Iron deficiency can be a problem, even for those who think they eat properly. This may occur from not eating foods which contain enough iron or not being able to absorb enough iron from food. To prevent iron deficiency, it helps to know a little about the nutrient, iron, and where it can be obtained.

What is Anemia?
Anemia occurs when your blood doesn't have enough hemoglobin. Hemoglobin is a protein in your red blood cells that carries oxygen from your lungs to the rest of your body. A common cause of anemia is not having enough iron. Your body needs iron to make hemoglobin.

Symptoms of anemia
While sometimes anemia can develop without symptoms, here are some telltale signs:
• Paleness
• Fatigue or lethargy
• Shortness of breath during execise
• Rapid heartbeat
• Cold hands and feet
• Brittle nails
• Headaches
• Sore or reddened tongue

What Can Cause Low Iron Levels?
A number of things can cause you to be low in iron:

Lack of Iron in the Diet
This is mostly a problem for children and young women. Children who drink a lot of milk and don't eat iron-rich foods or young women who follow "fad" or vegetarian diets may be at risk for iron deficiency.

Growth Spurts
Children under the age of 3 are growing so fast that their bodies may have a hard time keeping up with the amount of iron they need.

Pregnancy
Women who are pregnant or who are breast feeding need 2 ½ times as much iron as men. That's why pregnant women may be tested for anemia and should eat more iron-rich foods or take a daily iron pill.

Blood Loss
This is a common reason for iron deficiency anemia in adults. Blood loss can also be caused by internal bleeding, usually in the digestive tract. A stomach ulcer, ulcerative colitis, cancer, or taking aspirin or similar medicine for a long time can cause bleeding in your stomach or intestines. That's why it's important to find the reason for a low iron level.

How is Anemia Diagnosed?
Talk to your doctor if you think you might have anemia. A blood test will probably be done. Other tests may be needed to find out what's causing the problem.

If anemia results from losing too much blood, the cause of the blood loss will need to be treated. If your blood iron level is low, your health care provider may refer you to a dietitian to discuss a dietary increase in iron-rich foods. He or she may also recommend a multivitamin or prescribe an iron supplement. Although iron is found in a variety of different foods and supplements, its availability to the body varies significantly. In general, iron is not readily absorbed by the body. Availability is partially determined by whether the iron is found in the form of heme or non-heme iron.

Heme iron is found only in meat, fish and poultry and is absorbed much more easily than non-heme iron, which is found primarily in fruits, vegetables, dried beans, nuts and grain products.

The following factors will increase the iron absorption from non-heme foods:
• Taking vitamin C pills or eating foods high in vitamin C, such as oranges, grapefruits, tomatoes, broccoli and strawberries, at the same time you eat iron-rich foods or take your iron pill, can help your body absorb the iron two to four times more.
• A heme and non-heme food eaten together
• A non-heme food cooked in an iron pot, such as a cast iron skillet
The following factors will decrease non-heme iron absorption:
• Large amounts of tea or coffee consumed with a meal (the polyphenols bind the iron)
• Excess consumption of high fiber foods or bran supplements (the phytates in such foods inhibit absorption)
• High intake of calcium—take your calcium supplement at a different time from your iron supplement.

The Recommended Dietary Allowance (RDA) for iron for non-vegetarian, pre-menopausal women is 18 mg/day. The RDA for non-vegetarian men and post-menopausal women is 8-10 mg/day. Because of iron absorption issues in a healthful, high-fiber vegetarian diet, the RDAs for vegetarians are higher—14 mg/day for vegetarian men and 33 mg/day for vegetarian women. The upper level of intake should not exceed 45mg/day

Can Anemia be Prevented?
Some types can be prevented, such as those caused by diet. You can help prevent this type of anemia by making sure you eat foods that contain iron.

Foods High in Iron
• Liver and other meats
• Dried fruits like apricots, prunes and raisins
• Nuts
• Beans, especially lima beans
• Green leafy vegetables, such as spinach
• Whole grains

Can Iron Pills Cause Problems?
Iron pills can cause stomach upset, heartburn and constipation. Be sure to tell your doctor about any discomfort you notice.

These Tips May Help Reduce This Discomfort:
• Take the pills with food.
• Start slowly. Try taking one pill a day for three to five days, then two pills a day until you aren't bothered by that amount. Increase the number of pills until you're taking the amount your doctor recommended.
• Increase the fiber in your diet if you have constipation. This is worth trying, even though fiber may get in the way of how well your body can absorb iron. You'll still be able to absorb some iron, and it's better than not taking any iron at all.
• Don't take iron pills at bedtime if they upset your stomach.
• If one type of iron pill causes problems, talk to your doctor about trying a different formula or brand.

Be sure to talk to your doctor if you think you may have a problem. Iron deficiency is very treatable. Eat foods rich in iron and try to stay away from the foods/drinks that inhibit iron absorption.

Written by: Laura Shammah, nutrition counselor