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Iron deficiency is a common deficiency in the world; in fact, it is the most common in the world (WHO, 2002). It is a pity that women are at a higher risk of this disorder due to the monthly loss of blood through menstruation. This means that women should be more careful in their intake of iron-rich foods and supplements if any to keep this nutritional disorder at bay. It is even more tasking for women who are vegetarians.
This paper is on the business of outlining the various aspects of the vegetarian diet and how it is deficient in providing sufficient iron for women in Australia. It also states how the problem can be approached.
Significance of iron at a glance
Nature
Iron is a compound formed by the coming together of the following elements: hemoglobin, cytochromes, myoglobin and the enzymes that assist in the redox reactions. It can exist in various forms hence its ability to attach itself easily to oxygen, sulfur atoms, and nitrogen. Most of the body’s iron exists in hemoglobin, a quarter of the rest exists as metabolized iron-ferritin in the liver and the rest is found in the muscle tissue and selected enzymes.
Requirements
For one to have an adequate supply of iron in the body, they have to take at least 1mg per day while women on their menses need 1.5 mg per day. This is not a fixed value since people vary and some might need a little more intake than others might. For pregnant mothers they must take 4 to 5 mg per day especially in the last trimester (Nutrient Reference Values for Australia and New Zealand, 2005). Growing children are more active and require a bigger amount and so do adolescents.
Factorial modeling is the criterion used to measure the amounts of iron required by individuals of different ages, sex orientation and physiological states. It suggests daily intakes according to the degree of basal losses (mandatory excretions by skin, sweat and urine included), losses due to menstruation (females), and extra doses needed in growth, by marooning adolescents and expectant mothers. The model seeks to make sure an individual gets the right amounts enough to sustain and not to culminate in excesses that may lead to further complications (Bothwell et al., 1979).
Symptoms of deficiency
A lack of iron in the body leads to three of the following. First, one could end up having low iron stores due to low serum ferritin. Secondly, one could develop an early deficiency in iron, which is because of the inefficiency of the serum ferritin in transmission. This could develop further to anemia caused by a lack of iron in the body.
These conditions are evidenced by the following symptoms: for expectant mothers it could cause unexpected outcomes in terms of the child. For instance, it could cause the child’s immunity to dwindle inefficiency, the child might also start walking or making movements at a later age than usual. The child’s rate of acquisition of knowledge and even the thought processes involved may be reduced a great deal. That also applies to adults. Iron deficiency leads to a general reduction in the functionality of a person; they do not function at the same capacity anymore.
Nutrition in New Zealand and Australia
The main sources of food that provide iron are meats, poultry, fish and the whole grain (cereals). There are conditions that will influence the rate and amount of iron absorbed during digestion in the body. The first factor is the number of iron stores in an individual whether low or high. The second is the amount of iron in the meal and the components of the same.
Iron gotten from animal foods like poultry meat and fish can be either heme or non-heme while that from plants is non-heme. The bioavailability of heme is higher when consumed by humans than that of non-heme.
Vegetarian diet consists of plants mostly fruits cereals and vegetables. There are four categories under this umbrella. There is the Lacto-vegetarian whose diet includes all the dairy products except eggs. Second is the ovo-vegetarian, which is opposite to the lacto-vegetarian, in this one, one eats eggs but not the dairy products. A lacto-ovo-vegetarian is a combination of the two, one eats both dairy products and eggs alike. A vegan diet is the most extreme and strict of them all, there is no consumption of any animal products whatsoever.
The diets contain same amount of iron as non-vegetarian meals but are lower in bioavailability. Animal products contribute the most amount of zinc. Absorption of the iron and zinc in vegetarians is also poor (Hunt, 2010). Bioavailability simply means the ability of the chemical composition of iron to be absorbed. It is possible to have two sources of meals with the same iron content but different amounts of bioavailable iron. Vegetarian diets contain no heme iron, which is the most absorbable form of iron as compared to non-Heme iron. People that consume enough red meat have large amounts of heme iron while those that consume less have high amounts of non-heme iron.
Non-vegetarians get an almost full supply of these nutrients depending on the diet. The vegetarians tend to take a lot of dried legumes and dried beans in excess as compared to refined grain products. As a result, the efficiency in the absorption of nonheme iron in the body is reduced. Ascorbic acid and carotene in vegetarian diets act as enhancers in place of those that would normally be provided by meat and fish but they do not function as well, in the same capacity. Furthermore, the absorption of the non-heme iron is reduced by the presence of phytic acid, which is found in the nuts, legumes and grains that are in a vegetarian diet. Other components that have the same influence include polyphenols found in cereals, vegetables, spices and coffee, even eggs ( Hunt, 2003, p.634S).
NS-not significant
F-females
The above table is a representation of mineral bioavailability from vegetarian diets as extracted from The American Journal of Clinical Nutrition by Hunt (2003, p. 635S). A study was done to compare the status of iron availability in vegetarians and that of nonvegetarians (control groups).
