tag:theconversation.com,2011:/fr/topics/iron-deficiency-30581/articlesIron deficiency – The Conversation2024-01-23T13:57:59Ztag:theconversation.com,2011:article/2203122024-01-23T13:57:59Z2024-01-23T13:57:59ZWhy your period symptoms might be worse in the winter<figure><img src="https://images.theconversation.com/files/570844/original/file-20240123-19-dn93f6.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5472%2C3637&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Symptoms such as fatigue, irritability, poor concentration and a weaker immune system may be pointing to iron deficiency.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-woman-lying-on-sofa-looking-2249910765">Photoroyalty/ Shutterstock</a></span></figcaption></figure><p>Period symptoms are frustrating no matter the time of year. But those who menstruate might feel like certain symptoms are worse during the winter months, when the weather is gloomy, the days are short and cold and flu seem to always be lurking. This phenomenon has even been dubbed “<a href="https://www.huffingtonpost.co.uk/entry/winter-weather-period-fatigue_uk_652fae8fe4b03b213b07e33e">winter period fatigue syndrome</a>”.</p>
<p>Unfortunately, there’s no evidence that such a thing as winter period fatigue syndrome exists. There’s also no good evidence to suggest changes in the seasons can worsen period symptoms. But that doesn’t mean there isn’t a scientific explanation for why you might feel some of your period symptoms are worse during the colder months.</p>
<p>Symptoms such as fatigue, irritability, poor concentration and a weaker immune system, may in fact be pointing to the more obvious cause of <a href="https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/signs-symptoms">iron deficiency</a>.</p>
<hr>
<p><br>
<br>
<em>This piece was published by <a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+R292024&utm_content=InArticleTop">The Conversation</a> as part of Taking Care, <a href="https://www.refinery29.com/en-gb/taking-care-of-health">Refinery29</a>’s health and wellness hub.</em></p>
<hr>
<p>The body needs iron in order to function. Iron helps produce red blood cells, which carry oxygen throughout the body. But many people don’t get enough iron in their diet. In fact, iron deficiency is the <a href="https://pubmed.ncbi.nlm.nih.gov/35427520">most common nutritional deficiency</a> in the world.</p>
<p>Alongside the symptoms that iron deficiency can cause, low iron can also lead to <a href="https://www.who.int/news-room/fact-sheets/detail/anaemia">anaemia</a> – a fall in <a href="https://www.who.int/health-topics/anaemia#tab=tab_1">red blood cell count</a>. While the symptoms of anaemia can be very similar to those caused by iron deficiency (including fatigue, tiredness, and cold hands and feet), symptoms can be more severe, too – leading to heart palpitations, shortness of breath and even loss of consciousness.</p>
<p>Menstruation is a leading cause of both iron deficiency and <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00127-9/fulltext">anaemia</a>. People with <a href="https://www.nhs.uk/conditions/heavy-periods/">heavy or prolonged periods</a> are particularly at risk as they regularly lose more blood each month than their body can replace. Some studies even estimate that in women who experience heavy periods, 90% are iron deficient and <a href="https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12394">60% are anaemic</a>.</p>
<figure class="align-center ">
<img alt="A woman with her period picks up a pink pad from a table." src="https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/570846/original/file-20240123-23-p573ga.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Heavy or prolonged periods put you at greater risk of iron deficiency and anaemia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/classic-comfort-menstrual-pads-black-woman-2300535095">Prostock-studio/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Those who normally have heavy periods might not realise that this could actually be the cause of their fatigue, irritability and difficulty concentrating. This is because so many who have heavy periods just <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997654/pdf/bjgpapr-2023-73-729-e294.pdf">assume their blood loss is normal</a>. But left unchecked, heavy periods can leave women and people who menstruate trapped in a vicious cycle of progressive blood loss and iron loss, leading to anaemia, which can be difficult to break.</p>
<p>And even though <a href="https://pubmed.ncbi.nlm.nih.gov/33247314/">many clinical guidelines</a> for managing heavy menstrual bleeding recognise the importance of treating iron deficiency and anaemia caused by excessive blood loss, these conditions are still <a href="https://www.figo.org/resources/figo-statements/iron-deficiency-and-anaemia-women-and-girls">often missed</a> – despite how treatable they are.</p>
<h2>Winter symptoms</h2>
<p>Many of the symptoms of iron deficiency and anaemia overlap with other health conditions. This is why it’s important to talk to your doctor as soon as symptoms start to make sure you’re getting the right treatment.</p>
<p>For example, fatigue, lethargy and changes in mood can also be symptoms of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673349">seasonal affective disorder</a>. This is a type of depression that affects some people only in the autumn and winter.</p>
<p>So if you find your symptoms began when the shorter days and colder weather arrived, then exercise, self care (such as resting if you need to and getting plenty of sleep each night) and eating a balanced diet that contains plenty of fibre, complex carbs and protein <a href="https://www.nhs.uk/mental-health/conditions/seasonal-affective-disorder-sad/treatment">may help somewhat</a>. Your GP may also recommend talking therapy.</p>
<p>But if you find you have such symptoms all year round – and suffer from heavy or prolonged periods – this may be a sign you have iron deficiency. Certain symptoms of iron deficiency may also seem worse during the winter months. </p>
<p>Since iron deficiency affects how well your immune system functions, this could explain why you may feel you suffer from more seasonal illnesses during the colder weather. This will require a trip to the GP to be diagnosed, as well as taking an iron replacement if your doctor recommends it. This should significantly improve your quality of life and symptoms.</p><img src="https://counter.theconversation.com/content/220312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jahnavi Daru has worked as a consultant for the World Health Organization in the Department of Nutrition and Food Safety on projects related to maternal anaemia and has received grant funding from the National Institute for Health Research</span></em></p><p class="fine-print"><em><span>Ewelina Rogozinska receives funding from the National Institute for Health Research. </span></em></p><p class="fine-print"><em><span>Varsha Jain received funding from Wellbeing of Women. </span></em></p>Heavy periods are one of the leading causes of iron deficiency and anaemia.Jahnavi Daru, Senior lecturer in Women's Health, Queen Mary University of LondonEwelina Rogozinska, Research Fellow, MRC Clinical Trials Unit, UCLVarsha Jain, Clinical Research Fellow, MRC Centre for Reproductive Health, The University of EdinburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2108992023-09-13T02:03:34Z2023-09-13T02:03:34ZCould my child have low iron? And what are my options if they do?<p>Around <a href="https://www.mdpi.com/2072-6643/14/7/1381">75%</a> of infants aged six to 12 months and 25% of toddlers aged one to two years in Australia don’t get the recommended dietary intake of iron.</p>
<p>Despite their small size, weaning infants and children require <a href="https://www.eatforhealth.gov.au/nutrient-reference-values/nutrients/iron">similar amounts of iron</a> to adults. The iron is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631790/">crucial</a> for supporting their rapid growth in blood and muscles, immunity, brain development and learning. </p>
<p>Untreated iron deficiency can progress to anaemia – severe iron deficiency where there are insufficient healthy <a href="https://www.rch.org.au/immigranthealth/clinical/Iron_deficiency_and_anaemia/">red blood cells</a> to carry oxygen around the body. Alarmingly, anaemia affects around <a href="https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/iron-deficiency-and-associated-factors-in-australian-children-aged-46-years/3BA7853FF00196359E6F07EF4C50E282">8%</a> of Australian children under five, and if untreated, can be associated with developmental setbacks and later <a href="https://publications.aap.org/pediatrics/article/126/5/1040/65343/Diagnosis-and-Prevention-of-Iron-Deficiency-and">cognitive deficits</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-iron-is-such-an-important-part-of-your-diet-69974">Why iron is such an important part of your diet</a>
</strong>
</em>
</p>
<hr>
<h2>How do I know if my kids have iron deficiency?</h2>
<p>Iron deficiency in children is often <a href="https://www.aafp.org/pubs/afp/issues/2016/0215/p270.html">associated with vague or no symptoms</a>, especially if it has not progressed to anaemia. </p>
<p>Symptoms can include <a href="https://australianprescriber.tg.org.au/articles/non-anaemic-iron-deficiency.html">fatigue, difficulty concentrating</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121846/">poor behaviour, frequent infections, and pica</a> (eating non-food substances such as paper, clay or soil).</p>
<p>Diagnosis typically involves a blood test that screens for iron markers such as ferritin, a protein that stores iron. Doctors often recommend these tests for people who are at high risk, detailed in the figure below.</p>
<iframe src="https://flo.uri.sh/visualisation/14722840/embed" title="Interactive or visual content" class="flourish-embed-iframe" frameborder="0" scrolling="no" style="width:100%;height:600px;" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation" width="100%" height="400"></iframe>
<div style="width:100%!;margin-top:4px!important;text-align:right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/14722840/?utm_source=embed&utm_campaign=visualisation/14722840" target="_top"><img alt="Made with Flourish" src="https://public.flourish.studio/resources/made_with_flourish.svg"> </a></div>
<h2>What are the first options for treatment?</h2>
<p>When iron deficiency and anaemia are caused by a lack of dietary iron, both can often be effectively addressed through <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5155616/">changes to the diet</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/36849195/">oral iron supplements</a>. </p>
<p>The <a href="https://www.rch.org.au/clinicalguide/guideline_index/iron_deficiency/">Royal Children’s Hospital</a> in Melbourne recommends boosting intake of <a href="https://www.rch.org.au/uploadedFiles/Main/Content/nutrition/Iron.pdf">iron-rich foods</a> such as meat, fish, eggs, leafy greens and legumes, and drinking less than 500mL (about two cups) of cow’s milk per day. This is because cow’s milk has been associated with <a href="https://academic.oup.com/nutritionreviews/article/69/suppl_1/S37/1815349">reduced iron stores</a> in young children.</p>
<p>Doctors might also prescribe oral iron supplements. A course of liquid or tablets would usually be recommended for a minimum of <a href="https://www.rch.org.au/clinicalguide/guideline_index/iron_deficiency/">three months</a> , during which follow-up blood tests can show how well the child is responding to the supplementation.</p>
<p>Existing evidence suggests <a href="https://www.sciencedirect.com/science/article/abs/pii/S0025712516373552?via=ihub">supplements</a> are a more effective way to replenish iron stores than dietary changes alone, and ferrous sulfate is the most <a href="https://gh.bmj.com/content/8/2/e010745">effective iron supplement</a> for young children.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Plain background with pieces of meat, bowl of cheese cubes etc" src="https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=416&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=416&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=416&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=523&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=523&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545719/original/file-20230831-29-or4uvz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=523&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meat, legumes and nuts are high in iron.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Navigating the side effects</h2>
<p>Iron supplements are known to have some nasty <a href="https://www.ncbi.nlm.nih.gov/books/NBK557376/">side effects</a> including constipation, nausea, diarrhoea, dark stools, and stained teeth. This may make compliance challenging, especially for young children. The approaches to alleviate side effects vary depending on the child. </p>
