Iron Deficiency Anemia: Causes, Symptoms, and Dietary Guidelines

     As the name suggests, iron deficiency anemia is a condition that occurs when the body does not have enough iron.

Before discussing the appropriate diet for anemia, let’s first talk a bit about the mineral iron and the symptoms of this condition.

Iron and Hemoglobin

Iron is found in cells that carry hemoglobin. In an adult human body, there are approximately 3-5 grams of iron, and more than half of this amount is found in the blood. Iron does not move freely in the blood or body; it binds to different proteins and takes on various roles. One of its vital functions is transporting oxygen from the lungs to other tissues in the body and returning carbon dioxide from the tissues to the lungs. It also plays a role in synthesizing enzymes needed to produce energy for our bodies. Moreover, it is an essential part of the system that eliminates harmful substances and medications from the body.

Symptoms of Iron Deficiency Anemia

Due to insufficient oxygen transport to tissues, the most obvious symptoms of iron deficiency anemia are excessive fatigue and weakness. Other symptoms include brittle nails and white spots on them, cold hands and feet, rapid heartbeat and shortness of breath during physical effort (e.g., climbing stairs), unusual cravings for non-food substances like dirt, ice, clay, or chalk, pale skin, and poor appetite in infants and children. Additionally, there may be increased susceptibility to infectious diseases and lead poisoning caused by air pollution.

Iron Absorption and Balance in the Body

In a healthy individual, iron balance is supported by the absorption of iron from daily food intake. The body absorbs the amount of iron it needs to compensate for what’s lost in the breakdown-build-up cycle. Once it meets its requirement, the body stops absorbing iron. During periods when demand increases—such as infancy, pregnancy, breastfeeding, menstruation, childbirth, blood donation, or bleeding due to injuries—the body increases iron absorption from food to maintain balance. However, this balance can be disrupted by excessive aspirin use, intestinal parasites, long-term inadequate and unbalanced diets, gastrointestinal diseases causing malabsorption, or inherited enzyme disorders.

Types of Iron in Food

The iron we consume in food exists in two forms: heme iron and non-heme iron. Heme iron is more easily absorbed and is mostly found in animal-based foods. Non-heme iron is found in plant-based foods and requires sufficient stomach acid and vitamin C for proper absorption.

Iron Supplementation and Drug Interactions

If no other underlying cause for the deficiency exists, iron supplements are prescribed in appropriate doses based on the severity of deficiency and the individual’s circumstances. To get the full benefit, iron supplements should be taken on an empty stomach because they interact with foods and medications. Antacids used for heartburn also reduce iron absorption, so iron supplements should be taken at least two hours before taking such medications.

THINGS TO CONSIDER IN YOUR DIET


  • Vitamin C: A deficiency in vitamin C can reduce iron absorption. Also, excessive intake of dietary fiber found in fruits and vegetables can hinder absorption. Therefore, foods rich in vitamin C should be prioritized to prevent this. Starting the day with freshly squeezed lemon water, and including parsley, green peppers, and tomatoes or carrots in breakfast plates is beneficial. Continue supporting vitamin C intake with two servings of seasonal fruits throughout the day. Fruits like oranges, mandarins, grapefruits, peaches, and strawberries are high in vitamin C.

  • In Children: For children who are picky eaters or refuse medications, iron supplements can be given with a glass of freshly squeezed orange or grapefruit juice to ensure treatment adherence.

  • Protein Intake: Protein is necessary for the production of blood cells. If protein intake is insufficient, the amount of iron absorbed from food decreases. Proteins are classified by their usability in the body as “reference proteins,” “high-quality proteins,” and “low-quality proteins.” Animal-based proteins are typically in the reference or high-quality group, while proteins from grains, legumes, and vegetables fall into the low-quality group. Red meat has higher iron content compared to chicken or fish. If you do not have high cholesterol, plan meals with red meat 2-3 times a week. If you don’t have high cholesterol or an egg allergy, eat one egg per day. Meal combinations of grains with vegetables or legumes can also provide adequate protein for adults. Cooking these with vitamin C-rich vegetables (like tomatoes) can further boost iron absorption.

Foods That Inhibit Iron Absorption:

  • Phytates found in grains and legumes reduce iron absorption. Therefore, avoid white or bran bread. Opt for yeast-leavened whole wheat bread instead.

  • Soaking grains and legumes in water for at least 20 minutes before cooking and discarding the soaking water reduces phytate content and enhances iron bioavailability.

  • Tannins in tea, coffee, and cocoa reduce absorption by 40-60%. Do not consume these beverages with meals. Instead, drink them at least 45-60 minutes before or after eating.
  • Processed deli meats contain nitrites and nitrates, which hinder absorption, so they should not be considered good sources of protein or iron.

Iron-Rich Foods:

Leafy green vegetables have a high iron content. Dried fruits, especially raisins and dried apricots, molasses, nuts like hazelnuts and pistachios, sesame, and tahini are all good sources of iron. One serving of dried fruits per day, 1-2 teaspoons of molasses at breakfast, and 5-6 nuts as snacks can be beneficial.


REFERENCES:

  1. Nomkong, R. , Ejoh, R. , Dibanda, R. and Gabriel, M. (2019) Bioavailability of Iron and Related Components in Cooked Green Leafy Vegetables Consumed in Cameroon. Food and Nutrition Sciences, 10, 1096-1111. doi: 10.4236/fns.2019.109079.
  2. Küçükceran, H. , Ayhan Başer, D. , Ağadayı, E. , Demir Alsancak, A. & Kahveci, R. (2018). Ankara İli Akyurt Bölgesindeki Gebelerde Demir Eksikliği Anemisi Prevalansı ve Demir Eksikliğine Sebep Olan Faktörler . Konuralp Medical Journal , 10 (1) , 13-19 . DOI: 10.18521/ktd.316896
  3. Çifci, A. & Özkan, M. (2018). Demir fizyopatolojisi ve demir eksikliği anemisine yaklaşım: yeni tedavi stratejileri . Journal of Health Sciences and Medicine , 1 (2) , 40-44 . DOI: 10.32322/jhsm.430073
  4. Baysal A. (2012) Beslenme, Hatipoğlu Yayınları, 14. Baskı
  5. Baysal A. , Aksoy M. , Besler T. , Bozkurt N. , Keçecioğlu S. , Mercanlıgil S. M. , Merdol T. , Pekcan G. , Yıldız E. (2014) , Diyet El Kitabı, Hatipoğlu Yayınları, 8. Baskı 

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