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St Agnes Medical Center
Fresno, California
HOW IS ANEMIA PREVENTED?
Dietary Recommendations for Preventing Anemia
Forms of Iron. Iron found in foods is either in the form of heme or non-heme iron.
Heme iron is better absorbed than non-heme iron.
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Foods containing heme iron are the best for increasing or maintaining healthy
iron levels. Such foods include (in order of iron-richness) clams, oysters,
organ meats, beef, pork, poultry, and fish.
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Non-heme iron is less well absorbed. About 60% of iron in meat in non-heme
(although meat itself helps absorb non-heme iron). Eggs, dairy products, and
iron-containing vegetables only have the non-heme form. Such vegetable
products include dried beans and peas, iron-fortified cereals, bread, and
pasta products, dark green leafy vegetables (chard, spinach, mustard greens,
kale), dried fruits, nuts, and seeds.
The absorption of non-heme iron often depends on the food balances in meals. The
following are foods that enhance absorption of non-heme iron.
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Meat and fish not only contain heme iron -- the best form for maintaining
stores -- but they also help absorb non-heme iron.
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Increasing intake of vitamin-C rich foods can enhance absorption of nonheme iron during a single meal. In any case, vitamin-C rich foods are healthy
and include broccoli, cabbage, citrus fruits, melon, tomatoes, and
strawberries. One orange or six ounces of orange juice can double the
amount of iron your body absorbs from plant foods. (Taking vitamin C
supplements does not appear to have any significant effect on iron stores.)
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Foods containing riboflavin (vitamin B2) may help enhance the response of
hemoglobin to iron. Sources include liver, dried fortified cereals, and yogurt.
Certain nutrients impede the body's absorption of dietary iron. They include the
following:
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Polyphenols (found in tea, coffee, red wine, berries, apples)
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Phytates (found in foods such as seeds, dried beans, soy, and bran) Such
foods are typically high in fiber. It is commonly believed that fiber impedes
iron absorption, but researchers report that it most likely has no effect.
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St Agnes Medical Center
Fresno, California
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Calcium. Calcium impairs the absorption of heme and non-heme iron.
However, calcium intake needs to be fairly high to cause any significant
problems. For example, a 2002 study reported that cheese had no effect on
iron absorption from meals rich in heme and non-heme iron.
Cooking methods can enhance iron stores. Cooking in cast iron pans and skillets is well
known to increase iron content of food. According to one study, however, boiling,
steaming, or stir-frying in utensils composed of any material significantly increased the
release of non-heme iron stored in vegetables.
Sources of Vitamins B12 and Folate. Vitamins B12 and folate are important for
prevention of megaloblastic anemia and good health in general.
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The only natural dietary sources of B12 are animal products, such as meats,
dairy products, eggs, and fish (clams and oily fish are very high in B12); like
other B vitamins, however, B12 is added to commercial dried cereals. The
RDA is 2.4 mcg a day. Deficiencies are rare in young people, although the
elderly may have trouble absorbing natural vitamin B12 and require synthetic
forms from supplements and fortified foods.
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Folate is best found in avocado, bananas, orange juice, cold cereal,
asparagus, fruits, green, leafy vegetables, dried beans and peas, and yeast.
The synthetic form, folic acid, is now added to commercial grain products.
Vitamins are usually made from folic acid, which is about twice as potent as
folate. Many experts now recommend that adults have 400 mcg of folic acid
daily, which is considerably higher than standard recommendations of 400
mcg of folate, which does not take into consideration the possible benefits of
folate on the heart. Women who are trying to conceive, who are pregnant,
and who are breast feeding should take 400 mcg of folic acid. [See Box
Anemia and the Pregnant Woman.]
Recommended Daily Allowance for Iron
The Recommended Daily Allowance of iron for people who are not
iron deficient varies by age group and other risk factors. (Iron
supplements are rarely recommended in people without evidence of
iron deficiency or anemia.)
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Children between the ages of one and three: 10 mg per
day
Teenage boys: 12 mg
Premenopausal girls and women: 15 mg per day
Pregnant or nursing women: 30 mg per day
Adult men (up to age 50): 10 mg per day
Older men and women (over age 50): 10 mg
Transfusion Free Program
St Agnes Medical Center
Fresno, California
Preventing Anemia in Infants and Small Children
The main source of iron for an infant from birth to one year of age is in milk, either from breast
milk, iron-fortified infant formula, or cereal. The best methods for preventing iron deficiency
during infancy are the following:
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Breast-fed infants. Breast fed babies have enough iron to last four to six months,
assuming that the mother had adequate iron stores during pregnancy. Iron
supplementation should start after that time. Some infants who are only breast fed
for the first year do not become iron-deficient, although it is not determined what
factors in the mother, child, or both are responsible for this protection. Breast milk
itself is low in iron, but if the mother's diet is healthy, vitamin C and lactose in the
breast milk may enhance iron absorption
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Iron-fortified formulas and avoidance of cow's milk in infants. If infants are not
breast fed, they should start with iron-fortified formulas. Breast fed babies should
have iron supplements after four to six weeks. Most experts strongly discourage the
use of low-iron formulas (less than 4.0 mg/L). Of note, a 2002 study suggested that
formulas with iron levels as low as 1.6 mg Fe/L provide sufficient iron to infants and
higher amounts do not add any benefit. Experts advise against cow's milk for the first
year of life. Parents should discuss the best formula with their doctor Children given
iron supplements may have a slightly higher risk for diarrhea.
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Recommendations for toddlers. After the first year, children should be given a
varied diet that is rich in sources of iron and vitamin C. Some experts recommend no
more than 24 ounces of cow's milk a day (equal to three glasses). Some also advise
iron-fortified vitamins or drinks, although this is controversial. Toddlers who did not
have iron supplements during infancy should be checked for iron deficiency.