Rima sat shocked with her blood work reports in her hand. She had been diagnosed with anemia with significantly low levels of Hemoglobin. Why she was aghast was that she was very health conscious and ensured that the meals did have enough iron and other micronutrients. Micronutirients are those nutrients required in trace amounts for the normal functioning of the body and iron is one of the very important micronutrients. Iron is needed for carrying oxygen in the red blood cells since it forms an integral part of Hemoglobin, the pigment which gives blood its red colour. Now you know why an anemic person gasps for breath even at the slightest exertion? The oxygen carrying capacity is compromised in anemia patients due to a shortage of iron.
Iron deficiency anemia (IDA) is the most common micronutrient deficiency in the world. In India particularly, anemia is a major public health issue, with high prevalence among women, pregnant women, children, and diabetic patients, affecting not only rural communities but also a growing segment of the young urban population. What is surprising these days is the increasing population of males especially adolescents with anemia. When the iron absorption does not meet the body’s requirements, iron stores in the body gradually decrease over time and can eventually lead to anemia.
How does iron deficiency occur? If there is no underlying health issues, the primary causes of anemia lie in either iron deficiency or due to the presence of intestinal parasites. That does not guarantee that everyone who consumes good quantity of iron by the diet is precluded from anemia. That is where a factor called bioavailability comes in question – Bioavailability is the amount of iron that you consume, which is actually absorbed and used by the body. This factor changes the dynamics of food consumption quite significantly.
Dietary iron is found primarily in two forms: heme and non-heme iron, to put it in simple terms heme iron is present in iron rich animal based food while non heme iron is predominant in cereals, millets, pulses, legumes, vegetables, nuts and seeds. Heme iron is readily absorbed and ready-to-use like the instant food you heat and eat in your kitchen while non-heme iron requires other parameters in the meal to ensure maximal absorption.
So who are the culprits? What factors diminish the iron absorbed from the food we consume? Some food act as blockers of iron absorption from not just the diet but also from supplements you take. Some common Iron blockers include
- Polyphenols and tannin in tea, coffee, cocoa, and some wines
- Phytates (phytic acid) in whole grains (brown rice, wheat, oats, sorghum), legumes (chickpeas, kidney beans, black gram green gram), nuts and seeds
- Calcium from dairy and supplements at high doses
- Oxalates in foods like spinach and some teas.
So does this mean one should stop consuming these foods? No way! It would be a blunderous thing to do since there are very important macro and micronutrients in the above food as well. What one could do is it to follow certain dietary and food consumption practices.
For example, one could avoid these items 2 hours before or after eating iron-rich meals to maximize absorption.
- High-oxalates foods like black tea, spinach, beets, and berries
- Eggs since they contains phosvitin, which binds iron molecules together
- Certain Medications like antacids that one takes for acidity
- Polyphenol rich food like coffee, cocoa, apples and herbal teas
- Calcium-Rich food like milk, cheese, yogurt, and broccoli
- Phytate rich food like walnuts, almonds, whole grains, and lentils.
Dietary strategies to maximise Iron absorption:
Tea and coffee consumption: Studies has showed that tea consumption may reduce iron absorption by as much as 60% and coffee by 50%. This is because they contain phytochemicals called polyphenols and tannin that bind to iron during digestion, making it harder for the body to take it in. Do not worry. You can still have your hot cuppa every day – just time it well.
Timing makes a big difference: The closer in time you consume tea or coffee to your meals or iron supplement, the greater, would be the interference with iron absorption. Allowing a time space between them gives your body more ability to absorb the iron before these inhibitors are introduced. If you take iron supplement on an empty stomach, it is advisable to maintain a gap before consuming tea or coffee. However, taking iron supplements on an empty stomach can cause gastric discomfort in some and can best be avoided. Many health guidelines recommend a one to two hours gap between taking an iron supplement and drinking tea or coffee.
Vitamin C: Vitamin C can help improve the absorption of non-heme iron. Iron is best absorbed in an acidic environment that Vitamin C can help in. Taking your iron supplement with vitamin-C rich food or a drink may help. Pair iron rich meals with vitamin C sources like citrus fruits, amla, guava, tomatoes, bell pepper or lemon juice. Vitamin C can undo the impact of polyphenols and help your body absorb iron up to several times more.
Balancing with heme iron: If you are a non-vegetarian, adding heme iron from meat, fish, or poultry helps, as these sources aren’t as easily blocked by inhibitors.
Food processing: Processing like soaking, sprouting, or fermenting grains and legumes reduce phytate content, which helps your body absorb iron more effectively.
Timing Calcium supplements: Avoid taking high-dose calcium supplements together with iron-rich meals or iron tablets, as calcium can interfere with iron absorption. What happens if you take iron and calcium together? When you take iron and calcium supplements at the same time, calcium greatly decreases how much iron your body can absorb. Research indicates that taking calcium alongside iron can reduce iron absorption by about 28% to more than 60%, depending on the amount consumed. Even modest quantities of calcium such as 165 mg from milk, cheese, or a supplement can reduce iron absorption by roughly 50%. Calcium doses ranging from 300 to 600 mg, frequently found in supplements, can decrease iron absorption by 50 to 60%. This implies that when taken together, a significant amount of your iron supplement may pass through your digestive system without being absorbed, thereby lowering its effectiveness.
To lead an anemia free life, one need to thus focus not only on quantity of iron consumed but also following practises that maximises its absorption. Let us resolve this week (Nutrition Week) to become aware of these and try to implement this in our homes and eradicate anemia. Here is to an anemia free society!
Authors: Vinodhini P., Kavya Satheesh and Dr. Kavitha Sankaranarayanan