Unlike heme iron, it is difficult for the body to absorb nonheme iron from food because there are some chemical compounds that are found in food that inhibit the absorption of nonheme iron. It is widely known that phytates and polyphenols inhibit nonheme iron absorption. An example of a phytate that greatly inhibits nonheme iron absorption is sodium phytate, and after extensive investigation it was determined that it is the in vitro solubility characteristics of phytates that cause its inhibitory effects on nonheme iron absorption. Polyphenols, which are often found in tea, have an inhibitory effect on the absorption of nonheme iron because of their polymerization with iron and their consequent formation of insoluble complexes. (absorbic acid study)
There have been a lot of studies investigating substances that can inhibit/reduce the inhibition effects of phytate and polyphenols. Ascorbic acid is a major promoter of nonheme iron absorption. One study researched the effects of phytates and polyphenols and how many grams of ascorbic acid are needed to overcome their inhibitory effects. The experimenters made a few loaves of bread, each containing a different amount of phytate phosphorus (phytate P). The results showed that as the amount of phytate P in the bread increased the iron absorption ratio decreased. For example, when there was 14mg of phytate P in the bread the absorption ratio was 1.21, however when the phytate P content was increased to 22mg the absorption ratio was only .77. The absorption ratio decreased to .54 when the phytate P content was 58mg. Once the study established that phytates do indeed decrease nonheme iron absorption, they experimented with adding different contents of ascorbate. When 30mg of ascorbate was added the absorption ratio increased to 2.08. The absorption ratio increased to 2.97 when 50mg of ascorbate was added, and the absorption ratio increased to 3.21 when 150mg of ascorbate was added. The experimenters also tested the effect of polyphenols on iron absorption. They added various amounts of tannic acid to the flour that they used to make the bread. As noted above the phytate P decreased the nonheme iron absorption ratio, and the tannic acid had the same effect. However, tannic acid exhibits a greater inhibitory effect than the phytates. For example, 12mg of tannic acid decreased the absorption ratio to .70, and the absorption ration decreased to .22 when 263mg of tannic acid was added. The study concluded that you need at least 30mg or more of ascorbic acid to overcome the inhibitory effect of phytate phosphorus, and you need at least 50mg or more to overcome the effects of polyphenols.(ascorbic acid study)
Another substance that has been proved to decrease the inhibitory effects of phytates and polyphenols is vitamin A. In the study that we came across, the experimenters prepared two breakfast meals—one that contained vitamin A and the other lacking vitamin A. They had the subjects eat the different breakfast meals alone and with coffee, which contains polyphenols. The subjects who ate the breakfast meal with the vitamin A and coffee exhibited no apparent change in the amount of iron that was absorbed, which suggests that vitamin A inhibited the inhibitory effects of polyphenols. This fact was made even more apparent when the results showed that when the subjects ate the meals without vitamin A and with coffee exhibited a major decrease in iron absorption. (vitamin A Study)
We have mentioned that phytate and polyphenols inhibit the absorption of nonheme iron. Calcium is another substance that has been linked to a decrease in nonheme iron absorption, but unlike the factors mentioned before calcium also affects heme iron bioavailability. One study was reported to have shown that there was a fifty to sixty percent decrease in iron absorption from a breakfast meal when 500mg of calcium was added to it. Another study also reported similar results when supplemental calcium was added to meals with iron. Comparable results were also shown when dietary calcium was added to a meal with iron in it. (calcium study)
All the studies about the effect of calcium and the studies about the effect of phytates and polyphenols on iron absorption were all testing how these factors affect iron bioavailability in single meals, but none of these studies tested the affects of these factors in a complete meal composition.
There are many physical signs and symptoms of iron-deficiency anemia. A person suffering from severe iron-deficiency anemia will experience dizziness, fatigue, weakness, and headaches. They will also be very irritable, have pale skin and eyes, have a rapid heartbeat, and exhibit shortness of breath, especially when they exercise. However, these symptoms may not appear in a person who has mild anemia.
If the physical symptoms of iron-deficiency anemia are exhibited by the patient, their doctor will then most likely order blood tests and a complete blood count to check for the hematocrit levels, which is the percentage of your blood volume made up by red blood cells and hemoglobin. They will also check the hemoglobin levels, the size and color of red blood cells, the iron levels, the iron binding capacity in the blood, and the serum ferritin level, which is a protein that helps store iron in the body. If the hematocrit levels, hemoglobin levels, the iron levels, and the serum ferritin levels are low, and the red blood cells are small/pale and there is a high iron binding capacity in the blood then the patient is diagnosed with iron-deficiency anemia. After being diagnosed with iron-deficiency anemia, the patient’s physician determines the proper treatment based on several factors, which include the age, the overall health, and the medical history of the patient. Other factors that establish treatment take account of the extent and cause of the anemia, the patient’s tolerance for medications, procedures or therapies, and the patient’s expectations for the course of the anemia. (lumc.edu/health) Although all of these factors are considered when treating anemia, the first step for treatment usually starts by looking for and correcting the cause for low iron levels. For example, iron is lost through blood loss, so once the source of the blood loss is identified iron stores can be replaced in two ways if the patient has no problems absorbing iron. One of the ways to replace iron stores is for the patient to follow an iron-rich diet, which includes many dietary guidelines. Primarily, the patient should avoid eating calcium rich foods at the same time as iron-rich food because this can reduce the absorption of iron. Instead the patient should separate iron-rich meals from high calcium meals. Also, the patient should eat foods high in vitamin C because it increases iron absorption and is essential for the production of hemoglobin. Last but not least, the patient should eat foods rich in iron such as:
- Dried beans and peas (pinto beans, black-eyed peas, and canned baked beans)
- Dried fruits and nuts
- Green leafy vegetables (cabbage, broccoli, kale, turnip greens, and collards)
- Iron-fortified white breads, cereals, pasta, and rice
- Meats (beef, pork, lamb, liver, and other organ meats)
- Eggs and Poultry (chicken, duck, turkey, and liver)
- Fish (shellfish, including clams, mussels, and oysters, sardines, and anchovies)
Eating iron-rich foods is beneficial to the patient, however that alone will not correct the problem; they also need iron supplementation to help replace iron stores. (robots.cnn.co)
After undergoing treatment for iron-deficiency anemia there are usually no complications or long-term effects, nevertheless the patient should get regular follow-ups because there is a chance that the anemia can reoccur. However, if the anemia is left untreated for a long time then the anemia may become severe and lead to several health problems. For example, it may lead to a rapid or irregular heartbeat because your heart must pump more blood to compensate for the lack of oxygen in the blood when you are anemic. It can also cause angina, which is a chest pain caused by decreased oxygen and blood flow to the heart muscle, and in severe cases of untreated anemia the heart muscle may become permanently injured or weakened. Untreated iron-deficiency anemia can also cause problems during pregnancy. For instance, severe iron-deficiency anemia in pregnant women has been linked to premature births and low birth-weight babies. In infants and children, untreated anemia can cause physical and mental delays such as walking and talking, and it makes them more susceptible to lead poisoning and infection. (robots.cnn.com) These are just some of the many complications and long-term effects of untreated anemia, which can be easily prevented if the patient seeks treatment for their anemia immediately.
