The Tribune, Chandigarh, India

Vegetarians are prone to anaemia
by Dr Sumitra Dash
Anaemia is a clinical state where the quantity and quality of haemoglobin is reduced below the norms appropriate for the age and sex and thus resulting in a plethora of clinical signs and symptoms. In India, haemoglobin levels below 12.5g/dl in men and 11.5g/dl in women is considered as anaemia, requiring investigation and treatment.

S. Asian women in UK at cancer risk
London: A new study reveals that breast cancer risk in South Asian women in the United Kingdom is linked to numerous lifestyle factors and depends largely on their specific ethnic subgroup.

Now a blood test to predict miscarriage
London: Recent studies indicate that a blood test for a natural body chemical could be able to reveal protein levels and also predict whether a woman has a high risk of miscarriage. Researchers in Australia have observed that even weeks before losing their baby, women had reduced levels of a protein called MIC 1.

Tumours fool immune system
Washington: In one of the biggest advances in its 16-year history, the researchers of H Lee Moffitt Cancer Center & Research Institute have unlocked a part of the mystery of how tumours flourish undetected by keeping their presence a secret from sentries of the body's immune system.

Vegetarians are prone to anaemia
by Dr Sumitra Dash

Anaemia is a clinical state where the quantity and quality of haemoglobin is reduced below the norms appropriate for the age and sex and thus resulting in a plethora of clinical signs and symptoms. In India, haemoglobin levels below 12.5g/dl in men and 11.5g/dl in women is considered as anaemia, requiring investigation and treatment. Nutritional anaemias are caused by the dietary deficiency of the essential elements necessary for the production of haemoglobin, e.g. iron, Vit B12 and folic acid. Although nutritional anaemias are widespread, its clinical manifestations are not spectacular, and for this reason the disease is often ignored. While clinical manifestations of nutrient deficiencies account for less than 10 per cent, moderate-to-severe forms of dietary deficiency without clinical signs are present in 30-50 per cent of our population.

The vegetarian people are at increased risk for Vit B12 deficiency, because Vit B12 is supplied primarily through the dietary intake of animal products — meat and dairy foods. Breast-fed infants of vegetarian mothers may also develop Vit. B12 deficiency. Vit. B12 deficiency is also more common in the older population than in the younger persons because of inadequate dietary intake and age-related gastro-intestinal abnormalities that limit the absorption of Vit B12 from the diet. Many gastrointestinal abnormalities lead to malabsorption and increased risk for deficiency. High demand states as in diseases with increased production of red blood cells such as thalassaemia, cancer or bacterial overgrowth can lead to deficiency, even if absorption is intact and there is adequate Vit B12 in the diet. Repetitive hemodialysis for renal failure has also been shown to deplete Vit B12 stores.

The deficiency of Vit B12 causes a slowly developing anaemia and produces few symptoms until the hemoglobin levels are very low. About 2 mg of Vit B12 is stored in the liver and another 2 mg in other parts of the body. The normal daily requirement is only 2.4mg. Because of high body stores and low turnover, it takes months or years for the deficiency to develop in a healthy person. Deficiency in a strict vegetarian develops in 10-20 years.

Clinical features of the Vit B12 deficiency involve blood, the nervous system, the gastrointestinal tract and , more recently, heart diseases. Anaemia is the most common manifestation. Patients with anaemia may report weakness, light-headedness, vertigo and tinnitus (ringing in the ear) along with palpitation, angina and symptoms of congestive heart failure. Other blood cells such as platelets and white blood cells may also be affected and result in bleeding and frequent bouts of infections. Neurologic manifestations may occur in persons even with normal haemoglobin levels.

