Nutrition & Physical Activity
Who knew the selection of salts could be so satiating? Kosher salt, sea salt, and table (regular) salt all have the same basic nutritional value, despite the fact that sea salt is often marketed as the more natural or healthier choice. In other words, the chemical compositions of various types of salts are all 40 percent sodium and 60 percent chloride. Therefore, the health effects of the three types of salt are generally the same. The differences between these three varieties are mostly limited to taste, texture, and granule size.
Kosher salt tends to be larger in grain size. As a result, kosher salt may have less sodium per teaspoon than regular table salt. Kosher salt contains no preservatives, and can be derived from either seawater or underground sources. The name “kosher” comes from the koshering process performed on the salt. Kosher salt is particularly good for preserving foods because its large crystals draw moisture out of meats and other foods more effectively than other salts.
True to its namesake, sea salt is derived from seawater. While sea salt may not be larger in grain size than table salt, it contains more minerals due to its deep-sea origins. This is because sea salt is harvested from evaporated seawater and receives little or no processing. These minerals may slightly flavor and color the salt. Sea salts may contain less sodium per teaspoon than table salt. Here’s a tip: it might not be worth forking out extra money for sea salt if you’re going to cook or dissolve it in liquid, as this may cause it to lose its unique flavor.
Regular table salt is mined from underground salt deposits, and includes a small portion of calcium silicate, an anti-caking agent added to prevent clumping. It possesses very fine crystals and a sharp taste. Because of its fine grain, a single teaspoon of table salt contains more salt than a tablespoon of kosher or sea salt.
Your body needs only a very tiny amount of salt to stay healthy. Most people ingest too much salt, mostly from eating processed foods. If you are concerned about the effects of salt on high blood pressure, the following tips can help you limit your sodium intake:
- Go light on the saltshaker! Try to refrain from adding a lot of salt to your food.
- Pay attention to the ingredients in processed foods, which can be chock full of salt. Scan the ingredients for keywords such as soda, sodium, or the symbol “Na”.
- Spice up your food — in a different way! Instead of adding salt, try using herbs (fresh or dried) or spices.
So there you have it. Kosher salt, sea salt, and table salt all contain the same basic nutritional values. As for any other information you hear regarding the topic at hand — take it with a grain of salt!
Ahh, good ‘ole vitamin D — one of the most versatile and important vitamins. When combined with calcium, vitamin D promotes calcium absorption, helps maintain bone health, and is crucial for bone growth and remodeling. Adequate levels of vitamin D can prevent rickets in children and help protect adults from osteoporosis. Vitamin D is also important for regulation of cell growth, neuromuscular and immune function, and reduction of inflammation. Many genes that regulate cell growth, differentiation, and cell life cycle are also regulated in part by vitamin D.
The 25-hydroxy vitamin D test is currently the most accurate way to measure a person’s vitamin D level. Normal levels of vitamin D range between 30 and 74 ng/mL, and levels below 12 ng/mL are considered high risk for vitamin D deficiency. Speaking with your health care provider may help you better understand your test results. Extremely low levels of vitamin D can cause bones to become thin, brittle, or misshapen. Vitamin D deficiency is also associated with an elevated risk of cancers of the colon, breast, and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities.
Those who cannot get adequate sun exposure may consider the use of a vitamin D supplement. People with serious deficiencies may be prescribed weekly doses of up to 50,000 units (I.U.) until their levels are corrected. It appears that at nutritional doses, D2 and D3 supplements are equally effective. At high doses though, D3 may be more effective than D2. Speaking with your health care provider again can help you decide which supplement is best for you. The current recommended intake of vitamin D, as established by the Institute of Medicine, is as follows:
- 200 I.U. (5 micrograms, or 0.005 mg) per day from birth to age 50 years old
- 400 I.U. per day for adults ages 50 to 70 years old
- 600 I.U. for adults older than 70 years old
- 1000-2000 I.U. for certain populations, such as sun-deprived individuals, pregnant and lactating women
Aside from vitamin D supplements, most people obtain the recommended amount through exposure to UVB rays in sunlight. Researchers have found that exposure to the sun without sunscreen (except on your face, of course!) between 5 and 30 minutes per day, at least twice per week, can lead to sufficient vitamin D production. Remember though, too much UV exposure can increase your risk of skin cancer. If you’ve already got your vitamin D time covered, cover up your body with adequate clothing and sunscreen.
