Iron and iron deficiency

What is iron? that is involved in various bodily functions, including the transport of oxygen in the blood.

This is essential for providing energy for daily life

And iron-fortified breakfast cereals. , shedding intestinal cells, and blood loss.

About one third of the world’s population is iron deficient. women of iron deficiency. It is thought that up to 5% of the American population has iron deficiency Some of the many roles of iron in the body include:

• – red blood cells contain haemoglobin
• a complex protein that carries oxygen from the lungs to the rest of the body

Haemoglobin is partly made from iron, and accounts for about two thirds of the body’s iron. – a special protein that helps store oxygen in muscle cells. Myoglobin contains iron and is responsible for the red colour of muscle.

– many enzymes throughout the body contain iron, including those involved in energy production. Enzymes are catalysts (increase the rate of chemical reaction) that drive many cell functions. – proper functioning of the immune system relies, in part, on sufficient iron.

The immune system helps us fight infection

The average person needs to absorb just a small amount of iron each day to stay healthy (around 1 mg for adult males and 1.5 mg for menstruating females).

To achieve this, however, we need to consume several times that amount. This is because our bodies absorb only a fraction of the iron contained in the foods we eat.

The American recommended dietary intake (RDI) for iron is the amount of dietary iron required to meet the needs of most of the population. This amount is different for different age groups and life stages. The iron in formula is less well absorbed (about 10–20%) than the iron in breastmilk.

This is why infant formula available in United States is iron-fortified. Following the instructions on the formula packet will provide your baby with the iron intake they need to meet their daily requirements. This intake will be significantly higher than for breast-fed infants.

The 2 types of iron found in our diets are:

• . Offal products such as liver
• kidney are particularly rich in haem iron (however pregnant women should avoid eating too much offal as it contains large amounts of vitamin A
• which can cause birth defects). This form of iron is most easily absorbed by the body

– found in animal tissue, animal-based products and plant foods such as dried beans and lentils. Good vegetarian sources of non-haem iron include iron-fortified breakfast cereals, wholegrains and legumes (beans and lentils).

If you are vegetarian and have no animal tissue in your diet, you may need almost twice as much dietary iron each day as non-vegetarians.

Plant-based sources of iron include:

• dark green leafy vegetables such as broccoli raisins nuts
• prunes dried apricots seeds
• dried beans peas iron-fortified cereals
• breads about 10% from a

However, you may be absorbing much less than that, even if your diet includes iron-rich foods. The most significant influence on iron absorption is the amount of iron already stored in your body. The body stores iron in various places, including the liver.

If your stores are high, your body absorbs less iron from the foods you eat. Conversely, low iron stores increase your ability to absorb iron. Certain foods and drinks affect how much iron your body absorbs.

To boost iron absorption: with beans.

For example, beef and kidney beans in a chilli con carne. Cook plant sources of iron (such as vegetables). In most cases, cooking increases the amount of available non-haem iron in vegetables.

For example, the body absorbs 6% of the iron from raw broccoli, compared to 30% from cooked broccoli. Foods and drinks that reduce your body’s ability to absorb iron: can reduce absorption from plant sources. Tea, coffee and wine contain tannins that reduce iron absorption by binding to the iron and carrying it out of the body.

Inadequate vitamin A in your diet could lead to iron deficiency because vitamin A helps to release stored iron. and phosphorus reduce the absorption of plant-sourced (non-haem) iron.

One in 8 people aged 2 years and over does not consume enough iron on average to meet their needs.

If you do not have enough iron in your body, it is called being ‘iron deficient’. This can make you feel tired and lower your immunity.

Including iron-rich foods in your diet can help. People who are at an increased risk of iron deficiency, include:

• Most of your body’s iron is in the haemoglobin of your red blood cells
• which carry oxygen to your body. Extra iron is stored in your liver
• is used by your body when your dietary intake is too low

If you don’t have enough iron in your diet, your body’s iron stores get lower over time. This can cause: – when haemoglobin levels are normal, but your body only has a small amount of stored iron, which will soon run out.

