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Natural solutions for your daily iron needs Embraced by women for over 60 years Dr. Cathy Carlson-Rink is a licensed Naturopathic Physician and Registered Midwife in general family practice, specializing in by Dr. Cathy Carlson-Rink, Naturopathic Physician women's and children's health. She completed her Bachelor of Science with Honours in Physical Education, with a major in Health and Fitness and a minor in Physiology, at the University of Saskatchewan. She went on to receive her Doctor of Naturopathic Medicine (ND), with a postgraduate specialization in midwifery, from the prestigious Bastyr University in Seattle, Washington. Dr. Carlson-Rink is an instructor of Obstetrics and Pediatrics at the Boucher Institute of Naturopathic Medicine. She is recognized across Canada as the first woman to be both a licensed naturopathic doctor and registered midwife. Salus celebrates Leaders in Health Since 1916 Distributed by Flora • www.florahealth.com • 1.888.436.6697 © 2004. All rights reserved. May not be reproduced in part or whole without written permission. 94772 90 Years 1916 - 2006 Has your get up and go, got up and went? “Iron deficiency is an underrecognized problem in women in their reproductive years.” – British Medical Journal, 2003 Prevention is a girl’s best friend. One out of every four women struggles with iron deficiency. Fatigue, poor concentration, Why is this deficiency so often missed? The main reason is inadequate testing for it. dark circles under the eyes and physical weakness are keynote symptoms. In a recent So many women just accept the fatigue as part of the day-to-day grind. As a doctor, study of women who complained of fatigue, 85% had low iron stores or iron deficiency. I have seen how this can affect women’s lives. I watch women crawl into my office so The researchers concluded that fatigue due to iron deficiency is an under-recognized exhausted they feel they have had the joy of life zapped right out of them. As someone problem in women in their reproductive years (British Medical Journal, 2003). It only who has personally been affected by iron deficiency, I also know how much this easily makes sense to focus on basic preventative solutions. remedied problem can wipe out your quality of life. However, the health concerns Research shows that if women took 20 mg/day of iron daily during their reproductive do not end with exhaustion; iron deficiency has been linked with PMS, depression, years, the majority of iron deficiency would be prevented (European Journal of Clinical decreased fertility, pregnancy complications and, more recently, postpartum depression Nutrition, 1994). This would pre-empt a lot of all-too-familiar health complaints. (Annals of Family Medicine, 2005). Feeling exhausted is common for many women. In fact, women are three times more Take the time to learn about iron deficiency – you’re worth it! likely than men to report this symptom to their doctor (British Medical Journal, 2003). We attribute it to our hectic lifestyle. We burn the candle at both ends. Everything we do is on the run, including how we eat. In the reproductive years, women require 18 mg of iron per day but most women get only 8-10 mg. Women require a consistent dietary intake of iron because of blood loss due to their monthly cycle. Cathy Carlson-Rink One woman in four is at risk! Is it you? Or is it a member of your family? While iron deficiency is primarily associated with women, certain groups of men are at risk as well. From the general population, high risk groups include: High risk groups: Women in their childbearing years For women, these years put the most demands on us with the balance of work, play and family. We need optimum energy to get through the day yet many of us are dragging ourselves through just trying to survive. The rates of iron deficiency are staggering. Girls between ages 12 and 19 and premenopausal women show the highest occurrence with as many as 40% suffering from iron deficiency. (Danish Food Directorate). However, we do not need to live with the exhaustion as iron deficiency is completely preventable. In People with a general need for iron: • Women in their childbearing years (due to menstruation) • Women planning a pregnancy fact, studies show 20mg/day of iron can correct iron deficiency in four out of five women suffering from iron deficiency without anemia. (Eur J Clin Nutr 1994) It has more far reaching effects than just exhaustion as iron deficiency has been linked with sub-fertility and pregnancy complications. People with a decreased ability to absorb iron: • Women pregnant/lactating • Elderly (decrease in stomach acid) • Teenagers Pregnant women or planning a pregnancy • Low protein intake • Children between