Peripheral nerves are first to be affected, resulting in peripheral neuropathy which manifests in the form of tingling and burning sensations, and partial numbness in the feet and fingers. When the nerves of the spinal cord and brain are involved it results in decreased or absent vibratory and positional senses, drowsiness, giddiness, weakness, poor coordination, psychosis in the form of depression, schizophrenia, smell and vision impairment, forgetfulness and dementia. Neurologic manifestations are often irreversible, but treatment can arrest progression. Gastrointestional symptoms of the Vit B12 deficiency includes anorexia, moderate weight loss, tongue pain with a smooth and red tongue and perversion of taste.

The important medical history includes the dietary habit, the intake of various drugs such as metformin, slow release potassium chloride, omeprazole, cimetidine which might significantly reduce the absorption of Vit B12. Patients should be asked about alcohol consumption, as it not only decreases Vit B12 absorption but also nutritional intake is poor in alcoholics. Surgical procedures involving stomach and intestines will also reduce Vit B12 absorption.

The recommended treatment is a high dose Vit B12 of 1000mg per day (given by an intra-muscular injection). Oral Vit B12 can also effectively treat the deficiency. A daily dose of 50mg-100mg will correct the deficiency. The more recently developed Vit B12 intra nasal gel is given intra-nasally at 500mg every week. However, this is an expensive agent and provides no advantage over oral preparations. Yet to be established is whether once-a-month intra-muscular administration is more economical than daily oral dosing in the long-term care setting. But most people will probably prefer to avoid a monthly injection.

Importance of Vit B12 in heart disease: Deficiency of Vit B12 can also predispose the blockade of blood vessels because of its role in the normal functioning of the blood vessels. It is, therefore, given as a preventive measure to the patients who are at high risk for heart disease such as diabetics, hypertensives and patients who already had some heart ailments.

The vegetarians are, therefore, prone to develop Vit B12 deficiency unless they supplement their diet with Vit B12 preparations. Oral replacement therapy is safe, inexpensive and effective.

— The writer, Professor of Haematology, PGI, Chandigarh, is the President of the Indian Society of Haematology and Transfusion Medicine.

S. Asian women in UK at cancer risk

London: A new study reveals that breast cancer risk in South Asian women in the United Kingdom is linked to numerous lifestyle factors and depends largely on their specific ethnic subgroup.

According to a report in BBC, researchers at the London School of Hygiene and Tropical Medicine, observed that Muslim women from India and Pakistan have twice the risk of breast cancer compared to Gujarati Hindu women.

The research published in the British Journal of Cancer attributes it to the difference due to lifestyle factors such as diet and body size, and warns that clubbing all South Asian women as "low risk", would seem to be misleading and potentially dangerous.

The experts interviewed more than 700 first-generation South Asian women from the West Midlands and the London area, including 240 women who had been treated for breast cancer. The women were categorised as Gujarati Hindu, Punjabi Hindu, Punjabi Sikh, Pakistani and Indian Muslim, or Bangladeshi Muslim.

They found that in general, South Asian women living in England are less likely to be diagnosed with breast cancer than their native-English counterparts, but the risk varied depending on the ethnic group. — ANI

Now a blood test to predict miscarriage

London: Recent studies indicate that a blood test for a natural body chemical could be able to reveal protein levels and also predict whether a woman has a high risk of miscarriage. Researchers in Australia have observed that even weeks before losing their baby, women had reduced levels of a protein called MIC 1.

Experts are cautious about the finding and believe that bigger and more comprehensive studies are required to prove any connection. It is "tempting to speculate" that low MIC 1 levels may be to blame, The Lancet was quoted by BBC as saying.

Often a miscarriage happens due to the a subtle genetic problem which makes it impossible for a foetus to develop normally, but is unlikely to reoccur the next time a couple tries for a baby.

However, up to 1 per cent of women suffer recurrent miscarriages and some may be due to repeated genetic flaws in the embryo. But there is evidence that the mother's immune system, instead of being held in check, is treating the embryo as a foreign invader and destroying it.

Scientists are delving into the complex interplay of chemicals between the growing placenta and the mother which are designed to keep the immune system at bay and are optimistic of finding a common physical factor that unites women who suffer miscarriage. — ANI