Wednesday, January 13, 2010

What happened to iron-poor blood?

Nobody talks about iron anymore. When I was growing up, every night on TV were “Geritol” commercials for how to fix iron-poor blood – with vibrant, grey-haired older folks radiating their newfound oxygenated blood. I haven’t seen one of those in years. Or any commercial or advertisement about taking iron supplements. What happened to all of that? Did we all suddenly stop becoming anemic?

Perhaps the issue of being anemic, or not having enough iron in the blood, has been swamped by bigger health problems, like obesity, smoking, and eating too much sugar. The brunt of the iron-deficiency anemia problem, however, has been somewhat “cured” by our society’s rampant use of processed foods – to which iron has been added. Cold cereals, breads, anything with “enriched” flour – there’s the iron of today. This, no doubt, is why iron-deficiency is not perceived to be as much of a problem anymore.

But anemia certainly hasn’t gone away. Especially in babies, toddlers, and children – which is fairly common. Just today, I found out the two-year old daughter of a good friend of mine is anemic (as in iron-deficiency). As is her mother. I myself have always been borderline low, as was my mother. Yet, one of my sisters has high iron in her blood – a situation that has a fancy name I’ll look up one of these days. A brother-in-law gets “bled” regularly to get some of the iron out of his blood. It can probably be more dangerous to have too much iron. But not having enough iron in the blood is bad enough. That’s how we get oxygen transported through our blood to every organ in the body. Without oxygen, there’s no life (here on earth anyway).

And the symptoms for anemia in small children are a little worrisome. Poor appetite, fatigue, and irritability are a few. But their brain and motor development can also be slowed significantly, without enough iron. Even after they get their iron up-to-snuff, they can still be deemed “slow” at 5 years of age, just from a bout of anemia in early childhood that is not fixed quickly.

Low iron is easy for me to fix. I take iron supplements. I actually became anemic once after eating no meat for a year. No matter how much raisins and spinach I ate (can anyone really eat enough spinach?), the hemoglobin dropped down below normal into the anemic range. I remember being very very tired. So I started eating beef again, and have been a meat eater ever since. And took iron supplements for a year or so to replenish my red blood storage (sternum and long bones).

Here are a few more possible symptoms of iron-deficiency anemia:

· Weakness
· Fatigue
· Shortness of breath
· Irritability
· Difficulty concentrating
· Poor appetite
· Increased susceptibility to infections
· Intolerance of cold temperatures
· Constipation
· Brittle, flat, thin fingernails
· Slower brain, mental, and motor development (for babies/toddlers)

So what about a two-year old, who might be a finicky eater? And won’t take pills? I didn’t realize how common iron-deficiency anemia is in small children. When they start growing fast, the iron has trouble keeping up. And apparently, eating iron-rich foods is not enough and drinking too much milk (more than 8 oz a day) makes it worse for a child who is actually anemic.

In this case, iron supplements are probably also required (about 7 mg for a 2-year old) with the iron-rich foods. The iron syrup that is usually recommended for children is ferrous sulfate or ferrous succinate. Plus, any food (such as fruit juices) that might keep the child from eating more iron-rich food should also be limited.

So what are some of the foods with the most iron? Dried peaches, prunes, raisins, avocados, clams, tofu, oysters, beans, greens, beef, black-strap molasses, almonds, and chicken – are a few of the foods with high iron. And of course, processed foods that are enriched are a good possibility, as in cereals and breads like the cereals Total, Cheerios, Cream of Wheat, and instant oatmeal.

The “enriched food” thing is a bit of a double-edged sword to me. While the enriched foods help stave off iron deficiency in a culture-wide way, it also makes it easier to feed children cold cereal -- which I do not advocate.

I was raised on Wheaties, Cheerios, and Wonderbread – the headliners for a host of processed foods. These days I try very hard to eat very few packaged or processed foods and I know many others who have the same goal. For mothers that try to feed their children real food, the processed, iron-enriched cereals are a very easy choice that’s not available. So be it. There are plenty of real foods and meats available to eat (with iron) that don’t come in a box.

Interestingly, potato skins contain 5 times as much iron as the inside of the potato, which is another good reason to “eat the skins”.

Then there are toddler formulas (or any fortified cow’s milk substitute) that can be used instead of cow’s milk, which should be limited (less than 8 oz per day). I didn’t know until today that cow’s milk can actually injure the gut, causing some blood loss. Which would also contribute to an anemia situation.

Can you have symptoms of iron-deficiency anemia, and still have a normal blood test? Yes! This is probably true of many blood tests, for example, thyroid hormones. Those of you who know me, know I’m big into “functional” medicine – which means getting treated based on how your body is functioning and not the lab tests. That’s why it’s good to have blood “ferritin” measured, which shows how much iron is stored throughout the body.

If your hemoglobin is low, however, this means you are already in a later stage of iron deficiency and probably need supplements. It’s difficult to get enough iron absorbed from food at this stage. Even worse, you may notice symptoms of iron deficiency anemia, such as being tired, irritable, and having difficulty concentrating, long before anemia shows up with the hemoglobin test.

For adults, some iron supplements are better absorbed than others. And for everyone, iron is better absorbed with some Vitamin C at the same time – on an empty stomach if it can be tolerated. If not, then with food.
Ask me, if I can help answer any questions.


  1. Hello Adele,
    This is a wonderful informative blog and I feel so privileged to get in on it right from the beginning. I have been supplementing with iron to see if it helps with symptoms of restless leg syndrome. Twice in the past few years, when I have tried to go and donate blood, I was turned away because of being just below the "ok" line regarding my iron level. I am taking a supplement called Bifera (which I found at Walgreens) and am wondering if you have heard of it AND what you think of it. It has 2 forms of iron in it and the pharmacist says it is good because the iron is readily absorbed.


  2. Hi Niki -- welcome! Thanks for coming by. Smart of you to take an iron supplement, especially if you're below "low normal" even. It's hard to get enough iron from food...unless it's juicy red beef (not my favorite anymore.) I'm also usually low normal, and this also affects the thyroid -- wouldn't you know! Thyroid hormones need iron (and iodine) among others, to function well. It takes about 6 months to get your iron stores back up to par. Hang in there!