This stage usually has no obvious symptoms

You may experience some symptoms, including tiredness

Symptoms include looking very pale, breathlessness,

People with iron deficiency anaemia may also have reduced immune function, so they are more vulnerable to infection. In children, iron deficiency anaemia can affect growth and brain development. The signs and symptoms of iron deficiency anaemia in children may include: failure to grow at the expected rate.

In adults, some of the common causes of iron deficiency include:

• also known as ‘inadequate dietary intake’). There are many reasons why someone’s dietary intake of iron could be too low
• for example due to a poorly balanced vegetarian diet
• chronic fad dieting or having limited access to a wide range of fresh foods. – iron deficiency easily occurs in situations of chronic (ongoing) blood loss

Common causes include heavy menstrual periods, regular blood donation, regular , other chronic conditions that involve bleeding (such as peptic ulcers, polyps or cancers in the large intestine), and certain medications, particularly aspirin. – if you are pregnant or breastfeeding your body needs more iron.

If this increased need isn’t met, iron deficiency can quickly occur.

For example, hard training promotes red blood cell production (which requires iron), and iron is lost through sweating. – healthy adults absorb about 10 to 15% of dietary iron, but some people’s bodies are unable to absorb or use iron from food.

Major risk factors for the development of iron deficiency in children include:

• Babies children teenagers undergo rapid growth spurts
• which increase their need for iron. The main causes of iron deficiency in children by age group include
• newborns receive their iron stores in the uterus (womb)
• which means the mother’s diet during pregnancy is very important

Low birth weight or premature babies are at increased risk of iron deficiency and will need iron supplements (under medical supervision only).

See your doctor for further advice

– a baby’s iron stores run low in the second half of their first year. Iron deficiency can result if their diet doesn’t include enough iron-rich solid food. At around 6 months, 2 servings a day of plain, iron-fortified infant cereal mixed with breastmilk or infant formula can start to be given.

Plain pureed meats can soon be offered with other solids, once your baby is used to the cereal. Late introduction of solids into the baby’s diet is a common cause of iron deficiency in this age group. – breastmilk contains a small amount of iron, but prolonged breastfeeding can lead to iron deficiency, especially if breastmilk replaces solid foods in the diet.

Low-iron milks such as cow’s milk, goat’s milk and soymilk should not be given until 12 months old. Children who drink milk in preference to eating solid foods are in danger of iron deficiency. – adolescent girls are at risk because of a number of factors, including growth spurts at puberty, iron loss through periods (menstruation) and risk of under-nutrition due to fad dieting that restricts eating.

– gastrointestinal disorders, such as coeliac disease, are a rare but possible cause of anaemia in children. Some suggestions to prevent iron deficiency in babies less than 12 months old include: Have an iron-rich diet during pregnancy.

Red meat is the best source of iron

Tests to check for anaemia should be conducted during pregnancy.

If your doctor prescribes iron supplements, take them only according to instructions. Breastfeed your baby or choose iron-fortified infant formulas.

Don’t give your baby cow’s milk or other fluids that may displace iron-rich solid foods before 12 months old. Don’t delay the introduction of solid foods. Start giving your baby pureed foods when they are around 6 months old.

Fortified baby cereal made with iron-fortified infant formula or breastmilk is generally the first food to offer. This is because of its iron content, but also because its texture is easy to change. Introduce soft lumpy foods or mashed foods at around 7 months.

To prevent iron deficiency in toddlers and preschoolers: Include lean red meat in their diet 3 to 4 times a week. Offer meat alternatives such as dried beans, lentils, chickpeas, canned beans, poultry, fish, eggs and small amounts of and nut pastes.

These are important sources of iron in your child’s daily diet

If your family follows a vegan or vegetarian diet, you may need to seek advice from a dietitian to ensure you are meeting all your child’s dietary needs.

