Friday, October 16, 2009

No Energy Due to Anemia

At a recent social event, a friend of mine was telling me she was low in energy. She had been to her doctor who diagnosed her with anemia. As I didn’t want to give a lesson in nutrition over a glass of champagne, I decided to write an article on iron-deficient anemia (lack of iron in the blood).

Why do we need iron?
Iron is essential for:
➢ Forming hemoglobin which carries oxygen in the blood
➢ Forming myoglobin which carries oxygen to the muscles
➢ Several enzymes and proteins
➢ Energy
➢ Brain growth and development in infants and children
➢ Life Like many nutrients, excess iron is toxic.

Symptoms of Deficiency
These are some of the symptoms to look for if you think you have anemia, literal translation “without blood”:
➢ Pallor – pale-look as blood flows away from the skin
➢ Low energy and easily tired due to oxygen starvation
➢ Shortness of breath (dyspnea) with exertion
➢ Dizziness and fainting due to lack of oxygen in the brain
➢ Inability to work properly
➢ Fast heart rate (tachycardia) as the heart has to work harder
➢ Ringing in the ears (tinnitus) due to oxygen starvation in the brain cells
➢ Decreased tolerance of cold
➢ Poor appetite
➢ Increased risk of infection
➢ Lower resistance to disease
➢ Brittle, concave finger nails (koilonychia)
➢ In children, decreased growth, apathy, short attention span and irritability
➢ Heart failure

Deficiency can occur despite the body’s wonderful way of increasing absorption when stores are low, and decreasing absorption when stores are high. However, if not treated, an iron deficiency can lead to death.

Who is at Risk for Anemia?
➢ Females - 15% have anemia. Possible causes are:
a. Low intake of iron-rich foods
b. Excessive bleeding during menstruation
c. Pregnancy with it’s increased iron needs
d. Sports anemia in female athletes due to menstrual losses, inadequate iron intake and increased breakdown of red blood cells.
e. Teenage girls – due to rapid growth, menstruation and fad diets
f. Eating disorders – anorexia and bulimia
➢ Vegetarians – it is recommended to consume twice as much iron as meat eaters because absorption of non-heme iron from plant foods is lower compared to the heme-iron from animal foods. I’ve seen some overweight anemic vegetarians, replacing beef with doughnuts – not a good idea. Vegetarians who eat a well balanced diet do not have higher rates of anemia than non-vegetarians.
➢ People on fad diets
➢ Breast fed infants after six months who do not consume iron-rich foods or formulas.
➢ Toddlers under two years of age who are not on iron-fortified formulas or eating iron-rich foods.
➢ People with peptic ulcers, inflammatory bowel disease and bowel cancer which cause gastrointestinal bleeding.
➢ People in developing countries
➢ People with anemia producing parasites such as malaria.

On the other hand, men usually eat more than the recommended daily iron intake leading to possible toxicity.

What are the Recommendations?

The Recommended Daily Allowances (RDA) for iron is 8 mg for men and 18 mg for women, 19 – 50 years. From ages 51+ years, iron intake for men and women is 8 mg; pregnant women’s RDA is 27 mg a day; breastfeeding it’s 9 mg. Upper Limits (UL) for adults and the elderly is 45 mg.

Sources of Iron:
• Iron is stored in the liver of humans and animals, making liver a major source of iron
• Animal foods supply heme and non-heme iron. Good sources are liver, meat, sausages and the dark meat of turkey. Iron is better absorbed from animal products than from plant products
• Plant foods supply non-heme iron. Good sources are whole grain and enriched cereals and pasta, dark green vegetables, dried fruits and legumes.

Enhance absorption:
Some foods increase the absorption of iron, such as
• Meat, poultry and fish
• Vitamin C rich fruits and vegetables
For vegetarians, when eating a plant food containing iron, e.g. iron enriched pasta, bean soup or fortified cereals, be sure to include a fruit or vegetable. For those willing to eat a little animal food, just a small amount plus a fruit or vegetable will increase the absorption of iron from plant foods considerably. A client recently said “I was a vegetarian for five years then decided to follow your advice, and add a little meat to my diet. My energy soared immediately.” I know some of you are die-hard vegans, but maybe a little fish two or three times a week is all you need to help with iron absorption and increase your energy level.

Decrease availability:
There are foods that decrease iron absorption. This doesn’t mean avoid these foods; it means you need to eat a variety of foods to ensure good absorption
• Phytates in the fiber of whole grains
• Oxalates in spinach
• Calcium and phosphorus in dairy products
• Soy protein
• Polyphenols in tea, coffee, and other beverages and plants.
• Tannin in tea. Decaffeinated drinks do not reduce the polyphenols or the tannin I don’t want to encourage you to lower your intake of these foods, as there is so much goodness in them, rather add a little meat and a fruit or vegetable to the meal to counteract this effect. Once again, we are proving the point of moderation in everything.