Unfortunately, very few foods in nature contain vitamin D. Most vitamin D in the American diet comes from fortified foods such as cereal or milk. For example, cow’s milk in the U.S. is fortified with 100 I.U. per cup. Fatty fish and fish liver oils are also good natural sources. Small amounts of vitamin D may also be found in beef liver, cheese, egg yolks, and some types of mushrooms.
It is important to be aware that certain medications can impair the body’s ability to absorb and metabolize vitamin D. For example, corticosteroids (such as prednisone) can reduce calcium absorption and impair vitamin D metabolism. Both phenobarbital and phenytoin (sold as Dilantin), used in preventing and controlling epileptic seizures, increase the metabolism of vitamin D to inactive compounds and reduce calcium absorption. Additionally, the cholesterol drug cholestyramine (sold under Questran, LoCholest, and Prevalite) can reduce the absorption of vitamin D and other fat-soluble vitamins. Make sure your doctor knows if you are taking any other medications. If you are a Columbia student, you can make an appointment with a registered dietitian by contacting Medical Services (Morningside) or the Student Health Service (CUMC).
Here’s to happy bodies and healthy vitamin D levels!
Dear Tired and Flabby,
Don’t run yourself ragged! It seems that there is a larger issue here: not getting enough sleep. Sleep deprivation increases your risk of developing cognitive problems and chronic diseases such as diabetes and obesity. Exercising every day is a great way to help you get back into a healthy sleep routine. In addition, regular exercise may help control weight, protect against certain health conditions and diseases, boost energy, improve your mood, and have a positive effect on your sex life (oh, baby!). However, research has shown that a lack of sleep can undermine the awesome health benefits of exercise.
Sleep affects important hormonal activity tied to appetite and therefore has a direct impact on your ability to lose weight (i.e. body fat). Leptin (a hormone secreted by our fat cells) and ghrelin (a hormone secreted in our stomachs) work like a checks and balances system in the body and control your feelings of fullness and hunger. When you don't get enough sleep, your leptin levels drop and your ghrelin levels rise. In other words, sleep deprivation makes you more likely to crave sugary, high-carb foods (thanks to higher levels of ghrelin) that have the potential to sabotage your diet. Finally, sleep releases growth hormone, which is extremely important for tissue repair — an important function when you’re working your muscles.
Have you considered why you may be experiencing insomnia? For example, have you been under any added stress or feeling considerable anxiety? It may be helpful to try some relaxation exercises before bed, such as listening to a guided meditation, or perhaps taking a warm bath or listening to calm music. A walk after dinner may even help you wind down and start to focus on relaxing a bit in preparation for bedtime.
You can get more sleep! Here are some tips for upping your ZZZ score:
- Limit caffeine, alcohol, or nicotine close to your bedtime. These products have all been shown to interfere with sleep quality, which in turn may keep you awake at night.
- Limit naps to 20 to 30 minutes. Try to get your sleep at night, but, if napping during the day, keep 'em short and sweet to reduce grogginess and to maintain alertness and performance without disrupting your nighttime sleep.
- Exercise regularly, but try to finish up at least three hours before you plan to go to bed. While exercising daily is known to improve sleep quality exercising close to your bedtime may increase alertness, keeping you awake.
- Avoid late night eating. This may make you less comfortable when settling down for bed.
- Keep a regular bedtime schedule, even on weekends.
- Avoid exposing yourself to bright lights right before going to bed, such as bright computer and cell phone screens.
- Try to make sure your bed is used only for bedtime activities. Studying in your bed may cause your mind to associate your bed with work, thus cueing your mind to think about work instead of rest.
- Create a sleeping environment that is dark, quiet, cool, and comfortable.
Moral of the story: If you “are very tired and have been getting little sleep for several days,” your best bet is to hit the hay. Better to catch up on those zzz’s than hit the gym or walking path sleep deprived and fuzzy-eyed. Exercise can help you stay toned and get back into a healthy sleeping pattern, but it’s necessary to get enough sleep so you can actually reap the health benefits of exercise.
