Iron

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Iron is a nutrient (macro-mineral). Iron is a mineral that the human body uses to produce the red blood cells (hemoglobin) that carry oxygen throughout the body. It is also stored in myoglobin, an oxygen-carrying protein in the muscles that fuels cell growth.

Absorption of iron is aided by vitamin C taken at the same time as iron-containing foods, and reduced by calcium, phosphate and phytic acid. Iron content of foods per 100?g: liver 6-14 mg, cereals up to 9 mg, nuts 1-5 mg, eggs 2-3 mg, meat 2-4 mg. Iron is added to flour so that it contains not less than 1.65 mg per 100 g. Fortified cereals provide 35% of the iron of British diets. Prolonged deficiency gives rise to anaemia.

Iron Deficiency

Iron deficiency anemia occurs when your body doesn't have enough iron.

Iron is important because it helps you get enough oxygen throughout your body. Your body uses iron to make hemoglobin. Hemoglobin is a part of your red blood cells. Hemoglobin carries oxygen through your body. If you do not have enough iron, your body makes fewer and smaller red blood cells Click here to see an illustration.. Then your body has less hemoglobin, and you cannot get enough oxygen.

What causes iron deficiency anemia?

Iron deficiency anemia is caused by low levels of iron in the body. You might have low iron levels because you:

* Have heavy menstrual bleeding.
* Are not getting enough iron in food. This can happen in people who need a lot of iron, such as small children, teens, and pregnant women.
* Have bleeding inside your body. This bleeding may be caused by problems such as ulcers, hemorrhoids, or cancer. This bleeding can also happen with regular ASA use. Bleeding inside the body is the most common cause of iron deficiency anemia in men and in women after menopause.
* Cannot absorb iron well in your body. This problem may occur if you have celiac disease or if you have had part of your stomach or small intestine removed.

What are the symptoms?

You may not notice the symptoms of anemia, because it develops slowly and the symptoms may be mild. In fact, you may not notice them until your anemia gets worse. As anemia gets worse, you may:

* Feel weak and tire out more easily.
* Feel dizzy.
* Be grumpy or cranky.
* Have headaches.
* Look very pale.
* Feel short of breath.
* Have trouble concentrating.

Babies and small children who have anemia may:

* Be fussy.
* Have a short attention span.
* Grow more slowly than normal.
* Develop skills, such as walking and talking, later than normal.

Anemia in children must be treated so that mental and behaviour problems do not last long.

How is iron deficiency anemia diagnosed?

If you think you have anemia, see your doctor. Your doctor will do a physical examination and ask you questions about your medical history and your symptoms. Your doctor will take some of your blood to run tests. These tests may include a complete blood count to look at your red blood cells and an iron test that shows how much iron is in your blood.

Your doctor may also do tests to find out what is causing your anemia.

How is it treated?

Your doctor will probably have you take iron supplement pills to treat your anemia. Most people begin to feel better after a few days of taking iron pills. But do not stop taking the pills even if you feel better. You will need to keep taking the pills for several months to build up the iron in your body.

If your doctor finds an exact cause of your anemia, such as a bleeding ulcer, your doctor will also treat that problem.

If you think you have anemia, do not try to treat yourself. Do not take iron pills on your own without seeing your doctor first. If you take iron pills without talking with your doctor first, the pills may cause you to have too much iron in your blood, or even iron poisoning. Your low iron level may be caused by a serious problem, such as a bleeding ulcer or colon cancer. These other problems need different treatment than iron pills.

You can get the most benefit from iron pills if you take them with vitamin C or drink orange juice. Do not take your iron pills with milk, caffeine, foods with high fibre, or antacids.

Can you prevent iron deficiency anemia?

You can prevent anemia by eating the right amount of iron every day. Iron-rich foods include meats, eggs, and whole-grain or iron-fortified foods. You can also get iron from many other foods, including peas, beans, oatmeal, prunes, and figs.

You can prevent anemia in babies and children by feeding them enough iron. To make sure they get enough iron:1

* Breast-feed your baby or use an iron-fortified formula for 4 to 6 months after your baby is born.
* After 4 to 6 months of age, give your baby 2 to 3 servings of iron-rich foods a day. Iron-fortified cereals are a good source of iron.
* Do not give cow's or goat's milk to a child younger than 12 months of age. These milks are low in iron.

