Many of us aren't getting enough of it. And no, it's not actually vegans and vegetarians who are most at risk.
Natalie Parletta

The Conversation
14 Dec 2016 - 11:05 AM  UPDATED 14 Dec 2016 - 11:09 AM

According to the World Health Organisation, iron deficiency – a condition where your body doesn’t have enough of the mineral iron – is a global public health problem of “epidemic proportions”. It is the single most prevalent nutrient deficiency in developing and industrialised countries, and the most common cause of anaemia.

Anaemia occurs when our red blood cell count and/or haemoglobin levels are too low, resulting in an inability to transport sufficient oxygen throughout the body. Iron is required in order for haemoglobin to transport oxygen.

This week Australian Prescriber published an update on the problem of iron deficiency in Australia. Young women, children and disadvantaged groups are at highest risk. Around 12-15 per cent of women who are pregnant or of reproductive age and eight per cent of preschool children in Australia are estimated to have iron deficiency anaemia. Iron deficiency without clinical anaemia is even more widespread.

Although vegetarians and vegans are broadly thought of as being at high risk of iron deficiency due to an absence of red meat in the diet, there is little evidence to support this. However restricted diets can confer higher risk if not well balanced, for instance in young overweight women who are trying to lose weight.

Why is iron important?

Iron has an essential role in numerous metabolic pathways in the body, including transport of oxygen in the blood, DNA synthesis, breathing, immune function and energy production.

Symptoms of iron deficiency include tiredness, neurobehavioural disorders like attention deficit hyperactivity disorder and restless leg syndrome (a nervous system disorder that creates an irresistible and sometimes unbearable urge to move the legs), and cognitive impairment in children. Iron deficiency can have a serious impact on health and productivity.

Iron is essential for the developing brain. Iron deficiency with and without anaemia in infancy can have long-term negative impacts on brain function and behaviour, and even when levels are corrected, those effects may not be completely reversed.

Maternal anaemia can result in preterm birth, and along with high blood pressure or diabetes can compromise fetal iron levels in pre-term or term infants.

Breastfeeding provides adequate iron to meet infant needs up to the age of six months. However from seven to 12 months the requirement for iron increases significantly (up to 11 milligrams per day), and must be provided via solid food in addition to breast milk.

It’s important to understand problems can be caused by both too little as well as too much iron. Hence iron concentrations in the body are carefully regulated and professional advice must be sought before supplementing with iron.

Causes of iron deficiency

There are lots of complex causes of iron deficiency and anaemia, and they should be carefully investigated before being addressed.

Poor dietary intake is an important cause of iron deficiency, particularly when requirements are increased during infancy, menstruation and pregnancy.

Iron is one of a number of essential nutrients we need to get through our diet. Iron deficiency is therefore one of several casualties of poor dietary patterns in Australia and other westernised countries, characterised by excessive intake of highly processed foods and inadequate intake of nutritious whole foods.

Iron requirements

Dietary iron requirements vary by age and gender. The recommended daily intake (average daily intake that is sufficient to meet the needs of the majority of people) for males varies from eight to 11 milligrams a day for ages one to 18 years, and eight milligrams for all other ages.

Women have higher requirements. For ages 14-50 years, recommended daily intakes range from 15 milligrams (14-18 years) to 18 milligrams a day. Needs are higher during pregnancy, jumping to 27 milligrams per day. However during lactation they are slightly less, at nine to ten milligrams a day.

Iron requirements for vegetarians have been estimated as 1.8 times more than non-vegetarians, however this conclusion was based on limited research.

Dietary sources of iron

Dietary iron is obtained in the form of haem iron or non-haem iron. Haem iron sources include red meat, poultry and fish, while non-haem iron comes from a variety of plant foods such as legumes, wholegrains, green leafy vegetables, nuts, seeds, fresh and dried fruit. These plant sources are core components of both vegetarian and vegan diets.

Non-haem iron is believed to be less available than haem iron. This is because plant foods contain substances that can inhibit absorption of iron.

However, vitamin C can enhance non-haem iron absorption thereby counteracting these inhibitory effects. To address this in your diet, you might like to try:

• eating hummus that contains chickpeas and lemon juice

• lemon juice drizzled over Indian dhal or lentil soup

• salads containing high vitamin C sources such as red capsicum or tomato as a side dish

• kiwifruit, strawberries, papaya or a glass of freshly squeezed orange juice with muesli

• a side dish of lightly steamed broccoli, cauliflower and/or brussels sprouts - good sources of vitamin C – which can be boosted with lemon juice (plus extra virgin olive oil, garlic and salt for ultimate flavour and nutrition)

• mixing baby spinach in salads - green leafy vegetables contain iron and vitamin C, a complete package.

Soaking and sprouting legumes, wholegrains and seeds makes the iron more available from these foods.

It is important to note the absorption of non-haem iron varies considerably, and has been shown to be higher in people who have greater iron requirements. This suggests the body adapts to low iron by increasing its absorption.

Vegetarians who follow a balanced diet have been shown to have higher iron intake than that of non-vegetarians and there is little evidence of lower iron status.

A table of the iron content of foods commonly available in Australia is provided here.

Iron is an essential nutrient with a range of critically important functions in the body and brain. Assessing iron stores and causes of anaemia is complex and should be performed by a professional.

We can ensure adequate intake of iron by eating a healthy balanced diet with a variety of whole foods including (but not limited to) meat as well as plant sources.


 Senior Research Fellow and Dietitian/Nutritionist, University of South Australia. This article was originally published on The Conversation. Read the original article.


Iron-rich recipes
Florentine t-bone steak (bistecca alla Fiorentina)

“Bistecca alla Fiorentina is considered the epitome of Tuscan steaks. It is usually made with the revered Chianina breed of cattle. Weighing in at over one kilogram, the steak is prepared and cooked simply over hot coals to showcase the quality of the beef.” Poh Ling Yeow, Poh & Co. 2

Yellow dhal with peas (arhar dhal matar)

This easy, one-pot dish is flavoured with ginger, cumin and turmeric and mildly spiced with Kashmiri chilli.

My mother’s roast capsicum salad (insalata di peperoni arrosto)

No family feast gets under way in the Colloca household without my mum’s vibrant roast capsicum salad. Dad and my uncle Claudio would be completely up in arms if it wasn’t on the antipasto platter – not that they would ever volunteer to make it themselves! Mum is too wise to provoke any tantrums, and she happily roasts, peels and marinates while the two handsome gentlemen discuss which vintage of Montepulciano d’Abruzzo they should crack open. And so the family festivities begin ...

Broccoli shoots with spring garlic and anchovy

Some of the broccoli we grow forms a big head, some doesn’t, but it all produces plenty more sweet and tender shoots once you start harvesting it. You can also make this recipe using regular broccoli – simply cut into long florets by cutting from the stem end first. Spring garlic hasn’t yet formed a bulb, but it’s really yummy, and is milder and sweeter than regular garlic cloves. Sometimes we also add sliced red chilli to this recipe. If doing so, add in Step 1 before the broccoli.