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Iron & Anemia


  1. Where can I find a dietitian who works with people who have anemia? Answer
  2. I am doing a practical period in a zoo in Europe. There is a problem with some birds because they diet of too much iron. Answer
  3. Is there any nutritional significance to the habit of chewing ice? Answer
  4. I am a teacher and have assigned a written report on pica. Do you have any suggestions? Answer
  5. Have you ever heard of pica and of someone craving paper? Answer
  6. Do you have any recommendations for a vitamin that might give me more energy? Answer
  7. I have heard that it is not good for you to take iron pills because of the free radicals? Answer
  8. I crave red meat prior to and during my period. Do you think this is my body telling me it wants extra iron? Answer
  9. I donate blood and am a vegetarian. My doctor told me I had low iron. What should I eat? Answer


  10. Should an active male who eats red meat and supplements with a multiitamin take one which doesn't contain iron? Is too much iron toxic? Answer
  11. Can men get their RDA for iron from their normal diet? Answer
  12. I was recently told I have low saturation levels of iron in my blood. How can I increase the protein in my diet without sabotaging the fat intake? Answer
  13. WIC can only give out iron fortified formula until 12 months of age. A doctor in our area says babies don't need iron fortified formula due to iron in the water. Answer
  14. Cooking spaghetti sauce in a cast iron pot adds a lot of iron. It that iron the kind that is absorbed? Answer
  15. How would a person get their daily iron requirement if that person eats a balanced diet, but eats no meat? Answer


Where can I find a dietitian who works with people who have anemia?

The Medical Nutrition and Nutrition Entrepreneurs dietetic practice groups of the American Dietetic Association provide medical nutrition therapy based on your diagnosis. Dietitians often have their own private practice nutrition counseling services in addition to services provided in a clinic or hospital. You can find a dietitian at the Academy of Nutrition and Dietetics. Include your zip code or city / state, the type of service you want (individual consultation) and expertise needed.


I am doing a practical period in a zoo in Europe. There is a problem with some of their birds because they die of too much iron in their liver. We want to feed the birds a diet that is low in iron. Their diet consists of many different kinds of fruit, perhaps you could tell me, which kinds of fruit contain the most iron. They are now being fed apple, orange, carrot, raisins, banana, pineapple, kiwi and melon. I hope you know which fruit are low in iron! Thank you very much!

I would recommend you contact a veterinarian who is familiar with birds. Sorry, but I can only advise you about human nutrition, not animal nutrition. In humans, high blood iron levels can lead to cardiac death in males.

I can though provide you with iron content in foods people eat that animals may also eat. Raisins (2 milligrams iron per 100 grams raisins) have the highest iron content in the list below. However, do you remove the seeds from watermelon? Watermelon seeds contain 7.3 milligrams of iron per 100 grams. I checked other melons (cantaloupe, casaba, honeydew, watermelon and wax gourd) and the iron levels are low. I would suggest that you look elsewhere for the excess iron content unless the birds are eating watermelon seeds.

Cereal grains intended for human consumption are fortified with iron in the US. Sometimes iron fortification is required for all grains prior to being added as an ingredient in a food product. Do the birds get any grains? How about any supplements? Read the food label to see if any grains are fortified with iron?

I would suggest you purchase a good nutrition analysis program with a large database of foods to analyze what the birds eat. Nutrition analysis software allows for custom nutrient goals for humans. If you knew the nutritional needs of different bird varieties, you could add these nutritional requirements as custom nutrient goals. Then, make a recipe of all the foods a bird eats in a day to calculate the iron content. Substitute foods lower in iron content that the birds will eat.


I couldn't find this issue addressed on your web page. I hope this isn't a duplicate question. Is there any nutritional significance to the habit of chewing ice?

I have heard that dentists advise against it because it could damage your teeth. Is this true?

However, what I am really wondering is if it signifies any deficiency or something along those lines. I seem to remember hearing something like this once. Perhaps it is just an "old wives tale"? Any information you can give me would be greatly appreciated. Thanks.

If you are a chronic ice chewer meaning you chew ice regularly compared to periodically chewing ice in your beverage glass, then I would make an appointment with your doctor to get your iron tested. You may have pica which can indicate iron deficiency anemia.

As to damage to your teeth, chewing on ice could break teeth, fillings or crowns. Ask your dentist about ice chewing next visit.