The good side
• If you have anemia, your physician will recommend a supplement. You will notice immediate improvements in your energy and health.
• Food alone cannot overcome anemia; iron supplements are necessary. With iron therapy, your blood values should return to normal in two months.
• If you’re slightly iron deficient, seeing a dietitian could be your best investment.
• Supplements from well-known brands are specifically formulated for your type, with increased iron content for pregnant women and lower iron content for children, the elderly and men.

The bad side
• Toxicity is rare from dietary sources, however, toxicity can occur from ingestion of iron supplements
• Zinc supplements compete with iron for absorption
• Although best to take iron supplements on an empty stomach, they can cause stomach pain and constipation. If so, take with vitamin C rich fruits and vegetables but not with milk and antacids.
• When you self prescribe, you don’t really know how much is optimum for you.
• Different members of the family have different requirements.
• Carefully read the warning notices on iron supplements.
• Adult or prenatal supplements can lead to iron poisoning and accidental deaths in children, occurring within a few hours after swallowing just a few pills. Keep supplements out of the reach of children and store with medications in a locked cabinet.
• Excess iron intake can lead to damage to the liver, pancreas, heart or immune system, hemorrhaging, decreased absorption of copper and death.
• Iron overload leads to hemachromatosis, particularly in African men, and increased risk for heart disease, severe organ damage and again death.

I’m sure you would like to have a Good Iron Day. With the following variety of foods and estimated iron-content, you can mix and match. Here are examples to suit people with different food preferences:

Food Item

Meat Eaters – Men and post-menopausal women (8 mg iron)
1 cup cereal, iron enriched: 3 mg
3 oz beef, venison, lamb, ham or sausage: 3 mg
½ cup rice: 1 mg
2 cups cooked vegetables: 1 mg
TOTAL: 8 mg

Meat Eaters – Adult Women (18 mg)
1 cup cereal, iron enriched: 5 mg
2 oz chicken liver: 5 mg
1 cup canned tuna: 2 mg
½ cup legumes (beans): 2 mg
½ cup peanuts: 1 mg
1 cup enriched pasta, cooked: 2 mg
2 cups cooked vegetables: 1 mg
TOTAL: 18 mg

Fish eaters – Adult Women (18 mg)
1 cup cereal, iron enriched: 5 mg
4 clams or 6 shrimps or oysters: 6 mg
1 cup cooked turnip greens: 2 mg
2 oz whole wheat bagel: 3 mg
2 cups cooked vegetables: 1 mg
10 dates: 1 mg
TOTAL: 18 mg

Lacto-ovo Vegetarians (milk and eggs) (20 mg due to poorer absorption)
1 cup cereal, iron enriched: 5 mg
3 eggs: 4 mg
½ cup cooked barley: 1 mg
2 cups enriched pasta, cooked: 4 mg
1 cup cooked Swiss chard: 2 mg
½ cup prune juice: 2 mg
½ cup almonds: 2 mg
TOTAL: 20 mg

Vegans (no animal products at all) (26 mg due to even poorer absorption)
1 cup cereal, iron enriched: 5 mg
1 oz wheat germ: 1 mg
3 oz tofu wiener or burger: 3 mg
½ cup lentils: 3 mg
2 slices bread: 2 mg
2 cups enriched pasta, cooked: 4 mg
3 oz avocado: 1 mg
1 cup cooked spinach, kale or collard greens: 2 mg
½ cup cashews: 4 mg
1 cup blackberries: 1 mg
TOTAL: 26 mg

When you see these lists, it is surprising we have anemia. These foods seem easy to eat every day. Here are more options:
3 oz chicken: 1 mg
½ cup canned baked beans, vegetarian: 0.5 mg
¼ cup hummus: 1 mg
12 halves dried apricots: 2 mg
10 dried prunes: 2 mg
2 dried figs: 1 mg
¼ cup raisins or dried apricots: 2 mg
½ cup walnuts, pecans or mixed nuts: 2 mg
1/4 cup sunflower seeds: 3 mg
2 Tbsp pumpkin seeds: 2 mg
1 cup trail mix: 5 mg (and 700 calories)
Cereal bars: 1 – 5 mg
These values are averages; you’ll need to read labels on boxes.

Every day need not be perfect. Some days will have more iron-rich foods and other days less. Just know how much you need, where to find these foods and plan to include a variety of these foods in your diet every day.

If you’re feeling tired, aren’t eating well and fit into the risk categories, contact your physician and find a dietitian on