the ages of one to four because of rapid growth and lack of iron in the diet. Planning for a pregnancy involves many details. Ensuring you have • Digestive problems that result in fast transit time of food (diarrhea, loose stools) optimum iron levels is one of them. During the childbearing years, adequate iron is needed for optimum fertility, proper placenta People who may have inadequate iron intake: development at the time of conception, prevention of low birth • Vegetarians and vegans stores for the baby’s first six months of life. Women’s iron • Women who use IUDs for birth control (increases menstrual loss by up to 100%) • Diets high in processed foods (white flour, white sugar) requirements double during pregnancy and, without proper diet and • Athletes (through sweat, digestive bleeding, bruising) • People on calorie restricted diets People with increased loss of iron: • Women with heavy periods. (perimenopause) or excessive blood loss with childbirth • Surgery or injury (iron should be part of pre-surgery and post surgery supplements) • Elderly due to decreased intake of food and bad teeth weight babies and pre-term labor, and to provide sufficient iron effective supplementation, iron stores can drop and continue to decline with each subsequent pregnancy. Women planning a pregnancy should have serum ferritin levels of at least 70 ug/l. Currently only 1/5 of women have this level of iron stores. (Acta Obstet Gynecol Scand 1994) According to the National Institute of Nutrition low iron stores are also associated with decreased fertility stores than those children whose mother’s did not receive iron. This lowers the risk of as iron is involved with making reproductive hormones including estrogen and developing iron deficiency in the first year of life. (Danish Food Directorate) The first two progesterone. (Danish Food Directorate) years are a vulnerable period for brain growth and the effects of anemia may be Fifty percent of pregnant women not taking iron supplements are deficient sometime in associated with developmental delays in both motor and mental abilities. (Archives of their pregnancy. A recent study with pregnant women showed that a low dose iron Disease in Childhood, 2001) These delays may be long lasting and possibly irreversible. supplement of 20 mg/day from the 20 week of pregnancy to delivery reduced iron Iron deficiency in this age group also decreases the rate of growth and weight gain. deficiency anemia and iron deficiency at delivery and postpartum without the side effects 10 mg of iron supplementation for all 1–2 year olds is currently recommended for usually found with high dose iron supplements. (Journal of Nutrition, 2003) High dose prevention. (Contemporary Pediatrics 2003) iron supplements in pregnancy are very poorly tolerated as constipation is usually worse at this time. There has also been a concern that doses of higher than 60 mg/day in Children pregnancy may be linked with increased low birth weight, premature births and free Symptoms that develop with iron deficiency are: decreased ability to learn, behavioral radical damage. (Biological Trace Element Research, 2001) Clearly, preventing deficiencies disturbances (irritability, crankiness, whining), decreased appetite, frequent colds and with iron rich foods and low dose iron supplements is a much safer option. infections, lack of focus and tiring easily with physical activities. Iron deficiency impairs the immune system and has been shown to lead to recurrent ear infections. Iron cost of a normal pregnancy The iron "cost" of pregnancy is high. Iron provides the transport of oxygen between mother and baby. The mother doubles her blood volume during pregnancy and provides the iron stores for her baby for the first six months of life. In the last trimester 3 -4 mg /day of iron is transferred to the baby. Also after birth, the mother needs iron during breast feeding and to recover from the blood loss from childbirth. Decreased episodes of ear infections were found when anemia was corrected with iron supplementation. (Am J Otolaryngol 2001) Teenagers Iron contributed to the baby 200 – 370 mg In placenta and cord 30 – 170 mg In blood loss at delivery 90 – 310 mg Lactation 0.5 – 1 mg/day Teens are at higher risks because of growth spurts, higher activity levels, erratic eating habits (i.e. fast food, weight loss diets), and for girls, the start of their menstrual cycle. Researchers have found that teenage Newborns & toddlers Iron deficiency is common in infants and toddlers because this is the most rapid growth girls who suffer from iron deficiency may also have a low IQ. A study by period in their whole life which demands enormous increase in blood volume. This is why from 6 months onward, the recommended intake for children