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Doctors' Answers to "Frequently Asked Questions" - Iron Deficiency

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Iron Deficiency [posted 8/13/98]
Question: How can a male or menstruating female on a vegetarian diet of no red/white meats and no seafood avoid iron deficiency? Assume the diet includes daily whole grain products and fiber that can interfere with non-heme iron absorption. Also assume that essentially no heme-forms of iron are being absorbed through food intake. Is the recommendation for elemental iron of 10 milligrams per day for a male and 15 mg/day for a female something determined from people who get no heme-iron? What does 15 milligrams per day mean? If iron absorption is as inefficient as 2 percent to 10%, and can increase up to 30% when citric acid is present, how could a person normally know when their 300 milligram reserve of iron becomes depleted? How much iron normally comes from non-heme supplements added by food manufacturers to food used in a normal American vegetarian diet. A cereal, such as Coco Wheats, lists one serving as having over 90% RDA for iron. Is milligrams of iron listed for a food the average total iron atoms, in milligrams, measured as being present in an entire serving unit of that food? Who provides the official measure of milligrams normally available for digestive absorption, based on milligrams actually observed as being absorbed and resulting in changes to measured iron content in blood? Specifically, what is one to make of a listing of 5 milligrams of iron in one cup of cooked kidney beans? Is that from FDA laboratory spectral analysis measurements of total iron molecules present in one cup, or of chemical detection of iron? How much of that will the normal vegetarian male or female be able to convert into heme-iron for active and reserve body use? Suppose the one cup of beans is eaten with whole wheat bread by one person, another cup eaten with tomato sauce by another, another eaten plain and followed by a cup of coffee, another mixed with egg yolks in a salad. Are you aware of where measurements of such variations are available? The ongoing costs and troubles of taking enough self-measurements of iron to get a seasonal or monthly picture seems to be beyond what the average person would or should consider doing. Yet iron deficiency is supposed to be America's most common nutritional deficiency. What are the health deficiencies and organ reactions to different levels of iron deficiency and what would any levels trigger, especially in terms of immune system weakness and susceptibility to viral infections? Since the oxygen carrying/delivery system is quite diverse and large, how could change be measured on a systematic level? Iron deficiency seems to be popularly presented as a rather minor or harmless condition. Wouldn't lack of iron affect health from the mitochondrial level to the ability to maintain physical activities at work or as part of a group? Have iron deficiencies been observed to affect how the brain processes glucose? Iron nutrition calculation information seems to suggest that daily ingestion of iron from a source such a ferrous sulfate 325 milligram tablets is at the border of potential iron toxicity for males, but not, perhaps for females. With so much variableness in such calculations and figurings, have any actual measurements of iron in the blood of males and females eating a normal vegetarian diet and taking daily of every-other-day iron supplements been made? If so, what does the study suggest as any recommendation for a scheme of iron supplementation from a source such as iron sulfate tablets or food additives? Should a menstruating female follow pattern of supplementation near, at, or immediately after menstruation days - or a pattern that varies with the monthly cycle? Does iron toxicity result in fetal damage evident after birth? What senses enough iron in the body? What are your recommendations concerning iron levels and taking supplements for senior citizens medicated with ACE inhibitors, beta blockers, high blood pressure reducing compounds, or blood thinners or anticoagulants? Does taking aspirin and acetaminophen affect iron?

Answer: Avoiding iron deficiency is difficult in vegetarian women, especially if they have heavy periods. About the only way to do it is to take iron supplements. Iron has no effect on pregnancy other than to help the blood counts. The major symptoms of iron deficiency are fatigue and there are few organs affected unless the anemia is severe which is unusual. Costs of iron replacement are really pretty minimal. Men rarely need iron replacement since they do not lose blood monthly.

Iron Deficiency
Question: Could you explain a test result listed as abnormal TIBC of 405. (in a 45 year old female)

Answer: It would depend a great deal on what the Serum Iron is. That is, a low iron level would show iron deficiency(common in menstruating females) and the body responds by elevating TIBC to try to compensate. A high iron and a high iron binding should suggest further testing to rule out hemochromotosis, which is an inherited iron storage disease. However, this is rare and with your age, I suspect that you are merely moderately iron deficient.
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