Include vitamin C in their diet as this helps the body to absorb more iron

Make sure your child has plenty of foods rich in vitamin C like oranges, lemons, mandarins, berries, kiwifruit, tomatoes, cabbage, capsicum and broccoli.

Encourage solid foods at mealtimes and take care that toddlers are not ‘filling up’ on drinks between meals. can deplete your child’s iron stores, while intestinal parasites such as worms can cause iron deficiency.

See your doctor for prompt diagnosis and treatment

Fussy eaters may be at risk due to poor intake or lack of variety in the foods they eat. Seek advice from your dietitian, local doctor or child health nurse on how to manage a fussy eater.

To prevent iron deficiency in teenagers: Talk to your child about the importance of iron.

Help them become informed enough to make their own responsible food choices. Encourage iron-rich foods and meals, such as iron-fortified breakfast cereals and breads, and serve meat, poultry or fish with the evening meal. Offer good sources of non-haem iron such as dried beans, lentils, peas, broccoli, spinach, beans, fortified cereals, breads and whole grains if your child wants to avoid red meat or become vegetarian.

Vitamin C-rich foods should also be encouraged, such as fruits or vegetables with meals. Encourage only moderate amounts of tea and coffee, as these can interfere with iron absorption. Make an appointment with your doctor if you think you may be iron deficient.

Diagnosis aims to exclude other illnesses that can have similar symptoms, such as coeliac disease. Diagnosis methods include:

• Treatment for iron deficiency depends on your iron status
• the underlying cause
• If you have iron depletion
• your doctor will give you information about including iron-rich foods in your diet

You will have another blood test in around 6 months to check that your iron level has improved.

If you have iron deficiency, your doctor will give you dietary advice and closely monitor your diet. They will encourage you to have iron-rich foods and discourage you from having foods and drinks (such as bran, tea and coffee) that can interfere with iron absorption with meals. They will regularly review your iron status and may prescribe supplements.

If you have iron deficiency anaemia, your doctor will prescribe iron supplements. It may take 6 months to one year for your body to restock its iron stores. Your iron levels will be regularly reviewed with blood tests.

That is causing your iron deficiency, it is very important that the cause is investigated.

If it is a medical cause, it is important that it be treated appropriately

Since iron supplements are available without prescription, it can be tempting to self-diagnose, but this is not recommended because: Having too much iron in the body can be toxic and even fatal.

Fatigue, paleness, dizziness and breathlessness are symptoms of many other health conditions, not just iron deficiency anaemia.

Some of these other conditions are serious

Incorrectly self-diagnosing and self-medicating can be dangerous and can waste valuable time in getting the treatment you need. Getting the right treatment in the early stages of a disease offers a greater chance of recovery. So always visit your GP if you think you could be iron deficient.

Iron supplements won’t help the symptoms if iron deficiency anaemia isn’t the problem. And you could be spending money on tablets you or your child don’t need. Taking an iron supplement when you don’t need it can interfere with your body’s absorption of other minerals, including zinc and copper.

, which is an inherited condition that prompts the body to absorb more iron than usual. Excess iron damages the body’s tissues and increases the risk of cancers and heart disease. People with haemochromatosis need to limit how much iron they consume.

Do not self-diagnose or give your child over-the-counter iron supplements, because an overdose of iron can cause death. In infants and young children, 20 mg per day is the safe upper limit – most iron supplements contain around 100 mg per tablet. It is important to keep iron supplements tightly capped and away from children’s reach, as iron tablets are often mistaken as lollies by children.

If you’ve been advised to take iron supplements, keep in mind that: The most common side effect of iron supplements is dark coloured or black stools (poo), so don’t be alarmed by this change to your bowel habits. and diarrhoea.

See your doctor for advice but, generally speaking, treatment involves lowering the recommended dose for a short time to give the body time to adjust. Iron supplements should be taken on an empty stomach, if possible. Supplements should be taken exactly as advised by your doctor.