is 10 mg of iron per day, Iron deficiency impairs the immune the same as an adult male. Healthy full term babies have enough iron stores for the first system and has been shown to lead six months of life. Children of mothers who had iron supplementation have higher iron to recurrent ear infections. It is recommended that seniors supplement with ten mg/day of iron concurrently with B12. Athletes and the physically active It has been well known that female endurance athletes commonly develop iron deficiency. It is also well known that this deficiency impairs exercise researchers at King's College, London, found a significant link between low hemoglobin levels and poor mental performance. Previous research carried out by the same team suggests that between 10 and 30% of adolescent girls have poor iron reserves or mild performance. Only recently have we realized that even mild degrees of iron deficiency affects the ability to exercise. We are also finding out that it is not just heavy-duty training that can lead to a deficiency but moderate workouts as well. Research is also showing those new to exercise can easily develop iron deficiency. (American Journal of Clinical Nutrition 2002) iron deficiency. However, this is not a The good news is that iron supplementation has condition that affects just girls. shown to help improve exercise performance. Forty- Between ages 13 and 16 boys develop one women between ages 18 and 33, who had a the risk for iron deficiency as their iron mild iron deficiency, when supplemented with 16 mg intake simply cannot keep up with of iron/day improved their exercise endurance and iron their rapid speed of growth. levels in only 6 weeks. (American Journal of Clinical Nutrition, 2002) In another Seniors study, women receiving 10 mg of iron The seniors’ challenge is the reduction in stomach acid leading to decreased absorption twice a day improved in muscle of iron and B12. Anemia increases after 65 and sharply rises after age 80. Anemia has endurance by 15% and muscle strength by been shown to be associated with poor mobility, increased mortality, poor health and 26.5% compared to no improvement with the control depression. (Journal of American Geriatric Society, 2002 & 2003). A recent study of group over a 6 week period. (American Journal of 4000 men and women over the age of 70 found that low iron status was a powerful Clinical Nutrition, 2003) predictor of death by all causes but particularly cardiovascular disease. (American Why does iron deficiency make it hard to get through Journal of Cardiology 1997) Iron deficiency causes 15 to 30% of anemia in seniors; your work out? First, iron’s job is to carry oxygen while another 10% is caused by B12 deficiency. B12 deficiency in seniors has been around the body and so if you are low in iron, linked to alzheimer’s disease, heart disease, stroke and accelerated aging. (Nutrition and you are low on oxygen. Second, iron deficiency Health 1998) Iron deficiency is a common finding with B12 deficiency and if B12 is reduces the muscles’ ability to use oxygen. supplemented alone then it increases the rate of iron deficiency. Therefore, it is recommended that seniors supplement with ten mg/day of iron concurrently with B12. (New Zealand Medical Journal 1997) Why is iron so important to the body? Iron has an affinity for oxygen. That's why iron and steel objects rust, or oxidize, so readily. Iron is part of the Running on empty? hemoglobin within red blood cells. It enables the blood to carry oxygen to tissues within the body, and it gives our blood, especially oxygenated blood, its rich, red color. That's just the beginning. Iron is also part of myoglobin, the substance that provides oxygen to muscles at the start of exercise or exertion. It's needed: for aerobic metabolism (oxygen must be present); by a variety of enzymes in the metabolism of energy; for liver detoxification; to protect cells from damage; to make adenosine triphosphate (ATP), a substance that helps fuel cells; and by the neurotransmitter systems, such as serotonin, that help with sleep and brain function. Low iron can also lead to the accumulation of toxic metals including lead and cadmium which can create additional medical problems of their own. (Journal of Pediatrics 1990, American Journal of Public Health 2002) How does a deficiency rob energy? Why Does Iron Deficiency Rob Us Of Our Get Up And Go? Just as a fire can't burn if we cut off its supply of oxygen, a shortage of iron in the blood means that our cells are deprived of the oxygen they need to burn the body's Decreased Iron Decreased Iron Decreased oxygen to the body Decreased ATP in cells Decreased energy No fuel for cells fuel. The problem is further compounded since iron is required to produce the ATP our cells use