<p>The doctor may recommend alternative supplements as some may be <a href="https://australianprescriber.tg.org.au/articles/non-anaemic-iron-deficiency.html">better tolerated</a> than others. Another option is to adjust the dosage, with lower dose supplements or taking it <a href="https://ashpublications.org/hematology/article/2019/1/315/422602/Management-of-iron-deficiency">every other day</a>. </p>
<p>Consuming iron supplements with food or immediately after eating can also <a href="https://www.ncbi.nlm.nih.gov/books/NBK557376/">lessen side effects</a>. However this may result in reduced absorption, and should be discussed with your doctor. </p>
<p>For cases where iron supplements don’t appear to be working or where compliance is an issue, <a href="https://www.blood.gov.au/system/files/documents/appendix-2-from-iron-product-choice-and-dose-calculation04082015.pdf">iron infusions</a> may be prescribed by your doctor. These involve injecting iron over multiple visits at a hospital and/or specialist clinic, with each session potentially lasting an hour or more.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-been-diagnosed-with-iron-deficiency-now-what-87670">I've been diagnosed with iron deficiency, now what?</a>
</strong>
</em>
</p>
<hr>
<h2>How can I prevent iron deficiency in my kids?</h2>
<p>To prevent iron deficiency, it’s important to keep an eye on your child’s iron intake, and the factors that may influence their absorption. </p>
<p>For example, drinks which contain tannins (tea, coffee, chocolate drinks) may inhibit iron absorption. But vitamin C and organic acids from fruits and vegetables, as well as high-quality proteins such as those found in meat and fish, can <a href="https://pubs.acs.org/doi/full/10.1021/acsomega.2c01833">promote absorption</a>. </p>
<p>From infancy, following the <a href="https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers">national feeding guidelines</a> will help to support your child’s iron status. This includes introducing iron-rich solid foods from around six months of age for healthy breastfed infants to replenish their iron stores from birth. </p>
<p>Around six months is also the prime time for introducing foods to minimise <a href="https://www.frontiersin.org/articles/10.3389/fped.2020.00448/full">risk of food allergies</a>, including to iron-rich foods such as seafood and nut butters.</p>
<hr>
<iframe src="https://flo.uri.sh/visualisation/14810991/embed" title="Interactive or visual content" class="flourish-embed-iframe" frameborder="0" scrolling="no" style="width:100%;height:600px;" sandbox="allow-same-origin allow-forms allow-scripts allow-downloads allow-popups allow-popups-to-escape-sandbox allow-top-navigation-by-user-activation" width="100%" height="400"></iframe>
<div style="width:100%!;margin-top:4px!important;text-align:right!important;"><a class="flourish-credit" href="https://public.flourish.studio/visualisation/14810991/?utm_source=embed&utm_campaign=visualisation/14810991" target="_top"><img alt="Made with Flourish" src="https://public.flourish.studio/resources/made_with_flourish.svg"> </a></div>
<hr>
<p>From 12 months onwards, children’s diets should align with the <a href="https://www.eatforhealth.gov.au/">Australian Dietary Guidelines</a>, emphasising a balanced, nutritious diet encompassing a range of foods. Diets following this pattern should deliver ample iron from meats, breads and cereals, as well as iron absorption promotors such as oranges, capsicum and other fresh fruits and vegetables?.</p>
<p>In cases where the child is a picky eater, or where access to a diversity of foods is limited, look for fortified iron options such as in bread, drinks (for example juice for <a href="https://www.nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers">kids over 12 months</a>, and Milo for older kids), and breakfast cereals.</p>
<p>If your child is diagnosed with iron deficiency, remember each path to recovery is unique. Consultation with a GP or dietitian can help tailor solutions catering to their specific needs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-drink-with-dinner-to-get-the-most-iron-from-your-food-and-what-to-avoid-156579">What to drink with dinner to get the most iron from your food (and what to avoid)</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/210899/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yianna Zhang has previously received a postgraduate scholarship from CSIRO, which investigated food-based chemical interactions potentially affecting iron absorption.</span></em></p><p class="fine-print"><em><span>Amanda Patterson has previously received funding from the Hunter Medical Research Institute and Meat and Livestock Australia for research on Iron Deficiency.</span></em></p><p class="fine-print"><em><span>Ken Ng does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite their small size, infants and children actually require about the same amount of iron as adults, to help them grow. Many aren’t getting enough.Yianna Zhang, Sessional tutor, The University of MelbourneAmanda Patterson, Senior Lecturer in the School of Health Sciences, University of NewcastleKen Ng, Senior Lecturer & Course Coordinator (Master of Food Science), The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2121772023-09-08T12:25:59Z2023-09-08T12:25:59ZAnemia afflicts nearly 1 in 4 people worldwide, but there are practical strategies for reducing it<figure><img src="https://images.theconversation.com/files/546721/original/file-20230906-33614-a4o8yh.jpg?ixlib=rb-1.1.0&rect=15%2C7%2C5126%2C3484&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Anemia symptoms include shortness of breath, dizziness and fatigue.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-holding-blood-in-test-tube-royalty-free-image/1180192054?phrase=anemia&adppopup=true">Peter Dazeley/The Image Bank via Getty Images</a></span></figcaption></figure><p>Anemia is a major health problem, with <a href="https://doi.org/10.1016/S2352-3026(23)00160-6">nearly 2 billion people</a> affected globally. It afflicts more people worldwide than low back pain or diabetes – or even anxiety and depression combined. </p>
<p>Despite this, investments in reducing anemia have failed to substantially reduce the massive burden of anemia globally over the last few decades.</p>
<p>People <a href="https://www.ncbi.nlm.nih.gov/books/NBK499994/">become anemic</a> when their blood lacks enough healthy red blood cells to carry oxygen throughout the body. This decreased oxygen delivery causes many of the most <a href="https://www.nhlbi.nih.gov/health/anemia/symptoms">common symptoms of anemia</a>, including fatigue, shortness of breath, lightheadedness, difficulty concentrating and challenges with work and daily life tasks. </p>
<p>In addition to its direct health effects, anemia can <a href="https://doi.org/10.1111/nyas.14105">inhibit brain development and fine motor skills</a> in children and heighten the <a href="https://doi.org/10.3390/jcm10122556">risk of stroke</a>, <a href="https://doi.org/10.1681/ASN.2005030226">cardiovascular disease</a>, <a href="https://doi.org/10.1212/WNL.0000000000008003">dementia</a> and other chronic illnesses in older adults. <a href="https://doi.org/10.1111/nyas.14093">Anemia during pregnancy</a> can lead to increased rates of anxiety and depression, early labor, postpartum hemorrhage, stillbirth and low birth weight. Infections for both mother and baby are also more likely when the mother is anemic.</p>
<p>We are <a href="https://scholar.google.com/citations?user=LbtdQcsAAAAJ&hl=en">global</a> <a href="https://scholar.google.com/citations?user=0kfiPK8AAAAJ&hl=en">health</a> <a href="https://www.healthdata.org/about/people/nicholas-kassebaum">researchers</a> with expertise in epidemiological modeling of anemia alongside other maternal, neonatal and nutritional disorders. </p>
<p>Our work is part of the <a href="https://www.healthdata.org/research-analysis/gbd">Global Burden of Disease Study</a>, a large research study comprehensively estimating health loss due to hundreds of diseases, injuries and risk factors around the globe. Through our analysis, we have produced annual estimates of anemia prevalence by underlying cause for 204 countries and territories, by age and sex, from 1990 to the present. We have collected thousands of data points across hundreds of sources to produce the most comprehensive picture of anemia burden.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/z0Z1QMouVgE?wmode=transparent&start=29" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Anemia is often measured by the amount of hemoglobin – an oxygen-carrying protein within red blood cells – that a person has in their blood.</span></figcaption>
</figure>
<h2>Anemia is a widespread problem</h2>
<p>Anemia is diagnosed by a simple blood test and can be caused by a number of underlying conditions. </p>
<p>Decreases in healthy red blood cells can occur due to excessive loss of existing red blood cells, such as through bleeding or destruction by the body’s immune system. Anemia can also occur due to decreased production of new red blood cells or changes in the normal structure or lifespan of red blood cells that make them less effective.</p>
<p>Globally, anemia is the third-largest cause of disability: Our recent study found that <a href="https://doi.org/10.1016/S2352-3026(23)00160-6">nearly 1 in 4 people has anemia</a>. This burden is concentrated among children younger than 5 years and adolescent girls and women, one-third of whom are anemic. Anemia rates are particularly high in sub-Saharan Africa and South Asia, where we estimated that 40% – or two out of every five people – have anemia.</p>
<p>Reductions in anemia rates have been slow and uneven, dropping from 28% to 24% globally from 1990 to 2021. Adult males have fared better, with young children and adolescent girls and women – who bear the highest burden of anemia – showing the least progress. On the positive side, there has been a shift toward milder forms of anemia, which result in much less disability compared to severe anemia.</p>
<h2>Reducing anemia means tackling underlying causes</h2>
<p>Substantially reducing anemia globally is complicated by its many underlying causes. Dietary iron deficiency is the <a href="https://doi.org/10.1016/S0140-6736(15)60865-0">most common cause</a> across the globe. But other important drivers of anemia include blood disorders such as <a href="https://www.cdc.gov/ncbddd/sicklecell/index.html#">sickle cell disease</a> or <a href="https://www.cdc.gov/ncbddd/thalassemia/facts.html">thalassemias</a>, infectious diseases like <a href="https://theconversation.com/locally-transmitted-malaria-in-the-us-could-be-a-harbinger-of-rising-disease-risk-in-a-warming-climate-5-questions-answered-208726">malaria</a> and <a href="https://theconversation.com/parasitic-infections-hit-the-health-of-low-income-black-communities-where-states-have-neglected-sewage-systems-205616">hookworm</a>, gynecologic and obstetric conditions, <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">inflammation</a> and chronic diseases. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three-dimensional illustration of human artery anatomy, showing normal red blood cells and sickle-shaped blood cells flowing away from the heart." src="https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=381&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=381&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=381&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547067/original/file-20230907-9809-nfpk9n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sickle cell disease – characterized by crescent or sickle-shaped red blood cells that can block blood flow to the rest of the body – is a well-recognized cause of anemia.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sickle-cell-cardiovascular-royalty-free-image/1130415446?phrase=sickle+cell+disease&adppopup=true">wildpixel/iStock via Getty Images</a></span>
</figcaption>
</figure>
<p>Anemia in adolescent and adult women often occurs due to loss of blood from menstruation and increased needs for blood for the developing baby during pregnancy. Much of the anemia burden in this group is <a href="https://doi.org/10.3390/nu13082745">likely related to</a> <a href="https://theconversation.com/the-us-lacks-adequate-education-around-puberty-and-menstruation-for-young-people-an-expert-on-menstrual-health-explains-187501">lack of menstrual education</a>, inadequate options for effectively managing menstrual problems in those who have them, and unmet needs for family planning services. These are also important drivers among transgender men and nonbinary people who menstruate. </p>
<p>Young children <a href="https://doi.org/10.1016/j.jpeds.2015.07.014">have increased requirements</a> for iron as their bodies grow, and malnutrition is a common cause of anemia in this group globally.</p>
<p>Iron supplementation has historically been the primary form of treatment and prevention of anemia. This includes large-scale addition of iron to foods such as flour, rice or milk, as well as providing oral iron tablets and intravenous iron, depending on the context and severity. </p>