I am a teacher and have assigned a written report on pica. We are having trouble locating articles and just plain information on the subject. Do you have any suggestions? Thank you.

There is quite a bit of information in my iron topic. Please read FAQs below. If you have more questions, write back.


I am a 33 year old married mother of one. I have what I feel is an embarrassing and possibly life threatening disorder. Some years ago I was diagnosed as being anemic. The iron level was so low that the doctor asked if I ate or craved anything unusual. I told him that I crave and chew ice quite often. The doctor explained that this was a pica and I should stop chewing the ice because it was affecting my body's ability to absorb iron. What I did not tell the doctor is that I crave and chew plain white paper (typing paper). I have done this since I was a teenager and chew about 2 pages per day. I have never discussed this problem with anyone.

Can you help me with my questions: Have you ever heard of pica and of someone craving paper? Is this detrimental to my health? I fear that I have a large quantity of paper or chemicals stored somewhere in my body as a result of this disorder? Is there anything I can do to stop the paper and ice cravings?

Check out the second to last question in children topic as it deals with pica. You have iron deficiency anemia and need to take iron supplements with vitamin C to remedy the anemia which is causing the pica (eating ice and paper). Chewing ice is a symptom, not a cause or interference as your doctor stated. There is not a lot of research on pica, but one reports about Black women in the south with pica who ate laundry starch and clay. Your body is telling you need iron. Give it some. The paper and ice eating will stop when your iron levels near normal, which is 13 to 15 for menstruating females.


Do you have any recommendations for a vitamin that might give me more energy? I currently take slow-Fe (iron) and a multivitamin, but find that at the end of the day I am exhausted. Any suggestions? Thank you.

You didn't give me a lot of information to go on, but here are my thoughts. Since you are taking iron, I wonder if you are anemic? If so, you may need time before your lack of energy improves. Also, if you are already taking a multivitamin supplement, I don't think vitamins are the problem.

Iron is necessary to the formation of hemoglobin, which carries oxygen in red blood cells. When iron levels in hemoglobin get low, a person feels tired and lacks energy to do every day tasks due to lack of oxygen delivery to organs and tissues. Since a red blood cell lives 120 days, it may take close to 4 months before you feel like your old self.

Also, persons who live at higher altitudes have more red blood cells because the oxygen is thinner. So if you live above 5,280 feet (1 mile) above sea level, then you still will feel tired until your red blood cells recover.

Another possibility is that your iron stores may be low. Your body stores iron in your liver and long bones where red blood cells are made. Low iron stores won't show up as a low hemoglobin, but will show up on iron storage blood tests. Some vegetarian may have low iron stores due to the lack of iron rich cereals and vegetables in their diet. A blood test for hemoglobin, hematocrit, iron, red blood cells (RBC), ferritin, transferrin, total iron binding capacity (TIBC) and mean corpuscular hemoglobin (MHC) may be recommended if your symptoms do not improve. If you were not diagnosed with anemia prior to taking the iron supplements, I would suggest you make an appointment to see your doctor.


Hi, I have heard that it is not good for you to take iron pills because of the free radicals (I'm not sure if it's correct English). Is this true?

I have now got a serum iron of 6 and I understand it is not good. Is there a better way of getting compliments (if not food) than the ordinary iron pills you get from a doctor? Sorry for my bad English. Kind regards.

Free radicals have a high degree of association with cancer cell formation. Iron supplements to not produce free radicals. Antioxidants like beta-carotene, vitamin E and C and selenium are effective at scavenging these free radicals and neutralizing them. Read the Vitamin A, Vitamin C and Vitamin E topics for more information about these nutrients. The best source for these nutrients is food.

If your serum iron is low and your doctor has prescribed iron supplements, I would recommend you take them. Iron is most absorbable in the ferrous form (fumarate or sulfate, less so in the gluconate form) than ferric.

Of course, you can eat more foods high in iron which include red meat, especially liver, fortified breakfast cereals, whole grains and dark green leafy vegetables. (Read second question below for specific foods high in iron.) Iron absorption from your intestines is improved by Vitamin C. So include some citrus fruits or broccoli at the same time as your iron foods.


I've been finding that I seriously crave red meat prior to and during my period. Do you think that this is my body telling me that it wants extra iron during this time?

