You’ve gotten a solid eight hours of sleep, ate a good breakfast, but yet by 11 am your eyelids are drooping and you’re ready for a nap. Maybe your drag yourself to the gym after work and a five-minute jog that used to feel easy suddenly feels like a struggle. You’re thinking, “why the f#%@ am I so tired??!!!

Sound familiar? Before you pour yourself another cup of coffee, consider that the reason for your fatigue may be that you are anemic.

What is Anemia?
Hemoglobin is a protein in red blood cells that carries oxygen in the blood, delivering it to cells in your body, helping you move and breathe Anemia is a deficiency in the size or number of red blood cells, or the total amount of hemoglobin the red blood cells contain. Nutrition-related anemia is caused when you don’t get enough of the nutrients required to build healthy red blood cells. 

What Causes Nutritional Anemia?
The main nutrient deficiency that can lead to anemia is iron.

A deficiency can be caused by:

1. Inadequate intake of iron-containing foods

2. Inadequate absorption of iron from food

3. Increased iron needs (i.e. during pregnancy, significant blood loss)

4. Inability to access iron stores

What Are Symptoms of Anemia?
How do you know if you are anemic? Unfortunately, by the time low hemoglobin counts show up on bloodwork, it means you have been iron deficient for some time. You can be iron deficient before hemoglobin counts are low enough to be diagnosed as iron-deficiency anemia.  If you are noticing any of the early signs of anemia, speak to your dietitian or doctor who can recommend ways to prevent further deficiencies.

Early signs
Even slightly lowered iron levels can affect energy metabolism and neurotransmitter synthesis. This results in reduced capacity for physical work and a decrease in mental productivity. This type of fatigue is different from lack of sleep, and only presents during times of physical and mental exertion. For example, simple work tasks or physical activity (like a light jog) that used to be easy, now seem exhausting, and you may feel lethargic after a solid night’s sleep.

Other Symptoms:

• Trouble focusing or concentrating 

• Irritability

• Headache around temple or behind eyelids 

Later signs
If iron-deficiency is prolonged, and iron-deficiency anemia develops, physical symptoms become visible. The lack of hemoglobin can cause the skin, tongue, and insides of the eyes to become noticeably pale. Other signs include feeling cold all the time, concave, brittle nails, headaches, shortness of breath, and fatigue. 

How Do You Prevent Anemia?
In order to prevent iron-deficiency anemia, meeting nutritional requirements is key. This means eating iron-rich foods like meat, poultry, and fish. Or beans, tofu, and iron-enriched grain products, if following a vegetarian or vegan diet, and supplementing if necessary.

What Foods Contain Iron?

Bioavailability
Heme iron, found in meat, fish, and poultry, is 3x more available than the non-heme iron found in beans, vegetables, and grains, so much more of it is absorbed. For vegetarians and vegans, sufficient amounts of non-heme iron must be eaten to meet the body’s requirements or supplements may be needed to make up the difference.

Heme Iron Sources

• Meat (beef, pork, lamb, organ meats)

• Poultry (chicken, turkey)

• Fish & Seafood (salmon, tuna, shrimp, mussels, oysters)

Non-Heme Iron Sources

• Lentils and other legumes

• Spinach

• Potatoes (with skin)

• Nuts and seeds

• Fortified cereals

• Dark chocolate (70% or more cocoa)

How Much Iron Do I Need?
Women need significantly more iron per day than men do because of blood loss during menstruation. This number increases even more during pregnancy when the mother is also providing iron for the developing baby.  Once women hit menopause, their iron requirement decreases to the same as males because they are no longer menstruating. 

Iron Requirements

Women 19-50 years: 18 mg/day

Men >19 years: 8mg/day

Women 51 years and older: 8mg/day

Pregnant Women: 27mg/day

Iron sources in common foods per serving

Chicken breast, 6 ounces: 2mg

Salmon fillet, 6 ounces: 0.7mg

Steak , 8 ounces: 6mg

Tofu, 1/2 cup: 3mg

Lentils, ½ cup, cooked: 3 mg

Peanut butter, 2 tbsp: 0.6 mg

What Increases Iron Absorption?

1. Vitamin C is one of the most potent enhancers of iron absorption. Pair your steak with dark leafy greens like spinach and kale, or carrots, squash, and sweet potato to maximize absorption.

2. Animal proteins like chicken, meat, and fish not only contain more heme iron, but also contain a peptide that enhances absorption of non-heme iron from other foods. That means you’ll absorb more of the iron from grains if you pair them with meat.

What Inhibits Iron Absorption?

Some foods contain compounds that bind to iron and inhibit absorption.* 

These Include:

1. Tea and coffee

2. Red wine

3. Legumes

4. Whole grains and rice

5. Calcium from milk products and supplements 
   

   * You don’t need to exclude these items from your diet entirely, but be mindful of your consumption until your iron level return to normal.

Other factors that may inhibit absorption include:

1. Low stomach acidity (i.e. the use of antacids). An acidic environment is necessary for iron to be absorbed from food.

2. Diarrhea. Abnormal, frequent bowel movements mean food is moving through the large intestine too quickly, and is not in contact with the large intestine long enough for iron to be properly absorbed, in addition much is lost through feces.

Do you need an iron supplement?
Those following vegetarian/vegan diets, or who are eating mostly plant-based, may have trouble meeting their iron needs through food alone. In this case, supplementation can be helpful. It’s important to confirm with a blood test that you are actually iron deficient before starting to take supplements. Too much iron can lead to toxic levels in the body- there can be too much of a good thing!

Iron from supplements is less absorbed than from food, so continuing to include iron-rich foods in the diet is important. When selecting a supplement, look for ones labelled “Ferrous Sulfate” or “Iron chelate”, these forms are best absorbed by the body. 100-200 mg/day is recommended. 

Supplementation Tips:

• For optimal absorption, try breaking up the recommended amount  into 2 doses per day, and take with food to help prevent stomach upset.

• Take the supplement with vitamin C-containing foods that increase absorption, like a glass of orange juice.

• Avoid taking supplements with foods that inhibit iron absorption, like coffee, tea, antacids, or calcium supplements