Dear the Pounds Thief,
Kudos to both of you for trying to maintain healthy eating patterns during the major life transition of moving in together! Your question seems to indicate that you two have different nutritional needs, but not wildly different diets. The good news is that your nutritional needs may not be as different as you think; what will vary more are you daily caloric requirements. The other good news is that partners who have very different diets move in together all the time: vegans with carnivorous dairy lovers, gluten-free and gluten-loving people, diabetics with non-diabetics, pescatarians with vegetarians. You get the idea. So you’re in good company as you try to figure this all out.
Two primary factors determine one’s caloric needs: body size and activity level. Sedentary people (regardless of gender) need about 13 calories per pound of body weight per day. Moderately active people need about 16 calories for every pound per day, and very active people should boost that amount to about 18. People tend to over-estimate how much protein they need. As a general rule, people of any activity level and gender and size need only 15 percent of their daily calories to be from proteins. Excess protein can decrease calcium absorption and cause calcium to be lost in the urine. Excess protein is also stored as fat, so it can contribute to weight gain from fat, not only muscle. Excess protein can also cause kidney stones. Typically 6-8 ounces of meat will cover it, less if you are eating other protein rich foods like beans and some cheeses.
Approximately 45-65 percent of your daily calories should be from carbohydrates. The more fiber in those sources, the better. It’s also great if your carbohydrates are coming from dark leafy greens like kale and spinach, because these will also have lots of iron and B vitamins.
Fat consumption should be below 30-35 percent of your total caloric intake (or 20-25 percent if weight loss is a concern). Try to avoid trans fats (found in some types of margarine, fried foods at restaurants, and store-bought snacks). And try to have more mono-unsaturated fats (avocadoes, olive oil, flax, fish) then saturated fats (found in dairy, vegetable oil, and meats).
Couples with different caloric or dietary needs may need to do a bit more planning and be more intentional about their menus than others. There is no rule that says you have to eat exactly the same items at the same time and in the same amounts. Here are some tips to help with meal times:
- If you’re worried about portion control, try to be mindful of how much you put on your plate at a time. People often feel compelled to finish what’s on their plate, even if they are no longer hungry. Try loading your plate with less and then going back for more if you’re still hungry.
- Try to keep fewer unhealthy snacks in the house. If they aren’t there, you’re less likely to consume the “empty calories” from these snacks when you get hungry.
- Speaking of snacks, do you snack throughout the day? If not, consider trying it! People will eat less at meal times if they have been snacking some throughout the day. This also is easier on your metabolism and digestive system. Try keeping lots of healthy snacks around: whole grain breads, yogurt, granola, fruit, carrots, raisins, walnuts, and celery are all good, healthy, lean yet filling snack choices that will put a dent in your appetite by dinner.
- Along these same lines, don’t skip meals! This will make you hungrier by dinner and that’s when people are most likely to eat more than needed.
- Buy foods you both like and alternate nights cooking for each other. On the night your partner cooks for you, eat the foods you most prefer. If it is not quite enough for him, perhaps he can cook up a side dish to give him a little extra. On the night you cook for him, make him a meal he loves. If he doesn’t want veggies, cook up a side of veggies for yourself. This can be a great way to honor each other’s dietary preferences.
- Do you like cooking together? Consider taking a cooking class or checking out some recipes online that might incorporate food ingredients that you both would enjoy. Make it a fun project of discovery.
As you noted, having different activity levels and different dietary needs in the same household can be a source of stress. But, working through and honoring these differences can also strengthen a relationship. As the poet Rainer Maria Rilke said: “Once the realization is accepted that even between the closest human beings infinite distances continue, a wonderful living side by side can grow, if they succeed in loving the distance between them, which makes it possible for each to see the other whole against the sky.”
Here’s to love and food,
Kudos to you for developing a healthy workout habit! No matter how fit and healthy you are, all runners require rest periods in order to allow the body to recover and grow stronger. How much rest one needs depends on a lot of factors, such as the type of training one is doing, ageing, injuries, illness, and increases in exercise intensity. Some runners take only one day off per week and find that this is sufficient. Others find that they are their healthiest when they take more. After an intense run, muscles need about 48 hours to recover. Do you find that you are quite sore after running for three days? If so, are you still sore or stiff after your day of rest? If so, this may be an indication that you could benefit from a bit more rest, but there are other causes of soreness besides not enough rest. In addition to soreness, significant weight loss, difficulty sleeping, or an elevated resting heart rate are other indicators you may need more rest.