The last 6 months I have drastically reduced my red meat consumption due to the fat content. I have been charting my food in piece of diet software for the past 3 months and can tell you that I am eating only 10 CFF. I have now discovered buffalo burgers as well as venison and elk to be VERY low fat versions of red meat and this is what I eat when I crave it.

By the way, my cholesterol is 174, triglycerides 95, glucose 92, BP 174/80 and this is at 285#. Of course, that is down from 390!! So, assuming I am as healthy as my "numbers" say........shall I continue to believe that my body is giving me valid messages and go ahead and increase my red meat when I crave it? Thanks for listening!

Also, what do you think of an average calorie intake of 1300 calories which includes an average of 200 gm carbohydrates, 100 gm protein, 40 gm fiber and 15 gm fat. BTW, I am also a 1-year kidney cancer survivor.

First off, congratulations on your surviving and secondly, congratulations on losing 105 pounds. Your lab results look good. Blood pressure could be lowered though by continuing to lose weight and exercise.

Food cravings are especially difficult to pin down to a cause. Eating lean red meats 3 times a week is generally recommended. Red meat is now leaner and pork equals chicken in percent fat content.

Red meat is a significant source of iron for menstruating women. The trend in eating less red meat may increase iron deficiency anemia, especially among young children.

Please clarify what 10 CFF means? I do not understand the abbreviation.

Buffalo, venison, elk and most other wild game is lower in fat than beef, veal, pork or lamb. These lower fat red meats would make good food choices.

The 1300-calorie diet you describe is 62% carbohydrate, 31% protein, 10% fat and high fiber. A minimum of 13 grams of fiber is recommended. I am concerned about the high protein content of your diet. Most diets have 15 - 20% protein. What has your doctor said about protein intake in light of your kidney cancer?


I recently had a medical examination. The only problem that turned up was low iron. I forget the units, but my hemoglobin was 12.1. The doctor told me I should be 14 or more (for men). I hadn't thought I had a problem since I regularly donate blood. I have since found out that the Red Cross limit is 12, so I suppose I have just barely been making that.

I am a vegetarian and told the doctor and she gave me some iron pills to take. They will measure my blood again in a few weeks and see if my hemoglobin has improved.

So now my question: what should I eat and not eat to maximize absorption of the ferrous sulfate supplements in the short time I have? I'd like to know about anything that helps, even a little and anything that blocks absorption, even a little.

Thank you very much for your pages and your help.

First of all, quit donating blood until your hemoglobin gets back to the norm for men which is 14.0 to 18.0 gm / dl. That was probably obvious to you.

Iron is very important because it is responsible for transporting oxygen to muscles and organs, including your brain. If the iron content of the blood falls, a person may feel tired or have little energy, but that may not happen until the hemoglobin falls below 10 gm / dl.

Ironically, the body recycles iron from red blood cells as cells age and rupture, but iron is not often lost in males unless there is an injury where blood is lost or donated. Red blood cells last 120 days, so your hemoglobin turns over every 4 months. Your need for iron will be continuous.

Vegetarians often have normal hemoglobin, but low iron stores (ferritin) in liver, muscles and bone marrow. Iron absorption is improved by including Vitamin C (75 mg per meal or about 6 oz orange juice) along with an iron supplement (as much as 50 mg per day) and high iron foods. The ferrous form of iron is more absorbable than ferric.

Unfortunately, iron supplements often cause constipation. To offset that side effect, make sure you eat sufficient fiber (11.5 grams per 1,000 calories consumed) and drink enough water.

Phytates and oxalates can interfere with iron absorption from the gut, but the research is not conclusive on this subject. Phytates are found in bran and whole grains. Oxalates are high in nut and nut butters, beets and beet greens, tea, strawberries, gelatin, rhubarb, spinach, chocolate and wheat bran. Most of these foods are the very substance of a vegetarian diet.

Iron in non-meat foods is called non-heme iron. Vegetarians should eat dark green leafy vegetables, broccoli, legumes, yeast leavened whole grain breads, iron-enriched pasta, rice and cereal and meat analogs which are high in iron. Unfortunately, the iron in these foods is not as absorbable as the iron in meat.

But foods rich in Vitamin C (papaya, orange, cantaloupe, broccoli, brussel sprouts, raw green peppers, grapefruit, strawberries, etc.) can be as effective as meat meals in improving iron absorption. Remember though sunlight and heat destroy that Vitamin C.

