Does anyone else feel like all medical professionals bang on about iron and being iron deficient and how to get more iron in your body constantly? Well, even though it might feel like we are flogging a dead horse, there is good reason to.
WHAT IS IT?
Iron is an essential mineral needed in our bodies. It is needed to make hemoglobin (Red blood cells that carry oxygen around our body) and myoglobin (carrying oxygen into the muscles). Ferritin is a protein that stores the iron in the body, and transferrin is how well the body transports that ferritin (imagine transferrin is the bus that takes the little ferritin ‘people' to where they need to go).
WHY IS IT SO IMPORTANT?
So now I hear you saying ok cool Em, but why is it so important? Well simply put, low iron--> low oxygen transporting through your body, and low oxygen transporting through your body--> your body can’t grow, change, develop, and move. That's why we see kids who are iron deficient (Iron Deficiency Anaemia or IDA) have brain development issues, their bone marrow and physical growth stunted, and this is shown by behavioural changes (because they find it hard to understand what we are teaching them and get bored), fatigue (because they simply don’t have enough oxygen running through their body to move and jump and play),they are anxious and depressed (they are anxious because they can’t keep up with everyone else, and sad cause they want to play but their bodies are too tired!).
OK SO WHERE DO I GET IRON FROM?
The only source is food! There are two main sources: heme and non-heme. Heme source foods include:
- Red meat
- Poultry
- Seafood
- dairy (very small amounts)
Non-heme sources include:
- whole grains/ pseudo grains (think wheat, rice, barley, quinoa, millet, oats, corn etc)
- Nuts and seeds (sesame, hemp, almonds, macadamia, walnuts, pine nuts pistachio, pumpkin seeds etc)
- Beans/ Lentils
- Spinach and other vegetables (in small amounts).
Heme sources of iron have a much higher absorption rate (15-35%) in comparison to non-heme iron sources ( 2-20%). Funnily enough, there are more non-heme sources (more vegetables, pulses, nuts and seeds) of iron than there are heme; however it has been shown that one of the greatest factors of increasing the absorption of non-heme sources of iron is the digestion of heme sources together.
OK SO, I NEED TO EAT BOTH HEME AND NON-HEME SOURCES OF IRON FOR OPTIMAL ABSORPTION, IS THERE ANYTHING ELSE?
Yep, ascorbic acid (vitamin C) has been shown to increase the bio-availability of iron into the cells. Other vitamin co-factors (this just means they help deliver the vitamin into the cell better) are B12, B9, and B6.
IS THERE ANYTHING THAT INHIBITS THE ABSOPRTION?
Unfortunately yes there are a number of constituents that inhibit iron. These include:
- Calcium (particularly dairy products)
- Polyphenols (found in fruits and vegetables, coffee, tea, red wine, chocolate)
- Phytates (found in nuts, seeds, legumes, unprocessed whole grains)
Interestingly, ascorbic acid actually overcomes the negative effects of the above inhibitors, further enhancing our recommendation to consume vitamin C rich foods with iron rich foods for optimal absorption.
TIP: a great way to reduce phytates in nuts, seeds, legumes and grains is to soak them before hand!
WILL I BE ANAEMIC IF I DON'T HAVE ANY HEME SOURCES OF IRON?
The short answer is yes. 95% of functional iron in the body is from a heme source, and your body can not convert non-heme sources into heme sources. Unfortunately I have yet to see a patient who is vegetarian/vegan and not anaemic.
HANG ON WHAT ABOUT THE INFLAMMATION OF RED MEAT IN THE GUT?
I hear you, there is some definitive research to suggest that you are at risk of systemic inflammation if you are consuming lots of red meat and daily. However good quality, grass fed organic red meat has been shown to have much lower inflammatory markers and if consuming 2 times a week, the benefits of a healthy heme iron intake outweighs the benefits of none by 10 fold. Furthermore, a diet high in FOS (fructooligosaccarides) and GOS (glucooligosaccarides) will aid digestion which consequently lowers inflammation and increases absorption of nutrients.
Foods high in FOS and GOS are fruits, vegetables, legumes, whole grains, nuts and seeds (hello fibre!).
It is important to note if you have an IBD (Crohn’s disease or Ulcerative Colitis) you are at a much higher risk of mal-absorption of both heme and non-heme sources of iron as it gets absorbed in the upper part of the small intestine. If this is you, I would recommend you see a nutritionist/GP to manage and monitor your overall nutritional profile.
TAKE HOME POINTS:
1. You need to consume both heme and non-heme sources of iron. It is best absorbed when eaten together (think bolognaise, prawns and lemon juice, chicken and cous cous).
2. It is not recommended to be a long term vegetarian/vegan. The absence of heme iron long term, will be detrimental to your overall health.
3. Kids, teenagers, and pregnant women need a higher intake of iron as these are periods of rapid growth.
4. Monitor dairy intake. A diet too high in dairy can inhibit the absorption of iron in food.
5. Make sure you are having vitamin C rich foods with your iron consumption.
6. Do not drink coffee, tea, or red wine with your iron consumption (both supplements and food).
7. Ensure you are maintaining a diet of fibrous foods (FOS AND GOS) such as fruits, vegetables, nuts, seeds, legumes and whole grains to help with digesting iron.
8. Soak nuts, seeds, legumes, and grains to reduce the phytate value in them. This will increase the absorption of iron on consumption.
8. Iron Deficiency Anaemia (IDA) is treatable. A nutritionist can test and provide appropriate iron supplementation in therapeutic doses along with dietary and lifestyle recommendations.
Resources:
- Abbaspour N, Hurrell R and Kelishadi R 2014 ‘Review on Iron and its importance for human health’ Journal of researching medical science, vol 19, issue 2, pp. 164-174.
- Hooda J, Shah A, and Zhang L 2014 ‘Heme, an Essential Nutrient from Dietary Proteins, Critically Impacts Diverse Physiological and Pathological Processes’ Nutrients vol 6, issue, 3, pp 1080-1102.
- Monsen ER, 1988 'Iron nutrition and absorption: dietary factors which impact iron bioavailability’ Journal of American Dietetic Association, vol 88, issue 7, pp 786-790.
- Murat S, Ali U, Serdal K, Süleyman D, Ilknur P, Mehmet S, Bahattin A and Tunahan U 2015 ‘Assessment of subjective sleep quality in iron deficiency anaemia’ African Health Sciences, vol 15, issue 2, pp. 621-62.
- Selhub J 2002 ‘Folate, vitamin B12 and vitamin B6 and one carbon metabolism’ The Journal of nutrition health & aging, vol 6, issue 1, pp 39-42.
- Young I, Parker HM, Rangoon A, Prvan T, Cook RL, Donges CE, Steinbeck KS,O’Dwyer NJ, Cheng HL, Franklin JL, O’Conner HT 2018 ‘ Association between Haem and Non Haem Iron Intake and Serum Ferritin in Healthy Young Women’ Nutrients vol 10, issue 81 pp 1-13.