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The Nuts and Bolts of Dietary Iron

Amy Campbell, MS, RD, LDN, CDE

Symptoms. Anemia may not always be quickly diagnosed, since the signs and symptoms are similar to other health conditions. However, contact your health-care provider if you experience any of the following, because they can be signs that you are anemic:

  • Fatigue
  • Weakness
  • Lightheadedness or dizziness
  • Ringing in the ears
  • Rapid heartbeat
  • Shortness of breath
  • Headaches
  • Irritability
  • Paleness
  • Difficulty concentrating
  • Brittle nails
  • Cracked lips
  • Smooth, sore tongue

Children with anemia may experience a decrease in their performance in school and slow cognitive and social development. Pregnant women who are anemic may exhibit unusual conditions called pica and pacophagia. Pica is the consumption of nonedible items such as dirt, clay, or paper. In pacophagia, a person constantly craves ice. Iron-deficiency anemia during pregnancy is a cause for concern because there is an increased risk for premature delivery of the baby, a low birth-weight baby, and complications that occur in the mother.

Diagnosing anemia. If your health-care provider suspects that you have iron-deficiency anemia, you will likely have a physical exam, a review of your symptoms, and special blood tests. These include a complete blood count, which can give an idea of the condition of your blood cells; iron tests, which can determine the type and severity of anemia; reticulocyte count, a count of immature red blood cells; and a ferritin level test to determine the level of iron stores in the body. Sometimes a portion of the bone marrow is also obtained to better determine the cause of anemia. If your physician suspects bleeding in the digestive tract, he’ll also order a fecal occult blood test, a colonoscopy, an endoscopy, and/ or an upper GI series (x-rays of the upper gastrointestinal tract).

People at risk. Because older infants, toddlers, teenage girls and boys, women of childbearing age, and pregnant women have higher iron needs, they are more likely to not get enough iron, putting them at risk for a deficiency. Women who have heavy menstrual periods also often need more iron to prevent deficiencies. Women in minority groups and women from a low-income background are more likely to not be meeting the RDA for iron because of inadequate diets.

Other people may be at risk for anemia. Endurance athletes, such as long-distance runners, can be at increased risk if they do not increase their intake of iron to compensate for their increased losses of iron (from sweat and a faster cycle of death and production of their red blood cells). Strict vegetarians are also at risk for anemia because they avoid the animal foods that are the richest sources of absorbable dietary iron. However, anemia can be easily prevented in vegetarians with an eating plan rich in fruits and vegetables high in vitamin C. And there’s evidence that vegetarians actually adapt to a lower iron intake by increasing iron absorption and decreasing iron losses. Anyone who has problems with malabsorption of food in the digestive tract because of celiac disease, Crohn disease, or ulcerative colitis, for example, or who has had a portion of his intestines removed is at high risk for developing anemia.

Iron supplements
Given the ready availability of iron supplements and the small but real possibility of developing iron-deficiency anemia, it may seem logical to take a supplement just in case. However, chronic high intakes of iron can lead to iron overload, a condition in which an excess amount of iron is found in the blood and is stored in the heart and liver, sometimes damaging those organs, so single-nutrient supplements of iron (those that provide from about 18 to 65 milligrams of iron) should only be taken under the guidance of your health-care provider. Taking an iron supplement on your own to self-treat what you suspect is anemia may also delay the diagnosis of a more serious problem, such as a bleeding ulcer or colon cancer.

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Also in this article:
Recommended Dietary Allowances for Iron
Food Sources of Iron



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