A diet high in milk or milk products can increase iron deficiency because these are high protein, low iron foods and filling. There are soy beverages high in iron available (also iron fortified infant soy formulas) that you could drink. Look for one to compliment your vegetarian diet.

Cook in cast iron pans as that will increase the iron content of your diet. However, this form of iron is not absorbed very well.

Tetracycline is often used to treat acne or infection, interfere with iron absorption.


Given an active male who eats a well-balanced diet, including red meat, green, leafy vegetables, and whole grains, and, who additionally supplements his diet with a multi-vitamin, should he choose a multi which does not contain iron?

I'm suggesting that he is getting plenty of iron in his normal diet. I think I read that too much iron can be toxic...is this correct?

Yes. Should a man feel the need to take a multivitamin, he should choose a multivitamin without iron. A man who is not losing blood can get enough iron from food to meet their Recommended Dietary Allowance for iron without taking a multivitamin. Research has indicated that men with high iron in their blood which can be due to either taking iron supplements or a multivitamin with iron are at increased risk of a heart attack.


I take a multivitamin to supplement my diet. I have read, on a couple of occasions (don't ask me where), that men should use a multivitamin which does not contain iron. The reason, if I remember correctly, was that men could get their RDA of iron from their normal diet. Is this true?

Men who eat red meats, iron rich whole grains and green leafy vegetables can probably meet their iron RDA (10 mg per day). Men do not lose iron except through the gut unlike women who through their monthly menses lose iron and therefore have a higher iron RDA (18 mg per day).

There has been some recent research suggesting that iron fortification of foods may not be necessary and may increase a person's risk of heart attack.




I was recently told I have low saturation levels of iron in my blood, although I am not anemic at the present time. I also have recently been diagnosed with an adrenal tumor that, so far, tests have shown to be benign. I have no systemic indications of malignancy. I'm being followed with a CT scan in two months. All other tests have been in the normal range.

I started a low fat diet about five weeks ago, limiting myself to less than 25 grams a day. I also walk on a treadmill, at three mph, for 30 minutes a day. My weight dropped from 228 to 215 and has stayed there for two weeks. I'm 5'8" tall and 49 years old. What is my healthy weight? Also, could the drastic reduction in fat intake (trust me, it was drastic), have contributed to the low iron saturation?

Also, how can I increase the protein in my diet without sabotaging the fat intake?

Are daily multivitamins a good idea for me?

By low iron saturation, do you mean transferrin saturation? Transferrin is a protein molecule in the blood that transports iron and controls the amounts and where iron is in the body. Low Transferrin saturation can produce iron deficiency anemia.

If in reducing fat, you also reduced red meats than you probably also reduced the iron content of your diet. Have you reduced calories also? You are eating 225 fat calories (25 grams times 9 calories per gram) which if fat represented 25% of calories you would be eating 900 calories per day. Eating less food will also reduce your intake of all nutrients. Yes one daily multiple vitamin may be indicated. Considering you have a current health problem, I suggest you consult your doctor.

Four cooked ounces of lean red meats, poultry and fish that are good sources of protein should fulfill your protein needs along with 2 cups of skim milk daily. A 3 - 4 ounce piece of meat should be as big as the back of your hand and as thick as your little finger. Use this technique to judge meat portions.

Your "healthy body weight" is 136 to 176 pounds. See the calculations in the Overweight topic. If you are not reducing calories along with fat, that may be the reason for your weight plateau for the last 2 weeks. Keep exercising with your doctor's approval. I would suggest you see a registered dietitian for assistance in planning your diet to include all your nutrition and health issues.


Under our federal guidelines for WIC (Women, Infants and Children), we can only give out iron fortified formula until 12 months of age. Every so often we hear from parents that a doctor told them that they don't need iron fortified formula because they will pick up iron from the rural well water they use. Most of our area has a lot of iron in the water. This poses a problem for our WIC clients and us.

Current iron recommendations for infants under the age of one year is iron fortified formula or breast milk. Iron deficiency anemia is the most common nutritional deficiency in children. WIC (Women, Infants and Children) is a federal program whose main purpose is providing iron, calcium, vitamin D and vitamin C rich foods to prevent anemia and rickets in children. This program covers pregnant and breastfeeding women, infants and children up to the age of five. It is very effective in the public health role it serves.