<p>Some research has suggested that less than half of people with anemia will <a href="https://doi.org/10.1111/nyas.14175">fully respond to supplemental iron</a> if the underlying causes of iron deficiency remain untreated. For example, cells in our bodies <a href="https://doi.org/10.1016/j.beha.2004.08.020">sequester iron</a> as part of the immune response to some infections. Supplementing with iron without treating the underlying infection will do little to solve the iron deficiency in the long run, and it <a href="https://doi.org/10.1016/S0140-6736(06)67962-2">may even be harmful</a>.</p>
<p>Additional interventions include <a href="https://www.cdc.gov/hiv/risk/art/index.html">HIV treatment and prevention</a>, with <a href="https://theconversation.com/long-acting-injectable-prep-is-a-big-step-forward-in-hiv-prevention-190225">pre-exposure prophylaxis</a> and <a href="https://www.cdc.gov/hiv/basics/livingwithhiv/treatment.html">anti-retroviral therapy</a>. Preventing initial infection with HIV or suppressing the effects of the virus once infected will reduce the anemia burden related to HIV/AIDS.</p>
<p>Other strategies include malaria control methods, such as insecticide-treated bed nets and vaccination, and monitoring and prevention of chronic illnesses such as <a href="https://www.cdc.gov/kidneydisease/basics.html#">chronic kidney disease</a> and <a href="https://www.niehs.nih.gov/health/topics/conditions/inflammation/index.cfm">inflammatory conditions</a>. In combination with a robust supplementation program, these interventions could meaningfully reduce the global burden of anemia.</p>
<p>Anemia makes it hard for nearly 2 billion people worldwide to learn in school, perform at work and take care of their families. We hope our findings will allow for more comprehensive intervention and treatment plans, especially for the most vulnerable – adolescent and adult women, children and the elderly.</p><img src="https://counter.theconversation.com/content/212177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Kassebaum receives funding from the Bill & Melinda Gates Foundation. </span></em></p><p class="fine-print"><em><span>Theresa A McHugh and William Gardner do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Among young children, adolescents and adult women, anemia strikes 1 in 3 globally. Most cases are driven by dietary iron deficiency, red blood cell disorders and untreated tropical diseases.William Gardner, Researcher in Neonatal and Child Health at the Institute for Health Metrics and Evaluation, University of WashingtonNicholas Kassebaum, Adjunct Professor in Health Metrics Sciences and Professor of Anesthesiology and Pain Medicine, University of WashingtonTheresa A McHugh, Researcher and Scientific Writer at the Institute for Health Metrics and Evaluation, University of WashingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2123552023-09-01T04:03:05Z2023-09-01T04:03:05ZFuture diets will be short of micronutrients like iron — it’s time to consider how we feed people<p>Iron deficiency is one of the <a href="https://pubmed.ncbi.nlm.nih.gov/23355536/">most common forms</a> of nutrient deficiency around the world. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/24297872/">Severe iron deficiency</a>, also known as anaemia, affects nearly 50% of women of reproductive age in regions like South Asia, Central Africa and West Africa (in contrast to 16% of women in high-income countries). </p>
<p>In <a href="https://www.health.govt.nz/publication/focus-nutrition-key-findings-2008-09-nz-adult-nutrition-survey">New Zealand</a>, 10.6% of women aged 15-18 and 12.1% of women aged 31-50 suffer from iron deficiency. The risk increases during the third trimester of pregnancy, and the iron status must be carefully monitored to ensure good health for both the mother and baby. </p>
<p>As more people consider switching to plant-based diets, the risk of iron deficiency will likely increase. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1697009633599139993"}"></div></p>
<p>We use the <a href="https://sustainablenutritioninitiative.com/login/?redirect_to=%2Fmodels-tools%2Fexplore-the-future%2F">latest version</a> of the <a href="https://sustainablenutritioninitiative.com/">Sustainable Nutrition Initiative®</a> global food mass balance model to project nutrient availability in current and future global food systems. It suggests we can expect a gap in dietary iron by 2040 if global patterns of food production and supply remain unchanged.</p>
<p>This means we’ll have to address iron shortfalls in our diet, especially in populations with higher requirements such as adolescents and women. We argue that fortifying foods with iron could provide a one-stop solution to bridge nutrient gaps caused by inadequate dietary intake.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/low-iron-is-a-health-risk-made-worse-by-covid-how-to-get-more-without-reaching-for-supplements-185020">Low iron is a health risk made worse by COVID. How to get more without reaching for supplements</a>
</strong>
</em>
</p>
<hr>
<h2>Food fortification</h2>
<p>Many foods in supermarket shelves, including common staples such as bread and cereals, already have added nutrients. </p>
<p>Unlike mandatory <a href="https://www.mpi.govt.nz/food-business/bakery-and-grain-based-products/iodine-fortification/">iodine</a> and <a href="https://www.mpi.govt.nz/food-business/bakery-and-grain-based-products/folic-acid-fortification-of-bread/">folic acid</a> fortification of bread, there is currently <a href="https://www.foodstandards.gov.au/code/Pages/default.aspx">no government initiative</a> to encourage or mandate iron fortification in New Zealand. </p>
<p>Since iron-fortification strategies have the potential to prevent deficiencies in many countries, including New Zealand, we argue that introducing iron to our foods may be a convenient and cost-effective way to provide a source of dietary iron. </p>
<h2>Shift to plant-based diets</h2>
<p>More consumers are opting for diets that include fewer animal-sourced foods in the hope of reducing environmental impacts and emissions. Recent <a href="https://www.statista.com/statistics/1306000/new-zealand-yoy-change-in-plant-based-vegetarian-or-vegan-diet/">statistics</a> show a 19% increase in the adoption of vegan and vegetarian diets among New Zealanders from 2018 to 2021. </p>
<p>Considering these plant-based diets for a sustainable food system must involve conversations about nutrient availability. Plant foods often contain high amounts of fibre and phytates, which reduce the body’s capacity to <a href="https://www.frontiersin.org/articles/10.3389/fsufs.2021.727533/full">absorb the iron</a>. </p>
<p>Iron in plant foods such as whole grains, nuts, seeds, legumes and leafy greens is known as non-heme and is less readily absorbed than heme iron in animal-sourced foods. In a mixed diet, consisting of vegetables, grains and animal-sourced foods, the <a href="https://link.springer.com/article/10.1007/s00394-012-0348-y">consumption of some red meat, fish or poultry</a> facilitates non-heme iron absorption.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-drink-with-dinner-to-get-the-most-iron-from-your-food-and-what-to-avoid-156579">What to drink with dinner to get the most iron from your food (and what to avoid)</a>
</strong>
</em>
</p>
<hr>
<p>Fortification can be a potent strategy in helping people to shift towards plant-based diets by enriching these diets with nutrients that would otherwise be lacking. </p>
<p>A recent <a href="https://www.mdpi.com/2072-6643/15/11/2473">study</a> investigating this potential revealed that fortifying foods with essential micronutrients, including iron, enables a more gradual dietary adjustment. Consumers wishing to adopt more plant-based diets without compromising nutrient adequacy may find this approach helpful.</p>
<p>However, there’s a caveat. These iron-fortified foods often contain wheat or cereal-based ingredients, which can act as iron absorption inhibitors. As these are common breakfast foods that may be consumed with a <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1301/002966402320285137">morning coffee or tea</a>, the inhibition effect may be even stronger due to the presence of phenolic compounds in these beverages.</p>
<p>One solution could be to eat iron-rich plant foods with foods high in <a href="https://sustainablenutritioninitiative.com/a-global-perspective-in-iron-awareness-week/">vitamin C</a>, such as orange juice, which helps to convert iron to a more absorbable form. </p>
<h2>Is NZ ready for iron-fortified foods?</h2>
<p>Although fortified foods can offer great benefits in tackling iron deficiency, some consumers are hesitant to include these foods in their diets. </p>
<p>Food Standards Australia New Zealand (<a href="https://www.foodstandards.govt.nz/Pages/default.aspx">FSANZ</a>), a government entity responsible for developing food regulations for both nations, found many consumers had <a href="https://www.foodstandards.gov.au/publications/documents/fortification%20report%20-%20qualitative.pdf">second thoughts about reaching for fortified foods</a>, viewing them as unnatural, processed and less healthy. </p>
<p>This hesitancy was particularly evident when it came to non-mandatory fortifications. Added vitamins and minerals in breakfast cereals or, more recently, in plant-based milks and meat alternatives, are examples of non-mandatory or “voluntary fortification”. Consumers often perceive this as a marketing tactic rather than a health-promoting intervention. </p>
<p>Given the importance of adequate dietary iron intake and the projected shortage in dietary iron, it is crucial to evaluate the benefits of fortification. Educational interventions such as <a href="https://sustainablenutritioninitiative.com/iron-awareness-week-2023/">promoting awareness of iron deficiency</a> and positive impacts of fortification may help improve consumers’ acceptance of these initiatives.</p><img src="https://counter.theconversation.com/content/212355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mahya Tavan receives funding from the Global Dairy Platform for developing a dietary optimisation model called The iOTA Model. </span></em></p><p class="fine-print"><em><span>Bi Xue Patricia Soh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many plant-based foods are rich in iron, but they also contain high amounts of fibre and phytates, which reduce the body’s capacity to absorb the essential nutrient.Mahya Tavan, Postdoctoral research fellow - Sustainable Nutrition Initiative, Massey UniversityBi Xue Patricia Soh, PhD Fellow - Sustainable Nutrition Initiative, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1850202022-07-07T00:00:17Z2022-07-07T00:00:17ZLow iron is a health risk made worse by COVID. How to get more without reaching for supplements<figure><img src="https://images.theconversation.com/files/469940/original/file-20220621-13-ah9l7b.jpg?ixlib=rb-1.1.0&rect=43%2C68%2C5708%2C3759&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/healthy-nutrition-dieting-concept-assortment-600w-1902198490.jpg">Shutterstock</a></span></figcaption></figure><p>“Beauty is an iron mine,” once remarked the Australian mining magnate, Gina Reinhart. She was talking about a precious resource, but iron is also profoundly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464783/">important to living organisms</a>: from bacteria and fungi, to mammals like us. </p>
<p>Iron acts as a key to numerous metabolic functions within our bodies. But iron deficiency remains as <a href="https://cdn.who.int/media/docs/default-source/nutritionlibrary/focusing-on-anaemia_970a28fe-a055-4e63-b3ba-11be7b940b16.pdf?sfvrsn=9ab36bdb_6&download=true">one of the top global health risks</a> recognised by the World Health Organization (WHO).</p>
<p>Iron deficiency has become the most prevalent micronutrient disorder worldwide, and COVID may be worsening the problem.</p>
<h2>Iron is hard to get</h2>
<p>The type of iron we mine is different from the “free-form” iron that can be used biologically. Free-form iron has a propensity to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842161/">jump between two chemical states</a>, allowing it to bind to various molecules, and participate in all sorts of essential reactions within our bodies. </p>
<p>But we see a different story again during food digestion. Inside our upper small intestine where iron is most effectively absorbed, free-form iron tends to bind to oxygen, other minerals and food components. This often results in rock-like, insoluble clumps (which are like the ones we mine!). These are too big to pass through or between our cells.</p>
<p>This means that even when we consume enough iron, <a href="https://www.ncbi.nlm.nih.gov/books/NBK448204/#:%7E:text=Heme%20iron%2C%20derived%20from%20hemoglobin,and%20is%20less%20well%20absorbed.">typically only ~15–35% of it is absorbed</a>. It also means iron availability can be <a href="https://ift.onlinelibrary.wiley.com/doi/10.1111/1541-4337.12669">improved, or inhibited</a> depending on how we eat it or what we eat it with. </p>
