Iron is an essential component of haemoglobin, transporting oxygen in the blood to all parts of the body. It also plays a vital role in many metabolic reactions. Iron is essential for the formation of haemoglobin, the red pigment in blood. The iron in haemoglobin combines with oxygen and transports it through the blood to the body's tissues and organs. The body contains between 3.5 and 4.5g of iron, 2/3 of which is present in haemoglobin. The remainder is stored in the liver, spleen and bone-marrow. A small amount is present as myoglobin, which acts as an oxygen store in muscle tissue. Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues. Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in enzymes that assist biochemical reactions.
Dietary iron exists in two different forms. Haem iron only exists in animal tissues, whilst in plant foods iron is present as non-haem iron. In a mixed omnivore diet around 25% of dietary iron is non-haem iron. Non-haem iron is less easily absorbed by the body than is haem iron. The amount of iron absorbed from various foods ranges from around 1 to 10% from plant foods and 10 to 20% from animal foods.
Iron, one of the most abundant metals on Earth, is essential to most life forms and to normal human physiology. Iron is an integral part of many proteins and enzymes that maintain good health. In humans, iron is an essential component of proteins involved in oxygen transport.. It is also essential for the regulation of cell growth and differentiation. A deficiency of iron limits oxygen delivery to cells, resulting in fatigue, poor work performance, and decreased immunity. On the other hand, excess amounts of iron can result in toxicity and even death.
Iron is also found in proteins that store iron for future needs and that transport iron in blood. Iron stores are regulated by intestinal iron absorption. The absorption of iron is influenced by other constituents of a meal. Phytates, oxalates and phosphates present in plant foods can inhibit absorption, as can tannin in tea. Iron absorption refers to the amount of dietary iron that the body obtains and uses from food. Healthy adults absorb about 10% to 15% of dietary iron, but individual absorption is influenced by several factors. Fibre may also inhibit absorption. Vitamin C greatly increases the absorption of non-haem iron. Foods rich in vitamin C include citrus fruits, green peppers, and fresh leafy green vegetables. Citric acid, sugars, amino acids and alcohol can also promote iron absorption. Iron absorption can also be influenced by the amount of iron in the diet. Lowered levels of iron in the diet result in improved absorption.
Good sources of iron for vegetarians include wholegrain cereals and flours, leafy green vegetables, blackstrap molasses, pulses such as lentils and kidney beans, and some dried fruits. Heme iron is derived from hemoglobin, the protein in red blood cells that delivers oxygen to cells. Heme iron is found in animal foods that originally contained hemoglobin, such as red meats, fish, and poultry. Iron in plant foods such as lentils and beans is arranged in a chemical structure called nonheme iron. This is the form of iron added to iron-enriched and iron-fortified foods. Heme iron is absorbed better than nonheme iron, but most dietary iron is nonheme iron.
Storage levels of iron have the greatest influence on iron absorption. Iron absorption increases when body stores are low. When iron stores are high, absorption decreases to help protect against toxic effects of iron overload. Iron absorption is also influenced by the type of dietary iron consumed. Absorption of heme iron from meat proteins is efficient. Absorption of heme iron ranges from 15% to 35%, and is not significantly affected by diet. In contrast, 2% to 20% of nonheme iron in plant foods such as rice, maize, black beans, soybeans and wheat is absorbed. Nonheme iron absorption is significantly influenced by various food components.
Meat proteins and vitamin C will improve the absorption of nonheme iron. Tannins (found in tea), calcium, polyphenols, and phytates (found in legumes and whole grains) can decrease absorption of nonheme iron. Some proteins found in soybeans also inhibit nonheme iron absorption. It is most important to include foods that enhance nonheme iron absorption when daily iron intake is less than recommended, when iron losses are high (which may occur with heavy menstrual losses), when iron requirements are high (as in pregnancy), and when only vegetarian nonheme sources of iron are consumed.
Iron deficiency develops gradually and usually begins with a negative iron balance, when iron intake does not meet the daily need for dietary iron. This negative balance initially depletes the storage form of iron while the blood hemoglobin level, a marker of iron status, remains normal. Iron deficiency anemia is an advanced stage of iron depletion. It occurs when storage sites of iron are deficient and blood levels of iron cannot meet daily needs. Blood hemoglobin levels are below normal with iron deficiency anemia.
Iron deficiency anemia can be associated with low dietary intake of iron, inadequate absorption of iron, or excessive blood loss. Women of childbearing age, pregnant women, preterm and low birth weight infants, older infants and toddlers, and teenage girls are at greatest risk of developing iron deficiency anemia because they have the greatest need for iron. Women with heavy menstrual losses can lose a significant amount of iron and are at considerable risk for iron deficiency. Adult men and post-menopausal women lose very little iron, and have a low risk of iron deficiency.
