The mineral that is the bane of my existence

Ladies, I am sure you will know exactly what mineral I am talking about. Men, maybe some of you can relate too. But I feel pretty confident my fellow females will roll their eyes and groan in agreement when they find out the mineral I am talking about.

Depending on your life stage you may think "Calcium!" but actually, today I'm talking about Iron.

I suffer from low iron. I have dark circles under my eyes, pale skin, my energy levels really suffer. I will never forget when I returned to work after a two week holiday over the Christmas period, and a physician I work with asked me "Are you sick? You don't look well." Oh boy, that was disappointing to hear. I literally could not have been any more rested after my vacation! Curse you low iron! How can a mineral be so essential to our health yet so difficult to absorb. To make it even more daunting, your iron needs will significantly increase if you conceive (x1.5 percent more iron per day). To ensure mom and baby have the best chance of meeting their requirements, prenatal vitamins are a routine part of care. Some women who are susceptible to low iron levels or anemia will need to take an additional iron supplement on top of their prenatal vitamins. Sometimes I sit and wonder how our ancestors looked while they were pregnant, before these vitamins were available. Prenatals became a part of routine care around the 70s, what about the women before them? Were they truly glowy and radiant? Did people have better iron absorption back then and not need pills? My guess is that the latter is unlikely. The prenatal vitamin had to satisfy some gap in the market. I can only assume it is because the prevalence of low iron or anemic women was high.

Iron may not seem like a big deal to write a whole article over, but if you have been chasing that carrot for years you know exactly how I feel. It is so frustrating. Low iron severely decreases quality of life! It is also quite a visible deficiency, and can often attract unwanted attention. I die a little inside when people make smart comments like "Oh aren't you a dietitian? Shouldn't you know how to eat enough iron?" I'm doing my best okay!

Others who are at risk of iron deficiencies include pregnant women/breast-feeding women/small children due to increased iron needs. People with gut related illnesses typically have a more difficult time absorbing iron. Anyone who follows a vegan and vegetarian diet are considered higher risk for low iron levels due to dietary restrictions. As well as people who experience monthly or regular blood loss. This is not limited to menstruating females, but can also include people who go regularly for blood donations.

So what to do?

• Know how much iron you need based on your gender and age. A link for this information can be found here
• Know the difference between the types of iron found in the diet (see below for more information).
• Non-heme iron is found in plant sources (spinach), and needs some help getting absorbed. Vitamin C helps your body absorb the non-heme iron. So pairing a fresh spinach salad with vitamin C rich fruits (strawberries, orange slices, or even red bell pepper) can help your body's absorption abilities.
• Heme-iron is found in animal products (red meat), and is the most readily absorbed by our bodies. A link for a list of heme and non-heme iron food sources can be found here.
• Know which factors inhibit non-heme iron absorption; calcium and tannins! Tannins are natural compounds found in black teas and wine. They decrease the absorption of non-heme iron by chelating the mineral (essentially morphing the shape of the mineral, which is no longer able to bing to it's absorption site). Leave ample time between your meals and having tannin rich foods, especially if your iron rich foods were primarily vegetarian.
• Always complete bloodwork before starting a supplement. Talk to your doctor about options if your iron levels are low. Iron supplementation needs to be recommended by a professional to limit the risk of iron toxicity.
• The reality is sometimes iron levels are so low, a supplement as well as dietary changes are recommended to rectify an iron deficiency. If you are worried about the side effects of an iron supplement (usually constipation), fear not! There are many gut-friendly options on the market. Talk to your pharmacist, they are the experts on current retail options.
• If none of the above listed criteria apply to you, but you still have low iron, talk to your family MD about completing tests to rule out any possibilities of internal bleeding.

Iron, oh iron. I empathize with all the patients who have low iron. An interesting note to end on is that in Canada we actually have an initiative to fortify our grain products with iron, to decrease prevalence of iron deficiencies. One serving of shreddies cereal has 50% of your daily iron needs. Now that people are eating less carbs, I wonder if that will impact iron levels? To be fair, protein intake has gone up. Maybe the extra heme-sources will balance the lack of iron-fortified grains in the diet? What happens to the vegans or vegetarians who also follow low carb, will they need to supplement indefinitely? What if new parents consider starting their baby on a low carb diet, and omit the iron fortified cereals? This is of course NOT recommended, and yet I do receive questions from patients on this topic. "Can my baby follow a low carb diet?" No, baby can not follow a low carb diet. Please use the iron fortified products available to you. Iron is important from the womb to the rest of the lifespan.

Julia Zakrzewski, Registered Dietitian

March 2, 2021