<p>For example, heme iron from animal flesh has a <a href="https://omlc.org/spectra/hemoglobin/hemestruct/heme-struct.gif">cage-like structure</a>, which carries the iron in a soluble form that prevents it from clumping during absorption. In many Western countries, heme iron only accounts for <a href="https://academic.oup.com/metallomics/article/3/2/103/6016197?login=true#219037456">10% of the iron eaten, but two thirds</a> of the total iron absorbed.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=271&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=271&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=271&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=340&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=340&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469809/original/file-20220620-25-fib3iq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=340&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Iron is often better absorbed when taken with foods such as citrus, alliums and meat.</span>
<span class="attribution"><span class="source">Illustrator: Ren Guo</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>More of us are at risk of deficiency</h2>
<p>Getting sufficient iron sounds like simple maths: we want to <em>add</em> enough to our dietary intake to make up for the iron being <em>lost</em> from the body, such as through faeces, skin shedding, menstruation (for women) and sweat. But the two sides of the equation can change depending on who and where we are throughout our lifetime. </p>
<p>Generally, iron deficiency occurs when our body’s stores of iron are depleted from not having consumed or absorbed enough iron to meet our needs. </p>
<p>This can happen when people restrict their diets, such as for religious, social or medical reasons. Some people also have a tough time keeping up when their iron needs increase, such as <a href="https://www.nature.com/articles/s41430-019-0400-6">pregnant women</a> and <a href="https://academic.oup.com/ajcn/article/106/suppl_6/1681S/4823199">growing children</a>.</p>
<p>But iron deficiency can also happen when the body has enough iron, <a href="https://onlinelibrary.wiley.com/doi/10.1111/bjh.12311">but can’t effectively transport it into cells</a>. This is common in those with both acute and chronic infections, heart and autoimmune conditions, and cancers. In these cases, the underlying disease needs to be treated first, rather than improving iron intake. </p>
<p>The table below summarises some common causes of iron deficiency. Sometimes multiple causes may occur simultaneously – for example, for many elite athletes (<a href="https://link.springer.com/article/10.1007/s00421-019-04157-y">35% of women and 11% of men</a>), iron deficiency results from reduced absorption due to inflammation, on top of increased loss through sweat and breakdown of blood cells.</p>
<p><iframe id="tc-infographic-723" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/723/c41e20d19ac49d195172ae0d32b32c9e7edad23b/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>COVID hasn’t helped</h2>
<p>The ongoing COVID epidemic has also introduced multiple risk factors for iron deficiency. </p>
<p>We know severe infection with SARS-CoV-2 (the virus that causes COVID) may change the way some people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8305218/">metabolise iron</a>, leading to lower iron levels up to two months after infection. This <a href="https://onlinelibrary.wiley.com/doi/10.1002/jmv.26774">contributes to symptoms</a> commonly reported after infection, such as fatigue and lethargy.</p>
<p>Recovery from the pandemic itself has also exacerbated <a href="https://www.oecd.org/coronavirus/policy-responses/food-supply-chains-and-covid-19-impacts-and-policy-lessons-71b57aea/">food supply issues</a>, as well as the <a href="https://blogs.worldbank.org/developmenttalk/global-income-inequality-and-covid-19-pandemic-three-charts">rising global income inequality</a>. </p>
<p>This means more people face barriers to food security – and the nutrient-dense foods that help boost our iron intake like red meat or leafy greens may be unavailable or unaffordable for them. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-we-should-take-a-women-centred-approach-to-diagnosing-and-treating-iron-deficiency-159198">Why we should take a women-centred approach to diagnosing and treating iron deficiency</a>
</strong>
</em>
</p>
<hr>
<h2>Before you pick up a pill</h2>
<p>It may be tempting to pick up one of the many widely available iron supplements to attempt to boost your intake. However, we have to keep in mind that conventional iron supplementation is <a href="https://www.tandfonline.com/doi/full/10.1185/03007995.2012.761599">associated with some negative side effects</a>. </p>
<p>These include damage to our gut lining, nausea, diarrhoea and constipation. Iron supplementation has also been linked to changes in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400826/">gut microbiome</a>, a critical determinant of health.</p>
<p>The WHO has recommended <a href="https://cdn.who.int/media/docs/default-source/micronutrients/gff-part-1-en.pdf?sfvrsn=afc1c426_2">two other approaches</a>: diet diversification and food fortification. </p>
<p><a href="https://cdn.who.int/media/docs/default-source/anaemia/areacop-webinar---24-september-2020/areacop-webinar-nancyaburto-presentation.pdf?sfvrsn=7abd1427_4">Diet diversification</a> is exactly as it sounds: having a diet with a variety of wholefoods such as fruits and vegetables, grains and legumes, meat, dairy, and nuts and seeds. </p>
<p>This approach not only ensures sufficient levels of iron are found in the foods we eat, but also that they come with different forms or “vehicles” to improve absorption. This approach works <a href="https://apps.who.int/iris/bitstream/handle/10665/349086/WHO-EURO-2021-4007-43766-61591-eng.pdf?sequence=1&isAllowed=y">even with plant-based foods</a>. </p>
<figure class="align-center ">
<img alt="hand with reddish brown pills" src="https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469941/original/file-20220621-25-qkpieo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Before resorting to pills and supplements, try diversifying or fortifying the iron in your diet.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/iron-supplements-number-formulations-used-600w-1618887754.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-drink-with-dinner-to-get-the-most-iron-from-your-food-and-what-to-avoid-156579">What to drink with dinner to get the most iron from your food (and what to avoid)</a>
</strong>
</em>
</p>
<hr>
<p>Food fortification, where iron is added to processed foods, is also a fairly safe yet accessible option due to its lower dose. In Australia, iron is commonly fortified in products such as bread, cereals and ready-to-drink mixes. </p>
<p>It can be challenging to get the iron into our body and where it’s needed. But before turning to supplements, we must remind ourselves that food sources should always be first-in-line. In cases of diagnosed deficiencies, your healthcare professional will provide you with further information where supplements are necessary.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/lemon-water-wont-detox-or-energise-you-but-it-may-affect-your-body-in-other-ways-180035">Lemon water won't detox or energise you. But it may affect your body in other ways</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/185020/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yianna Zhang receives funding from the CSIRO as a part of the Postgraduate Scholarships program, and from the University of Melbourne's Melbourne Research Scholarship program. </span></em></p><p class="fine-print"><em><span>Ken Ng, Regine Stockmann, and Said Ajlouni do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Getting enough iron is tricky – even if we eat enough, we might not absorb enough. But diversifying the menu and looking for fortified foods can help.Yianna Zhang, PhD Candidate, The University of MelbourneKen Ng, Senior Lecturer & Course Coordinator (Master of Food Science), The University of MelbourneRegine Stockmann, Principal Research Scientist, CSIROSaid Ajlouni, Associate Professor, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1591982021-05-05T20:40:17Z2021-05-05T20:40:17ZWhy we should take a women-centred approach to diagnosing and treating iron deficiency<figure><img src="https://images.theconversation.com/files/398783/original/file-20210505-21-naj69h.jpg?ixlib=rb-1.1.0&rect=5%2C65%2C3988%2C2287&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Florian Gaertner/Getty Images</span></span></figcaption></figure><p>Iron deficiency is a common nutritional disorder worldwide, and pre-menopausal women are <a href="https://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia_2011/en/">most at risk</a> of being diagnosed with it.</p>
<p>New Zealand’s most recent <a href="https://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/surveys/past-surveys/nutrition-survey">nutritional survey</a> (from 2008/09) shows 12% of women may suffer from iron deficiency. But more <a href="https://pubmed.ncbi.nlm.nih.gov/32990625/">recent research</a> in New Zealand suggests up to 55% of women of a similar age but of various ethnicities (Caucasian, Middle Eastern and South Asian) present with depleted iron levels.</p>
<p>This higher incidence of iron deficiency in women is often explained as a result of blood loss during menstruation. But my <a href="https://pubmed.ncbi.nlm.nih.gov/33583330/">research</a>, which analyses the iron status of athletic and active women, suggests female physiology has evolved to counter iron loss through complex interactions between female reproductive hormones and the hormone that influences iron regulation.</p>
<p>The research shows variations in iron status during a woman’s monthly cycle, and based on this, we would recommend doctors note what phase of the menstrual cycle a women is in when conducting iron-screening blood tests. In addition, before interpreting test results, they should ask women if they have a natural menstrual cycle, not influenced by any hormonal contraceptives (pill or IUD).</p>
<h2>Iron in the body</h2>
<p>Iron is <a href="https://www.healthnavigator.org.nz/health-a-z/i/iron-deficiency/">fundamental for optimal health</a> and well-being. It is an essential part of haemoglobin, the pigment in red blood cells, and transports oxygen throughout the body. </p>
<p>Even though iron is important for healthy and normal functioning, we can’t make the mineral and rely on recycling it within the body and getting enough from food. Dietary <a href="https://nutritionfoundation.org.nz/nutrition-facts/minerals/iron">sources of iron</a> include whole grain cereals, legumes, fish, poultry and meat. </p>
<p>The body controls and regulates iron well. Daily <a href="https://academic.oup.com/nutritionreviews/article/54/10/295/1836886">iron losses</a> are only 1-2mg. Research suggests women will lose an additional 1mg of iron each day of their menses, which may bring the total <a href="https://pubmed.ncbi.nlm.nih.gov/29280410/">iron loss</a> to 3-5mg during the time of menstrual blood loss (which may last 1-5 days). This can be exaggerated in women who experience <a href="https://pubmed.ncbi.nlm.nih.gov/24048634/">heavy or extended menstrual bleeding</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-to-drink-with-dinner-to-get-the-most-iron-from-your-food-and-what-to-avoid-156579">What to drink with dinner to get the most iron from your food (and what to avoid)</a>
</strong>
</em>
</p>
<hr>
<p>The primary iron regulatory hormone is <a href="https://pubmed.ncbi.nlm.nih.gov/12663437/">hepcidin</a>. It <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099567/">works</a> on the only known iron export channels in the body — found in the small intestine (iron absorption from foods), on the surface of white blood cells (iron recycling in the body) and in liver cells (iron release from its reservoir in the liver). </p>
<p>Higher levels of hepcidin lead to a degradation of the iron export channels, effectively stopping the movement of iron from the gut and the release from its storage sites. This also limits the body’s ability to recycle iron from dead red blood cells, either for the production of new red blood cells or to store it in the liver.</p>
<h2>Female physiology and iron status</h2>
<p>To date only two <a href="https://pubmed.ncbi.nlm.nih.gov/26842695/">research</a> <a href="https://pubmed.ncbi.nlm.nih.gov/26687536/">investigations</a> have sought to clarify the changes in iron status and hepcidin across the menstrual cycle in pre-menopausal women. </p>
<p>My <a href="https://pubmed.ncbi.nlm.nih.gov/33583330/">research</a> shows a dramatic fall in hepcidin (and some other iron-related factors) during menstruation (days 1-5 of the monthly cycle). Hepcidin remains depressed for the few days following the period and then gradually starts rising at ovulation (at about day 14). </p>