for fuel. With too little oxygen and too little fuel, instead of running on all eight cylinders, we run on two or three, and sputter through our day. Decreased energy Fact Iron deficiency! Anemia! Are they one and the same? : There are three stages of iron deficiency. First, the body’s iron stores (serum ferritin) begin to drop. Next, red blood cells decrease in size and colour. After that, hemoglobin levels begin to drop. Common testing methods for iron check only hemoglobin, the last marker to show a decrease in iron levels. Therefore, an iron deficiency that could have been diagnosed in the early stages, is often discovered later, when its symptoms are much more intense. In a nutshell, no, iron deficiency and anemia are not the same. In fact, it is estimated that 40% of childbearing women are iron deficient while only 4% are actually anemic. (Danish Food Directorate) The signs & symptoms of iron deficiency But iron deficiency can lead to anemia, and unfortunately, unless those with iron • Pale skin especially under eyes, nails, palms of hands • Brittle hair • Nails are thin, brittle, flattened and will become spoon shaped if deficiency not treated • Poor concentration • Poor sleep • Low, listless mood • Dizziness/faintness • Sore tongue (papillary atrophy) and canker sores Pale mucous membranes (pull down your lower eyelid) • Cold hands and feet • Rapid pulse • Ringing in head or ears (British Medical Journal, 2003) • Fatigue and weakness • Chest pain during exercise Consequently, many exhausted women put up with the needless fatigue and associated • Increased infections i.e. colds and flus • Headaches • Restless leg syndrome • Decreased ability to exercise • Dry and dull hair • Shortness of breath • • Heart palpitations Cracks at the corners of the mouth deficiency are also anemic, they tend to fall through a major crack in the medical system. Despite the fact that one woman in four suffers from iron deficiency, it is not routinely tested for during medical examinations. It boggles the mind, especially in view of the fact that iron deficiency can be detected using a simple test called serum ferritin. As it stands, iron stores need to be almost completely depleted before anemia (a lower red blood cell count) will become apparent through a routine blood test. • This failure to catch iron deficiencies during the preliminary stages of the disease, a stage called pre-anemia, is so prevalent that more than half the women in a study of 136 women between 18 and 55 with unexplained fatigue had low serum ferritin levels. symptoms of iron deficiency by blaming it on our fast-paced lifestyle. The consequences of pre-anemia are not confined to women. A study of non-anemic, iron deficient teenagers who were supplemented with iron significantly improved verbal learning and memory. (Lancet 1996) Up to 25% of teenagers in the US are iron deficient and pre-anemic. How can I get enough Iron? Safe iron supplementation It is important to recognize that even though iron is such a vital nutrient, that too much of a good thing is also not beneficial. Animal iron, found in flesh foods, has no feedback mechanism to shut off its absorption when your body has enough iron. It continues to absorb at a rate of 20% even when your iron stores are normal. Plant iron can shut down its absorption to 2–3% when your body has enough iron. For prevention, use a plant-based supplement and do not exceed dosages above 30 mg. Lower doses of iron are safer over time and do not have the side effects of constipation, digestive upset and iron overload. In a large study, no connection between non-heme, (plant) iron in food or supplementation has been linked with cardiovascular disease. (Circulation 1994) Diet vs supplementation Iron deficiency can be prevented with iron rich food and correct iron supplementation. The average American diet only has 8 –10 mg of iron day. The recommended daily allowance is 15 –18 mg so women are always struggling to get enough iron. To get the iron you need, you should eat a diet rich in leafy green vegetables, such as spinach, kale, or even seaweed, which can be added to soup. Other foods high in iron are raisins, prunes, apricots, lean meats, and eggs. In a recent study at the Heidelberg Women’s University Clinic, Floradix, a plant based iron supplement, was found to be effective at normalizing iron levels. Further, 90% of the participants were able to take it without side affects. 70% of the women in the study reported improved symptoms versus 28% who increased iron rich foods alone. While many fruits and vegetables are a good source of iron, and certainly a key component of any healthy diet, they must be eaten in very large quantities to correct an iron deficiency, so supplementation is still recommended. 