From the above table the experiment that was done to acquire the above results, it was observed that female vegetarians have fewer reservoirs of iron than those on a nonvegetarian diet. This however did not prove at all that prevalence of anemia caused by lack of iron in female vegetarians was higher than in female non-vegetarians, this was because of a study done in Western countries.
It was advised by the ‘Dietary Reference Intake’ that vegetarians should increase their level of intake of iron in food by a whole eighty percent so as to compliment the amount of iron bioavailability that they get from their diet which is a meager ten percent. In comparison to the eighteen percent that a non-vegetarian gets from a Western diet, this was awfully low.
The amount of iron recommended for males is 14mg Fe/d that they can easily garner from their meals though vegetarian. It becomes much difficult for females whose is 33 mg Fe/d to attain this from the diet solely. They need the supplements to have the minimum required amount of iron, this is necessary especially for women of childbearing age. Women on contraceptives use fewer amounts of iron according to studies (Tetens et al., 2007, p. 444). This is called for because attempts to plan a diet rich in iron have only been able to supply 11 to 18 mg/d of the required amount. The intake of these supplements has to be continuous to be effective on women with low iron stores.
When a woman has low iron stores, they are more susceptible to a deficiency in other elements in the body. It has not been proved yet that low iron stores with the absence of anemia could lead to reduced vigor inactivity. This reduced functionality can however be caused by a deficiency in hemoglobin in the blood. To make sure the state does not come to that, women who are low in iron stores should go for hemoglobin screening so that when the supplements are being made they are made to measure specifically for the respective women. This could go a long way in reducing the negative effects of supplements if not doing away with them.
Some of the side effects of using supplements are the slowing down of the process of assimilation of iron from the diet (Roughhead & Hunt, 2000) and an increase in levels of stress (oxidative) because of the iron that is unabsorbed in the bowels( Lund et al.,1999). Supplements also cause constipation and in some cases nausea and vomiting. They also cause stool to assume a black color and abdominal cramping preceding that. In minor cases, there have been cases of diarrhea. To reduce the extent of some of the side effects one can take the tablets with meals.
If a person chooses to go for the supplements, they should be careful to get the right prescription that will last three months since that is the time one takes to recover from low iron stores. This conclusion was because of analysis of the facts that it takes men and women around three years or two on the lower side to recover from depleted stores of iron. Supplements help reduce this period per se (Deakin, 2010).
Iron supplements come in two forms the ferrous and ferric. Those in the ferric form are difficult to absorb into the body, however, the ferrous ones are assimilated more easily. The ferrous include ferrous gluconate, ferrous fumarate, and ferrous sulfate. A dose of 100mg per dosage is advisable for three months or longer. In critical cases, bigger doses of 300mg/d have been administered which is an amount way above what a normal human needs for physiological needs. Studies have been done in the past and it has been discovered that supplements administered on a daily basis do not prove to be more effective than those given three days of a week spaced out. This research was done on athletes to increase the amount of serum ferritin and to some level hemoglobin. In another study done in Malaysia, 624 females in their adolescent stage and suffering from mild cases of anemia were given 120mg of iron supplements to take on one day every week. It was found out that the results were similar to those of taking half the amount of supplements every day. The replenishing of iron stores in terms of hemoglobin and serum ferritin was identical for the two cases (Deakin, 2010). Some scientists like the idea of a daily intake, which they say replenishes the iron stores faster than weekly doses.
Some other ideas put forward to help in the absorption of iron from vegetarian food is to improve the methods of preparing various foods. For instance, one could invest in buying pans made of iron. After investing in such, they can be careful to buy acidic foods that will dissolve the iron while cooking. The other way is by eating foods that are rich in ascorbic acid to help the process and to shun those that are rich in phytic acid. Limiting things like coffee or tea during meals is also essential unless of course taken in between meals. It takes time to improve the serum ferritin levels in the body so that is why supplementation is vital since foods only cannot cater for the iron stores (Heath et al., 2001).
High serum ferritin causes the iron storage disorder known as hemochromatosis (Tuomainen et al., 1999). A high intake of iron is known to inhibit the absorption of other essential elements such as zinc and calcium in the body. It is also known medically to raise the chances of having colorectal cancer. In general, whether vegetarian or not, men and women who are past menopause are advised to avoid supplements that provide iron and artificial foods (Hunt, 2003, p. 636S).
The iron injection is a fast way of getting iron stores back to normal but could easily lead to iron overload. This in turn could translate into higher susceptibility to anaphylactic shock, which is triggered by the same, it can cause death.
Zinc is also considered an important nutrient that is left out in huge numbers when individuals sorts into a vegetarian diet. Plants that are rich in this element unfortunately are also coincidentally flourishing in the greatest inhibitor of its bioavailability-phytic acid. These include foods like nuts grains and several legumes. Its bioavailability is also increased by protein obtained from the vegetarian diet. High intakes of calcium may inhibit the bioavailability of zinc. In a study that was undertaken by scientists where the diet was controlled, the substitution of meat with carbohydrates saw the amount of zinc assimilated by women past menstruating age go down in amount by 1.6 mg/d from a high of 3.6 mg/d to a 2.0 mg/d. This was in relation to the zinc content of the diet that was greatly reduced.
