“ Anemia is the decrease in the usual red blood cell mass, which is what gives oxygen to the tissues and allows for a normal life. A man is considered to have anemia when he has less than 13 grams of hemoglobin per deciliter of blood and when a woman has less than 12 grams of hemoglobin per deciliter of blood, “explains Fiorella Medina Salazar, from the Hematology Service of the San Carlos Clinical Hospital (Madrid) and member of the Spanish Group of Erythropathology of the Spanish Society of Hematology and Hemotherapy (SEHH) .
According to the hematologist, “weakness, prolonged tiredness, pale skin, increased heart rate and tachycardia , concentration problems and dizziness are symptoms of anemia. At the beginning of the disease, when the anemia is mild, the patient may not notice the symptoms. In fact, the intensity of the symptoms depends on the level of hemoglobin and the rate of onset of anemia. For example, iron deficiency anemias take longer to show up than digestive hemorrhages, because in the second case the organism does not have the capacity to compensate blood losses as quickly. The diagnosis is made by means of blood analysis ”.
” Iron deficiency is the most frequent cause of anemia worldwide – receiving the name of iron deficiency anemia.” The deficit of folic acid or vitamin B12 can also cause nutritional anemia , “says Julia Ocon, a member of the Nutrition area of the Spanish Society of Endocrinology and Nutrition (SEEN) .
“There are some substances, nutrients and foods that are promoting or activating the absorption of iron. Among them vitamin C (also called ascorbic acid) stands out for its importance . This vitamin is found in high concentrations in acidic fruits -such as kiwi, strawberries , mango, grapefruit juice-, and some vegetables -such as red pepper , cabbage, cauliflower and broccoli- “, says the endocrinologist.
Animal proteins (meat and fish), organic acids -such as citric, lactic and malic-, and some sugars -such as sorbitol and fructose- are also facilitators of iron absorption .
What foods make iron absorption difficult? And how much to space them from the supplement?
There are some nutrients or foods that are considered inhibitors of iron absorption. Among them, it is worth highlighting phytates (they are found in legumes and on the cover of cereal grains, the one known as bran or dietary fiber), in polyphenols (specifically in tea tannins, coffee, and possibly wine), in the egg yolk, the oxalates (spinach, chocolate and beets). It also hinders the absorption of iron excess phosphate and calcium .
Therefore, Ocón stresses that “ taking iron supplements together with dairy products should be avoided , since these contain calcium and casein (a protein present in milk) that inhibit its absorption. Its effect on absorption decreases after two hours of intake. “Therefore, it is recommended to separate the taking of iron supplements from the intake of milk or derivatives, and coffee or tea, as well as not taking iron supplements along with calcium supplements.”
The iron supplement should be taken outside the different meals, preferably on an empty stomach in the morning (that is, when the stomach has been empty), so that it is better absorbed. In this regard, Medina points out that “it is important to take the iron supplement with vitamin C, for example with a glass of orange juice, when you get up and wait an hour for breakfast” and recalls that it is better to take an iron supplement than a complex vitamin that includes iron.
The hematologist comments that many patients do not take iron supplements correctly because they are not well tolerated – they cause nausea, among other side effects. An option in that case could be to ingest the supplement at night, distancing it from foods that hinder the absorption of iron.
In case of anemia, what are the most recommended foods?
“The diet should be made up of foods that contain heme iron, which is the iron that has a better and more effective absorption. Foods of animal origin are the main source of heme iron: red meats, including liver, blue fish (sardines and tuna) and shellfish (clams, mussels, cuttlefish and Norway lobsters) stand out ”, advises the expert from the SEEN.
These foods must be consumed together with absorption activators, as are those foods rich in vitamin C.
As for the foods advised against in case of anemia, they are those that inhibit the absorption of iron previously mentioned.
Can some types of diet like vegan can cause anemia?
“A well-planned vegan diet is safe and provides an adequate amount of nutrients, with the only exception of vitamin B12, which is of exclusively animal origin. Vitamin B12 deficiency can also cause anemia, “says Ocón.
However, the endocrinologist comments that there may be a risk of iron deficiency in the case of diets that are not well designed and without advice from a professional. Therefore, adequate dietary advice is necessary to meet all the requirements, because the different food groups and their way of preparing them must be properly combined.
There are some combinations of foods in the diet that can be beneficial. For example, adding foods rich in vitamin C, such as tomatoes or citrus fruits to a meal can increase iron absorption up to six times. Combinations like beans and tomato sauce or sauteed tofu with broccoli are very rich in iron and vitamin C.
Balanced diet for prevention
“In the general population, eating a varied and balanced diet that regularly includes iron-rich foods of animal origin (meat and fish) together with fruits and vegetables rich in vitamin C helps prevent anemia,” describes the endocrinologist.
Iron fortification of wheat, rice or corn has been shown to be effective in preventing anemia in underdeveloped countries.
