Lots of women-not just vegetarians and pregnant women-find it hard to get enough iron.
“During pregnancy, your body needs more iron, but it’s hard to meet your increased needs through diet alone,” notes Dr. Nan Schuurmans, an Edmonton obstetrician and co-author of the book Healthy Beginnings. Your healthcare provider may prescribe an iron supplement that you will need to take along with your prenatal vitamins.
As for vegetarians, because they do not eat meat (which is rich in iron), Dietitians of Canada recommends that they eat greater amounts of iron-containing fruit, vegetables, grains, nuts and beans in order to get adequate amounts of the nutrient. “However, vegetarians who make proper food choices don’t have a higher incidence of iron deficiency compared to non-vegetarians,” says Vesanto Melina, a registered dietitian in Langley, B.C., who specializes in vegetarian and vegan nutrition, and is co-author of a joint position paper on vegetarian diets from the Dietitians of Canada and the American Dietetic Association.
But you’re not home-free if you’re not in either of the above groups. Here are some other common causes of iron deficiency:
Poor iron absorption: This could be due to not eating enough iron-rich foods, or eating foods that can hinder the way your body absorbs this essential mineral. “Because iron is absorbed in the gut, faulty absorption could also be due to a digestive issue such as untreated celiac disease or colitis,” says Ehman. A 2010 study published in the International Journal for Vitamin and Nutrition Research suggested that people who are obese may not be able to absorb iron well. And absorption can be blocked for those taking large amounts of antacids such as ranitidine, or a proton-pump inhibitor (PPI) medication such as omeprazole or esomeprazole.
Too-vigorous workouts: If you are training extra-hard-for a half-marathon, for example- “you can lose small amounts of iron through sweat and urine,” explains Alex Paton, a Winnipeg registered dietitian who specializes in sport nutrition. Running can also cause minor GI bleeds (that the runner may not even notice) simply because the body is being jostled and shaken, she adds.
Another factor is foot strike-literally, red blood cells bursting in the feet when they hit the ground. (You might experience foot pain or extreme fatigue if this is the case.) “Running shoes with firm insoles decrease the amount of blood loss through foot strike,” notes Kamal Janakiraman, a researcher and physiotherapist who co-authored a 2011 study in Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology.
Giving blood: Canada Blood Services screens donors for low iron levels and turns down anyone whose levels are below a certain amount. Blood donation causes a temporary drop in hemoglobin, but your body makes new red blood cells to replace those lost. It’s a good idea to eat iron-rich foods for a few days after donation, and space out your donations if your levels are in the low-normal range.
Looking pale and feeling faint are not the only signs of iron deficiency.
The symptoms of iron deficiency can be vague, says Ehman. “Women come into my office talking about feeling fatigued and not being able to exercise the way they used to.” He adds that restless leg syndrome can also be a sign. Other possible symptoms are a red, inflamed tongue; dizziness; headache; difficulty maintaining body temperature; shortness of breath; brittle nails; irritability; and rapid or irregular heartbeat. In mild cases, you might not notice any symptoms at all. Your doctor can order blood tests to check your iron levels.
You can usually get enough iron from your diet.
The good news is, you don’t have to eat bales of spinach or a Fred Flintstone-size steak. But it’s important to understand there are two kinds of iron, explains Vinnci Tsui, a registered dietitian in Calgary, who often advises clients about iron intake. “Heme iron, which comes from meat or seafood, is absorbed more readily by the body,” she says. Non-heme iron, which comes from plants and vegetables, can also be a source of iron, but the body doesn’t absorb it as well. You have to combine it with foods that are rich in vitamin C, which helps the body absorb the non-heme iron more efficiently.
“Enjoy a mixed bean salad made with lemon vinaigrette and topped with chopped tomatoes, so you get iron from the beans and vitamin C from the lemon and tomatoes,” Tsui suggests. “Trail mix made with pumpkin seeds, raisins and dried apricots for iron, along with dried cranberries for vitamin C, is also great.”
Melina, co-author of Cooking Vegetarian, recommends a stir-fry made with tofu, red peppers and pineapple juice. Most grain products like pasta, bread and cereal are fortified with added non-heme iron, so your daily levels could add up without too much difficulty. For example, a package of enriched instant oatmeal contains up to 6.7 mg of iron, while a bagel can have 3.2 mg.