Iron is needed for healthy blood. Every one of the millions of red blood cells floating in the blood contains iron. It?s actually the iron that binds with the oxygen we breathe and carries it through the blood. In muscles, iron is part of myoglobin, and without it our muscles wouldn?t have oxygen. Iron is also part of oxidative enzymes found in all cells, so it has a role in thousands of body processes.
Iron is recycled efficiently by the body, so normal daily loss is very slow. Deficiencies are usually due to blood loss ? from injury, surgery, internal bleeding or menstruation ? or inadequate intake during a growth spurt. Infants may be deficient unless the mother?s iron status was excellent. Children may be deficient during rapid growth, especially since they often don?t eat adequate amounts of meat. Pregnant women need generous iron to prevent deficiency and build the baby?s liver stores. A healthy baby is born with a six month supply of iron in its liver.
Signs of deficiency include fatigue, weakness, irregular or rapid heartbeat, cravings for dirt or ice, cold hands and feet, hair loss, and iron-deficiency anemia. A different kind of anemia can be caused by deficiencies of folic acid and B-12 rather than iron. Blood tests for iron, iron binding capacity, ferritin (the storage form of iron), and a complete blood count (CBC) can reveal anemia and its cause. Iron levels alone are inadequate to diagnose this, since blood levels vary widely. Health practitioners often ignore the levels of such blood components as hemoglobin and hematocrit (revealed in the complete blood count) when they are at the low end of the normal range, but even a borderline deficiency can cause fatigue. Anemia can also be caused by a chronic illness such as inflammatory bowel disease; or low stomach acid levels, both of which inhibit absorption.
If you?re not low in iron, supplementation can cause toxicity. High iron is toxic to the blood and heart, so men and non-menstruating women should avoid iron supplementation ? even the amount in a multiple vitamin-mineral supplement if it contains iron ? unless blood tests show deficiency. They should also limit their intake of iron-fortified foods, especially dry cereals. Regular white wine intake and regular use of cast iron cookware can also cause excess iron buildup. Often there are no external signs of toxicity. If you have excess iron, either from over-supplementation or hemochromatosis, donating blood is recommended to correct or control the problem. The amount of iron from natural foods and whole foods supplements will not cause iron excess.
Iron-rich foods should be emphasized when restoring iron status. In roughly descending order by amount of iron provided in a normal serving, good sources are:
? oysters, liver and heart
? red meats ? including beef, pork, poultry thighs, buffalo, deer and elk
? blackstrap molasses and brewer?s yeast
? red beans and certain other legumes such as lima beans
? greens ? including spinach, collard greens and kale
? plums, prunes, blackberries and blueberries
? enriched breads and cereals
Iron from plant foods isn?t as easily absorbed as iron from flesh foods, but studies show that combining plant or supplement sources with an animal source significantly enhances the absorption of plant iron. If you?re taking an iron supplement, we recommend taking it with a meal that includes meat.
Deficiency can rarely be corrected in a reasonable time with diet alone, so a supplement is recommended. Good forms of iron include ferrous fumarate, ferrous gluconate, and ferrous succinate. Ferrous sulfate is more likely than other forms to cause stomach upset. Iron supplement labels often list both the mgs. of iron and the mgs. of the entire compound, so be careful not to confuse the two. For example, 300 mg of ferrous gluconate provides 34 mg of iron. For mild deficiencies, take 60 to 65 mg of iron twice a day for two to three months, and then recheck blood levels. For severe deficiencies, take as much as twice this dose three times a day, and recheck blood levels in three to four months. Start children at ? to ? of adult doses, depending on weight.
Taking iron is recommended under certain conditions, especially if blood levels are below the middle of the normal range. Be sure you don?t already have high-normal or elevated iron levels before doing this. You may need extra iron supplementation (beyond the amounts found in multiple-vitamin minerals that provide iron) if:
? you?re about to have or have just had surgery
? your blood tests reveal iron-deficiency anemia or poor iron status.
? you?re planning a pregnancy, are pregnant, or have recently delivered
? you sustained injuries that led to blood loss
? you?ve had a bleeding ulcer, bleeding hemorrhoids, or other internal bleeding
? you?re a menstruating woman and you have heavy periods
? you?re a peri-menopausal woman and you have episodes of heavy blood loss
If a supplement causes stomach upset, reduce the dose and be sure to take it in the middle of a meal ? preferably lunch or dinner. You might also try another form or brand of iron. A liquid supplement may be better tolerated and absorbed.
Iron tends to cause constipation while magnesium loosens the stools if you take enough to reach ?bowel tolerance.? If taking iron causes constipation, counter this by taking magnesium during this time. Gradually increase magnesium until stools are loose. If you?re starting out with constipation, start the magnesium supplement first.
Yellow dock is an herb that can strengthen the liver and help the body retain iron and build iron stores. Nettles also help build iron in the blood.
Calcium, antacids and antibiotics interfere with good iron absorption. Try to keep milk, cheese, yogurt and calcium supplements out of the meal at which you take iron.
Vitamin C enhances iron absorption. As little as 50 mg of vitamin C or a small glass of orange juice significantly increases absorption when taken at the same time as the iron supplement or iron-rich food.
The 18 mg. of iron found in many multiples is the amount needed by the average woman for replacing iron losses due to menstruation. For men and non-menstruating women, multiples without iron are available in all health food stores and our office.
Jari Serra, R.D.