If you are pregnant, you can prevent anemia by taking prenatal vitamins. Your doctor will give you prenatal vitamins that include iron. Your doctor will also test your blood to see if you are anemic. If you are anemic, you will take a higher-dose iron pill.

General Use

Iron is abundant in red meats, vegetables, and other foods, and a well-balanced diet can usually provide an adequate supply of the mineral. But when there is insufficient iron from dietary sources, or as a result of blood loss in the body, the amount of hemoglobin in the bloodstream is reduced and oxygen cannot be efficiently transported to tissues and organs throughout the body. The resulting condition is known as iron-deficiency anemia, and is characterized by fatigue, shortness of breath, pale skin, concentration problems, dizziness, a weakened immune system, and energy loss.

Iron-deficiency anemia can be caused by a number of factors, including poor diet, heavy menstrual cycles, pregnancy, kidney disease, burns, and gastrointestinal disorders. Individuals with iron-deficiency anemia should always undergo a thorough evaluation by a physician to determine the cause.

Children two years old and under also need adequate iron in their diets to promote proper mental and physical development. Children under two who are not breastfed should eat iron-fortified formulas and cereals. Women who breastfeed need at least 15 mg of dietary or supplementary iron a day in order to pass along adequate amounts of the mineral to their child in breast milk. Parents should consult a pediatrician or other healthcare professional for guidance on iron supplementation in children.

It has been theorized that excess stored iron can lead to atherosclerosis and ischemic heart disease. Phlebotomy, or blood removal, has been used to reduce stored iron in patients with iron overload with some success. Iron chelation with drugs such as desferrioxamine (Desferal) that help patients excrete excess stores of iron can be helpful in treating iron overload caused by multiple blood transfusions.

Iron levels in the body are measured by both hemoglobin and serum ferritin blood tests.

Normal total hemoglobin levels are:

* neonates: 17-22 g/dl
* one week: 15-20 g/dl
* one month: 11-15 g/dl
* children: 11-13 g/dl
* adult males: 14-18 g/dl (12.4-14.9 g/dl after age 50)
* adult females: 12-16 g/dl (11.7-13.8 g/dl after menopause)

Normal serum ferritin levels are:

* neonates: 25-200 ng/ml
* one month: 200-600 ng/ml
* two to five months: 50-200 ng/ml
* six months to 15 years: 7-140 ng/ml
* adult males: 20-300 ng/ml
* adult females: 20-120 ng/ml

Preparations

Iron can be found in a number of dietary sources, including:

* pumpkin seeds
* dried fruits (apricots)
* lean meats (beef and liver)
* fortified cereals
* turkey (dark meat)
* green vegetables (spinach, kale, and broccoli)
* beans, peas, and lentils
* enriched and whole grain breads
* molasses
* sea vegetables (blue-green algae and kelp)

Eating iron-rich foods in conjunction with foods rich in vitamin C (such as citrus fruits) and lactic acid (sauerkraut and yogurt) can increase absorption of dietary iron. Cooking food in cast-iron pots can also add to their iron content.

The recommended dietary allowances (RDA) of iron as outlined by the United States Department of Agriculture (USDA) are as follows:

* Children 0–3: 6-10 mg/day
* children 4–10: 10 mg/day
* adolescent–adult males: 10 mg/day
* adolescent–adult females: 10-15 mg/day
* pregnant females: 30 mg/day
* breastfeeding females: 15 mg/day

A number of herbal remedies contain iron, and can be useful as a natural supplement. The juice of the herb stinging nettle (Urtica dioica) is rich in both iron and vitamin C (which is thought to promote the absorption of iron). It can be taken daily as a dietary supplement. Dandelion (Taraxacum officinale), curled dock (Rumex crispus), and parsley (Petroselinum crispum) also have high iron content, and can be prepared in tea or syrup form.

In Chinese medicine, dang gui (dong quai), or Angelica sinensis, the root of the angelica plant, is said to both stimulate the circulatory system and aid the digestive system. It can be administered as a decoction or tincture, and should be taken in conjunction with an iron-rich diet. Other Chinese remedies include foxglove root (Rehmannia glutinosa), Korean ginseng (Panax ginseng), and astragalus (Astragalus membranaceus).