1 2 5 10 15 20 Our bodies can only absorb 5–10% of the available iron in the foods we eat. Once it has become chronic, an iron deficiency cannot be corrected by diet alone and requires supplementation of at least 30 mg of elemental iron per day. Veal muscle Hemoglobin Fish muscle Food of animal origin Veal liver Lettuce Wheat Soybean Ferritin Corn Rice Black Spinach Beans Iron absorption % Food of vegetable origin Iron availability – solids vs. liquids Solid tablets first need to be broken down by the body before nutrients become available for absorption. Tablets are held together with binders and coated with substances to help them keep their shape. Due to the binders, fillers and coating, the body cannot easily get to the nutrients in a tablet. Liquid supplements, on the other hand, do not need to be broken down by the body before the active ingredients can be released and absorbed. They are right there for the body to pick out and absorb through the small intestine, since liquid supplements provide the body with a much larger surface area to volume ratio for easy absorption. Nutrients that interfere with absorption if taken simultaneously: Foods that decrease iron absorption: • tea and coffee consumption with a meal reduces iron absorption up to 60 –70% (Danish Food Directorate) • • • • oxalates (found in uncooked spinach, rhubarb) This is why it is better to take iron away from food and your multivitamin. • • fiber Factors that Increase Iron Absorption • milk proteins • • • • • • vitamin E calcium zinc magnesium manganese excess copper and heavy metals such cadmium, cobalt or lead in the body • vitamin C (ascorbic acid) (increases absorption in the digestive tract) • • • • • B12 and folic acid fructose (fruit juices), glucose amino acids/protein chelating agents such as gluconate or fumurate presence of heme iron (animal) which increases non-heme iron absorption phytates (found in uncooked grains) carbonates (found in carbonated beverages) phosphates (found in soft drinks and processed foods) protein deficiency as protein is needed to carry iron from the small intestine to the blood Note: The best time to take iron is between meals, not with coffee or other supplements. Floradix liquid iron Reliable and trusted, Floradix is a girl’s best friend. Floradix Formula Liquid Iron provides iron gluconate, a highly soluble, organically bound iron compound that is easy on the digestive tract and readily absorbable. It is combined with iron-rich whole food and herbal extracts, as well as co-factors such as vitamins to further enhance its absorption. The formula is in a base of natural fruit juices to ensure proper stomach acidity for maximum absorption. Certified Kosher and suitable for vegetarians and vegans, this popular iron supplement is recommended during pregnancy and breastfeeding and is a safe way to meet the recommended daily dietary intake of iron on a long-term basis. It also tastes great, so it’s easy to use. Floradix – easy on the digestive tract Due to the low absorption rate of most iron supplements, unabsorbed iron is moved to the large intestine for elimination. This unabsorbed iron may irritate the intestinal walls, causing cramping, black stools and constipation. At the best of times, constipation is painful and irritating. During pregnancy, it can become incapacitating. Thanks to the high absorption rate of Floradix and the addition of digestive herbs, very little unabsorbed iron enters into the intestinal tract and therefore constipation is unlikely to occur. Floradix has been embraced worldwide for over 60 years. It’s your natural iron solution. *For those with sensitivities to yeast and gluten, there is Floravit, the yeast- and gluten-free formula. Winner of 8 alive Awards and voted #1 iron supplement by U.S. retailers in 2003 & 2004. Reprinted from an article in Beyond Fitness Magazine - Spring 2004, by Bruce W. Cole Leah Pells Canadian Olympic Athlete June 2004 – Leah Pells, the Canadian middle distance runner, has her sights set on making the Canadian Olympic team for an unprecedented fourth time. If things go according to plan, she'll be running her specialty, the 1500 metres, in Athens prior to her 40th birthday. It won't just be the 40-and-over crowd pulling for the popular B.C. athlete. Being a relatively new mother, Leah is also something of a "poster girl" for other young moms, tending to the needs of her son Luke (two on July 1), while still squeezing in 130 kilometres of roadwork each week. It’s ironic that the supreme joy of joys that motherhood brings also brought to Leah Pells a serious health concern. For the pregnancy also presented something that came dangerously close to ending her illustrious track career, and putting the Olympic dream on hold forever. The thought of Leah not