Running is one the best endurance sports you can do — it gives your cardiovascular system a great workout. It also gives your body quite a beating and this is one reason why rest periods for runners are particularly important. But a day off doesn’t have to mean a day off from all physical activity. Many runners (and other athletes, as well) find that they benefit from what’s known as the “active rest.” This involves doing some other activity in place of running and toning down the intensity level somewhat. Your rest day activity could involve a brisk walk, racquetball, swimming, or riding a bike, for instance. All of these are more low-impact than endurance running and give your body a different type of work out, allowing you to use different muscle groups.
Rest allows your muscles, tendons, ligaments, and bones the opportunity to recover from the beating they take during your 50 minute runs, but there are other ways to ease the stress on your body:
- A good stretch both before and after your run.
- Frequently replacing your running shoes.
- A long warm up (run slowly and ideally on a flat surface for the first 10-15 minutes of your run).
- A cool down period (5-10 minutes of a brisk walk or very slow jog at the end of your run).
- Hydration! Drink plenty of water.
Another good argument for changing up the type of exercise you do on your rest days is that your body “adjusts” to your workouts, which means that over time, if you do the same activity, your body becomes so good at it that the workout produces fewer benefits, even as you increase the intensity. Changing the type of activity “shocks” your body, as it is doing something it is less accustomed to and thus working harder. This extra hard work allows you to reap more benefits. Plus, variety keeps life interesting.
But even if you stick with your 50 minute runs 3-4 times a week, you are doing a great thing for your body. Good for you and keep it up! If you are a Columbia student, check out CU Move for tons of resources, information, and ideas for staying active. Your body will thank you.
Dear Da Windex Guy,
The cheapest and safest way to get tickets to the gun show is to hit the gym! Whereas human growth hormone (HGH) products like Sytropin may help your friend beef up, it only does so in the short-term while also beefing up other hormones in the body that may lead to some unintended side effects (as you suspected). As a general rule, take caution when using any substance that isn’t approved by the Food and Drug Administration (FDA) as well as using prescription drugs without the okay from a health care provider.
Initial development and prescription of HGH products were for people with growth disorders and for people with diseases such as AIDS who had growth hormone deficiencies. Now HGH has gotten a reputation for being abused in the sports world and also used controversially to increase milk production in cows. Normally, the pituitary gland (located in the base of the brain) regulates the natural release of HGH. Products like Sytropin introduce synthetic HGH into the body promoting cell growth, reproduction, and regeneration. This, in turn, reduces fat in the body, and increases lean body mass (muscle mass and bone density) and exercise capacity. However, though HGH may increase bulk, there is no solid proof that it increases strength or improves athletic ability (at least not in the long-term).
Your hesitation in using Sytropin or other HGH products is warranted because there is no solid evidence to prove their safety. HGH is only legally available by prescription and scientists still aren’t certain whether HGH taken in pill or spray form (like Sytropin) are effective. Other side effects of HGH use may include:
- Swelling in the limbs.
- Pain in the joints and muscles.
- Gynecomastia (swelling of the breast tissue in men).
- Higher risk for heart disease and diabetes due to increases in insulin and cortisol.
- Potential insulin resistance.
List adapted from the Mayo Clinic
Those who reap the most benefits of using HGH are people who have problems naturally producing growth hormone. The average Jane or Joe looking to boost their muscle volume will likely have the same luck (sans potential HGH side effects) if they stick to a healthy diet and workout regime. Though it may seem tempting to buy scalped tickets to the gun show from Sytropin, investing the extra time and effort into physical exercise is the best and safest approach to securing front row seats. Check out the exercise and diet tips in the Related Q&As below for more information.
Creating an at-home exercise program is a great way to get more physically fit, especially if you have limited time and resources. The good news is you can have a well-rounded workout without ever stepping in a gym or using machines! The Centers for Disease Control and Prevention (CDC) recommendations for physical activity are at least 150 minutes of moderate intensity each week, spread out over at least three days. Moderate intensity simply means that you will raise your heart rate and break a sweat. Strengthening activities are also recommended at least twice a week.
One way to incorporate aerobic and strengthening activities in a home-based workout is by alternating between cardio exercises and strength training exercises. For example, do jumping jacks for two minutes then do push-ups for one minute. Follow this up by repeating jumping jacks for two minutes and doing lunges for one minute, etc. In this type of circuit, you integrate aerobic activities with various strengthening activities in an efficient routine. Other examples of at-home aerobic activities include walking/marching/jogging in place and jumping rope. Sit-ups, squats, and leg lifts can be done at home to strengthen muscles.
