Iron

Beef is naturally rich in heme iron that is easily absorbed. Iron, an essential mineral found in every cell has the following main functions¹:

Formation of red blood cells
Cofactor of enzymes and other proteins involved
Transports oxygen from the lungs to all parts of the body

1. Institute of Medicine. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. National Academy Press, Washington. 2001.

For Your Clients
Take The Iron Challenge!
Your clients can test their iron know-how with this simple quiz.

Iron Recommendations

Individual iron needs differ depending on amount of iron losses (e.g. menstruation) and during periods of rapid growth and development, and times of greater requirements (e.g. pregnancy or breastfeeding).

The Recommended Dietary Allowance (RDA) is the daily intake your clients should strive to achieve. If usual intake meets or exceeds this level, it is almost certain they’ve met their requirement. Intakes below this level do not necessarily mean that iron intake is not adequate but that they may be at risk for not getting enough iron.

**Recommended Dietary Allowance (RDA)**
(mg/d – total iron intake)
Ages	Males	Females
0-6 months^*	0.27	0.27
7-12 months	11	11
1-3 years	7	7
4-8 years	10	10
9-13 years	8	8
14-18 years	11	15
19-50 years	8	18
> 50 years	8	8
Pregnancy		27
* Recommendations for infants 0-6 months are Adequate Intakes based on iron content of breast milk.

Practice Point
Vegetarians who don’t eat any meat, fish or poultry need almost twice as much iron due to the decreased bioavailability of non-heme iron. Recommended intakes of iron for a vegetarian can be estimated by multiplying the RDA by 1.8. For example, a 40 year-old vegetarian woman would need 32mg of iron.

Want to know more?
For more information on iron and health, including deficiency and iron safety, download Iron... Get Rich (PDF 3.8MB) and Iron for All Ages – Iron for Health (PDF 340KB) and order additional copies for your practice.

Health Implications

Iron deficiency occurs when iron intake fails to meet the iron needs of the body and stores are depleted. Over time, if iron intake does not increase, iron deficiency can progress to iron deficiency anemia.

Research on iron deficiency anemia and behaviour in human and animal studies shows a positive relationship between iron status and cognitive development.^1,2

Watch for early non-specific symptoms of iron deficiency in your clients; these symptoms apply to all ages and can be determined through discussion with the individual. Provide guidance on boosting iron-rich foods and consider supplementation as appropriate.

**Symptoms of Iron Deficiency**
Early Symptoms³	Physical Symptoms^3,4	Non-hematological Manifestations⁵
Tiredness Headache Irritability Depression	Change in pallor Fatigue Difficulty breathing Reduced capacity for work Reduced resistance to infection	Altered cellular function and growth Altered motor development, behaviour and cognitive function Altered fetal outcome and premature labour

Adequate iron intake is of special consideration for infants, teen girls and women.

1. Sandstead HH. J Nutr 2000; 130:347S-349S.

2. Kretchmer N et al. Am J Clin Nutr 1996; 63(6):997S-1001S.

3. Guthrie HA, Picciano MF. Human Nutrition. Mosby-Year Book, Inc. 1995.

4. Scrimshaw NS and San Giovanni JP. Am J Clin Nutr 1997; 66(2):464S-477S.

5. Prasad AN and Prasad C. Progress in Food Nutr Sci 1991; 15:225-283.

Want to know more?
For more information on iron and health, including deficiency and iron safety, download Iron for All Ages – Iron for Health (PDF 340KB).

Infants

Up to 6 months
Healthy full term babies meet their needs using iron stores and circulating hemoglobin along with the iron from breast milk (or iron-fortified formula).

7 to 12 months
Infants between 7 to 12 months of age are growing so fast that they need more iron than an adult man – about 11mg each day. Canadian scientific literature indicates that iron deficiency may occur in up to 65% of infants 6 to 12 months of age.^1,2

Longitudinal studies indicated that children who were anemic in early childhood continue to have poor cognitive and motor development and depressed school achievement into middle childhood.³ Screening for iron deficiency in infants and toddlers is a consideration for practice.

Encourage parents and caregivers to feed iron-rich foods to infants and toddlers; the main sources of iron for babies are iron-fortified cereal, iron-fortified formula and pureed/mashed Canadian beef, fish or poultry.

