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Increasing societal demands involving work and family can often lead to overexertion, excessive fatigue, and inadequate energy levels. But when exhaustion is also associated with ice cravings (e.g. pica), headaches, or dizziness, it might indicate a more serious medical condition. These all represent common signs of anaemia, a condition in which depleted iron stores lead to reduced production and circulation of red blood cells.

For further information on this topic, you may be interested to learn more about the HealthCert Professional Diploma program in Medical Nutrition Management.

Anaemia is estimated to affect one-third of all women of reproductive age [1]. Although there are many underlying causes of anaemia, including blood loss (e.g. through menorrhagia or gastrointestinal bleeding) and increased iron utilisation (as in infancy, adolescence, and pregnancy)[2], nutritional deficiency are generally the most common risk factors and may account for up to 50 per cent of all anaemia cases, depending on country-specific context [3].

Iron deficiency anaemia is the most common form of the condition, and the physician’s approach to diagnosis and management is vital to improve quality of care and to correct associated nutritional deficits. In general, the main aim of nutritional therapy is to replenish iron stores.

Dietary management

Dietary iron is available in two forms: the more bioavailable heme iron, found in animal products, and non-heme iron, found in plant products [4]. Patients should aim for a healthy balance of heme and non-heme iron-rich foods, such as meat and poultry, seafood, leafy greens, and legumes.

Although it is widely believed that meat is a preferred iron source, a balanced vegetarian diet that includes legumes, fortified or whole grains, dried fruit, nuts, seeds, and green vegetables easily provides adequate iron [5]. Studies have shown that the incidence of iron deficiency anaemia is no greater among individuals in Western nations consuming a healthy vegetarian diet than among omnivores [6].

It is also crucial to include foods that can improve the body’s absorption of iron and avoid foods that may interfere with this process. Fruits and vegetables contain vitamin C which increases absorption of non- heme iron, as well as vitamin A and carotenoids, which enhance overcomes the inhibiting effect of polyphenols and phytates (found in whole grains) on iron absorption [7]. Tannins (found in tea and coffee) also reduce iron availability before absorption and should be avoided at mealtimes [8].

Supplementation

In individuals with diagnosed iron deficiency, the iron content of foods is unlikely to be sufficient to replete iron stores. Oral iron supplements offer a more robust avenue for iron repletion. The most prescribed form is 325mg of ferrous sulfate, taken up to three times daily, with the option of lower and less frequent dosing in the elderly. Primary care physicians should tailor dosage to the magnitude of deficiency balanced with occurrence of side effects such as gastrointestinal upset and constipation.

Learn more about nutrition for anaemia and iron deficiency with the online HealthCert Professional Diploma program in Medical Nutrition Management.

– Lynette Law, Accredited Practising Dietitian

Read another article like this one: Medical nutrition therapy for bone health

References

1. Safiri, S., et al., Burden of anemia and its underlying causes in 204 countries and territories, 1990–2019: results from the Global Burden of Disease Study 2019. Journal of Hematology & Oncology, 2021. 14(1): p. 185.
2. Johnson-Wimbley, T.D. and D.Y. Graham, Diagnosis and management of iron deficiency anemia in the 21st century. Therap Adv Gastroenterol, 2011. 4(3): p. 177-84.
3. Stevens, G.A., et al., Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Glob Health, 2013. 1(1): p. e16-25.
4. Young, I., et al., Association between Haem and Non-Haem Iron Intake and Serum Ferritin in Healthy Young Women. Nutrients, 2018. 10(1).
5. Rizzo, N.S., et al., Nutrient profiles of vegetarian and nonvegetarian dietary patterns. Journal of the Academy of Nutrition and Dietetics, 2013. 113(12): p. 1610-9.
6. Melina, V., W. Craig, and S. Levin, Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. Journal of the Academy of Nutrition and Dietetics, 2016. 116(12): p. 1970-1980.
7. Collings, R., et al., The absorption of iron from whole diets: a systematic review. The American Journal of Clinical Nutrition, 2013. 98(1): p. 65-81.
8. Delimont, N.M., M.D. Haub, and B.L. Lindshield, The Impact of Tannin Consumption on Iron Bioavailability and Status: A Narrative Review. Curr Dev Nutr, 2017. 1(2): p. 1-12.