Zinc and iron are greatly connected in more ways than known by most people. The dilemma comes in when one has to decide whether to take supplements for the iron or the zinc deficiency (Whitaker, 1998). Further studies have to be made to prove the nature of interaction that exists. The effects are most likely to be felt if an individual takes the supplements without dietary support. A high intake of calcium components affects the assimilation of both iron and zinc (Hallberg et al.,1991).
Conclusion
Vegetarian women do not get all their iron requirements in abundance as required by their physiological activities as stipulated in the factorial modeling. A vegetarian diet does not contain all the needed sources of iron that a non-vegetarian meal has. A deficiency in this nutrient causes decreased cognitive abilities in both children and adults it causes children to develop at a much slower rate than usual. Among others, it causes a person to function at a lower efficiency than they normally would among others effects such as anemia and iron depletion in the blood contributing to low hemoglobin count.
The non-heme form of the iron component is what the plant foods provide. This is not a bad idea only the amounts that can be accessed cannot be compared to those of an omnivorous diet by any standards. This causes a major problem in the absorption since the bioavailability of non-hemes is quite lower than that of hemes. This condition can be improved by the intake of more foods rich in the compound and by improving cooking methods. Improving cooking methods here could consist of buying pans that are ironware and cooking acidic foods rich in ascorbic acid so that the acid dissolves the iron. Another is by reducing intake of coffee and tea with meals but instead taking food with more enhancers (Hunt, 2002).
If all fails and there is no recovery or if it makes it an important need of quick recovery, one can then opt to use iron supplements. They come in both tablet form and as injections. These can be ferric or ferrous. Ferrous is easier to absorb than ferric. Since according to studies it takes three years or more for a man or a woman to recover iron stores almost completely, the supplements are meant to reduce this time to a little over three months. The doses can be taken weekly or daily depending on urgency of results and the amount of activity one is involved in. Because women are involved in this report, they are advised to take more frequently to get the 33 mg/d they require or more for those menstruating and those who are in their final trimester.
These injections have side effects: They could lead to an iron overload since they are taken frequently and other complications such as hemochromatosis and inhibition of other essential elements such as zinc and calcium. Women and even men are cautioned against this because it raises a risk of anaphylactic shock, which is fatal in most cases. High iron intake also raises the risk of colorectal cancer and overconsumption is advised against. The use of iron supplements is not always a recommended first choice since it slows down the intake of iron in the diet and other effects such as constipation and nausea.
List of References
Bothwell TH, Charlton RW, Cook JD, Finch CA., 1979. Iron metabolism in man. Oxford: Blackwell Scientifi c,.
Deakin V., 2010, Iron depletion in athletes. In: Burke L, Deakin V. eds. Clinical sports nutrition. 4th Edn, Sydney: McGraw-Hill, 2010. Chapter 10, pp. 248-251.
Hallberg L, Brune M, Erlandsson M, Sandberg AS, Rossander-Hulten L., 1991, Calcium: effect of different amounts on nonheme- and heme-iron absorption in humans. Am J Clin Nutr;53:112–9.
Heath, A-LM, Skeaff, CM, O’Brien, SM, Williams, SM & Gibson, RS, 2001, ‘Can dietary treatment of non-anemic iron deficiency improve iron status?’ Journal of the American College of Nutrition, vol. 20, pp. 477-484.
Hunt, JR 2002, ‘Moving towards a plant-based diet: Are iron and zinc at risk?’ Nutrition Reviews, vol 60, pp. 127-134.
Hunt,JR 2003, ‘Bioavailability of iron, zinc, and other trace minerals from vegetarian diets’, American Jounral of Clinical Nurition , vol. 78, pp. 633S-639.
Lund EK, Wharf SG, Fairweather-Tait SJ, Johnson IT,1999, Oral ferrous sulfate supplements increase the free radical-generating capacity of feces from healthy volunteers. Am J Clin Nutr;69:250–5.
Roughead ZK, Hunt JR. 2000, Adaptation in iron absorption: iron supplementation reduces nonheme-iron but not heme-iron absorption from food. Am J Clin Nutr;72:982–9.
Tuomainen TP, Kontula K, Nyyssonen K, Lakka TA, Helio T, Salonen JT, 1999, Increased risk of acute myocardial infarction in carriers of the hemochromatosis gene Cys282Tyr mutation: a prospective cohort study in men in eastern Finland. Circulation;100:1274–9.
Tetens, I, Bendtsen, KM, Henriksen, M, Ersboll AK & Milman N 2007, ‘The impact of a meat- versus a vegetable-based diet on iron status in women of childbearing age with small iron stores’. European Journal of Clinical Nutrition, vol.46, pp. 439-445.
Whittaker P., 1998. Iron and zinc interactions in humans. Am J Clin Nutr;68(suppl):442S–6S. WHO. The World Health Report 2002. Reducing risks, promoting healthy life. World Health Organization, Geneva.
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