Iron Out Your Intake
Women are often deficient in this essential mineral. Are you getting enough?

By Annette Spence

Isn't it ironic? Women need more iron than men, but men are more likely to eat the richest source of iron: red meat. Women may lose 15 to 20 mg of iron each month during menstruation, but they're also more likely to diet and limit the foods that help them get the minerals they need.

In fact, it's common for women's iron levels to drop too low during their menstrual years: An estimated 16 percent of U.S. women are depleted of this essential mineral and therefore at risk for anemia. And supplementing with iron isn't always the answer. In adults, high intake of iron supplements is associated with constipation, nausea, vomiting, and diarrhea. Some people are even at risk, often unwittingly, from a genetic disorder causing the body to absorb large amounts of the mineral; an iron overload for these people could lead to severe problems such as liver disease or heart failure (see "Are You Predisposed to Iron Overload?".

Mineral matters: Many menstruating women have an iron deficiency, signaled by fatigue, pale skin, shortness of breath, light-headedness, and cold hands and feet. On the other hand, postmenopausal women are at risk for excessive iron intake. Where do you stand? Of course, polishing off a porterhouse isn't the only way to ensure you get enough iron. Dried beans or peas, leafy green vegetables, fortified cereals, seafood, and poultry are other options. And the good news is, the body is amazingly efficient at obtaining and storing enough iron to stay healthy, as long as iron-rich foods are consistently on the menu. Here's what you need to know to keep your levels in check.

Mighty Mineral
Think back to the chicken you had for dinner last night or the spinach salad at lunch. Both were rich sources of iron, essential for its role in helping red blood cells deliver oxygen to the body. Iron is used in the production of hemoglobin, a component of red blood cells, which carry oxygen from the lungs to the organs and tissues.

For healthy postmenopausal women and for men 19 or older, the daily iron requirement is 8 to 10 mg. That means getting enough of the mineral from a balanced diet is rarely a problem. A three-ounce portion of chicken contains 1 mg of iron; a cup of enriched rice, 2 mg; a half-cup of spinach, 2 mg. With all the iron-fortified cereals and breads on the market today, "there's not much concern that men or nonmenstruating women will become iron deficient," says Arianna Staruch, MD, a naturopathic physician with Transitions for Health Women's Institute in Portland, Ore.

But for others, getting sufficient iron is more of a challenge because their needs are much greater. Women ages 19 to 51 need 18 mg of iron per day, while girls ages 14 to 18 require 15 mg daily. Pregnant women need a whopping 27 mg each day.

Other variables can enter the iron equation. Women who experience heavy menstrual bleeding (soaking a pad every two hours) are at higher risk for iron deficiency, as are people with hidden sources of bleeding within the body (hemorrhoids, uterine fibroids, ulcers). Vegans need to be particularly vigilant about getting enough iron because their food choices provide fewer options for efficient iron intake. Marathon runners also may need additional iron to replenish minerals lost through prolonged physical exertion.

Among the richest plant sources of iron are fortified cereals, whole-grain breads and pastas, beans, peas and dark green leafy vegetables. If the body doesn't get sufficient iron in the diet, it can temporarily rely on the iron it stores away for such shortages. About 15 percent of the body's iron is reserved for future needs and mobilized when dietary intake is inadequate. However, if iron intake continues to be deficient, the body won't be able to make sufficient hemoglobin, and the red blood cells won't be able to get adequate oxygen to the tissues. The deficiency could lead to iron-deficiency anemia, with symptoms including fatigue, pale skin, shortness of breath, lightheadedness, and cold hands and feet.

It's possible to be mildly deficient in iron and not develop anemia. Full-blown anemia is rare, while partial deficiency is widespread. Initially, iron deficiency can be so mild as to go unnoticed. But as the condition progresses, signs and symptoms increase. A person with severe deficiency may experience cracks in the sides of the mouth, brittle fingernails, difficulty in swallowing, or irregular heartbeat. In severe cases of untreated anemia, the heart muscle may become permanently injured or weakened. In pregnant women, severe iron deficiency anemia has been linked to premature births and low-birth-weight babies.

What To Do
If you experience symptoms of iron deficiency or have questions about your iron intake, you should see your health care practitioner. For most people, though, getting enough iron is a matter of taking your particular needs into account and adjusting your diet accordingly. Here's how:

Choose foods wisely. Hands down, red meat is the richest source of iron. In fact, the heme iron found in animal foods (fish, seafood, poultry, eggs) is more easily absorbed by the body than the nonheme iron found in plant foods such as spinach or beans. "Heme iron is closer to the iron in the hemoglobin that we have in our own bodies, so there's less conversion of the nutrients that needs to happen," explains Felicia Busch, RD, a nutritionist from St. Paul, Minn., and spokesperson for the American Dietetic Association. But you don't have to eat a big juicy steak to meet your iron quota; lean meat is actually preferable to a fatty cut, since iron is most plentiful in the muscle portion of the meat. Among the richest plant sources of iron are fortified cereals, whole-grain breads, and pastas. Other sources include beans, peas, dark green leafy vegetables such as Swiss chard and kale, tofu, dried fruits and raisins, nuts and seeds.

Mix and match. Especially for nonmeat-eaters, choosing a variety of foods—and paying attention to certain combinations of foods—can maximize iron intake. For example, eating foods rich in vitamin C along with an iron-rich food source increases iron absorption in the body. Try adding mandarin oranges to a spinach salad. Make chili with beans and tomato sauce. Have red, black, and pinto beans with stewed tomatoes on a flour tortilla. Drink orange juice along with your iron-fortified cereal. Adding molasses to food or cooking with iron pots can also boost your meal's mineral content. (This will also boost iron content for everyone else in the household; men and seniors need to be wary of too much iron.)

You may want to think twice before drinking coffee or tea with your meal, however. Tannins and other substances in coffee and tea may bind with the iron and reduce absorption as much as 40 percent to 65 percent.

How about iron supplements? Physicians routinely recommend iron supplements for pregnant women, due to the needs of the growing fetus and blood loss during childbirth. But unless a doctor diagnoses iron deficiency and prescribes an iron pill, supplements are not recommended for most people. The concern is that supplement-takers will quickly get too much iron, leading to constipation, abdominal pain, drowsiness, and stained teeth (see "Pumping Too Much Iron?"). In general, iron-fortified multivitamins have less potential for causing iron overload since they usually contain only trace amounts of the mineral. But the consensus of nutrition experts seems to be: Try to get your iron from a wide variety of foods first before turning to supplementation.

"The important thing to remember is, iron is a two-edged sword," says Staruch. "If you are a menstruating female, it can be a challenge to get enough iron. If you're not a menstruating female, taking supplements without your doctor's recommendation can quickly become a problem." Work with your health care practitioner to determine your individual needs—and continue to eat your spinach.

Annette Spence, a freelance writer in Knoxville, Tenn., has also written for Health, Self, Walking and Weight Watchers Magazine.