<p>After ovulation, as women enter their luteal phase (days 15-28), hepcidin appears to increase and plateau before <a href="https://pubmed.ncbi.nlm.nih.gov/33583330/">repeating the cycle the following month</a>. </p>
<p>Research using <a href="https://pubmed.ncbi.nlm.nih.gov/22535765/">isolated cells</a> and studies with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4750915/">women undergoing in-vitro fertilisation</a> show that oestrogen tends to suppress hepcidin activity, while <a href="https://pubmed.ncbi.nlm.nih.gov/26657863/">progesterone stimulates it</a>. This explains the low levels of hepcidin in the follicular phase (days 1-14 of the menstrual cycle) and the rebound in the luteal phase (days 15-28). </p>
<p>These results suggest that in response to the blood loss that accelerates iron loss, female physiology is primed for maximising iron absorption in the first half of the menstrual cycle by reducing the activity of hepcidin. This could be a physiological counter mechanism to menstrual blood loss.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-way-we-measure-iron-deficiency-in-children-needs-to-change-heres-why-133097">The way we measure iron deficiency in children needs to change. Here's why</a>
</strong>
</em>
</p>
<hr>
<p>It is worth noting that a <a href="https://pubmed.ncbi.nlm.nih.gov/26687536/">few studies</a> have also shown that serum iron, transferrin and haemoglobin — all markers used to measure a person’s iron status — fluctuate throughout the menstrual cycle. In one <a href="https://pubmed.ncbi.nlm.nih.gov/8237879/">study</a>, 23% of women were classified as iron deficient during menstruation, but this dropped to 8% in the luteal phase. </p>
<p>Transferrin saturation is a measure of the percentage of iron being transported and used in the body. During the luteal phase, when iron levels may rebound, some women may reach transferrin saturation levels of 45%. This typically indicates excess iron or haemochromatosis, a genetic disorder that results in excessive absorption and storage of iron and can be <a href="https://www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/iron-overload-haemochromatosis">toxic for vital organs</a>. </p>
<p>Some may say research into iron deficiency is well established and we have covered our bases on how to detect and treat this micro-nutrient deficiency. But 18-55% of pre-menopausal women in New Zealand have sub-optimal iron levels. </p>
<p>Researchers have explored many lifestyle factors that affect a person’s iron balance, including <a href="https://pubmed.ncbi.nlm.nih.gov/25006582/">dietary preferences</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/32990625/">meat intake</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/31055680/">exercise</a>. But we have yet to fully consider female physiology and how the menstrual cycle influences the intricacies of iron deficiency diagnosis and effective treatment. </p>
<p>At a time when many call for female-centred research to identify specific health outcomes and treatments, it might be time to reopen the box on iron deficiency.</p><img src="https://counter.theconversation.com/content/159198/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Badenhorst is affiliated with Massey University Auckland. She has consulted with Beef and Lamb New Zealand on the topic of iron status in the New Zealand population and in athletes. </span></em></p>Researchers have explored many factors that affect iron levels, including diet and exercise, but we don’t yet fully understand the role women’s reproductive hormones play in regulating iron uptake.Claire Badenhorst, Lecturer at Massey University, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1565792021-04-21T06:59:01Z2021-04-21T06:59:01ZWhat to drink with dinner to get the most iron from your food (and what to avoid)<figure><img src="https://images.theconversation.com/files/396221/original/file-20210421-15-1acdwvv.jpg?ixlib=rb-1.1.0&rect=529%2C0%2C5308%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A drink with your breakfast, lunch or dinner can make your meal more enjoyable. But have you considered whether your drink of choice may affect the way your body absorbs the nutrients in your food?</p>
<p>Dietary factors that can increase the uptake of other nutrients are called enhancers, while those that can reduce the uptake of other nutrients are called inhibitors, or <a href="https://www.sciencedirect.com/science/article/abs/pii/096399699390069U">anti-nutrients</a>.</p>
<p>One of the most common nutrient deficiencies worldwide is iron, and can result in a condition called <a href="https://www.healthline.com/health/iron-deficiency-anemia">iron deficiency anaemia</a>. </p>
<p>So if you’re looking to increase your iron levels, it’s worth thinking not just about what you’re eating — but what you’re drinking too.</p>
<h2>A bit about iron</h2>
<p>Iron deficiency can develop when <a href="https://theconversation.com/ive-been-diagnosed-with-iron-deficiency-now-what-87670">we don’t get enough iron</a>, or don’t absorb iron to the extent our body needs. It’s more common <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(13)70001-9/fulltext">in women</a>, and can cause weakness and fatigue, among other symptoms.</p>
<p>If you’re worried you may be iron deficient, you can get a blood test from your general practitioner.</p>
<p>There are <a href="https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/iron">two forms of iron</a> in our diets; haem iron and non-haem iron. Haem is an iron-containing protein that forms part of the haemoglobin, a protein in your red blood cells that transports oxygen around your body. </p>
<p>Haem iron is found in animal sources of food, like meat, and is more easily absorbed into the body. </p>
<p>Non-haem iron is found in plant foods, like grains, beans and nuts, and is less easily absorbed. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-been-diagnosed-with-iron-deficiency-now-what-87670">I've been diagnosed with iron deficiency, now what?</a>
</strong>
</em>
</p>
<hr>
<h2>Some enhancers</h2>
<p>Choosing a drink that contains vitamin C — such as orange, tomato or grapefruit juice — around the time of your meal will increase the amount of the non-haem iron you can absorb. </p>
<p>In one study, 100mg of vitamin C <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">increased iron absorption four-fold</a>. This is roughly equivalent to what you’d get from one glass of orange juice.</p>
<p>Keeping this in mind is particularly important for people who don’t eat meat, as all of their dietary iron will be non-haem iron.</p>
<h2>Some inhibitors</h2>
<p>Tea is a popular drink with meals and is often enjoyed with Asian cuisine. But tea contains a bioactive compound called tannin, which is <a href="https://academic.oup.com/cdn/article/1/2/1/4558629?login=true">an inhibitor</a> of non-haem iron absorption.</p>
<p><a href="https://www.tandfonline.com/doi/abs/10.1080/10408699891274273">Tannin</a> is classed as an organic compound called a polyphenol. It’s also found in many foods including cocoa, almonds, grapes, berries, pomegranates, and spices (for example, vanilla and cinnamon), which may find their way into drinks like smoothies.</p>
<p><a href="https://www.researchgate.net/profile/Vikas-Kumar-190/publication/309632876_Kombucha_Technology_Microbiology_Production_Composition_and_Therapeutic_Value/links/581ab50b08aed2439386c9f5/Kombucha-Technology-Microbiology-Production-Composition-and-Therapeutic-Value.pdf">Kombucha</a>, a popular fermented tea drink, still contains some tannins.</p>
<p>Unfortunately the news is no better for coffee drinkers — coffee contains tannins too. And the <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">chlorogenic acid</a> in coffee is also an important inhibitor of iron absorption.</p>
<figure class="align-center ">
<img alt="A woman in a striped jumper holds a mug." src="https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396222/original/file-20210421-15-usngrb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Tea and coffee contain tannins, which inhibit iron absorption.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Tea and coffee are considered the strongest inhibitors of iron. A cup of tea reduces iron absorption <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">by about 75%-80%</a>, and a cup of coffee <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">by about 60%</a>. The stronger you make them, the greater the effect will be. </p>
<p>So it’s best to avoid tea and coffee while eating and for two hours before and after the meal. This is roughly the <a href="https://www.tandfonline.com/doi/full/10.1080/10408398.2020.1784841">length of time</a> food and drinks sit in your stomach before they’re fully absorbed. </p>
<p>This includes breakfast, a meal at which many people most commonly consume tea and coffee. For most of us breakfast normally consists of cereal and/or bread. Both of these naturally contain significant <a href="https://www.healthdirect.gov.au/foods-high-in-iron">levels of iron</a> and sometimes these products have iron added.</p>
<p>So if you’re iron deficient, it may be time to consider opting for a small glass of orange juice at breakfast, or preferably the whole orange (as you get fibre with it too), and saving the tea or coffee for a little later.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-kombucha-and-how-do-the-health-claims-stack-up-87180">What is kombucha and how do the health claims stack up?</a>
</strong>
</em>
</p>
<hr>
<h2>A little from column A, a little from column B</h2>
<p>There has always been speculation <a href="https://econtent.hogrefe.com/doi/abs/10.1024/0300-9831/a000036">dairy may inhibit iron absorption</a>, but to date the evidence seems to suggest it has no effect. </p>
<p>However plant-based milks, such as soy milk, contain phytates, a compound that stores phosphorus in plants, which inhibit <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231">iron absorption</a>.</p>
<figure class="align-center ">
<img alt="A group of people drinking beers with a meal." src="https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396223/original/file-20210421-23-d4fvuf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Beer increases iron absorption. But that doesn’t mean you should have it with every meal.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Meanwhile, <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231">alcohol increases the absorption of iron</a>, so a beer would be classed as an enhancer. </p>
<p>If you favour a glass of wine, you should select a white over a red. Red wine contains more tannins and other polyphenols, so overall <a href="https://academic.oup.com/ajcn/article/71/5/1147/4729231?login=true">red wine</a> inhibits iron absorption.</p>
<p>But as we know drinking alcohol increases the risk <a href="https://www.wcrf.org/dietandcancer/exposures/alcoholic-drinks">of cancer</a> and is linked to <a href="https://www.sciencedirect.com/science/article/abs/pii/S0031938410000259">other health concerns</a>, you shouldn’t start drinking alcohol to increase iron absorption.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-let-my-kids-drink-juice-we-asked-five-experts-92176">Should I let my kids drink juice? We asked five experts</a>
</strong>
</em>
</p>
<hr>
<h2>So what’s the take-home message?</h2>
<p>The bioactives I’ve mentioned also provide many nutritional and health benefits, and they’re all found in plant products. It would be virtually impossible to avoid tannins in your diet and still be consuming the healthy number of serves of fruit and vegetables. </p>
<p>This advice is mostly relevant if you’ve been diagnosed as iron deficient or with iron deficiency anaemia. And even if this is the case, you can still enjoy these drinks outside of meal times. </p>
<p>If your iron levels are within the normal range there’s no need to be concerned as your body is absorbing enough to meet your needs with what you’re drinking and eating.</p><img src="https://counter.theconversation.com/content/156579/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris receives funding from NHMRC. </span></em></p>From orange juice, to tea and coffee, to alcohol — different drinks can have different effects on iron absorption. This is worth thinking about if your iron levels are low.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1330972020-03-08T07:46:23Z2020-03-08T07:46:23ZThe way we measure iron deficiency in children needs to change. Here’s why<figure><img src="https://images.theconversation.com/files/318882/original/file-20200305-106579-sx76bw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>A deficiency of iron for normal body function is the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext">most common nutritional disorder in the world</a>. Iron deficiency is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/24297872">main cause of anaemia</a> and is associated with poor brain development and long-term impairment of behavioural and cognitive performance in children. </p>