Vitamin A helps mobilize iron from its storage sites, so a deficiency of vitamin A limits the body's ability to use stored iron. This results in an "apparent" iron deficiency because hemoglobin levels are low even though the body can maintain normal amounts of stored iron. Chronic malabsorption can contribute to iron depletion and deficiency by limiting dietary iron absorption or by contributing to intestinal blood loss. Most iron is absorbed in the small intestines. Gastrointestinal disorders that result in inflammation of the small intestine may result in diarrhea, poor absorption of dietary iron, and iron depletion.
Signs of iron deficiency anemia include:
- feeling tired and weak
- decreased work and school performance
- slow cognitive and social development during childhood
- difficulty maintaining body temperature
- decreased immune function, which increases susceptibility to infection
- glossitis (an inflamed tongue)
Eating nonnutritive substances such as dirt and clay, often referred to as pica or geophagia, is sometimes seen in persons with iron deficiency. There is disagreement about the cause of this association. Some researchers believe that these eating abnormalities may result in an iron deficiency. Other researchers believe that iron deficiency may somehow increase the likelihood of these eating problems.
People with chronic infectious, inflammatory, or malignant disorders such as arthritis and cancer may become anemic. However, the anemia that occurs with inflammatory disorders differs from iron deficiency anemia and may not respond to iron supplements. Research suggests that inflammation may over-activate a protein involved in iron metabolism. This protein may inhibit iron absorption and reduce the amount of iron circulating in blood, resulting in anemia.
If a person is otherwise healthy, it can take some time for the signs of anaemia to appear.
- The first symptoms will be tiredness and palpitations (awareness of heartbeat).
- Shortness of breath and dizziness (fainting) are also common.
- If the anaemia is severe, you may experience angina (chest pain), headache or leg pains (intermittent claudication).
Besides these general symptoms of anaemia, in pronounced and long-term cases of iron deficiency there will be:
- burning sensation in the tongue
- dryness in the mouth and throat
- sores at the corners of the mouth
- altered sense of touch
- brittle, spoon-shaped nails with vertical stripes and a tendency to fray
- pica (an insatiable craving for a specific food, eg liquorice)
- brittle hair
- difficulty swallowing
In rare cases iron deficiency can cause permanent changes to the soft lining in the throat (Plummer-Vinson syndrome). This condition is a preliminary stage to cancer.
Iron tablets will rapidly reverse anaemia, so long as any underlying cause of blood loss has been treated. The tablets can irritate the stomach and should be taken after food to prevent this. Iron tablets may colour the stools black and cause constipation or diarrhoea. There may be a need for intramuscular iron injections to be given instead of tablets, but this is far less common.
- Three groups of people are most likely to benefit from iron supplements: people with a greater need for iron, individuals who tend to lose more iron, and people who do not absorb iron normally. These individuals include:
- pregnant women
- preterm and low birth weight infants
- older infants and toddlers
- teenage girls
- women of childbearing age, especially those with heavy menstrual losses
- people with renal failure, especially those undergoing routine dialysis
- people with gastrointestinal disorders who do not absorb iron normally
Celiac Disease and Crohn's Syndrome are associated with gastrointestinal malabsorption and may impair iron absorption. Iron supplementation may be needed if these conditions result in iron deficiency anemia.
Women taking oral contraceptives may experience less bleeding during their periods and have a lower risk of developing an iron deficiency. Women who use an intrauterine device (IUD) to prevent pregnancy may experience more bleeding and have a greater risk of developing an iron deficiency. If laboratory tests indicate iron deficiency anemia, iron supplements may be recommended.
Iron deficiency is uncommon among adult men and postmenopausal women. These individuals should only take iron supplements when prescribed by a physician because of their greater risk of iron overload. Iron overload is a condition in which excess iron is found in the blood and stored in organs such as the liver and heart. Iron overload is associated with several genetic diseases including hemochromatosis, which affects approximately 1 in 250 individuals of northern European descent. Individuals with hemochromatosis absorb iron very efficiently, which can result in a build up of excess iron and can cause organ damage such as cirrhosis of the liver and heart failure. Hemochromatosis is often not diagnosed until excess iron stores have damaged an organ. Iron supplementation may accelerate the effects of hemochromatosis, an important reason why adult men and postmenopausal women who are not iron deficient should avoid iron supplements. Individuals with blood disorders that require frequent blood transfusions are also at risk of iron overload and are usually advised to avoid iron supplements.
Nutrient needs should be met primarily through consuming foods. Foods provide an array of nutrients and other compounds that may have beneficial effects on health. In certain cases, fortified foods and dietary supplements may be useful sources of one or more nutrients that otherwise might be consumed in less than recommended amounts. However, dietary supplements, while recommended in some cases, cannot replace a healthful diet." It is important for anyone who is considering taking an iron supplement to first consider whether their needs are being met by natural dietary sources of heme and nonheme iron and foods fortified with iron, and to discuss their potential need for iron supplements with their physician or healthcare professional.
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