IRON SHORTAGE

Iron is an essential element for the organism. Living organisms, from primitive to more complex life forms, need this element for various biological reactions e.g.  mitochondrial respiration (mitochondria are responsible for cellular respiration), cell proliferation and synthesis of proteins such as haemoglobin and myoglobin. Iron levels must therefore be finely regulated by an adequate homeostasis balance which allows cells to use iron and avoid harmful effects. Hepcidin, a hormone produced by the liver, is the main regulator of iron homeostasis. Fluctuations in hepcidin levels are closely correlated with serum levels of ferritin.

Iron is the trace element that has the highest level in the human body. In a healthy adult there are about 3-4 g of iron (on average 3 g in women and 4 g in man). About 60/70% of iron, is contained in the red pigment of the blood (haemoglobin). 20-30% is present in ferritin (protein involved in iron storage), and the rest in myoglobin (protein that transports oxygen to cells in the heart and muscles) and in metabolism proteins.

The amount of iron needed for a healthy adult man corresponds to about 10 mg per day, while for a healthy woman it is greater (about 15-18 mg). The need for iron is greater in certain periods of life e.g. childhood, pregnancy, breastfeeding and if there is chronic blood loss. The table summarizes the recommended intake levels (LARs) for the adult population according to the LARN (Nutrient and Energy Reference Intake Levels for the Italian population).

In some individuals, the risk of an iron deficiency is higher and may occur as a result of:

  • Increased need: pregnancy, breastfeeding, growth and development in adolescents, competitive sports, regular blood donations.
  • Strong blood loss: after childbirth, hypermenorrhoea (abundant menstrual cycle), chronic bleeding (for example of the gastrointestinal tract for esophagitis, inflammatory diseases such as Crohn’s disease, erosive gastritis etc.), haemorrhage after surgery.
  • Insufficient intake with diet: unbalanced diet, vegetarian diet.
  • Chronic diseases: chronic heart disease, oncological diseases, chronic kidney disease.

Other causes of iron-anaemia are summarized in the table.

IRON DEFICIENCY SYMPTOMS

We have seen that iron is involved in many processes of the body: oxygen transport in blood, muscle activity and protein metabolism. This explains why the symptoms of iron deficiency can be multiple and often nonspecific. The most common symptoms associated with an iron deficiency are:

  • asthenia: feeling tired, weak or lack of energy/strength, fatigue and stress (dyspnoea)
  • hair loss and weak nails
  • restless leg syndrome: a disorder that causes an urgent and irresistible need to move the legs, often accompanied by “unpleasant” sensations in the legs. Symptoms subside by moving the legs
  • heat regulation impairment: Low tolerance to cold. Iron appears to be associated with the mechanism that regulates body temperature
  • headache, angina, heart failure
  • pallor
  • increased disposition to infections

What are the biochemical signals of iron deficiency?
– Steric ferritin value less than 15 mg/dl.
– Sideremia (concentration of transport iron within the blood) less than 60 mg/dl.

Iron deficiency can turn into sideropenic anemia. This occurs when, in addition to lack of ferritin and sideremia, there is also a decrease in haemoglobin levels (values less than 12 g/dl for women and 14 for men).

Anemia is a very frequent complication in patients suffering from oncological diseases, both at the time of diagnosis and during therapeutic treatment. The European Cancer Anaemia Survey (ECAS) investigated the prevalence, incidence and treatment of anemia in cancer patients. It was observed that 39% of patients had anemia at the time of diagnosis, while 67% developed the disease during chemotherapy. There can be many causes of anemia in these patients but in a lot of cases, it is due to iron deficiency.

Iron-based drugs for oral or intravenous administration are available to treat iron deficiency and sideropenic anemia. Oral iron administration is the most widely used, based on the intake of iron salts including: iron sulphate, gluconate and fumarate. Some side effects may be associated with therapy, such as nausea, vomiting, constipation and a “metallic taste” in the mouth.

Intravenous administration is more effective than oral therapy and it increases iron and haemoglobin levels more quickly. However, there may be some side effects such as: nausea, vomiting, itching, headaches, muscular pain and chest/back pains.

The doctor will decide if drug therapy is necessary and the type of administration. Keep in mind that proper nutrition can have a positive impact by increasing the amount of iron and its absorption. Proper nutrition is not a substitute for prescribed drug therapy, but it can be a valid supplement.

IRON INTAKE FROM FOOD
The iron in our body comes from dietary intake. A balance is maintained between absorption and daily loss.After the iron has been absorbed by the intestine, it is broken down into various compartments of the body for synthesis, storage and transport. Since it is not possible to control its elimination, the amount of iron in the body is regulated by the control of its absorption. About 1-2 mg of iron per day is lost through skin, gastrointestinal mucosa and urogenital tract.

Iron is present in many foods, but the amount of iron that can actually be absorbed and used varies depending on the source. There are two kinds of iron in food:

  • HEME IRON, also called “animal iron”, is linked to a molecule of haemoglobin or myoglobin. It makes up about 40% of the iron contained in animal foods (meat and fish). This type of iron is easily absorbed (20 to 40% in healthy subjects).
  • NON- HEME IRON, also called “plant iron” is not assimilated by It makes up 60% of the iron contained in animal tissues and the totality of that found in plant foods. The amount of iron contained in vegetables that can be absorbed by the body is less than 5% due to the presence of substances that interfere with the use of mineral salts (especially tannins and phytos). This percentage can increase by up to 10-20% thanks to the presence of certain substances that positively affect the absorption as described below. As a result, the absorption of non-hemic iron is strongly influenced by the rest of the diet.