<p>Common symptoms of iron deficiency include pallor of the skin, eye and beds of nails, weakness, difficulty breathing, dizziness, headache, hair loss, dry or rough skin and cravings for non-food items such as ice, paper, dirt, or clay.</p>
<p>Iron deficiency is commonly diagnosed using laboratory blood tests that mainly measure levels of <a href="https://www.healthline.com/health/ferritin#ferritin">ferritin</a>, a protein that stores iron. In Africa, the tests can be misleading because ferritin levels go up in a person’s body during inflammation or infections such as malaria. This means that a person who is iron deficient may appear iron replete if they’re carrying an infection. </p>
<p>It is therefore challenging to estimate the burden of iron deficiency in settings such as sub-Saharan African where infections are common.</p>
<p>But accurate estimates of the burden of iron deficiency are important for designing public health interventions dealing with nutritional iron levels. Giving iron supplements based on poor data can lead to the wrong children being targeted. This could include children who should be getting supplements but aren’t, and those who don’t need them being given supplements with possible adverse effects.</p>
<p>To help overcome this problem <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-1502-7">we set out to calculate</a> more reliable estimates of the burden of iron deficiency in African children. </p>
<p><a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-1502-7">Our study</a> highlighted that a huge burden of iron deficiency may be missed out given the current tools used to measure it. This is important for governments to properly plan, monitor, and target effective interventions to deal with iron deficiency on the continent.</p>
<p>We analysed data for 4,853 children from communities in Kenya, Uganda, South Africa, Burkina Faso and The Gambia. We used statistical modelling to correct for the effects of malaria and inflammation on iron biomarkers. We found that over half (52%) of the African children were iron deficient. </p>
<p>We also found that <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/transferrin-saturation">transferrin saturation</a>, an indicator of transferrin-bound iron in the bloodstream, may more accurately estimate the burden of iron deficiency in African children. This is because transferrin saturation was the iron biomarker least influenced by infections. We found that transferrin saturation below 11% may indicate iron deficiency in African children. Transferrin saturation is easy to measure in routine laboratory tests.</p>
<h2>The implications</h2>
<p>We found that ferritin levels may be elevated even before children are defined as having inflammation. We also found that malaria infection influenced ferritin levels independently of inflammation.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=445&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=445&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=445&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=559&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=559&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318883/original/file-20200305-106589-7ccg6.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=559&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Source: Author.</span>
</figcaption>
</figure>
<p>The influence of malaria infection on ferritin levels is not accounted for in the World Health Organisation’s <a href="https://www.who.int/vmnis/indicators/serum_ferritin.pdf">definition of iron deficiency</a>. In addition, its <a href="https://www.who.int/vmnis/indicators/serum_ferritin.pdf">definition of iron deficiency</a> accounts for the effect of inflammation by applying an arbitrary higher cut-off of ferritin levels in individuals with inflammation.</p>
<p>Using the World Health Organisation definition, the overall prevalence of iron deficiency was 34%. But this is an underestimate of the burden of iron deficiency (52%) that we found. </p>
<p>In some communities, where the prevalence of infections was high, over a quarter of the children were misclassified as iron replete whereas they were iron deficient.</p>
<p>This has huge implications for the rollout of nutritional iron programmes. The World Health Organisation uses the prevalence of anaemia as a proxy of iron deficiency or need in a population. The organisation recommends that <a href="https://www.who.int/nutrition/publications/micronutrients/guidelines/daily_iron_supp_childrens/en/">daily iron supplementation</a> should be provided to all children if the prevalence of anaemia is more than 40%. In places where malaria is prevalent, the iron supplementation should be provided in conjunction with effective malaria controls and treatment measures since giving iron may increase the risk of malaria infection. </p>
<p>In <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-1502-7">our study populations</a>, the prevalence of anaemia was more than 40%. Therefore, based on the <a href="https://www.who.int/nutrition/publications/micronutrients/guidelines/daily_iron_supp_childrens/en/">World Health Organisation recommendations</a>, all children would receive iron supplementation although we found that approximately half of the children were iron deficient. Half of the children would needlessly take iron supplements. This suggests that the prevalence of anaemia is a poor indicator of iron need.</p>
<p>Giving iron supplements to children who are not iron deficient may predispose them to infections, including malaria. A <a href="https://www.ncbi.nlm.nih.gov/pubmed/16413877">large study</a> in Pemba, Tanzania, showed that iron supplemented children were more likely to die or be admitted to hospital. In <a href="https://www.ncbi.nlm.nih.gov/pubmed/16413877">that study</a>, iron supplementation increased the risk of malaria-related events by 16%. However, in iron deficient children, iron supplementation was not harmful. </p>
<h2>How to manage iron deficiency</h2>
<p>There are multiple causes of iron deficiency in children. These can include eating diets low in iron, impaired absorption of iron, excessive loss of iron through injury, increased iron need for growth, or genetic factors. </p>
<p>Iron in foods such as meat, fish and poultry is easily absorbed while iron found in plant foods, such as vegetables, cereals, beans and lentils, is poorly absorbed. Eating fruits rich in vitamin C enhances iron absorption. Grains and tea contain substances that inhibit iron absorption.</p>
<p>The need for iron varies. For example, iron requirements increase during the first year of a child’s growth. This means that weaning children should be supplemented with foods rich in iron.</p>
<p>In sub-Saharan Africa, chronic infections such as <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32279-7/fulltext">malaria, HIV, and TB are common</a>. These diseases may be an underlying cause of iron deficiency. This is because they can cause a blockade of dietary iron absorption. Thus, even iron supplements may not be effectively absorbed in the presence of infections. The <a href="https://academic.oup.com/ajcn/article/92/6/1406/4597520">fortification of foods has also been associated with gut disorders</a> since unabsorbed iron favours the growth of bad bacteria.</p>
<p>What this shows is that managing iron deficiency is complex and an integrated approach is required. <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-1502-7">Our study</a> suggests that improved control of malaria and other infections would also improve assessment of iron status in African children. </p>
<p>Improved control of infections may also improve absorption of iron although future research should quantify the benefits of such an approach in addressing iron deficiency.</p><img src="https://counter.theconversation.com/content/133097/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr John Muthii Muriuki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In some communities, over a quarter of the children were misclassified as iron replete whereas they were iron deficient.Dr John Muthii Muriuki, PhD Fellow, Open University (UK), Kenya Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/769812017-05-02T22:01:37Z2017-05-02T22:01:37ZFeeling worn out? You could have iron overload<figure><img src="https://images.theconversation.com/files/167448/original/file-20170502-26313-zixla5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No, not that type of iron overload – haemochromatosis, when your body absorbs too much iron.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/442118806?src=_STvjoIZMwVdZZezu0Copw-1-5&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Feeling a bit tired and worn out? Vague symptoms like these are common in iron deficiency and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anaemia">anaemia</a>. But before you reach for the iron supplements or chow down on steak, these symptoms are common in another condition related to iron. This time the trouble is <em>too much</em> iron, not too little, because of the iron overload disorder called <a href="http://haemochromatosis.org.au/explanation/">haemochromatosis</a>.</p>
<h2>What is haemochromatosis?</h2>
<p>Haemochromatosis is the most common iron storage disease in Australia, the US and most European countries and occurs in about <a href="https://www.ncbi.nlm.nih.gov/pubmed/9138148">one person in 200</a>. It is <a href="https://www.ncbi.nlm.nih.gov/pubmed/23577916">rare in people of Asian descent</a>. </p>
<p>It is a recessive genetic condition, meaning you have to <a href="https://www.niddk.nih.gov/health-information/liver-disease/hemochromatosis">inherited two copies of the haemochromatosis gene</a> (one from each parent). The defect is in the gene that regulates how much iron you absorb from food and supplements. This means that more iron gets into your system than you <a href="https://en.wikipedia.org/wiki/Human_iron_metabolism">need to make red blood cells or to perform other functions</a>. The excess iron ends up in your organs and <a href="https://www.niddk.nih.gov/health-information/liver-disease/hemochromatosis">can damage your heart, liver, pancreas, joint and glands that make hormones</a>. If left untreated, you are at a higher <a href="http://haemochromatosis.org.au/">risk of heart and liver disease, diabetes and arthritis</a>. </p>
<h2>Signs and symptoms</h2>
<p>Symptoms commonly appear in men aged 40-60 years, but appear later in women due to blood loss from menstruation and childbirth.</p>
<p>The most common symptoms are fatigue and joint pain. More advanced symptoms include osteoarthritis, hormonal changes with loss of libido, skin that has a bronze or slate grey colour, heart problems, diabetes (including <a href="http://www.diabetes.co.uk/hemochromatotis-bronze-diabetes.html">bronze diabetes</a>) and liver diseases such as cirrhosis and liver cancer.</p>
<p>It seems confusing that absorbing <em>more iron</em> could lead to fatigue. Iron is needed to make red blood cells that carry oxygen around the body. However, <em>too much</em> iron is toxic. <a href="http://www.mayoclinic.org/diseases-conditions/hemochromatosis/symptoms-causes/dxc-20167290">Excess iron gets deposited in your organs, and this then interferes with normal body functions</a>, as well as the production of hormones that regulate your metabolism and sex drive. Not surprisingly, you don’t feel well. </p>
<h2>Diagnosis and treatment</h2>
<p>Your GP can order a simple blood test to check your iron status. This includes <a href="https://en.wikipedia.org/wiki/Transferrin_saturation">transferrin saturation</a> and <a href="https://en.wikipedia.org/wiki/Ferritin">serum ferritin</a>. If these suggest you could have an iron overload disorder then a gene test will confirm the diagnosis. Once diagnosed, close relatives would also need to be checked for the condition. </p>
<p>The good news is that treatment for haemochromatosis is straight forward and effective. The <a href="https://en.wikipedia.org/wiki/Venipuncture">venipuncture</a> process (similar to becoming a regular blood donor) removes excess iron from the body.</p>
<h2>What do I need to avoid eating and drinking?</h2>
<p>Avoiding eating meat, chicken and fish or becoming a <a href="https://daa.asn.au/smart-eating-for-you/smart-eating-fast-facts/healthy-eating/vegetarian-diets-the-basics/">vegetarian</a> will help reduce the amount of iron you eat and can therefore potentially reduce what your body absorbs.</p>
<p>Other things to avoid are vitamin C supplements and juices high in, or supplemented with, vitamin C. Vitamin C converts the iron from legumes, eggs, nuts, seeds, grains and breakfast cereals into a form that is more easily absorbed, increasing your iron load.</p>