When babies are born, they have enough iron to last four months. This is assuming that the mother had adequate iron in her diet. The baby's system is connected to the mother's system by the umbilical cord. The mother's iron stores serves as an iron pool for the baby's production of hemoglobin, which is the oxygen carrier of red blood cells. Without an adequate amount of iron, the hemoglobin cannot carry enough oxygen to body tissues. The result is iron deficiency anemia with symptoms of tiredness and weakness.

Red blood cells that carry iron-rich hemoglobin, live only 120 days or four months. Unless there is a continual supply of iron, vitamin B12, vitamin C and folacin from either food or supplements, anemia will result in poorly formed red blood cells that are ineffective carriers of oxygen.

The main source of food for an infant from birth to one year of age is breast milk or infant formula. Breast milk is low in iron, but because breast milk is higher in lactose and contains vitamin C, the iron is better-absorbed (48% absorbed). Cow's milk, which is the basis for most infant formula, is low in iron and vitamin C. Because of this lower iron content, infant formula companies fortify formula with iron and vitamin C.

Because babies are not started on solid foods until four to six months, babies must rely on breast milk or iron fortified formulas to prevent iron deficiency anemia. Pabulum cereals are usually iron fortified to help supplement the infant's iron intake. Iron rich foods like liver and red meats are usually not fed to babies until eight to nine months of age. Also, the quantity of iron rich foods needed to prevent anemia in infants under the age of one, is more than an infant could usually eat.

The iron in hard water is not the form of iron that a person can absorb. I would not suggest anyone rely on hard well water for an adequate iron intake, especially infants. I would suggest that you discuss this with the doctor who is not recommending iron-fortified formula.

In addition, well water in many areas of the United States, is deficient in fluoride, which is necessary to form hard enamel on teeth. Pregnant women, infants and children up to the age of 12 should take fluoride supplements unless they are on fluoridated city water. This preventive fluoridation has significantly reduced the number of dental cavities in the last 15 years.




I read in a parent's magazine that cooking spaghetti sauce in a cast iron pot adds a lot of iron. Is that iron the kind that is absorbed?

It is true that foods cooked in cast iron skillets are higher in iron. However, the form of iron is not absorbed as well. Laboratory nutrient analysis techniques do detect the iron contributed by food cooked in cast iron pans, but the techniques are not able to separate out how much iron is absorbed. Also, absorption varies from individual to individual.

Non-heme iron (ferric) is highly variable in its availability for absorption. Foods high in non-heme iron are grains, vegetables, fruits, eggs and some iron supplements. Absorption of non-heme iron increases in the stomach's acidic environment and the presence of vitamin C in foods. Also, the present of meat would increase absorption of non-heme iron four times. However, oxalates and phytates found in dark green leafy vegetables and whole cereal grains decreases the absorption of iron because they bind with iron in the gastrointestinal tract.

Heme iron (ferrous), found in red muscle meats of animals, is far more effectively absorbed. The absorption of heme iron is influenced by other foods in the diet such as foods containing vitamin C and an acid environment like the stomach.

In contrast, cast iron pans degrade vitamin C. Another consideration is that the amount of hydrochloric acid, which would also favor better iron absorption, decreases with aging.

I would not recommend you depend on cast iron skillets for a significant amount of iron in your diet.

If you feel the need to take an iron supplement, take a ferrous sulfate supplement. I would recommend that persons avoiding red meat or any vegetarian take an iron supplement to prevent iron deficiency anemia.


How would a person get their daily iron requirement if that person eats a balanced diet, but eats no meat?

The Recommended Dietary Allowance (RDA) for iron is 10 milligrams for adult males and postmenopausal females. Males (ages 11 to 18) need 12 milligrams of iron per day. Females (ages 11 to 50 years) need 15 milligrams.

The best food source of iron is liver and red meats. These foods contain heme iron, which is better absorbed than non-heme iron. Non-heme iron can be found in dark green, leafy vegetables (spinach, chard and kale) and whole cereal grains (bran and whole wheat bread). However, oxalates and phytates found in dark green leafy vegetables and whole cereal grains decreases the absorption of iron because they bind with iron in the gastrointestinal tract.

If you choose not to eat meat, I would suggest you include dark green, leafy vegetables and whole cereal grains in your daily diet. You should also look at iron fortified cereals to supplement iron in your diet. Also, if you were a menstruating woman, I would suggest you contact your doctor about an annual blood work. You may not develop anemia on a meat-free diet, but your iron stores may be low.






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