1. Innis S, et al. Can J Pub Health 1997; 88(2):80-84.

2. Slotkin SH, et al. Nutr Res 1996; 16(5):729 -733.

3. Grantham-McGregor S. and Ani C. J Nutr 2001; 131:649S-668S.

For Your Clients
For a consumer pamphlet, download Iron and Infants (PDF 292KB) and order additional copies for your practice.

Want to know more?
For more on feeding infants, see Nutrition for Healthy Term Infants – Statement of the Joint Working Group: Canadian Paediatric Society, Dietitians of Canada and Health Canada.

Teens

Teen girls, 14 to 18 years of age should aim to have 15mg of iron each day; they need 30% more iron than teen boys because they lose iron during menstruation.¹

In addition, teen girls who do not eat any meat such as beef, fish or poultry need almost twice as much iron as girls who do.¹ And, female teens who skip meals are less likely to meet their recommendations for iron.²

Encourage your teen clients to enjoy meals and snacks with foods from all four food groups in Eating Well with Canada’s Food Guide.

2. Siega-Riz AM et al. J Adoles Health 1998; 22:29-36.

For Your Clients
For a consumer pamphlet, download Iron and Teen Girls (PDF 412KB) and order additional copies for your practice.

Women

Iron recommendations for women are 40% higher than in the past. They reflect a new understanding of the varying needs of iron among women. Women 19 to 49 years of age should aim to have 18mg of iron each day. A woman may need more iron if she:

avoids red meat
uses an intra-uterine device
has heavy menstrual periods
is pregnant

Encourage your female clients to enjoy a wide-variety of iron-rich food choices from Eating Well with Canada’s Food Guide.

For Your Clients
For a consumer pamplet download Iron and Adult Women (PDF 380KB) and order additional copies for your practice.

Practice Point
Almost half of adult women (aged 18 to 49) and almost 60% of teenage girls do not eat the minimum number of servings of Meat and Alternatives a day in Eating Well with Canada’s Food Guide.¹ Individuals who eat red meat, like beef, are more likely to reach recommended intakes of iron.²

Your clients can check out Dietitians of Canada’s interactive online tool Eatracker to see how their diet compares to the recommendations in Canada’s Food Guide.

1. Jacobs Starkey L et al. Can J Practice Res 2001; 62(2): 61-67

2. Gray-Donald K et al. Can J Pub Health 2000; 91(5):381-5.

Iron: not all created equal

There are two different types of iron found in food. Heme iron, found in meat, such as beef or lamb, poultry, and fish is much better absorbed than the non-heme iron found in eggs and plant foods.

The amount of iron that is actually absorbed by the body is more important than the total iron in a food. So, for example, even though a bowl of bran flakes has more total iron, the amount of iron that can be absorbed from beef is higher.

**Foods With Iron**
Foods With Heme Iron Easily absorbed by your body	Foods With Non-heme Iron Not well absorbed
Beef Lamb Pork Liver Veal Turkey and chicken (dark meat has more iron) Fish and seafood	Breakfast cereals (fortified with iron) Breads and pasta (whole grain and enriched) Lentils, dried peas and beans Seeds and nuts (pumpkin, sesame, peanuts) Dried fruit (raisins, apricots) Dark green, leafy vegetables Eggs

Iron Enhancers

Some foods can enhance the body’s ability to absorb non-heme iron by increasing the solubility of non-heme iron or forming compounds that are more easily absorbed:¹

Foods with heme iron – meat such as beef, poultry, or fish (MFP factor)
Foods rich in vitamin C like oranges, grapefruit, and green peppers

Iron Inhibitors

Inhibitors are food components that, when consumed with a meal, limit the amount of non-heme iron absorbed; inhibitors bind with the non-heme iron to form insoluble complexes that are then excreted from the gastrointestinal tract.¹

The strongest inhibitors are polyphenols that are especially high in black tea, coffee and cocoa. To a lesser extent, plant compounds, like oxolates in spinach or phytates in whole grains, can also inhibit the amount of iron absorbed.

Practice Point
Simple recommendations to help your clients get enough iron:

Enjoy foods like meat, poultry or fish on a regular basis. Eating Well with Canada’s Food Guide recommends adults eat 2 to 3 servings of Meat and Alternatives.
Add red meat, like beef, or foods with vitamin C to meals to increase absorption of non-heme iron by up to four times.
Avoid drinking coffee or tea with meals and for at least one hour after meals.

From the team of registered dietitians at the