<p>There are many reasons why you could feel fatigued. If you have a lethargy that just won’t lift, see your GP for a check up.</p><img src="https://counter.theconversation.com/content/76981/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre for Physical Activity and Nutrition, the University of Newcastle, NSW. She is an NHMRC Senior Research fellow. She has received a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia, Diabetes Australia, the Heart Foundation. She has consulted to SHINE Australia, Novo Nordisk, Quality Bakers and the Sax Institute. She is a spokesperson for the Dietitians Association of Australia on some specific nutrition issues, including Australia's Healthy Weight Week.</span></em></p>Feeling tired and out of energy? Talk to your GP about checking your iron level.Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/699742016-12-08T02:29:26Z2016-12-08T02:29:26ZWhy iron is such an important part of your diet<figure><img src="https://images.theconversation.com/files/148984/original/image-20161207-25753-1lmyqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Iron is contained in many vegetarian foods, and there are yummy ways to enhance how much you absorb. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/516747673?src=SP9vbt4Ziya_qzzBMJHH1w-3-25&id=516747673&size=huge_jpg">Shutterstock/Uber Images</a></span></figcaption></figure><p>According to the <a href="http://www.who.int/nutrition/topics/ida/en/">World Health Organisation</a>, iron deficiency – a condition where your body doesn’t have enough of the mineral iron – is a global public health problem of “epidemic proportions”. It is the single most prevalent nutrient deficiency in developing and industrialised countries, and the most common cause of anaemia. </p>
<p><a href="http://link.springer.com/article/10.1007%2Fs00277-010-1144-5">Anaemia</a> occurs when our red blood cell count and/or haemoglobin levels are too low, resulting in an inability to transport sufficient oxygen throughout the body. Iron is required in order for haemoglobin to transport oxygen. </p>
<p>This week <a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">Australian Prescriber</a> published an update on the problem of iron deficiency in Australia. Young women, children and disadvantaged groups are at <a href="http://europepmc.org/abstract/med/9076267">highest risk</a>. Around 12-15% of women who are pregnant or of reproductive age and 8% of preschool children in Australia are estimated to have <a href="https://www.mja.com.au/journal/2010/193/9/diagnosis-and-management-iron-deficiency-anaemia-clinical-update?0=ip_login_no_cache%3D5b5ca34fad730a23f7740f2b74d0b0e4">iron deficiency anaemia</a>. Iron deficiency without clinical anaemia is <a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pd">even more widespread</a>. </p>
<p>Although vegetarians and vegans are broadly thought of as being at high risk of iron deficiency due to an absence of red meat in the diet, there is <a href="https://www.ncbi.nlm.nih.gov/pubmed/8172127">little evidence</a> to <a href="https://www.mja.com.au/journal/2013/199/4/iron-and-vegetarian-diets">support</a> this. However restricted diets can confer higher risk if not well balanced, for instance in <a href="https://www.mja.com.au/open/2012/1/2/iron-and-vegetarian-diets">young overweight women</a> who are trying to lose weight.</p>
<h2>Why is iron important?</h2>
<p>Iron has an <a href="http://www.sciencedirect.com/science/article/pii/S0098299700000066">essential role</a> in numerous <a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">metabolic pathways</a> in the body, including transport of oxygen in the blood, DNA synthesis, breathing, immune function and energy production. </p>
<p><a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">Symptoms</a> of iron deficiency include tiredness, neurobehavioural disorders like <a href="http://nutritionreviews.oxfordjournals.org/content/66/10/558.long">attention deficit hyperactivity disorder</a> and <a href="http://www.webmd.com/brain/restless-legs-syndrome/restless-legs-syndrome-rls#1">restless leg syndrome</a> (a nervous system disorder that creates an irresistible and sometimes unbearable urge to move the legs), and cognitive impairment in children. Iron deficiency can have a <a href="http://www.who.int/nutrition/topics/ida/en/">serious impact</a> on health and productivity. </p>
<p>Iron is essential for the developing <a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pdf">brain</a>. Iron deficiency with and without anaemia in infancy can have long term negative impacts on brain function and behaviour, and even when levels are corrected, those effects may not be completely reversed.</p>
<p>Maternal anaemia can result in <a href="http://ajcn.nutrition.org/content/71/5/1280s.short">preterm birth</a>, and along with high blood pressure or diabetes can compromise <a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pdf">fetal iron levels</a> in pre-term or term infants. </p>
<p><a href="http://pediatrics.aappublications.org/content/pediatrics/126/5/1040.full.pdf">Breastfeeding</a> provides adequate iron to meet infant needs up to the age of six months. However from seven to 12 months the requirement for iron increases significantly (up to 11 milligrams per day), and must be provided via solid food in addition to breast milk.</p>
<p>It’s important to understand problems can be caused by both too little as well as too much iron. Hence iron concentrations in the body are <a href="http://www.sciencedirect.com/science/article/pii/S0098299700000066">carefully regulated</a> and professional advice must be sought before supplementing with iron. </p>
<h2>Causes of iron deficiency</h2>
<p>There are <a href="https://www.nps.org.au/australian-prescriber/articles/correcting-iron-deficiency#r3">lots</a> of <a href="https://www.mja.com.au/journal/2010/193/9/diagnosis-and-management-iron-deficiency-anaemia-clinical-update?0=ip_login_no_cache%3D5b5ca34fad730a23f7740f2b74d0b0e4">complex</a> causes of iron deficiency and anaemia, and they should be carefully investigated before being addressed.</p>
<p>Poor dietary intake is an important cause of iron deficiency, particularly when requirements are increased during infancy, menstruation and pregnancy.</p>
<p>Iron is one of a number of essential nutrients we need to get through our diet. Iron deficiency is therefore one of <a href="http://www.abc.net.au/news/2016-11-29/resurgence-of-the-rare-condition-of-scurvy-among-diabetics/8073136">several casualties</a> of <a href="http://www.aihw.gov.au/publication-detail/?id=10737422319">poor dietary patterns</a> in Australia and other westernised countries, characterised by excessive intake of highly processed foods and inadequate intake of nutritious whole foods.</p>
<h2>Iron requirements</h2>
<p><a href="https://www.mja.com.au/journal/2013/199/4/iron-and-vegetarian-diets">Dietary iron requirements</a> vary by age and gender. The recommended daily intake (average daily intake that is sufficient to meet the needs of the majority of people) for males varies from eight to 11 milligrams a day for ages one to 18 years, and eight milligrams for all other ages. </p>
<p>Women have higher requirements. For ages 14-50 years, recommended daily intakes range from 15 milligrams (14-18 years) to 18 milligrams a day. Needs are higher during pregnancy, jumping to 27 milligrams per day. However during lactation they are slightly less, at nine to ten milligrams a day.</p>
<p>Iron requirements for vegetarians have been estimated as 1.8 times more than non-vegetarians, however this conclusion was based on <a href="https://www.mja.com.au/open/2012/1/2/iron-and-vegetarian-diets#0_CBBJFGAA">limited research</a>.</p>
<h2>Dietary sources of iron</h2>
<p><a href="http://ajcn.nutrition.org/content/59/5/1233S.long">Dietary iron</a> is obtained in the form of <a href="https://www.mja.com.au/journal/2013/199/4/iron-and-vegetarian-diets">haem iron or non-haem iron</a>. Haem iron sources include red meat, poultry and fish, while non-haem iron comes from a variety of plant foods such as legumes, wholegrains, green leafy vegetables, nuts, seeds, fresh and dried fruit. These plant sources are core components of both vegetarian and vegan diets.</p>
<p>Non-haem iron is believed to be <a href="http://ajcn.nutrition.org/content/59/5/1233S.long">less available</a> than haem iron. This is because plant foods contain substances that can inhibit absorption of iron.</p>
<p>However, vitamin C can enhance non-haem iron absorption thereby counteracting these inhibitory effects. To address this in your diet, you might like to try:</p>
<ul>
<li>eating hummus that contains chickpeas and lemon juice </li>
<li>lemon juice drizzled over Indian dal or <a href="http://helfimed.org/recipes/red-lentil-soup/">lentil soup</a></li>
<li>salads containing high vitamin C sources such as red capsicum or tomato as a side dish</li>
<li>kiwi fruit, strawberries, papaya or a glass of freshly squeezed orange juice with muesli</li>
<li>a side dish of <a href="http://helfimed.org/recipes/steamed-vegies/">lightly steamed</a> broccoli, cauliflower and/or brussel sprouts - good sources of vitamin C – which can be boosted with lemon juice (plus extra virgin olive oil, garlic and salt for ultimate flavour and nutrition)</li>
<li>mixing baby spinach in salads - green leafy vegetables contain iron and vitamin C, a complete package.</li>
</ul>
<p><a href="https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sau11494_fm.pdf">Soaking and sprouting</a> legumes, wholegrains and seeds makes the iron more available from these foods. </p>
<p>It is important to note the absorption of non-haem iron varies considerably, and has been shown to be <a href="http://www.andjrnl.org/article/S2212-2672(16)31192-3/pdf">higher</a> in people who have greater iron requirements. This suggests the body adapts to low iron by increasing its absorption. </p>
<p><a href="http://ajcn.nutrition.org/content/59/5/1233S.long">Vegetarians</a> who follow a balanced diet have been shown to have higher iron intake than that of non-vegetarians and there is <a href="https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sau11494_fm.pdf">little evidence</a> of lower iron status.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=562&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=562&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148988/original/image-20161207-13648-1olunxi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=562&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Foods such as red meat, spinach, nuts, seeds and legumes are good sources of dietary iron.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/527187667?src=7zaxtIY4FJYErFDQGkGrtw-1-0&id=527187667&size=medium_jpg">Shutterstock</a></span>
</figcaption>
</figure>
<p>A table of the iron content of foods commonly available in Australia is provided <a href="https://www.mja.com.au/system/files/issues/196_10_040612_supplement/sau11494_fm.pdf">here</a>.</p>
<p>Iron is an essential nutrient with a range of critically important functions in the body and brain. Assessing iron stores and causes of anaemia is complex and should be performed by a professional. </p>
<p>We can ensure adequate intake of iron by eating a healthy balanced diet with a variety of whole foods including (but not limited to) meat as well as plant sources.</p><img src="https://counter.theconversation.com/content/69974/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natalie Parletta (formerly Sinn) has received funding from the Australian Research Council and is currently employed by a National Health & Medical Research Council Program Grant. </span></em></p>Iron deficiency affects more than one in ten Australian women before they reach menopause. Better dietary choices can be part of the solution.Natalie Parletta, Adjunct Senior Research Fellow, Freelance Science Writer, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/660752016-10-04T19:15:38Z2016-10-04T19:15:38ZMaternal malnutrition affects future generations. Kenya must break the cycle<figure><img src="https://images.theconversation.com/files/140275/original/image-20161004-20213-18d7eqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A mother and her son at a nutrition clinic in Kenya. Adequate nutrition for mothers is important for the health of their children.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/kuap-pandipieri/17055944318/in/album-72157649672274083/">KUAP Pandipieri</a></span></figcaption></figure><p>Nutrition of women before and during pregnancy and when breastfeeding is critical in determining the health and survival of the mother and of her unborn baby. </p>
<p>Undernourished pregnant women have higher reproductive risks. They are more likely to experience <a href="http://www.care.org/sites/default/files/documents/MH-2013-Maternal-Nutrition-Maternal-and-Child-Health.pdf">obstructed labour</a>, or to die during or after childbirth. Poor nutrition in pregnancy also results in babies growing poorly in the womb and being born underweight and susceptible to diseases. These mothers also invariably produce <a href="http://www.care.org/sites/default/files/documents/MH-2013-Maternal-Nutrition-Maternal-and-Child-Health.pdf">low quality breast milk</a>.</p>