training to represent Canada at a major international event is almost beyond comprehension. She has worn the Maple Leaf at three Olympics (1992, 1996, 2000); at six World Championship (1991, 1993, 1995, 1997, 1999, 2001); and at three Commonwealth Games (1990, 1994, 1998). For a three-year period (1996 to 1998) she was ranked top 10 in the world in her event – the 1500m. Career start at a young age Running is something that has been a big part of her life since she was young. She Photo: Claus Andersen remembers clearly when the bug bit her. "I was six years old. I was at a track with my Dad one day and saw all these kids running. I asked him if I could do that, too." So it began. She recalls doing quite well right off the bat. "I didn't always win, but I had a fiercely competitive streak. If I did not win or do my best, I would the next time." Although she had a talent for running, Leah was also just a regular kid who loved all sports. "I was a kid who loved to be outside and to be as active as possible. My mom Leah Pells at home with husband would have to drag me into the house at the end of the day. I was a high energy kid." John and son Luke. She became serious about running in junior high school. And she credits her coach, Read – who was also her teacher in Grade 7 – with helping to fuel her passion for the B.C.-based company called Flora sport. " He was my first serious coach and we are still close friends to this day." Canada's national junior track team, a squad that headed to Japan for the world junior championships. In coming years, Leah would become a fixture at international track events until 2002, the year she gave birth to Luke. Post-pregnancy challenges Manufacturing & Distributing."I started to take it twice a day and within a Photo: Mike Wakefield Leah's first major leap into the spotlight came when, at age 18, she was named to month, I was feeling like a new person. It was totally amazing. I was able to run harder, and I had more energy. I believe a lot of women are anemic and do not even know it. But even a little bit of anemia can really drain you and Post-pregnancy Leah faced some serious challenges, and this remarkable resume was make you feel sluggish and tired. I take Floradix every day now and I feel great. I am almost put on hold. "After Luke was born, a variety of things happened. He was back to high mileage and have lots of energy." delivered by c-section. I hemorrhaged a great deal, losing a lot of blood in the process. This resulted in my iron levels plunging and severe anemia. Looking to the future "Also, I was tired due to the fact that Luke felt he did not need to sleep ... ever! I With things starting to get back to normal, and with Leah starting to recover her pre- started to run four weeks after he was born, and with the combination of lack of sleep pregnancy energy levels, she gradually increased her running and training volume. She and anemia, it made me even more tired. says it took about six months to start feeling fit again, and a full year to get back to "I am sure any woman who has had a child can relate. It's a wonderful experience, but where she was before Luke's birth. breast-feeding every two hours can be tiring. Luke had a huge appetite, so he was really In her career, Leah Pells has overcome many challenges. In the earliest days, it was as taking all my energy. Of course, it was totally worth it and wonderful, but as a runner, basic as making ends meet. "Being broke ... it's tough being an amateur athlete in it's a challenge. I was eating non-stop to replenish my stores." Canada ... there is very little money. You have to work full time and live below the Solving the iron crisis poverty line. I've also had my share of injuries ... lots of over-use injuries. "In recent times, it was getting over the anemia ... and now juggling motherhood with With her iron levels dangerously low, Leah paid a visit to her MD. "I have a fantastic being an elite athlete. I have over come all these things, by loving the running... and doctor and he knew I was having a hard time, so we checked the ferritin and simply doing the best I could do on that day." hemoglobin levels and they were seriously low. I started to take iron supplementation, but still the iron levels were not coming up." In the end, Leah's problem was resolved when she visited the Poco Health Food Store in Port Coquitlam. After listening to her explain the dilemma, the store's owner recommended a product called Floradix, a herbal iron supplement distributed by a These days, Leah says it's all good – running and life. "It is what you make it to be. I made my world a healthy and active place ... and I love it." On behalf of every Canadian who is 40 years of age and older, thank you, Leah Pells. You give us all hope.