I’m A Black Girl Living With Iron-Deficiency Anemia — Here’s How To Cope

One day in March 2020, I was in the supermarket near my favourite section by the entrance, where they keep the discounted seasonal items that are no longer in season. As I began to look through Easter mugs, adult colouring books and laundry labels, I felt my energy leave my body, and I was completely depleted of any strength I had left. I remember needing to find a seat. This was not a normal kind of tired; it was exhaustion coupled with weakness. I had to grab a bottle of water and my shopping snack I keep in my tote: a bag full of almonds. Once I ate the almonds and drank the water, I felt better.

Still, my body and spirit felt unsettled. I thought maybe the spell of lethargy was somehow tied to my PCOS, which is very common. I made an appointment with my OBGYN, explained what happened to me, and they performed a blood test. Things were abnormal, so they suggested I have a second opinion and referred me to a hematologist. Once the hematologists finished weeks of testing, they were noticing abnormal blood markers for things like blood cell count and blood inflammation. There was something more serious at play. It was then that I not only discovered my iron-deficiency anemia, but I was also diagnosed with lupus. Everything made more sense and became illogical all at once. 

I thought to myself, How could a nutritionist and wellness professional not listen to her own body? It brought on a guilt that was so intolerable it led to me going back to therapy. Every aspect of my health and well-being was being tried. I was in a dark place. Having to explain my conditions to people was far from easy, but I know my situation was not isolated nor uncommon. Many of us can relate to the emotionally taxing weight of a physical condition or chronic illness. The weight of iron-deficiency anemia, whether due to an underlying condition or a stand alone issue, can make you feel like the world is on your shoulders. For Black and brown women, this is especially true. According to Heathgrades, we are two to three times more likely to have low iron and iron-deficiency anemia, while 16.2% of Black women were found to have lower-than-normal hemoglobin levels versus just 3.9% of white women who had a less than normal range. 

Iron-deficiency anemia (IDA) occurs when your body does not have an adequate amount of iron to make hemoglobin, which carries oxygen through our red blood cells. If your body is not getting enough hemoglobin, your red blood cells will not function properly. Anemia is more than eating ice and having cold feet, as people on the internet like to joke. Anemia manifests in all aspects of your being; mentally, emotionally and physically. Having iron-deficiency anemia is the epitome of the quote, “I’m tired of being sick and tired.”

Iron is essential for energy, vitality and your overall wellbeing. The human body is simultaneously complex and miraculous. It takes a collaborative working system to maintain health and wellness. This is especially for menstruating and childbearing people, whose bodies experience blood loss through periods and pregnancy. There is an exponential increase in blood volume and blood cells in order to fulfil the needs of a growing fetus. Blood volume goes from 5 litres to 8 litres in pregnancy; that is a lot. Therefore, it is recommended that a woman should take 30-60mg of iron on a daily basis during pregnancy and menstruation. 

Iron deficiency is nothing to play about. I am a nutritionist and still struggle with IDA. But working with a competent and a thorough healthcare team has made my journey easier. I have advocated for myself more than ever and it has made a significant difference. Please do not be coy about your health. The search for good healthcare as a Black woman in this country is more daunting than the illness itself. I have had to switch multiple doctors in the span of two years. I’ve finally found my tribe of healthcare partners that has my back. My current providers and I work together to keep me relatively healthy.  

As a 35-year-old woman, it is sometimes difficult to navigate. But being intentional about my overall wellness has kept my hemoglobin range close to normal and has improved my mental and physical state. Whether it’s weekly iron infusions, or my intentional meal planning, I am navigating it with intention and purpose. I encourage you to do the same. Here are the basics.

IDA is the most common type of anemia. These factors can determine the type of anemia and the cause:

- Malnutrition & imbalanced eating

- Reduction in the number of red blood cells due to internal bleeding

- Conditions that require increased amounts of hemoglobin (pregnancy & heavy bleeding during menstrual period)

- Vitamin deficiency of vitamins like B12 and folate 

- Chronic disorders, like lupus, sickle cell, diabetes, hypothyroidism, PCOS, etc.