In addition to working out in your home, it can be easy to get extra exercise while going about your everyday activities. For example, get off the bus or subway a few stops early and walk the rest of the way. Taking the stairs instead of the elevator is always a good option, as well. And, if you have that extra hour, a brisk 30-minute walk or jog outdoors is great aerobic exercise and you will still have 30 minutes to take a shower and get ready for your next activity!
In addition to the information listed above, the USDA MyPlate initiative is a great resource for physical activity information. Also, many Columbia-affiliated students find Alice!’s physical activity initiative, CU Move, to be helpful. The program provides participants with physical activity tips and tools, motivational messages, and event calendars with access to plenty of free and low-cost physical activity options on campus and around NYC.
Break a sweat!
No matter the color, shape, or size, avocados are delicious — and nutritious! There are a wide variety of avocados on the market, each with a unique flavor, texture, and nutritional value. Thanks to alternating shipment seasons, people across the United States have access to avocados all year round. California and Florida produce the vast majority of avocados in the United States.
California avocados largely consist of the Hass variety, which are the most widely available type on the market. They have thick, leathery skin that turns dark green-to-black as the fruit ripens. California ships avocados throughout the United States, even all the way to Florida and other states on the East Coast. These medium-sized fruits weigh approximately 4.8 ounces (136 grams), and contain:
- Approximately 227 calories
- 2.9 grams of saturated fat
- 13.3 grams of monounsaturated fat
- 2.5 grams of polyunsaturated fat
Florida avocados are all members of the green-skinned avocado family. These have less fat, but more moisture than the Hass, and thus are not as sweet and nutty tasting. As they ripen, green-skinned avocados retain their light-green skin. Green avocados tend to bruise more easily during shipment because of their thinner skin, restricting shipments from Florida to primarily Eastern U.S. markets. These avocados tend to be larger in size, and typically weigh a hefty 10.7 ounces (304 grams). One green-skinned avocado contains:
- 6 grams of saturated fat
- 16.8 grams of monounsaturated fat
- 5.1 grams of polyunsaturated fat
No matter their hue, eating both black and green avocados provides multiple health benefits, including:
- Acting as a "nutrient booster" by enabling the body to absorb more fat-soluble nutrients in foods that are eaten with the fruit, such as alpha- and beta-carotene.
- Providing more than 25 essential nutrients, including fiber, potassium, vitamin E, B-vitamins, and folic acid.
- Providing consumers with a healthy source of fat. The avocado is virtually the only fruit that has monounsaturated fat (a.k.a. good fat).
- Providing a good source of fiber.
Adding heart-healthy unsaturated fats to your diet, available in avocados, nuts, and olive oil, may help you make the most of your fruits and veggies and eat a more balanced diet. One delicious way to eat avocados is using avocado spread in place of high-fat spreads, such as butter and mayonnaise. For more information, you can check out Avocados are fatty — are they healthy?.
See you…avocado go now!
It can be tricky to check in with a loved one about the concern that they may have an eating disorder. You may be afraid that you'll say something that might shut them down or hurt their feelings. You may be afraid that you're mistaken. This worry may be especially great for you since eating disorders are more prevalent in women (though eating disorders are more common among men than many people realize). Don't let these worries stop you from having an honest conversation about what you have observed and what your concerns are.
First, how might you recognize if a loved one has an eating disorder? There are a few different types of eating disorders, but you need not worry about making an "exact diagnosis." The following may be warning signs of bulimia, but a loved one need not exhibit all these signs in order to have it.
- Frequent complaining or worrying about being overweight.
- Use of "purging" tactics for weight loss, including excessive exercise, herbal weight loss supplements, weight loss medications, laxatives, or forced vomiting after eating.
- Not wanting to eat in front of other people.
- Eating large quantities of food in one sitting.
Warning signs of Anorexia can include:
- Significant weight loss.
- Enjoyment of cooking and preparing meals for others without eating much.
- Significantly distorted body image — sees self as overweight, when he or she is likely significantly underweight.
