files/100239/original/image-20151029-15358-s0odhi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kenya's nutrition plan has resulted in dramatic improvements in its nutrition targets. </span> <span class="attribution"><span class="source">Reuters/Mohamed Nureldin Abdallah </span></span></figcaption></figure><p>One in every three people globally suffers from malnutrition. And nearly half of all countries in the world face multiple serious burdens of malnutrition such as poor child growth, micronutrient deficiency and overweight adults, according to the <a href="http://ebrary.ifpri.org/utils/getfile/collection/p15738coll2/id/129443/filename/129654.pdf">2015 Global Nutrition Report</a>. </p>
<p>Three years after the World Health Assembly set the 2025 goals to improve undernutrition, countries across the globe have scaled up their programs to address malnutrition. The 2015 nutrition report reveals this is not nearly enough to meet the assembly’s targets.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=650&fit=crop&dpr=1 600w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=650&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=650&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=817&fit=crop&dpr=1 754w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=817&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/100174/original/image-20151029-15338-92ahs4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=817&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">WHO</span></span>
</figcaption>
</figure>
<p>The targets are to:</p>
<ul>
<li><p>reduce stunting in children under the age of five by 40%;</p></li>
<li><p>reduce anaemia in women of reproductive age by 50%;</p></li>
<li><p>reduce low birth weights by 30%;</p></li>
<li><p>reduce and maintain childhood wasting to 5%;</p></li>
<li><p>improve exclusive breastfeeding to 50%; and </p></li>
<li><p>ensure there is no increase in overweight children. </p></li>
</ul>
<p>Out of 74 countries that were analysed for the report, Kenya is the only country that is on track to meet all five targets by 2025. This is mainly based on its achievements in the last few years.</p>
<p>Kenya has reduced stunting to 26%. Its low birth weights are down to 5.6% and it has improved exclusive breastfeeding to 61.4%. Childhood wasting and obesity both sit at 4% and anaemia in women of reproductive age has been reduced to 25%.</p>
<p>Of the remaining 73 countries, only four others – Colombia, Ghana, Vanuatu and Vietnam – are on course for four targets.</p>
<p>So what is Kenya doing right, and how can it continue with its progress?</p>
<h2>A bold plan</h2>
<p>Kenya’s <a href="http://bit.ly/1G8RVz8">National Nutrition Action Plan 2012-2017</a> has been central to it combating malnutrition. There are several elements that have led to the strategy being successfully implemented. </p>
<p><strong>Strong government leadership and co-ordination</strong></p>
<p>A Nutrition Interagency Co-ordinating Committee, which was formed and is chaired by the government’s head of nutrition, has resulted in well-co-ordinated structures that implement actions around nutrition. Within these structures, all the stakeholders both inside and outside the government have clear roles and responsibilities. </p>
<p>The committee includes a network of government ministries: Health, Education, Agriculture, Planning, Labour as well as United Nations agencies, civil society, academic and research institutions, the private sector and multilateral and bilateral donors.</p>
<p>A budget of US$687 million (KES70 billion) was drawn, and the Kenyan government committed a total of US$58 million (KES6 billion) of public funds to the five-year plan.</p>
<p>Kenya has also forged international partnerships to boost the plan. Since 2012 it has been part of the global <a href="http://scalingupnutrition.org/">Scaling Up Nutrition</a> movement. The movement is made up of 55 countries committed to improving their nutrition figures. This has helped to develop an approach that works across sectors to implement nutrition-specific and nutrition-sensitive interventions and strategies. </p>
<p><strong>Support from donors</strong></p>
<p>Kenya’s network of development partners, which include the UN system and bilateral donors such as the European Union, the US, Japanese and UK governments and the World Bank, are all making commitments to support the national nutrition initiative. </p>
<p><strong>Good monitoring and research</strong></p>
<p>And to measure progress around the nutrition indicators, Kenya has incorporated strong monitoring and research and information management and sharing. It has guided how the nutrition plan is implemented and overseen by a nutrition information working group in the health ministry.</p>
<p><strong>Improved human resources for health</strong></p>
<p>The government and its implementation partners have increasingly enhanced the capacity of the healthcare staff. They support nutrition counselling by training healthcare workers on high-impact nutrition interventions such as importance of infant and young child feeding.</p>