Ferrum phosphoricum (iron phosphate), is used in homeopathic medicine to treat anemia. The remedy is produced by mixing iron sulfate, phosphate, and sodium acetate, which is administered in a highly diluted form to the patient. Other homeopathic remedies for anemia include Natrum muriaticum, Chinchona officinalis, Cyclamen europaeum, Ferrum metallicum, and Manganum aceticum. As with all homeopathic remedies, the type of remedy prescribed for iron deficiency depends on the individual's overall symptom picture, mood, and temperament. Patients should speak with their homeopathic professional or physician, or healthcare professional before taking any of these remedies.

Iron is also available in a number of over-the-counter supplements (i.e., ferrous fumerate, ferrous sulfate, ferrous gluconate, iron dextran). Both heme iron and nonheme iron supplements are available. Heme iron is more efficiently absorbed by the body, but non-heme iron can also be effective if used in conjunction with vitamin C and other dietary sources of heme iron. Some multivitamins also contain supplementary iron. Ingesting excessive iron can be toxic, and may have long-term negative effects. For this reason, iron supplements should be taken only under the recommendation and supervision of a doctor.

Precautions

Iron deficiency can be a sign of a more serious problem, such as internal bleeding. Anyone suffering from iron-deficiency anemia should always undergo a thorough evaluation by a healthcare professional to determine the cause.

Iron overdose in children can be fatal, and is a leading cause of poisoning in children. Children should never take supplements intended for adults, and should receive iron supplementation only under the guidance of a physician.

Individuals with chronic or acute health conditions, including kidney infection, alcoholism, liver disease, rheumatoid arthritis, asthma, heart disease, colitis, and stomach ulcer should consult a physician before taking herbal or pharmaceutical iron supplements.

If individuals taking homeopathic dilutions of ferrum phosphoricum experience worsening of their symptoms (known as a homeopathic aggravation), they should stop taking the remedy and contact their healthcare professional. A homeopathic aggravation can be an early indication that a remedy is working properly, but it can also be a sign that a different remedy is needed.

Patients diagnosed with hemochromatosis, a genetic condition in which the body absorbs too much iron and stores the excess in organs and tissues, should never take iron supplements.

Side Effects

Taking herbal or pharmaceutical iron supplements on an empty stomach may cause nausea. Iron supplementation may cause hard, dark stools, and individuals who take iron frequently experience constipation. Patients who experience dark bowel movements accompanied by stomach pains should check with their doctor, as this can also indicate bleeding in the digestive tract.

Other reported side effects include stomach cramps and chest pain. These symptoms should be evaluated by a physician if they occur.

Some iron supplements, particularly those taken in liquid form, may stain the teeth. Taking these through a straw, or with a dropper placed towards the back of the throat, may be helpful in preventing staining. Toothpaste containing baking soda and/or hydrogen peroxide can be useful in removing iron stains from teeth.

Signs of iron overdose include severe vomiting, racing heart, bloody diarrhea, stomach cramps, bluish lips and fingernails, pale skin, and weakness. If overdose is suspected, the patient should contact poison control and/or seek emergency medical attention immediately.

Interactions

Iron supplements may react with certain medications, including antacids, acetohydroxamic acid (Lithostat), dimercaprol, etidronate, fluoroquinolones. In addition, they can decrease the effectiveness of certain tetracyclines (antibiotics). Individuals taking these or any other medications should consult their healthcare professional before starting iron supplements.

Certain foods decrease the absorption of iron, including some soy-based foods, foods with large concentrations of calcium, and beverages containing caffeine and tannin (a substance found in black tea). These should not be taken within two hours of using an iron supplement. Some herbs also contain tannic acid, and should be avoided during treatment with iron supplements. These include allspice (Pimenta dioica) and bayberry (Myrica cerifera, also called wax myrtle).

Individuals considering treatment with homeopathic remedies should also consult their healthcare professional about possible interactions with certain foods, beverages, prescription medications, aromatic compounds, and other environmental elements—factors known in homeopathy as remedy antidotes—that could counteract the efficacy of treatment for iron deficiency.

Resources

Books

Medical Economics Company. PDR 2000 Physicians' Desk Reference. Montvale, NJ: Medical Economics Company, 1998.

Medical Economics Company. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Company, 1998.

Ody, Penelope. The Complete Medicinal Herbal. New York: DK Publishing, 1993.

Periodicals

de Valk, B., and J.J.M. Marx. "Iron, Atherosclerosis, and Is-chemic Heart Disease." Archives of Internal Medicine 159(i14): 1542.

[Article by: Paula Ford-Martin]

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