Cornell Iron Deficiency Health and Anemia

Live Well to Feeling tired? Learn Well Fatigue is not a symptom of a specific illness, Web: but has many different causes. If you’re tired, health.cornell.edu first consider whether your sleeping and eating patterns are adequate. If fatigue persists, a Phone (24/7): medical checkup can help determine whether you 607-255-5155 have a medical problem, such as anemia. Fax: Anemia is a low level of red blood cells or 607-255-0269 hemoglobin in the blood. Nutritional causes of anemia include insufficient iron, protein, or Appointments: vitamins B12 and folate. Anemia can also be Monday–Saturday caused by illness or by genetic factors, including Check web for hours, sickle-cell and thalassemia. services, providers, Iron deficiency is the most common cause of and appointment anemia. It is also the most common nutritional information deficiency in the US and worldwide, affecting Iron deficiency is the most common cause of anemia. mainly young children and women of childbearing 110 Ho Plaza, age. Fortunately, it can usually be easily diagnosed Ithaca, NY iron, iron stores will become depleted over time. and treated. Poor eating habits can create an iron deficit, 14853-3101 Iron is a mineral contained in all body cells where but even a reasonable food intake sometimes it is vital for many biochemical reactions. It is a does not supply enough. If you are in one of the key component in hemoglobin and myoglobin, following situations, you need to try even harder which transport oxygen in the blood and muscles, to get enough iron. and in cellular enzymes needed for energy • Dieting: The less you eat, the less likely that metabolism. Iron is stored in the liver, spleen, you will take in enough iron. Note that the bone marrow and other tissues, but low iron amount of iron from a 2000-calorie diet intake or blood loss can deplete these stores and averages only about 12 milligrams, which is result in anemia. below the RDA for women. • Endurance sports: Endurance athletes such as What are the symptoms? long-distance runners tend to have increased Fatigue or weakness sometimes occurs in the iron losses. early stages of iron deficiency, even before • Vegetarianism: Iron content is lower in most anemia develops. Anemia develops gradually, plant foods than in meat, and the iron is less as bone marrow stores of iron become too low well absorbed. to produce healthy red blood cells. Symptoms • Menstruation: Monthly blood losses result in can include dizziness, shortness of breath, pale increased iron needs (reflected in the RDA’s, appearance, and lower resistance to infection, below). If periods are especially heavy, anemia but some people do not have any symptoms. is more likely to occur. Iron deficiency anemia is sometimes associated • Pregnancy: Iron needs are higher in pregnancy with psychological depression, impaired cognitive to meet the needs of the growing fetus and function, and increased food cravings. placenta. Diagnosis of anemia is not difficult and is indicated • Other blood loss: Blood donation, surgery, and by low hemoglobin or hematocrit (percentage of illnesses with blood loss create an increased red cells in whole blood). A complete blood count need for iron. (CBC) provides additional information, and iron status is further determined by checking serum How much do we need? levels of iron transport and storage proteins, The Recommended Dietary Allowances (RDA’s) including ferritin. for different age groups take into account that not all the iron we eat gets absorbed. Iron absorption Who needs to worry? from foods varies with individuals, with type of Iron is normally recycled in the body, but a small iron in the food, and with other components in amount is lost every day— more with any blood foods. With iron deficiency, a higher intake than loss. If these losses are not replaced by dietary the RDA is needed to replenish iron stores.

Where is it found? deficiency. Most multivitamin/mineral supplements contain small amounts of Iron in food is found primarily in meat, iron, which is not usually a problem. poultry, fish, and beans. Heme iron (from These supplements can help prevent animal sources) is better absorbed than iron deficiency, but are not sufficient to non-heme iron. Other good sources replenish iron stores once depleted. are nuts, enriched or fortified ains,gr and certain fruits and vegetables. Dairy If you think you have iron deficiency, products are low in iron. a medical provider will help discover its cause, prescribe supplements to The Percent Daily Value (DV) on food correct it, and monitor your recovery. labels corresponds to 18 milligrams (mg). Iron in prescribed supplements comes in For example, if a label lists a food as various forms and doses, some of which containing 25% DV for iron, one serving may be better tolerated than others. would contain 4.5 mg. Side-effects are not dangerous but can Iron from cast-iron cooking pots and include gastrointestinal discomfort and some water supplies can also find its way constipation. If a prescribed supplement into the body, but the amount cannot causes problems, consult with your easily be measured. When acidic foods medical provider. Toleration usually (such as tomatoes) are cooked in iron improves over time or with a lower dose. pots, additional iron enters the food. Iron absorption What is too much iron? The most common cause of iron overload Popeye, the cartoon sailor, became is a genetic defect known as hereditary stronger from eating spinach, but iron hemochromatosis, which occurs in about is not easily absorbed from spinach and 4 out of 1000 people. It causes excess other greens. iron absorption and storage in the body, • What decreases iron absorption? but can be diagnosed by genetic est ting Plant compounds that inhibit iron and treated. absorption include oxalic acid in vegetables such as spinach, tannins Iron overload can also occur from in tea, and phytates in whole grains. excessive intake of supplements over However, these foods should not time. If not treated, iron overload can necessarily be avoided, as they have result in organ damage. Acute iron other nutritional value. overdose can be toxic or fatal and is • What increases iron absorption? the number one cause of accidental Vitamin C (in citrus fruit, tomatoes, overdose in children. Keep iron strawberries, peppers and broccoli) supplements out of reach of children. greatly increases iron absorption. Red meat, poultry and fish increase More information the absorption of nonheme iron from More information about iron can be other foods consumed at the found at the National Institutes of Health same time. (NIH) Office of Dietary Supplements: Maximize iron absorption from foods or ods.od.nih.gov/factsheets/iron.asp supplements: • If you drink tea or coffee, drink them only between meals and iron supplements. • Include a source of vitamin C (for example, orange juice) at every meal and with iron supplements. Who should take an iron supplement? Iron won’t make you stronger, unless you are deficient. And, you should generally avoid iron supplements unless there is a clear diagnosis of

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