By Sarah Colquitt

Feeling tired, finding yourself lacking energy and easily short of breath? It may not be just going to work, going for a ride, and looking after the kids, the dog and the husband. You could be the one in 12 women who suffer from Australia’s most common nutritional deficiency: iron. The relationship between iron and anaemia is simple but not straightforward. The body cannot manufacture iron but needs it to make haemoglobin: the substance that carries oxygen in the blood. If you fail to replenish your iron stores you will eventually be unable to make enough haemoglobin to deliver sufficient oxygen to your cells. In this anaemic state you’ll feel lethargic, be quick to fatigue and will easily become short of breath. But the anaemia suffered by between two and five per cent of Australian women is the result of iron depletion that may have taken months or years to develop, and some
studies now suggest iron deficiency – which affects nearly four times as many women as men – can affect your health and aerobic performance long before anaemia occurs. The total amount of iron in our bodies is usually between three and four grams but by recycling the iron in the blood we only need about one milligram a day from the food we eat. Considering the average western diet contains 12 to 15 milligrams of iron a day there shouldn’t be a problem. So why are one in 12 Australian women iron deficient? For a start, iron is difficult for the body to absorb. A food can be high in iron but its bio-availability may be low. Iron from meat (called haem iron) is the best absorbed, with between 15 and 18 per cent of the iron contained in meats available to the body. Iron contained in plants (non-haem iron) has a much lower bio-availability: usually less than five per cent. An Australian General Practice study found 25 per cent of adult female vegetarians – three times more than the population – were iron deficient. How much iron you absorb is also influenced by the other components of your diet. Combining iron-containing foods with foods high in vitamin C can increase the bio-availability of the iron by as much as 50% loss of iron from menstrual bleeding and you have, according to Professor Jack Metz,
Consultant Haematologist at Dorevitch Pathology in Melbourne, the major cause of aneamia in Australia. “Nearly all of the anaemias we see in young adults in Australia are the result of iron deficiency caused by a combination of increased requirement for iron that is not met by the diet,” says Prof Metz. “In older persons anaemia is much more likely to be the result of another disease than due to a nutritional cause, but in young females it is almost always iron deficiency that is the cause. “For all women menstruation generates a significant loss, but adolescent females are at a higher risk because the onset of menstruation is coupled with rapid growth that increases the body’s demand for iron,” warns Prof Metz. In adults at least, iron deficiency was once thought to only be a problem when supplies became so low that anaemia developed. It’s now accepted that the decline in iron stores normally passes through several stages and health problems might develop long before anaemia can be diagnosed. Stage one is where the body’s stores are reduced, but not exhausted. There are no clinical effects on the person or abnormalities that can be detected in blood tests. Stage two occurs when iron stores are depleted but anaemia has not yet developed. Because lab tests usually record low levels of iron in the blood but normal haemoglobin concentrations, this stage is called “biochemical deficiency without anaemia”, and until recently the clinical consequences of biochemical iron deficiency were not considered to be significant. It’s still not entirely clear, but recent research suggests that apart from the
haematological (blood) changes, this condition may actually adversely affect your ability to do strenuous aerobic work. Stage three occurs when the iron deficiency causes anaemia. With no iron available, haemoglobin production falls and haemoglobin concentrations start to decline and you may start to notice tiredness, lethargy and dizziness. To investigate these very general symptoms your doctor may request a blood test. “The first test will be a full blood count: a measure of how many red bloods cells you have, and if they are normally formed,” explains Prof Metz. A normal blood count result may exclude other forms of anaemia but it does not rule out low iron levels. Because haemoglobin levels only fall in the later stages, the pathologist will search for earlier signs of iron deficiency by measuring other compounds in the blood. Serum ferritin is the most useful measure
of iron status because it accurately reflects the body’s iron stores and is usually the first measure to change as iron levels fall. But serum ferritin levels can be affected by infection, inflammation or strenuous exercise so the pathologist may need to search for another iron marker. If the result shows you’re low in iron your doctor will help you to review your diet, adding iron rich foods, seek to limit blood loss and, if your stores are still low, you may be prescribed iron supplements. Regular reviews of your iron levels will check on how well your body responds to the treatment. Far easier than all of this, of course, is to add a little more iron to your diet – it really could be that simple.

RECOMMENDED DAILY IRON INTAKE
HAEM IRON SOURCES
Food                   Serve                    mg Iron
Liver                 100g cooked             11.0
Beef                 100g cooked             4.0
Chicken            100g cooked             1.2
Fish                  100g cooked          0.6-1.4

NON-HAEM IRON SOURCES
Food                                       Serve                mg Iron
Eggs                                    100 g (2)                 2.0
Breakfast cereal (fortified) 30 g (1 cup)            2.5
Wholemeal bread               60g (2 slices)           1.4
Spinach                              145g cooked            4.4
Lentils/kidney beans          100g cooked            2.5
Tofu                                         100g                   1.9
Dried apricots                          50g                     2.0
The absorption of non-haem iron can be improved by combining
sources of haem iron with non-haem iron and by including vitamin
C-rich foods with meals. 

ARE YOU IRON DEFICIENT?
You are at risk of developing iron deficiency if you fit two or
more categories:
¦ Suffer blood loss from heavy periods or small
but persistent bleeding from ulcers, gums, bowels
¦ Have a diet that delivers less than 70 of the RDI of iron
¦ Are pregnant
¦ Donate blood
¦ Breast feed
¦ Frequently take aspirin or ibuprofen.
¦ Follow a vegetarian diet
IRON IS USED BY THE BODY TO:
1. Transport of oxygen (haemoglobin).
2. In the production of energy.
3. For normal function of the immune and central
nervous systems.

It’s Not Just Iron
Although other forms of nutritional anaemia are rare, it’s important women are aware of how they can be avoided. “Women should take folic acid during pregnancy and lactation because those are the biggest drain on folate stores,” warns Professor Jack Metz, Consultant Haematologist at Dorevitch Pathology in Melbourne. Folic acid is essential for brain and spinal cord development and is found in many foods, especially in green, leafy vegetables. Folic acid is also added to most grain products in Australia so developing a deficiency without an increased demand is rare. A lack of vitamin B12, a substance found exclusively in animal proteins, can also cause anaemia. “It’s very uncommon in Australia but people who rigidly exclude animal products (vegans) can be susceptible to anaemia caused by vitamin B12 deficiency,” cautions Prof Metz, who suggests strict vegans take a B12 supplement or consume foods fortified with B12. In fact the most common cause of B12 related anaemia is actually a disease called pernicious anaemia, in which the body stops making a substance that is needed to absorb vitamin B12 from the diet.

EAT THE PAN!
Preparing food with iron cookware can greatly increase the iron in you diet: particles from the container get mixed with the food during cooking or storage.
IRONCLAD FOODS
The major contributors of iron in the average Australia diet are meat, fish, poultry and ironenrichedbreakfast cereals and breads. Dried fruit, legumes (lentils, dried peas) and green leafy vegetables such as broccoli, silver beet, spinach and Chinese green vegetables are other good sources of iron.