January 2016: Iron-deficiency Anemia? Deal with it fast before it rusts!

“Do not wait to strike while the iron is hot – but make it hot while striking” –William Yeats

I was recently diagnosed with having iron-deficiency anemia, which came as a surprise to me given that I eat well-balanced, healthy foods and exercise regularly. I also did not have the classic symptoms associated with being anemic, such as weakness, dizziness, and fatigue. However, I know this deficiency is something that can be resolved easily, even if it will take time. So I did some research to find better ways to improve iron uptake and, more importantly, one's capacity to absorb iron, through food as well as supplements.  

The Centers for Disease Control and Prevention defines iron deficiency anemia as an iron deficiency with a low hemoglobin value, typically less than 120 g/L. It is characterized by red blood cells being small because of a lack of hemoglobin (a protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues back to the lungs). An iron deficiency is not the only cause of anemia, so multiple measures of iron status should be taken to determine if anemia is truly the result of an iron deficiency. Although several dozen types of anemia exist (including anemia caused by low vitamin B12 levels), in this article “anemia” refers specifically to iron deficiency anemia.

Iron deficiency anemia is one of the most common mineral deficiencies in North America and in other parts of the world, but for different reasons. In America, it often results from “under-nutrition”—that is, eating unhealthy, refined, and highly processed foods with little nutritional value but with a high caloric content—while in several parts of the developing world, it often results from malnutrition and poverty. The relationship between food and nutrition gets even more complicated when combined with poor or limited food choices caused by the lack of access to and the affordability of iron-rich foods.

How do you know if you have sufficient iron in your body? Did you know that iron deficiency anemia can make you tired, weak, and irritable; lower your immunity; lead to hair loss; and compromise mental sharpness? It’s time to understand the benefits of iron, the best ways to get it from your diet, and, most importantly, how best to absorb the iron you consume.

Benefits of Iron

  1. Iron is crucial to delivering oxygen to every cell in the body. It is stored in the liver, bone marrow, spleen, and muscles, and it serves as an essential component of various metabolic processes that occur in the body.

  2. Iron in the diet may help reduce fatigue after exercise. Iron carries oxygen to the body’s cells through the blood; thus, iron plays an important role in energy production and muscle function. Inadequate levels of iron in the body may hinder muscle endurance, increase fatigue and cause the muscles to tire more quickly.

  3. Iron in the diet is especially beneficial for the health of T-cells and the ability of white cells to consume bacteria. It has pro-oxidation properties that the immune system needs to fight off harmful bacteria, which can help prevent infection and increase ones immune responses.

  4. Iron is required for DNA synthesis.

  5. Some evidence also shows that adequate levels of iron in the red blood cells may help prevent certain types of cancer and peptic ulcers.

Sources of Iron

Dietary iron comes in two forms: heme and non-heme. Heme iron is derived from hemoglobin. It is found in animal foods that originally contained hemoglobin, such as red meats, fish, and poultry. Non-heme iron is from plant sources.

Your body absorbs the most iron from heme sources, so if you are vegetarian or vegan, you may think it is hard to get an adequate amount of iron from food. But you can get an adequate amount of iron by eating the right plant foods and, more importantly, using ways to absorb iron efficiently from plant sources (see below). In fact, no conclusive evidence shows that vegetarians or vegans are more or less likely to be iron-deficient or anemic.

Some of the best plant sources for iron are

  1. Legumes: lentils, soybeans, tofu, tempeh, lima beans

  2. Grains: quinoa, fortified cereals, brown rice, oatmeal

  3. Nuts and seeds: pumpkin seeds, pinenuts, pistachios, sunflower seeds, cashews, un-hulled sesame seeds

  4. Vegetables: tomatoes, Swiss chard, collard greens

  5. Other: black-strap molasses, prune juice

Best Ways to Absorb Iron from Foods or through Supplements

  1. Eating iron-rich foods with foods that contain vitamin C may increase the absorption of iron by as much as five times. The iron in beans, grains, and seeds is better absorbed when combined with the vitamin C found in fruits and vegetables. Some common dishes already combine iron with vitamin C: beans and rice with salsa, falafel with tomatoes and cucumber, and hummus with lemon juice. Even better, some iron sources, like leafy greens, broccoli, and tomato sauce, already contain vitamin C.

  2. Coffee (even decaf), cocoa, and some green and black teas contain polyphenols, which include tannic acid, which inhibits iron absorption. It is best to avoid these foods an hour before or two hours after your meal. However, a study found that in the presence of a large dose of tannic acid from food, 100 mg of vitamin C increased iron absorption from 2 to 8%.

  3. Cooking food in a cast-iron skillet increases the iron in your meal, especially when you cook foods that contain vitamin C in it.

  4. Spinach contains oxalates that may block absorption, especially if spinach is eaten raw. Blanch or lightly saute spinach to decrease the negative effect of oxalates on iron absorption. Not all research agrees on this, but rather than eat only spinach, why not try some of the other iron-containing plant foods?

  5. Phytates, found in legumes and grains, can inhibit the absorption of plant iron. But soaking them for 4-6 hours (or overnight) may help minimize the negative effect of phytates on iron absorption. Some studies found that adding 50 mg of vitamin C to foods containing legumes and grains counteracted the phytate effect and adding 150 mg of vitamin C increased iron absorption to almost 30%.

  6. Calcium supplements can inhibit iron absorption if taken with meals.

  7. Regarding an iron supplementation, you should follow the above advice and take the supplement 20-30 minutes before a meal and preferably with some orange juice.

REFERENCES

  1. Iron-rich foods. WebMd.com, 2014.
  2.  Iron. VeganHealth.org
  3. Benefits of Iron in the Diet. Livestrong.com, 2015
  4. What every vegetarian needs to know about Iron. Nomeatathlete.com