IRON IN FOODS
The table lists foods high in iron and are shown in each group in descending order, from the richest to the poorest.

It is generally thought that the best food to get iron from is red meat. The highest iron content is found mainly in beef, pig and horse (liver, spleen, kidney, lung and heart). Some meats which contain a large amount of iron are: pheasant meat (8.1 mg/100 g), hare (6.2 mg/100 g), and horse (3.1 mg/100 g). White meat (poultry meat) contains on average just under 1 mg of iron per 100 g, but it depends on the chosen cut. The muscle tissue which contains most iron is the thigh.

Taking into account the recommendations of the WCRF (World Cancer Research Fund), the intake of red meat should be limited.

What are other sources of iron? Regarding animals, a good source are clams which provide as much as 14 mg per 100 g. You must not underestimate the iron content in salted mussels and anchovies, equal to 5.8 and 6.9 mg per 100g of product respectively. Since these foods are of animal origin, they contain a good quantity of heme iron, which is easily assimilated by the organism. Be careful as clams and mussels have a high level of cholesterol (50mg/100g for clams and 121 mg/100g for mussels).

As you can see from the table, many foods containing iron, are of plant origin. Vegetable iron is non-hemic iron, which is not absorbed by the human organism. As previously illustrated, phytos and tannins interfere with food digestion or metabolic functioning at the gastrointestinal, brain or hormonal level.

Phytoes are compounds that capture mineral salts, making them absorbable, through a chemical mechanism called chelation. They are present in legumes, cereals and cocoa powder. To try to reduce the presence of phytoes you have to follow some indications. As for dry legumes, the long soaking of the seeds ensures the removal of most of the phytoes. It is better to soak the legumes overnight, changing the water at least once or twice. Cooking and removing the ‘foam’ that is created during cooking is another useful method to ward off the phytoes. For this reason, it is always good to cook legumes for a long time and this also applies to whole grains.

Tannins, polyphenol substances synthesized in plants (particularly in the bark), are mainly contained in: tea, coffee, grapes, persimmons (just ripe) and wine. It is therefore not recommended to drink tea, coffee and wine during an iron-rich meal, as these antinutrients seize iron and make it absorable.

Fortunately, there are some substances that can increase the absorption of iron at the intestinal level. The introduction in the same meal of small amounts of fermented (e.g. homemade sauerkraut or miso), citric acid (lemon), ascorbic acid (vitamin C of vegetables) or even organic acids contained for example in tamari (soya sauce), also increases the absorbability of non-heme iron by up to 20%.

Herbs and spices are very rich in iron. When dried, they contain 30 to 120 mg per 100g of product, while fresh ones contain an average of 10-20 per 100g of product. Although the amount consumed is minimal, their constant use can be a valid source. They can be used to flavor the dishes, with the aim of limiting the use of kitchen salt. Another source of iron is brewer’s yeast (4.9 mg/100 g) which can be used to season salads or cooked vegetables. It is a good alternative to salt.

PROCEDURE

  • Wash chickpeas in running water for 2 minutes.
  • Cover them with water in a container and place in fridge for at least 8/12 hours.
  • Drain and carefully rinse again.
  • The chickpeas will double in size so place them in a large saucepan. Add half quantity of extra virgin oil, a whole clove of garlic and the aromas to taste.
  • Toast them a little under gentle heat and at same time, stir with a kitchen spoon.
  • Add the glass of white wine.
  • Cook over a gentle heat for about one hour and half. Add some water from time to time to keep them covered with liquid.
  • Add salt, remove the aromas and blend into a smooth cream with some of water used while cooking.
  • Brown garlic, chilli and rosemary with other half of virgin olive oil. Add to chickpea puree
  • Blend dried tomatoes until you get a puree.
  • Pour the chickpea puree on hot plates.
  • Garnish with rosemary, dried tomato puree and serve.

The remaining glass of wine is for you!

HEME OR NOT HEME … THIS IS THE QUESTION!

As we have seen before, iron can be found in two form in food: heme and non-heme.
Non-heme iron is mostly found in vegetables and it is less absorbed.  However, this does not mean that iron can’t be absorbed from plant-based foods.
This is a very tasty second dish. It is made with chickpeas and contains a fair amount of iron.
To be able to absorb this precious element in greater quantities, small measures should be taken:
– Soak the dry legume before cooking so as to limit phytic acid
– Consume the dish with foods containing vitamin C e.g. citrus fruits, kiwis, cabbage, peppers, rocket and lettuce. They can help increase iron absorption up to six times
– Avoid drinking coffee, tea, milk and derivatives with this dish.

Remember when you consume legumes or foods which are rash in iron, to follow these simple rules: Combine iron rich food with vitamin C foods, avoid coffee, tea, milk and derivatives. This is very important as it will allow you to have an iron intake not only from animal foods, but also from the non-animal sources thus ensuring a varied and healthy diet.