If you're tired all the time with little energy, it's worth paying a visit to your doctor for a blood test to check whether you have iron-deficiency anaemia. Lack of energy, poor stamina, pale skin, an inability to concentrate, frequent headaches, greater susceptibility to infections, and feeling the cold often are other tell-tale signs.
Iron deficiency is the most common nutrition problem in the world, affecting around 35 per cent of people in developing countries and 8 per cent in affluent countries. (Other causes of anaemia include inherited disorders such as thalassemia and sickle cell disease, chronic diseases like rheumatoid arthritis and some medications).
Because it is not life-threatening and because it mainly affects women and young children, iron deficiency never receives the attention it deserves.
The 6 groups who are commonly iron deficient
1. Women are much more likely to have iron-deficiency anaemia than men. First, women's needs for iron are almost double that of men's due to the monthly blood loss through menstruation (especially women who have heavy periods). See my post on Why women need more iron.
2. Teenage girls require more iron to meet the demands of rapid growth and the onset of menstruation. Unhappily, many of them have low iron intakes as they eat poorly, saying "no" to sensible meals and then picking at snacks. Or they become vegetarian without understanding how to meet their iron needs now they are missing out on meat, the best source of bio-available iron.
3. Vegetarians tend to have a lower iron status than meat-eaters. Although there is abundant iron in green vegetables and cereal grains, it is not well absorbed.
4. Young children under the age of two are at risk of iron deficiency as they are growing fast and can be fussy eaters. In children, signs of iron deficiency are delayed psychomotor development and poor capacity for exercise. Babies who had a low birth weight or were pre-term are the ones to watch.
5. Athletes also miss out on iron as the heavy pounding of running or exercising can prematurely destroy blood cells (known as haemolysis). Greater muscle mass means more myoglobin is produced, which further raises iron needs. "Sports anaemia" is well documented in professional female athletes and can affect their capacity to train to peak levels.
6. Poor absorbers - you can be at risk if, for some reason, your body can't absorb iron efficiently. For example, many people with coeliac or Crohn's disease don't absorb the iron (and calcium) they ingest as their inner bowel is inflamed and/or atrophied and so unable to do its job properly.
Eat to beat iron-deficiency anaemia
Ideally it's best to obtain iron from food as nature intended. [See my post on Iron for more detail]
Red meat is the best source of iron and it's well-absorbed by the body. Generally, the redder the richer, so enjoy that steak or lean lamb rump. Even if you only eat meat occasionally (which I recommend), small amounts (such as a few strips of beef in a vegetable stir-fry) can improve your iron absorption from the vegetables in your meal. See sample recipe here.
The iron in grains, vegetables, legumes, nuts and eggs is not absorbed as well as meat
Ways to boost your iron absorption
Adding a glass of fruit juice or some tomato or capsicum (all rich in vitamin C) to a meal increases the amount of iron delivered by grains or lentils. Most vegetarian meals, with their emphasis on vegetables and fruit, would automatically contain much vitamin C.
Watch what you drink with meals. Relative to water, orange juice doubles iron intake, while milk decreases it by 50 per cent and tea by 75 per cent. Best to save tea and coffee for between meals
Food first, supplements second. The body's iron is in delicate balance - too little leads to problems, but so can too much. Thus it's best to obtain iron as nature intended from food, rather than rely on supplements.
A US study of 60 females who exercised moderately found that the iron in meat was better absorbed than that from an iron supplement.
The researchers calculated that only 2.2 mg of iron was finally absorbed from a 50 mg controlled-release iron capsule.
Safety Note: Accidentally swallowing iron supplements is the commonest cause of poisoning in young children, who mistake them for lollies. Excess iron pills can be fatal for a small child. Keep all supplements well out of reach of children.
Chronic iron overload, or the slow accumulation of iron, can be lethal in someone who has a predisposition to storing excess iron. Known as haemochromatosis, this condition affects one in every 300 Australians and New Zealanders. This is another reason why you shouldn't take iron tablets without knowing your personal situation.
As there are usually no symptoms apart from fatigue, abdominal pain and joint pain (which can occur for a multitude of reasons), heamochromatosis is often not diagnosed unless an abnormally high iron count is picked up during a routine blood test. Or a close relative is diagnosed with the disease. If this sounds like you, get your doctor to check you out.
When an iron supplement can help
When body iron stores are low, an iron supplement can help but it pays to choose carefully. The most common form of iron in supplements is slow-release ferrous sulphate, but this tends to cause constipation, dark stools, nausea or upset tummy when taken daily.
Ferrous gluconate, ferrous fumarate and chelated forms of iron are more readily absorbed and may cause fewer problems. All however are non-haem forms of iron which are subject to the same poor availability as that in vegetables.
- Take one on an empty stomach, i.e. before breakfast, as food can inhibit absorption by up to 50 per cent.
- Take an iron tablet every second day as this is less likely to produce the unpleasant side effects.
Reference: Lyle RM et al, Iron status in exercising women: the effect of oral iron therapy vs increased consumption of muscle foods. Am J Clin Nutr 1992; 56:1049-55.
Iron in the news
A new test for iron deficiency, described in research published in Nature Communications, takes about a minute and provides immediate results. It involves using a small optical fibre to shine a blue laser light onto the lower lip. If zinc proto-porphyrin – a chemical compound found in the blood of iron deficient people – is present, then it gives off a fluorescent light in response.