<p>Maternal malnutrition has inter-generational consequences because it is cyclical. Poor nutrition in pregnancy is linked to undernourishment in-utero which results in low birth weight, pre-maturity, and low nutrient stores in infants. These babies end up stunted and, in turn, give birth to low birth weight babies. Optimal maternal nutrition is therefore vital to break this inter-generational cycle. </p>
<p>In Kenya, women’s nutritional needs during pregnancy has not received much attention. This has exposed a gap in efforts to improve maternal and child health. </p>
<p>Our <a href="http://kemri.org/dmdocuments/KEMRI%20Study%20Brief.pdf">study</a> at the Kenya Medical Research Institute looked at micronutrient deficiencies among pregnant women in Nairobi. The study found that close to 20% of women had anaemia and just over a third had iron deficiency. </p>
<p>Nearly a third of women had zinc deficiency. About 21% of the women had a combination of two to three deficiencies. The most common - in two thirds of the women - was the combination of iron and zinc deficiencies. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23661841">Studies</a> show that women with zinc deficiency are more likely to develop anaemia during pregnancy. Anaemia contributes to <a href="http://www.who.int/nutrition/topics/ida/en/">20% of all maternal deaths</a>, poor pregnancy outcomes and impaired physical and cognitive development in children.</p>
<h2>A continental problem</h2>
<p>Micronutrient deficiencies are common across sub-Saharan Africa.</p>
<p>About <a href="http://www.who.int/nutrition/topics/ida/en/">2 billion people</a> – or more than 30% of the world’s population – are anaemic due to iron deficiency. In developing countries, this translates into every second pregnant woman. About <a href="http://www.who.int/nutrition/topics/ida/en/">40% of preschool children</a> are anaemic. In resource-poor areas, anaemia is exacerbated by infectious diseases such as malaria, HIV/AIDS, hookworm infestation, schistosomiasis (snail fever) and other infections like tuberculosis.</p>
<p>The continent also has the highest prevalence of vitamin A deficiency globally with about <a href="https://data.unicef.org/topic/nutrition/vitamin-a-deficiency/">48% of children</a> between the ages of six months and five years affected. Vitamin A can be found in foods such as sweet potatoes, carrots and dark leafy green vegetables. But food insecurity and problems of bio-availability have resulted in vitamin A deficiency. This often leads to preventable childhood blindness. </p>
<p>Vitamin D deficiency is also <a href="http://www.samj.org.za/index.php/samj/article/view/10070/6859">extremely common</a> despite the fact that Africa has a great deal of sunlight. This results in bone pain and muscle weakness. Insufficient vitamin D affects <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/">almost half</a> of the world’s population. </p>
<p>From the study, more than half of the women had vitamin D deficiency while only 1% had vitamin A deficiency. </p>
<h2>Lacking the essential micronutrients</h2>
<p>Being undernourished in the womb increases the risk of death in the early months and years of a child’s life. While a baby’s weight at birth is a strong indicator of maternal and newborn health and nutrition, <a href="http://data.unicef.org/topic/nutrition/low-birthweight/">about 13% of infants</a> in sub-Saharan Africa are born with low birth weight. </p>
<p>Those who survive tend to have increased risk of disease. They are likely to remain undernourished, with reduced muscle strength and cognitive abilities throughout their lives. As adults, they suffer a <a href="http://data.unicef.org/topic/nutrition/low-birthweight/">higher incidence of diabetes and heart disease</a>.</p>
<p>It’s crucial that pregnant women get adequate micronutrients. If it is not addressed, there will be little progress made in promoting maternal and child health in Kenya. </p>
<h2>Changing the cycle</h2>
<p>Women in Nairobi have some access to resources and are likely to attend antenatal care. It is therefore possible that the micronutrient deficiency burden may be higher in rural areas where the health system infrastructure and capacity is limited. </p>
<p>What is clear is that there is an urgent need to address the issue of micronutrient deficiencies in pregnancy. We suggest the scaling-up of proven interventions that promote healthy pregnancies and improved pregnancy outcomes. This includes enhanced nutrition education and services in antenatal care. </p>
<p>These efforts should be complemented by other supporting interventions such as reduction of malaria infection; reduction of hookworm infection; birth spacing; decreased workload or rest during pregnancy. </p>
<p>Efforts geared at addressing maternal nutrition must be broad enough to encompass the pre-conception period, the pregnancy and after pregnancy – including the period of breastfeeding – to ensure safer and more optimal birth outcomes.</p><img src="https://counter.theconversation.com/content/66075/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Elizabeth Echoka receives funding from Kenya Medical Research Institute. </span></em></p><p class="fine-print"><em><span>Lydia Kaduka receives funding from Kenya Medical Research Institute. </span></em></p>In Kenya, not much attention has been paid to addressing pregnant women’s nutritional needs. This has exposed a gap in efforts to improve maternal and child health.Elizabeth Echoka, Senior Researcher, Kenya Medical Research InstituteLydia Kaduka, Senior Research Officer at Centre for Public Health Research , Kenya Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/639642016-08-23T19:18:22Z2016-08-23T19:18:22ZHow Vitamin A, iodine and iron play a part in beating malnutrition<figure><img src="https://images.theconversation.com/files/135194/original/image-20160823-30231-cuouzd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As incomes in developing countries rise people have moved towards eating food that is easy and fast to prepare – convenience foods. This processed food is often energy-dense and high in saturated and trans fats, sugars, salt and cholesterol. </p>
<p>This change in eating habits is known as a nutrition transition and it’s leading to increased health challenges, particularly in developed countries. As a result nutritionists and food system analysts across the globe are paying special attention to changes in the types and amounts of food that people consume, their exercise patterns and the affects of these lifestyles on their health.</p>
<p>What’s emerged is a focus on the “triple burden” of malnutrition – an energy deficiency from consuming too little food, the nutrient deficiencies from consuming food that doesn’t have essential micronutrients and an excessive net energy intake resulting in overweight and obese people.</p>
<p>While energy deficiency is a topic that gets most attention, and over-nutrition has also been <a href="https://theconversation.com/nutrition-may-be-as-big-a-challenge-today-as-hiv-aids-was-15-years-ago-64208">discussed</a> deficiencies in micronutrients are often less well understood. This is a problem because micronutrient deficiencies in vitamin A, iron, zinc, folate and iodine remain high, increasing a range of health risks. These include:</p>
<ul>
<li><p>dying during childbirth;</p></li>
<li><p>children having an increased risk of dying from common childhood illnesses such as diarrhoea; </p></li>
<li><p>childhood blindness; and,</p></li>
<li><p>the impairment of children’s physical and cognitive development.</p></li>
</ul>
<h2>Sub-Saharan Africa: worst in the world</h2>
<p>Sub-Saharan Africa has the highest prevalence of vitamin A deficiency in the world. About 48% of children between the ages of six months and five years suffer from this deficiency. Vitamin A deficiency is the leading cause of preventable childhood blindness. Vitamin A can be found in foods such as sweet potatoes, carrots and dark leafy green vegetables. </p>
<p>Iodine deficiency is easily preventable through the fortification of food, including salt. But in 2011 <a href="http://kan-kaz.org/english/files/J.Nutr_2012.pdf">321 million people in Africa</a> had an insufficient iodine intake, and seven of the top 10 iodine-deficient countries with the greatest numbers of school age children with insufficient iodine intake were from Africa.</p>
<p>In addition iron deficiency, which is the most common and widespread nutritional disorder in the world, affects a large number of children and women in developing countries. It is also significantly prevalent in the developed world. About 2 billion people – more than 30% of the world’s population – are anaemic. Many of these cases are due to iron deficiency. </p>
<p>In resource-poor areas, it is exacerbated by infectious diseases such as malaria, HIV/AIDS, hookworm infestation, <a href="http://www.who.int/mediacentre/factsheets/fs115/en/">schistosomiasis (snail fever)</a>, and other infections such as tuberculosis.</p>
<p>According to the World Health Organisation, in developing countries every second pregnant woman and about <a href="http://www.who.int/nutrition/topics/ida/en/">40% of preschool children</a> are estimated to be anaemic.</p>
<p>Anaemia contributes to 20% of all maternal deaths. Other major health consequences include poor pregnancy outcomes, impaired physical and cognitive development in children and increased risk of dying as well as reduced work productivity in adults. </p>
<h2>Its not all bad</h2>
<p>Some progress has been made in developed as well as developing countries.</p>
<p>Changes in technology, better diets and improved access to food has resulted in <a href="http://www.scidev.net/global/r-d/feature/can-technology-rescue-women-farm-workers-from-drudgery--1.html">many benefits</a>. This includes improved maternal and child health, the reduction of drudgery in the preparation of food, greater time for work or for leisure, and growth in both the food processing and distribution sectors. </p>
<p>In Africa the prevalence of under-nutrition, where people have a level of food intake that is insufficient to meet dietary energy requirements, has declined from 33% in 1990-1992 to 23% in <a href="http://www.fao.org/3/a-i4635e.pdf">2014-2016</a>. </p>
<p>Although food availability in sub-Saharan Africa has increased by nearly 12% over the past <a href="http://www.fao.org/3/a-i4635e.pdf">two decades</a> implying that more people have more food on their plates, the total number of undernourished people continues to increase. The figure sits at <a href="http://www.fao.org/3/a-i4635e.pdf">an estimated 220 million</a>. </p>
<p>In South Africa the situation is better than the rest of the continent. Only about 5% of the population is under-nourished. But this hasn’t improved since 1991, suggesting there is plateau that may need more than increases in food availability if under-nutrition is to be eliminated.</p>
<p>One way to gauge under-nutrition is to look at the rates of stunting. Children who are stunted are shorter than the expected height for their age by the time they are five. The prevalence of stunting has reduced only marginally in sub-Saharan Africa from 41% in 1990 to 35% in <a href="https://www.aho.afro.who.int/en/publication/1786/african-regional-health-report-2014-health-people-what-works">2012</a>. </p>
<p>There are countries on the continent that are doing well in terms of reducing under-nutrition. For example, Ethiopia reduced the prevalence of stunting from 57% in 2000 to 44% in <a href="https://www.aho.afro.who.int/en/publication/1786/african-regional-health-report-2014-health-people-what-works">2011</a>. Similarly in Ghana stunting has fallen from 35% in 2003 to 28% in 2011.</p>
<p>South Africa’s challenge is that although its stunting rate is lower, at 25%, the prevalence is nearly double what’s expected from a country with its economic wealth.</p>
<h2>Solving the problems</h2>
<p>Improving access to food is obviously key. But trends in childhood malnutrition suggest that more is needed than simply increasing the quantity of food consumed.</p>
<p>The challenge is that food has moved from being mostly produced on family farms and sold through fresh produce markets and small business to industrialised production, ultra-processing, mass distribution and globalised trade. This points to the need to fix flaws across the board, from how food is manufactured and distributed, to nutrition and health systems. </p>
<p>Addressing micronutrient deficiencies needs specific interventions. These include the fortification of food and promoting greater dietary diversity.</p><img src="https://counter.theconversation.com/content/63964/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian May receives funding from the National Research Foundation for the DST-NRF Centre of Excellence</span></em></p>Micronutrient deficiencies are not well understood as an aspect of malnutrition. The problem is that such deficiencies increase a range of health risks.Julian May, Director DST-NRF Centre of Excellence in Food Security, University of the Western CapeLicensed as Creative Commons – attribution, no derivatives.