Iron-Deficiency Anemia: How to Get the Most Iron Out of Your Diet & Supplements

Iron-deficiency anemia (IDA), also referred to as just plain “anemia,” is a medical diagnosis given to those who have fewer Red Blood Cells (RBCs) than normal. As a chief component of RBCs is iron, when there is a shortage of RBCs, deficiency in iron is usually the culprit. Although there are other types of “anemia,” for this discussion, only Iron-Deficiency Anemia will be discussed.

In Red Blood Cells is hemoglobin, which binds to oxygen that is inhaled; this oxygen is then transported throughout the body by those blood cells. At the same time, carbon dioxide is picked up and returned to the lungs for removal from the body via exhalation. For optimal health, the body needs enough RBCs to have adequate oxygen-carbon dioxide exchange; therefore, the blood needs enough iron to be available to make enough Red Blood Cells.

Prevalence of Iron-Deficiency Anemia

Unfortunately, not everyone has enough Iron in their bodies to make enough Red Blood Cells for optimal health and oxygen exchange. The Centers for Disease Control (CDC) has estimated that 19% of the American population has Iron-Deficiency Anemia, which is responsible for an average of 429,000 hospitalizations and causes an average of 4,686 deaths per year (CDC, 2009).

The two biggest groups that are affected by this Anemia are nursing home residents and women of child-bearing age (ages 13 to 45 years).

The RDA of Iron is 10 mg for children and adults; 15 mg for pre-menopausal women, and 30 mg for pregnant women.

Signs & Symptoms of Anemia

Most of the signs and symptoms of Anemia are due to a shortage of oxygen in the body tissues and the brain. The most common are fatigue, headache and pallor. If the Anemia is not corrected or worsens, then other symptoms follow: slowing of mental reactions, listlessness, irritability, poor concentration; difficulty swallowing; spoon-shaped fingernails; sensitivity to cold; heart palpitations, shortness of breath; increased menstrual bleeding; increased susceptibility to infections; and obesity.

For those with respiratory or heart-related ailments, Anemia can make symptoms worse or make it more difficult to control the ailments.

Causes of Iron-Deficiency Anemia

The chief cause of IDA is bleeding or blood loss. Blood loss can come from any source; when too much blood is lost, the body has difficulty compensating for the oxygen distribution that is essential for life. Most people are aware of blood loss, as from a wound, menstrual bleeding or bleeding hemorrhoids. However, sometimes bleeding can occur without a person knowing, as with a bleeding stomach ulcer. At times like these, they are unaware that they are Anemic.

Other causes:
> Inadequate dietary intake of Iron, or taking in Iron without converters (see below)
> Drinking alcohol or alcoholism
> Depletion of Iron by medical drugs
> Depletion of Iron by natural supplements
> Depletion of Iron by dietary foods

More about Iron Depletion

Iron depletion occurs quite rapidly as iron “floats around” in the blood. When a medical drug or herbal component enters the blood stream, the substance binds to the Iron, thus rendering the Iron AND the substance unable to be used—in the end the combination is flushed from the body either via the bowels or the urine. Either way, this can cause problems for those depending upon a drug, supplement and/or Iron for health reasons.

There are MANY medical drugs that deplete Iron from the body. Some of the categories are (this list is not complete):
> Antacids: such as those used to reduce stomach acidity, GERD, etc.
> Antibiotics: cephalosporins, penicillins, tetracyclines, etc.
> Anti-Inflammatory Drugs: ibuprofen, steroids, etc.
> Blood Pressure Lowering Drugs: calcium-channel blockers, ACE-Inhibitors, and others.
> Diuretics: “water pills”
> And the list goes on…

Some of the commonly-used natural supplements that deplete Iron by binding to it either in the blood or digestive tract (again, the list isn’t complete):
> Calcium
> Magnesium
> Artichoke
> Cascara sagrada
> Chamomile
> CoQ10
> And the list goes on…

Some foods and drinks that deplete Iron (when eaten/drunk with foods containing Iron or supplements of Iron):
> Dairy products
> Coffee
> Tea
> Alcohol & Wines

If the drug or supplement binds to the Iron in the digestive tract, then it is possible to separate Iron from the drug or supplement by two hours thus the Iron will have a better chance of being absorbed. If unsure, then it is best to not take Iron with the supplement (talk to your medical doctor or pharmacist about medical drug interaction with Iron).

3 Types of Iron: Heme, Non-Heme and Elemental

The types of Iron that are best absorbed (most rapidly) are Heme sources of Iron. Heme means they are the closest to the type of Iron that is used in making RBCs so they are readily used for making the RBCs. Common food sources of Heme Iron are red meats, liver, chicken, seafood and eggs.

Non-Heme Iron are sources of Iron that require modification of the Iron before it can be used—it needs vitamin C, vitamin A or Beta-Carotene to make it active for use. Without those assistants, this form of Iron will be unusable by the body. Sources of Non-Heme Iron are the non-meat/animal sources, such as dark green leafy vegetables, whole grains, nuts, blackstrap molasses and dried fruits; herbs such as cayenne, kelp, peppermint, and rosehips. To make the Iron in these substances usable, take vitamin C, vitamin A, or Beta-Carotene with the meal.

Treatment of Iron-Deficiency Anemia is usually a supplement, an Elemental Iron Source such as Ferrous Sulfate. Elemental Iron needs a conversion such as the vitamins mentioned above. Therefore, if you buy a bottle of Elemental Iron, it might say that each tablet contains 325 mg of Iron, but only 65 mg MAY be absorbed and utilized optimally (usually only about 20 mg is usable per tablet).

An odd fact of Iron (and nearly all vitamins and minerals) is that when it is needed by the body, more will be absorbed during its time of need.

All sources of Iron (when absorbed correctly) will turn stool dark green or near-black. This is a normal reaction.

Do Not Take Iron Supplements If…

Taking Iron supplements that are not needed by the body can cause health challenges such as heart disease, Iron Toxicity and can be damaging to the liver. Therefore, adult men and post-menopausal women should avoid supplements that contain Iron, unless otherwise directed by a healthcare practitioner.

Maximizing Absorption of Iron (Getting the Most of the Diet)

Iron is found in many vegetables, nuts and grains. However, as mentioned above, it is in a form that is unusable by the body. Without a converter (vitamin C, vitamin A, or Beta-Carotene), the Iron in these foods will be flushed from the body. Therefore, take in a vitamin source when eating foods that contain Non-Heme Iron. Foods that contain Heme Iron do not need the conversion—it is readily available for use.

Also, do not take Iron supplements or eat a diet rich in Iron with coffee, dairy products, alcohol or tea as these drinks bind to Iron and render it unusable, even with a converter such as vitamin C.

Vitamin C can be found in citrus fruits. Vitamin A and Beta-Carotene are best found in yellow or orange vegetables as well as broccoli.

Reference

Centers for Disease Control and Prevention (2009). “Anemia or Iron Deficiency” at http://www.cdc.gov/nchs/fastats/anemia.htm

Best wishes,
Dr. Ronda

Disclaimer: The information provided by Dr. Ronda Behnke Theys is for educational purposes only. It is important that you not make health decisions or stop any medication without first consulting your personal physician or health care provider.