<h2>The impact of policy changes</h2>
<p>The <a href="http://bit.ly/1G8RVz8">National Nutrition Plan</a> is part of a roadmap to success, called <a href="http://www.vision2030.go.ke/index.php/vision">Kenya Vision 2030</a>. Along with the nutrition plan, it draws on other strategies and policies:</p>
<ul>
<li><p>the maternal infant and young child nutrition 2012-2017 strategy; and </p></li>
<li><p>The <a href="http://bit.ly/1NsvuqF">Food and Nutrition Security Policy</a>.</p></li>
</ul>
<p>The infant nutrition strategy makes sure high-impact, cost-effective nutrition interventions like promoting breastfeeding and other maternal, infant and young child nutrition practices are implemented at health facilities in communities.</p>
<p>Along with Kenya’s newly promulgated <a href="http://www.lcil.cam.ac.uk/sites/default/files/LCIL/documents/transitions/Kenya_19_2010_Constitution.pdf">constitution</a>, the roadmap has brought positive changes to improve the Kenyan people’s health status.</p>
<p>One of these changes is a free maternity policy, which encourages more deliveries at health facilities. This has increased the number of babies born with a trained attendant at a facility from 43% in 2008 to 61% in 2014, based on the recent <a href="http://bit.ly/1ONxyws">national survey</a>. </p>
<p>Birthing at a facility results in care for the mother and baby after birth before going home. Mothers are taught how to adequately breastfeed and are counselled on family planning and babies get the required vaccinations.</p>
<p>Another change is the recently enacted <a href="https://extranet.who.int/nutrition/gina/sites/default/files/KEN%202012%20Thre%20Breast%20Milk%20Substitutes%20Regulation%20and%20Control%20Bill,%202012%20Arrangement%20of%20Clauses_0.pdf">Breast Milk Substitutes (Regulation and Control) Act</a>. The act protects, promotes and supports breastfeeding. Better breastfeeding practices leads to better child growth, development and survival.</p>
<h2>What next?</h2>
<p>Kenya is on track to achieve these highly ambitious but critically important global nutrition <a href="http://bit.ly/1KcGicQ">targets</a>. But more needs to be done.</p>
<p>Despite the strong commitment by the Kenyan government to raise close to 10% of the budget to implement the national nutrition plan, more government resources are critical to ensure success.</p>
<p>Although co-ordination is strong, there are still some gaps that need to be addressed, particularly around convening powers. To address these, discussions are underway to establish a Multi-sectoral Food Security and Nutrition Secretariat and a Nutrition Technical Committee. The secretariat would fall under the office of the oresident while the technical committee under the cabinet secretary for health.</p>
<p>A systematic investigation of the success factors is needed to ensure the entire country is on track to achieve these targets. But the championing of optimal nutrition is universal. </p>
<p>With sustained investment, sustainable progress towards our goal as a nation to ensure a high quality of life for everyone – beginning with the first day of their lives can be achieved.</p>
<p>As Kenya marks National Nutrition Week, promoting good nutrition as a human right, the Kenyan government must increase its support to the national nutrition plan to ensure that every child born in Kenya has a healthy start. </p>
<hr>
<p><em>Betty Samburu, programme manager at the maternal infant and young child nutrition programme within the Kenyan Ministry of Health; Marjorie Voleje from UNICEF and SUN Movement and nutritionist Grace Gitau also contributed to this article.</em></p><img src="https://counter.theconversation.com/content/49921/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Kimani-Murage previously received funding from the Wellcome Trust and is currently funded by PEER Health and Transform Nutrition. She works for the African Population and Health Research Center. She is affiliated with the Global Nutrition Report, Brown University and Glasgow University. </span></em></p>Over the last three years Kenya has seen marked improvements in its nutrition-related targets as a result of a national nutrition plan it has implemented.Elizabeth Kimani-Murage, Senior Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413392015-05-11T05:44:48Z2015-05-11T05:44:48ZBleed me: why excess iron can be dangerous<figure><img src="https://images.theconversation.com/files/80691/original/image-20150506-10953-e13tkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's good for you.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-152567954/stock-photo-blood-donor-at-donation-with-a-bouncy-ball-holding-in-hand.html?src=3_mXm_4Szh-PBk_fsHAVgw-2-15">Blood donation via www.shutterstock.com.</a></span></figcaption></figure><p>Iron is a most versatile element. It is essential to many of the enzymes that are the engines for life, and in mammals is also used to carry oxygen on hemoglobin in blood. Remember <a href="http://www.thekitchn.com/why-did-popeye-eat-so-much-spinach-the-surprising-answer-191802">Popeye and his spinach</a>: all that iron made him strong. </p>