- Problems absorbing iron 

- The side effect of certain medications and treatments like antiviral drugs and chemotherapy

The signs and symptoms of anemia vary and depend on the severity of the anemia. People with a mild case of anemia may not have any symptoms and on the other hand, another person may experience periodical fainting and distressed cardiac functioning. Insomnia can be another symptom, and is only life threatening when accompanied with chronic illnesses. Here are some of the most common signs and symptoms of iron deficiency anemia:

- A feeling of consistent weakness

- Easily fatigued 

- Palpitations

- Pale appearance

- Brittle nails

- Pica (urge to eat things that are not food, like clay and ice)

- Lightheadedness 

- Chest pain

- Insomnia and other sleep conditions 

- Low body temperature 

- Brain fog and cognitive impairment

During a visit with your GP or hematologist, explain to them everything you are feeling and experiencing. In preparation for my first visit, I noted all of my concerns prior to the visit. Once I saw the doctor it was easier to remember my concerns and talk about them when seeing them written. I told my doctor about the days where I could barely get out of bed or the days walking up flights of stairs left me feeling like I ran a 5k marathon because of the intense spurts of energy drainage. I even mentioned my sudden case of brain fog because I felt somehow they were linked. 

If you are like me, sometimes self-advocacy is difficult. We often feel like our concerns are burdens to others but medical conditions are not your cross to bear alone. Medical experts are trained to collaborate with us in treatment. They need your truths. Your concerns are valid. Once I explained my symptoms, my provider proceeded with blood work during that same visit. A CBC (complete blood cell count) is required to diagnose anemia. The test provides the hemoglobin level in a patients’ blood and a lower level than normal is needed to confirm anemia. The normal level is about 12-18mg/dl. In order to find the exact kind of anemia you have, advanced testing is required. It includes a peripheral smear, your blood iron levels, blood ferritin levels, and total iron-binding capacity (TIBC). 

The treatment options may vary by everyone’s condition depending on the cause of their anemia. In most cases, the provider will address the underlying causes and symptoms before developing a treatment plan. For example, if you are deficient in vitamin B12, your provider may write a prescription for a vitamin B12 supplement, and it will be the primary treatment for your anemia. In other cases, there may be an immediate need for an iron infusion which is the process of giving iron through IV (intravenously). Anemia has a good prognosis and is relatively easy to catch and treat.  

Here are five tips that helped me along my journey:

- Talk to a doctor and or a credentialed nutritionist. 

- Make sure you invest in a quality multivitamin. The average relatively healthy person should be consuming at least 16-18mg of iron daily, but remember it takes a variety of nutrients to keep you healthy. You need B vitamins and Vitamin C for iron absorption. Do the best you can with what you have. Frozen veggies are just as nutritious as fresh veggies and tend to be cheaper. Eat a variety of foods. I know it’s not always practical to be conscious about your dietary choices, especially for women. We wear so many hats and are often responsible for everyone. I am a mom to five children under eight years old, so I get how adulting can steal any resemblance of balance. But pack your snacks. Plan ahead and set a reminder to eat. I am a testament of  intentional eating. When I make time to nourish, I have sustained energy.

- Stay hydrated for sustainable energy. A lot of times we think we are tired when we are actually thirsty. I can admit, I am not the best at keeping up with my water intake. But it’s something that we should all prioritise. Dehydration and exhaustion are often first cousins. If you are thirsty, you are dehydrated. If you have a lot of, “whew girl, give me a second. I'm about to pass out” moments, you could be dehydrated. Your body relies on hydration to function. Make sure you are drinking enough water and eating enough water-based foods like, soups, broths, veggies, fruits and yogurts (plant-based yogurts are also available). Also a cute water bottle is a must. I drink more water when I have a cute water bottle. I don't know anything about the science other than aesthetics,  but it works for me.

- Have a realistic and flexible wellness routine. Make sure it’s not too many steps because a complicated routine can overwhelm. We do not need you breeding anxiety on top of exhaustion. It is literally too much! You do not have to be routinely. I started with just scheduling my water and food breaks. You can start there, too. It is motivating to see yourself prioritising your health throughout the day.

- Finally, extend grace to yourself and know that you are doing your best. I had to come to grips with understanding that sometimes the body does what the body wants. Sometimes illness just happens like anything else in life. The only thing we can do is to continue to research and trust the plan. Even during those dark moments, we have to embrace the challenge and accept our bodies in every state. Wellness begins with acceptance. We must accept who we are, how we are. Once we accept,  we can care for ourselves intentionally with purpose. As Audre Lordes said, “Caring for self is self-preservation and that is an act of political warfare.”