Iron is a mineral that is naturally present in many foods, added to some food products, and available as a dietary supplement. Iron is an essential component of hemoglobin, an erythrocyte protein that transfers oxygen from the lungs to the tissues. Iron supports metabolism. Iron is also necessary for growth, development, normal cellular functioning, and synthesis of some hormones and connective tissue. Intake recommendations for iron and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies (formerly National Academy of Sciences)
Recommended Dietary Allowance (RDA): average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals.
- Adequate Intake (AI): established when evidence is insufficient to develop an RDA; intake at this level is assumed to ensure nutritional adequacy.
- Estimated Average Requirement (EAR): average daily level of intake estimated to meet the requirements of 50% of healthy individuals. It is usually used to assess the adequacy of nutrient intakes in population groups but not individuals.
- Tolerable Upper Intake Level (UL): maximum daily intake unlikely to cause adverse health effects.
Fortified grain products have been used as a way of meeting daily iron needs. In the United States, about half of dietary iron comes from processed grains, including bread, cereal, and other grain products.
Iron depletion and deficiency progresses through several stages:
- Mild deficiency or storage iron depletion: Serum ferritin concentrations and levels of iron in bone marrow decrease.
- Marginal deficiency, mild functional deficiency, or iron-deficient erythropoiesis (erythrocyte production): Iron stores are depleted, iron supply to erythropoietic cells and transferrin saturation decline, but hemoglobin levels are usually within the normal range. In addition, plasma iron levels decline and plasma transferrin concentrations (measured by plasma total iron-binding capacity) rise, resulting in decreased transferrin saturation. Serum transferrin receptor concentrations also increase.
- IDA: Iron stores are exhausted; hematocrit and levels of hemoglobin decline; and the resulting microcytic, hypochromic anemia is characterized by small red blood cells with low hemoglobin concentrations.
Breast milk contains highly bioavailable iron but in amounts that are stated not to be sufficient to meet the needs of infants older than 4 to 6 months.
Important to know, frequent breast milk feedings will increase the amount of iron the baby receives through breast milk. Doctors often recommend that babies be breastfed on a schedule every three hours. I breastfed my children on demand, and as infants they often nursed every hour. Babies nursing on demand will be ingesting at least twice as much iron, and since the body can store iron, there will be more iron kept on reserve. I encourage mothers to nurse their babies on demand. Only your baby will know what nourishment he or she needs and how often it’s required for optimal health and development.
For nutritious breast milk, mother needs to make sure to include iron rich foods such as plenty of leafy green vegetables, pumpkin seeds, mulberries, watermelon and more.
The most common form of iron supplementation for infants is grain cereal such as rice cereal. This refined product has little to no nutrition and is an acid-forming food. The iron in these cereals is poorly absorbed, and this is an unnatural food choice which may be linked to cancer. We want to give our children their first foods to maximize their nutrition and minimize their toxic load. Nourishment should be in the form of whole plant food, extremely nutritious, instead of supplement pills and drops.
Soon after your child begins eating solid foods such as bite-sized pieces of ripe raw fruit, green smoothies and green juices should follow. Green smoothies are a fun and delicious way to get the iron rich leafy green vegetables into your child’s diet. Parsley has a high iron content and can be used in green juices. Later, it can be chopped finely in some raw recipes such as the middle eastern dish called tabbouleh.
Because Vitamin C enhances iron absorption, including Vitamin C rich foods at the same meal with foods containing high amounts of iron is wise. Berries and orange in a smoothie with leafy green vegetables insures this excellent combination.
Acute intakes of more than 20 mg/kg iron from supplements or medicines can lead to gastric upset, constipation, nausea, abdominal pain, vomiting, and faintness, especially if food is not taken at the same time. Taking supplements containing 25 mg elemental iron or more can also reduce zinc absorption and plasma zinc concentrations. In severe cases (e.g., one-time ingestions of 60 mg/kg), overdoses of iron can lead to multisystem organ failure, coma, convulsions, and even death.
Overdosing on iron supplements may cause gastrointestinal symptoms within the first six hours after ingestion. You may also experience a weak and rapid pulse, low blood pressure, fever or difficulty breathing. If the illness does not subside, the symptoms can elevate to failure of your cardiovascular, kidney, liver or central nervous system, and leave long-term damage.
Symptoms of an iron overdose include nausea, diarrhea, black stools, vomiting blood, a metallic taste in your mouth, stomach pain, fever and headache, which sometimes but not always occur within an hour of taking too many iron supplements. If you don’t get treatment, more severe overdose symptoms may include dizziness, chills, drowsiness, pale or flushed skin, fast or weak pulse and low blood pressure.
Iron supplements need to have “strong warning labels” because of the harmful side effects. There have apparently been deaths from iron supplementation as well.
“FDA currently requires that iron-containing dietary supplements sold in solid form (e.g., tablets or capsules but not powders) carry the following label statement: “WARNING: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose, call a doctor or poison control center immediately.”
The federal government’s 2010 Dietary Guidelines for Americans notes that, “Nutrients should come primarily from foods. Foods in nutrient-dense, mostly intact forms contain the essential vitamins and minerals that are often contained in nutrient supplements.”
Ranzi, Karen. Creating Healthy Children: Through Attachment Parenting and Raw Foods. Ramsey, NJ: SHC Publishing, 2010.
By Karen Ranzi, M.A. with Intern Nicole Ramirez