Let thy food be thy medicine and thy medicine be thy food,” advised the ancient Greek physician Hippocrates about 2,000 years ago. Twentieth century researchers, who studied the chemical complexities of food, found that the right food not only keeps us healthy but also plays a vital role in fighting ailments. Understanding that scurvy, the sailors’ scourge from vitamin C deficiency, was due to lack of fresh fruits and vegetables at sea, was a milestone. Anaemia is another such disorder where food holds the key to prevention and recovery.
What is anaemia?
Illustration by Jayachandran / Mint
Anaemia is an umbrella term for a variety of disorders characterized by the inability of the red blood cells (RBC) to carry sufficient oxygen. This is often attributed to an abnormally low level of haemoglobin—the iron-imbued, protein-based pigment in our RBCs— which carries oxygen from the lungs to cells throughout the body.
The most common type is iron-deficiency anaemia— there simply isn’t enough iron assimilated in the body, and hence not enough haemoglobin. A simple blood test can confirm the condition.
In mild anaemia, symptoms include pallor, fatigue and brittle nails; in more severe instances, sufferers may experience fainting spells, shortness of breath, abdominal discomfort, and in extreme cases, cardiac arrhythmia. Left untreated, it can lead to health problems such as low immunity and angina (painful constriction or tightness of the chest). In children and foetuses, it can also lead to developmental problems.
Who’s at risk?
Women of reproductive age are especially prone to the problem due to the monthly loss of blood from menstruation as well as the additional demands of pregnancy.
Vasundhara Singh, assistant dietician, All India Institute of Medical Sciences, New Delhi, says: “Our bodies take a long time to replenish such heavy loss of iron. Pregnant women particularly need more iron to cope with the demands of the growing baby and placenta.”
A lesser-known problem is that of worm infestation, which also leads to anaemia as the body is deprived of nourishment. Indeed, Singh says, “Worldwide, the most common cause of iron-deficiency anaemia is parasitic infestation.” These include hookworms and whipworms and other infections such as amoebiasis and schistosomiasis.
Such losses aren’t the only reason for iron deficiency, though; Some of us simply don’t get enough into our bodies in the first place. What, rather than how much we eat, is more the problem. Quoting from the National Family Health Survey (2005-06), Singh says: “Fifty-six per cent of women, 24% men, and 60-70% children in India are anaemic. In fact, 60% of women do not consume fruits even once a week.”
Eating to avoid anaemia
Smitha Suresh, clinical dietician at Nexicon-Health, Dallas, US, says: “Poor food choices and lack of iron and vitamin B-12 in the diet lead to anaemia. Conditions such as pregnancy, diarrhoea, intestinal disease and malabsorptive diseases increase the need for Fe, B-12 and folate, which are important nutrients to prevent anaemia. Old age can also induce anaemia as the absorption ability of the body often decreases with age. Up to one-third of people over the age of 50 produce inadequate amounts of stomach acid and cannot properly absorb B-12 from food.”
According to the Indian Council of Medical Research, the recommended dietary allowance of iron for men is 28mg daily; women should take 30mg and increase it to 38mg if pregnant (the figures are higher than suggested by some other nations, as our vegetarian population is largely confined to non-heme iron).
Anuradha Goyle, associate professor, department of home science, University of Rajasthan, says: “Food sources rich in iron can be categorized as heme iron sources and non-heme iron sources. Heme iron is better absorbed (about 15% absorbable) as compared to non-heme iron.
The absorption of non-heme iron varies from 3-8%, depending on the presence of promoters such as vitamin C, meat, fish and chicken.” On the other hand, iron absorption can be inhibited by oxalates, phosphates and phytates present in unrefined cereals, soyabean and some vegetables. Goyle explains: “Vegetable fibre may also inhibit non-heme iron absorption. Tea and coffee, when taken with meals, can reduce iron absorption by 50% through the formation of insoluble iron compounds with tannin. Phosvitin in egg yolk also reduces iron absorption.”
Suresh says, “As good sources of heme iron come mostly from meat, fish and poultry products, iron-deficiency anaemia can arise from inadequate iron intake in a vegetarian diet.”
According to a study conducted at the department of biochemistry, SMS Medical College, Jaipur, one simple way for vegetarians to counter this problem is simply to supplement their diet with citrus fruits and other sources of vitamin C—these promote the absorption of iron by the body.
GOOD SOURCES OF HEME IRON
• Chicken and turkey
• Oyster and clam
• Fish—bekti, singhi, pomfret, hilsa, tengra, sardines and tuna (sea fish have about 12% more iron than freshwater ones; dried fish is more concentrated than fresh ones)
• Shrimp, fresh or dried
• Lean red meat and pork liver
GOOD SOURCES OF NON-HEME IRON
• Beans, peas and lentils
• Dates, raisins and dried apricots
• Nuts and pumpkin seeds
• Blackstrap molasses
• Fortified cereals and pasta
• Wholemeal bread
• Asparagus and leafy greens
• Baked potatoes (with skin)
• Corn and enriched grains also provide folate
Certain foods interfere with the absorption of iron. Avoid eating them with iron-rich food.
• Coffee and tea
• Spinach, beet greens and chard
• Sweet potato
• Whole grains and bran
• Chocolate products
• Soy products
• Phosphates (found in ice cream, soft drinks and beer)
• The food additive EDTA (ethylenediaminetetraacetic acid), used as a sequestrant
Contrary to popular belief
Spinach, though a powerhouse of vitamins and minerals, is not a good source of iron. It has high levels of oxalate, which prevents our body from absorbing iron.
Certain foods enhance the body’s ability to absorb non-heme iron:
• Meat, fish and poultry
• Citrus fruits
• Brussels sprout and broccoli
• Green and red pepper
A 1986 study by the American Dietetic Association demonstrated cooking in a cast-iron skillet can add significant amounts of iron to food: 12ml tomato sauce provides 0.7mg of iron; cooking it in an iron pot adds a bonus of 5mg. Ironware may discolour food cooked in it, but the taste is unaffected.
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