Some people with eating disorders recognize that they have one, but are afraid to reach out for help. They may be afraid of being judged and/or losing loved ones if they open up about their eating disorder. Others may be in denial about having an eating disorder, while others may have such a low self-esteem that they feel, either consciously or unconsciously, that they do not deserve help. If you are afraid to check in with him about the possibility that he has an eating disorder, it may be helpful to know that eating disorders do not go away on their own and they can have severe health consequences. So the sooner he seeks help, the better his chances of recovery and the less damage that will be done.
But how to bring this up? There are a few good guidelines to cover that will help you convey a nonjudgmental attitude and also help ensure you are respecting your boyfriend's privacy:
- Make the basis of the conversation about your worry. Try to remain positive while also explaining that you care about him and because of this, you are worried about his health and his emotional state.
- Avoid comments about his appearance. Some people with eating disorders will not be affected, while others will be extremely affected by hearing your assessment of their weight (e.g. they may be flattered or they may be horrified. Either way, you may inadvertently reinforce their restricted eating or purging).
- Do not demand that he eat or change his behavior.
- Avoid placing blame or giving advice.
- Watch out for accidental "fat phobic" remarks that you might make inadvertently (in other words, avoid making disparaging remarks about weight or overweight people). Avoid making remarks even about your own body weight.
Aside from offering you nonjudgmental support, the most important thing you can do for a person with an eating disorder is to encourage him or her to get treatment. The longer an eating disorder remains undiagnosed and untreated, the harder it is on the body and the more difficult to overcome, so urge your boyfriend to see a therapist or his health care provider right away. If your boyfriend is a Columbia student, he can make an appointment with Counseling and Psychotherapy Services (CPS) or with his primary care provider through Open Communicator.
It may also be worth checking out the following resources:
- The National Eating Disorders Association's 24-hour information and referral helpline at 1-800-931-2237
- Eating Disorder Referral and Information Center
- Something Fishy Website on Eating Disorders
Recovering from an eating disorder usually takes time. Kudos to you for your patience and your willingness to support someone struggling with an eating disorder. This may at times be difficult for you, too, so make sure you are getting support, as well, whether it be through friends, family, and/or therapy.
Props to you for wanting to donate blood! Alas, isn't it iron(ic) that one of the foods with higher iron content also may contain an iron absorption inhibitor? It's one thing to worry about getting enough iron through your food sources, but a whole other thing to worry about whether that iron is actually being absorbed. Boosting your hemoglobin by upping your iron intake shouldn't be too tricky, but know that there are a number of possible causes for low hemoglobin — being low on iron is only one cause (more on that later).
Let's discuss the raisin bran question first. Phytic acid is often found in foods that contain whole grains, including some types of raisin bran. In large enough quantities, phytic acid can inhibit your body's iron absorption. This is annoying since these foods may also be high in iron. In addition to iron absorption inhibitors, there are also substances that aid in iron absorption. The primary is vitamin C, which is often also found in raisin bran. Your best bet is to check food labels so you know when you are consuming foods that contain phytic acid (and also whether it contains a substance such as vitamin C, which will help you absorb iron). If food products contain iron and phytic acid, chances are you'll still likely get at least some iron benefit from them (especially if that food contains vitamin C, too); however, it's wise to have additional sources or iron other than raisin bran. Another iron absorption inhibitor is tannic acid, which is often found in red wine, coffee, some teas, chocolate, and some sodas.
So what does all this mean? Diversified food sources of iron will be your best bet in ensuring that you meet your recommended daily allowance, but there's no harm in making raisin bran one of those sources. Check out the Q&A's below for more information on iron, how much you need, and getting enough of it through your diet.
Now, are you sure low iron is the cause of your low hemoglobin? There are several other possible causes. Cirrhosis (scarring) of the liver is one cause. Some common causes of cirrhosis include alcohol abuse, hepatitis B or C, cystic fibrosis, and some parasites caused by chronic liver damage. These conditions, as well as the cirrhosis itself, would likely be accompanied by additional symptoms, such as fatigue, nausea, weight loss, and/or easy bruising.
Other causes can include certain cancers of the blood (e.g. leukemia, multiple Myeloma) or of the lymphatic system (e.g. Hodgkin's and non-Hodgkin's lymphoma), enlarged spleen (splenomeglamy), or vasculitis (inflammation of blood vessels caused by an autoimmune response of various origins). Though anemia and iron deficiency are common causes of low hemoglobin, it may be worth a trip to your health care provider to rule out these other causes.
Happy hemoglobin boosting!