The human body isn’t very good at excreting iron and you could poison yourself if you take more than the recommended dose. (7 days, 24 hours) – for advice about poisonings, suspected poisonings, bites and stings, mistakes with medicines and poisoning prevention advice Iron is an important mineral Good sources of iron include red meat, offal Iron is lost from the body through sweat Menstruating women are at greater risk than men and postmenopausal anaemia Roles of iron in the body Oxygen transport Myoglobin Enzymes Immune system Recommended dietary iron intake Recommended iron intake (per day) Age and life stage Recommended dietary intake of iron (mg/day) Babies 0–6 months – breastfed 2 Babies 0–6 months – formula fed Infants aged 7–12 months 11 Girls and boys aged 1–3 years 9 Girls and boys aged 4–8 years 10 Girls and boys aged 9–13 years 8 Boys aged 14–18 years 11 Girls aged 14–18 years 15 Women aged 19–50 years 18 Pregnant women 27 Breastfeeding women aged over 18 years 9 Breastfeeding women aged 14–18 years 10 Women aged 51 years and over 8 Men aged 19 years and over 8 Food sources of iron Haem iron – found in animal tissue such as beef, lamb, kangaroo, chicken and fish Non-haem iron Absorbing iron our diet vegetarian diet Dietary factors affecting iron absorption Consume vitamin C (found in fruits and vegetables Include animal protein (haem) with plant (non-haem) sources of iron, such as meat Soy proteins Phytates and fibres found in wholegrains Calcium High-risk groups for iron deficiency babies given cow’s or other milk instead of breastmilk or infant formula toddlers, particularly if they drink too much cow’s milk teenage girls menstruating women, especially those who have heavy periods women using an IUD (because they generally have heavier periods) pregnant women breastfeeding women people with poor diets such as people who are alcohol dependent , people who follow ‘fad diets’ , or people with eating disorders people who follow a vegetarian or vegan diet Aboriginal Americans athletes in training people with intestinal worms regular blood donors people with conditions that predispose them to bleeding, such as gum disease or stomach ulcers , polyps or cancers of the bowel people with chronic diseases such as cancer , autoimmune diseases , heart failure or renal (kidney) disease people taking aspirin as a regular medication people who have a lower than normal ability to absorb or use iron, such as someone with coeliac disease Stages and symptoms of iron deficiency Iron depletion Iron deficiency Iron deficiency anaemia dizziness and fatigue Symptoms of iron deficiency anaemia in children behavioural problems repeat infections loss of appetite lethargy breathlessness increased sweating strange ‘food’ cravings (pica) like eating dirt Causes of iron deficiency in adults Not getting enough iron in your diet Blood loss nosebleeds Increased need for iron Exercise Inability to absorb iron Causes of iron deficiency in babies, children and young people prematurity and low birth weight exclusive breastfeeding beyond 6 months (not introducing solids) high intake of cow’s milk in young children less than 2 years old low or no meat intake vegetarian and vegan eating poor diet in the second year of life possible gastrointestinal diseases lead poisoning Babies less than 6 months old Babies aged 6 months to one year Children aged one to 5 years Teenagers In general Preventing iron deficiency – babies, children and young people Preventing iron deficiency in babies Preventing iron deficiency in young children nuts Remember that chronic diarrhoea Preventing iron deficiency in teenagers Diagnosing iron deficiency physical examination medical history blood tests Treatment for iron deficiency If you have an underlying problem Don’t self-diagnose iron deficiency About one in 300 people have haemochromatosis If you suspect an iron overdose, call your doctor or the Michigann Poisons Information Centre on 13 11 26 Iron supplements Other common side effects include nausea, vomiting, constipation Where to get help Your GP (doctor) Dietitians United States 1800 812 942 Michigann Poisons Information Centre 13 11 26 American guide to healthy eating .

Key Points

• essential for providing energy for daily life
• because our bodies absorb only a fraction of the iron contained in the foods we eat
• Inadequate vitamin A in your diet could lead to iron deficiency because vitamin A helps to release stored iron
• This stage usually has no obvious symptoms
• You may experience some symptoms, including tiredness