<p>But the very quality that makes iron so useful also makes it dangerous. Iron can easily lose or gain one electron going from the ferrous (Fe++) to the ferric (Fe+++) state, back and forth indefinitely. This is how it carries oxygen, for example. </p>
<p>It also means it can be a potent pro-oxidant – it catalyzes the production of free radicals which can destroy cells and tissue, and thereby contribute to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1567854/">cancer and heart disease</a>. </p>
<p>Life forms like us have developed extensive defense mechanisms that allow us to use iron for life’s work while keeping it away from anywhere it is not immediately needed within cells and in the body in general.</p>
<h2>Iron fortification sweeps the world</h2>
<p>Severe iron deficiency is a health problem in much of the world, but in the US it is uncommon. </p>
<p>The recommended daily allowance for adult men is about <a href="http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/#h2">8mg per day</a>, and for adult women under 50 it is about 18mg per day (for pregnant women 27mg per day is recommended). Recommended daily allowances are higher for vegetarians. Most Americans get all the iron they need from their diet. And some foods are supplemented with iron. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80722/original/image-20150506-10922-pqu74a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many foods, including bread, are enriched with iron.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-166231535/stock-photo-sliced-bread-in-plastic-bag-isolated-on-white.html?src=dFLUzBjrwEEQW09pwJgtJA-1-12">Loaf via www.shutterstock.com.</a></span>
</figcaption>
</figure>
<p>During the first half of the 20th century, both medical and public health forces began to aggressively promote iron fortification of food to fight iron-deficiency anemia, particularly in the developing world where the problem was most acute and as much as <a href="http://whqlibdoc.who.int/publications/2008/9789241596657_eng.pdf">half the population</a> of some areas fit the definition of anemia. </p>
<p>Of the many harmful effects of severe iron deficiency perhaps of greatest concern are the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266848/">developmental problems in children</a>. </p>
<p>Severe iron deficiency is harmful, but that isn’t the whole story.</p>
<p>Researchers found that Somali nomads who ate iron restricted diets (very low in meat, but rich in dairy) had lower prevalence of infectious diseases than those <a href="http://www.ncbi.nlm.nih.gov/pubmed/7445536">that ate more meat</a>. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=776&fit=crop&dpr=1 600w, https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=776&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=776&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=975&fit=crop&dpr=1 754w, https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=975&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/80728/original/image-20150506-10947-1gnwtcr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=975&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A source of non-heme iron.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-151636469/stock-photo-fresh-harvested-spinach-on-a-old-grungy-table.html?src=YpPIxoYSCqGeboThtbohDw-1-59">Spinach via www.shutterstock.com</a></span>
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<p>Dietary iron falls into two categories: heme iron which is easily absorbed from our gut, and non-heme iron which is not absorbed nearly as well. Iron from plants and dairy products is almost entirely non-heme, whereas, of course, red meat contains a lot of heme iron. </p>
<p>Almost all infectious agents including bacteria, fungi, and protozoa that cause disease require iron for their growth. They have developed proteins called siderophores that scavenge iron from their human hosts so they can <a href="http://www.sciencedirect.com/science/article/pii/S0304416508001451">thrive and multiply</a>. One defense mechanism we have against a bacterial infection is to develop a fever; this is because siderophores don’t work at temperatures above 104 F, whereas they work very well at our normal body temperature of 98.6 F. </p>
<h2>‘Fortification’ or adulteration?</h2>
<p>For a long time iron was sacrosanct as a nutrient: if a little is good, then more must be better. </p>
<p>This was the worldwide mantra to fight iron-deficiency anemia. Food was iron “fortified” as much as possible. For example, widespread fortification of flour in the United States <a href="http://web1.sph.emory.edu/users/hpacho2/PartnershipsMaize/Bishai_2002.pdf">began in the 1930s</a>.</p>
