Nutrition – anaemia

Tuesday 08 May 2018

This week I want to address the problem of anaemia, which is a very common symptom that can be developed during treatment for cancer.

Bone marrow produces our red blood cells and other components of the blood, and it does so at a very rapid rate, making millions of them a day. The fast production uses a great deal of vitamins and micronutrients, so quite clearly any deficiency in the diet can rapidly translate to anaemia.

The principle nutrients required by the bone marrow for making red blood cells are iron, vitamin B12 and folic acid. Each of these has a very specific role.

  • Iron is the mineral needed to transport oxygen around the body. Oxygen is needed for energy production within cells. The reasons why a person may develop anaemia can be quite complicated. Some medicines for treating cancer during chemotherapy can contribute to low iron stores by preventing the body from fully absorbing iron. Bleeding which can occur in some gastrointestinal cancers may be the cause. Low levels of iron in the diet can also cause anaemia.
  • Vitamin B12 is needed for the production of healthy red blood cells. Low B12 levels make the body produce larger than normal red blood cells which do not do their job properly. When this develops it is known as pernicious anaemia. It can be caused by a lack of a protein called the intrinsic factor that is made in the stomach and needed to absorb vitamin B12 from our food through the gastrointestinal tract. Any treatment or cancer affecting the digestive system, may result in pernicious anaemia. Low levels of B12 in the diet can also be a cause.
  • Folic acid, also known as folate, is one of the B vitamins and works with vitamin B12 so the two are normally considered together.

Symptoms of anemia

Anaemia has several causes but they all present a similar symptom picture. This is generally feelings of tiredness and fatigue, lack of energy or lethargy, being out of breath, feeling faint, having headaches and lack of appetite. In extreme cases it can lead to mouth ulcers, a sore red tongue, visual problems and depression. To know what is actually causing the problem, a routine blood test would be taken.

Once the cause has been established, the medics may decide on a course of action to rectify the problem, such as a blood transfusion or vitamin B12 injections. This of course would depend on the severity of the anaemia. But it is also important to try and make sure that the foods that we eat will supply plenty of these nutrients. This in turn will help turn to prevent the problem returning.


The main food sources of iron in the diet are red meat and offal (like liver and kidney). For many good reasons someone with cancer may decide not to eat these foods and so it is important to know which other foods are rich in iron.

These are molasses, cocoa, oat germ, pumpkin seeds, sunflower seeds, millet, almonds, raisins, prunes, dried apricots, parsley, curry powder, dark green leafy vegetables, pulses (beans and lentils), egg yolks, black treacle, liquorice and fortified breakfast cereals.

It is worth noting that the iron from non animal products i.e vegetables is better absorbed by the body in the presence of vitamin C rich foods. So adding peppers or tomatoes, berry fruits or citrus fruits to your meal will help.

Vitamin B12

The richest sources of vitamin B12 are liver and kidney followed by eggs, fish, cheese and meat, which as you can see again are all animal foods. Other sources are fortified breakfast cereals, nutritional yeast products, yeast extract (like marmite), soya products fortified with B12, wheatgrass juice and fermented foods like soya sauce.

Folic acid

Folic acid is found in all dark green leafy vegetables like broccoli, Brussels sprouts and spinach, and also asparagus, peas, chickpeas, brown rice and fortified breakfast cereals.

Note that I have found a product called Spa Tone that really helps to boost iron levels in a very natural way. It is a pure water that is iron rich. You buy it in sachets from most chemists and you simply drink one or two sachets a day. Because it is water it is rapidly absorbed and easily available to the body. 

Iron rich salad with a tahini dressing

3oz of alfalfa sprouts or bean sprouts

3oz of water cress chopped

3oz of broken walnut pieces toasted

1 orange segmented and cut into chunks.

2 tbsp of tahini
2 tsps of soya sauce
juice of 1 lemon
1/3rd of a cucumber grated
2 tsps of finely chopped mint
splash of water 


1.     Mix all of the salad ingredients in a bowl apart from the orange.

2.     Make the dressing by combining all of the ingredients in a bowl and whisk together till well blended.

3.     Drizzle the dressing over the salad and add the orange segments and serve.

The dressing of course can be used for any salad.

Blog written by Caroline November 2014 – updated April 2020

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