<p>The tipping point for the iron fortification debate came in 1978 when an eminent physician and scientist named William Crosby published a paper in the Journal of the American Medical Association called <a href="http://jama.jamanetwork.com/article.aspx?articleid=1722212">The Safety of Iron-Fortified Food</a>. </p>
<p>He argued that although there are some groups at risk of anemia such as pregnant women, adding iron to the food supply in general exposes many who are not at risk of iron deficiency, and who might therefore be harmed.</p>
<p>It was a provocative idea at the time. And it was taken seriously because of who he was: a World War II veteran who received a Bronze Star, a scientist with over 300 scientific publications to his name who had established hematology and oncology specialties at Walter Reed Army Hospital in the early 1950s. </p>
<p>Evidence of potential harm came the same year Crosby’s paper came out. In 1978 Researchers in Sweden found increasing rates of <a href="http://www.ncbi.nlm.nih.gov/pubmed/642130">early-stage hemochromatosis among men</a>. </p>
<p>Hemochromatosis is an iron overload condition that in its later stages kills by heart attack or cancer. Further studies in Sweden suggested that iron fortification <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.0954-6820.1983.tb03706.x/abstract;jsessionid=7B3494D6ECAD1746509488B14102FD66.f03t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false%20genetic%20hemechromoatosis">was harmful</a> for people with genetic hemochromatosis. Iron fortification of food in Sweden was the highest in the world until it was <a href="http://www.nature.com/ejcn/journal/v51/n11/pdf/1600488a.pdf">withdrawn in 1995</a>.</p>
<h2>Cancer and the battle over iron</h2>
<p>My PhD advisor was a Nobel prize winner named <a href="http://www.nobelprize.org/nobel_prizes/medicine/laureates/1976/blumberg-bio.html">Barry Blumberg</a>. He was interested in whether body iron level interacted with hepatitis B virus in causing liver cancer. </p>
<p>So he sent me all over the world to conduct studies of this possibility, and we found <a href="http://www.ncbi.nlm.nih.gov/pubmed/3007843">some support</a>. </p>
<p>Later, after obtaining a PhD, I took it a little further and published a paper in 1988 in New England Journal of Medicine that <a href="http://www.ncbi.nlm.nih.gov/pubmed/3173433">became a turning point</a> in how the medical and public health communities viewed iron. </p>
<p>Unbeknownst to me – a young researcher at the time – the battle over iron had been brewing for some time, and my paper provided the first hard evidence in humans that elevated body iron level was linked to increased cancer risk in general (not just liver). It became very highly cited by other scientists, and the battle was on. </p>
<p>Iron may help cause cancer as a pro-oxidant, but it may also play an important role in progression as a <a href="http://www.ncbi.nlm.nih.gov/pubmed/21875943">nutrient for existing cancer cells</a>.</p>
<p>Now, these many years later, it has become clear from work by molecular biologists that <a href="http://www.nature.com/nsmb/journal/v14/n12/full/nsmb1344.html">heme is the ligand for rev-erb alpha</a>. Translation into English: body iron level helps regulate our circadian rhythms and <a href="https://theconversation.com/a-dark-night-is-good-for-your-health-39161">their link to metabolism</a>. The implications of this exciting finding for our health are not yet clear.</p>
<h2>Too much iron is bad, but so is too little – what’s just right?</h2>
<p>After all these years of conflicting research and often extreme opinions on iron, it turns out that like anything else that is a benefit in moderation, in excess it is a detriment.</p>
<p>Severe iron deficiency anemia is still a real problem in the developing world and requires treatment, particularly for children and pregnant women. However, we must avoid over-treatment because too much iron is dangerous. There needs to be a balance. </p>
<p>Mild iron deficiency for non-pregnant adults may have some benefits such as lower risk of cancer and heart disease, and lower susceptibility to infectious disease.</p>
<p>The best way to attain mild deficiency is to <a href="http://www.redcrossblood.org/">donate blood</a> at the Red Cross with some regularity. Not that bloodletting is a cure-all, but maybe doctors back in the ancient days of medicine had inadvertently stumbled <a href="http://www.sciencedaily.com/releases/2012/05/120529211645.htm">onto something</a>.</p><img src="https://counter.theconversation.com/content/41339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Richard G. "Bugs" Stevens does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>After years of conflicting research and often extreme opinions on iron, it turns out that like anything else that is a benefit in moderation, in excess it is a detriment.Richard G. "Bugs" Stevens, Professor, School of Medicine, University of ConnecticutLicensed as Creative Commons – attribution, no derivatives.