PD_Character Studies_SS32014 Lethargy. Fatigue. Listlessness. Busy people attribute it to stress. Others are convinced that they need more sleep. But one real cause is ]]>iron-deficiency anemia]]> .

"I'm always tired, but I've gotten used to it," says Kathy, 49, an administrative assistant at a busy health clinic. "I come home from work, cook dinner, usually clean or do laundry. And I'm wiped out. Maybe I should get to sleep earlier, but it never seems to work out that way."

"I thought I was just run down and stressed out," says Julie, 28, a graduate student who admits that she often burns the midnight oil. "I just attributed everything to 'stress.' I had no idea there was a medical cause."

Kathy and Julie both have iron-deficiency anemia. It is a condition that develops because the body's stores of iron are slowly depleted. Millions of women in the United States have this form of anemia. Many more are prime candidates to develop it. Iron deficiency is the most widespread nutritional deficiency in the developed world. It hits menstruating women the hardest. More than 95% of women are not getting enough iron in their diets to make up for their losses.

Other signs and symptoms may include:

  • Soreness of your tongue
  • Brittle nails
  • Unusual cravings for substances (such as ice, dirt, or pure starch)
  • Poor appetite
  • Some experience ]]>restless legs syndrome]]>

Should You Be Concerned About Iron-deficiency Anemia?

For women of menstrual age, the answer is definitely yes. While anyone can develop iron-deficiency anemia, premenopausal women are at particularly high risk.

"My period lasts for two weeks," says Kathy, "And it's heavy. My doctor thinks that's contributing to the anemia."

Menstruating women lose a significant amount of blood every month. Iron escapes right along with it. Unless iron is replaced, these monthly losses can drain stores over time. But while premenopausal women need more iron than men, they generally eat less. This complicates the challenge of getting enough iron from foods.

Iron deficiency is also common in infants and children, as well as in adolescents of both sexes. Increased muscle mass, blood flow, and poor food choices lead to increased iron needs of teenagers.

Iron deficiency anemia can also result from a slow, chronic blood loss. In these situations, it can be a sign of a serious medical illness. A ]]>kidney]]> or bladder tumor, ]]>colon cancer]]> , ]]>peptic ulcer]]> , and ]]>uterine fibroids]]> can all present with iron-deficiency anemia. Gastrointestinal bleeding can also result from regular use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs).

Why Is Iron So Important?

Iron was first identified as a major (though misunderstood) component of blood in the early part of the 18 th century. Today we know that iron is the central component of heme. Heme is a molecule used to build hemoglobin, the oxygen-carrying part of red blood cells.

Oxygen is used by your body to help make energy. When iron stores are low, the body cannot make enough hemoglobin. There is then less oxygen to help generate energy. Iron also allows the normal functioning of the immune system, the production of collagen (wound healing), and the formation of amino acids, which are the backbone of proteins.

As levels of hemoglobin in the blood decrease, the symptoms of anemia start to appear:

  • Fatigue
  • Weakness
  • Apathy or irritability
  • Headaches
  • Pallor (pale complexion)
  • Lowered resistance to infection
  • Some people complain of being cold all the time
  • Others note that wounds or cuts take longer to heal
  • Finger nails may become "spoon" shaped
Anemia comes on slowly and quietly, so many people don't even realize that they have it.

Is it possible to have symptoms of iron deficiency without being anemic? Slight iron deficiency, too mild to cause anemia, may still cause symptoms, such as fatigue and decreased exercise capacity. For example, a double-blind, placebo-controlled study of 144 women with unexplained fatigue who also had low or borderline-low levels of ferritin (a measure of stored iron), found that using an iron supplement enhanced energy and well-being.

How Much Iron Do You Need?

The Recommended Dietary Allowance (RDA) for iron is higher for most adult women than it is for men. Premenopausal women and teenage girls need about 15 milligrams (mg) of iron each day. Adult men and postmenopausal women only need about 10 mg per day. The RDA is much higher (30 mg) for pregnant women, to accommodate the rapid rate of growth that occurs during pregnancy.

However, don't take iron just because you feel tired. Make sure to get tested to see whether you are indeed deficient. With iron, more is definitely not better. Excessive iron intake can be harmful.

Iron and Your Diet

If you've been diagnosed with iron-deficiency, your healthcare practitioner has probably advised you to include more iron in your diet. If anemia is especially severe, an iron supplement, such as ferrous sulfate or a multivitamin with iron may be prescribed. Knowing which foods are rich in iron is the first step toward boosting your iron stores. Take a look at the list further down the page to put more iron on your menu.

You'll notice that the foods listed on the table appear in two columns: heme and nonheme. That's because the iron in food is present in two different forms. Heme iron , which is efficiently absorbed by the body, is found in meats and animal products. Nonheme (plant) iron is discernibly less well absorbed. A third type of iron, additive iron is added in processing to create iron-enriched or fortified baked products and breakfast cereals.

Nutritionists have traditionally grouped meat, fish, and poultry together as the best sources of heme iron. But scientists at Utah State University published some results showing that some types of meat may pump more iron into your system than others. The winners? Beef ranked first for heme iron content, followed by lamb, pork, turkey, and chicken. Eggs are also a good source of heme iron.

Eating for Energy

It's not enough to know where iron is lurking; you also have to get it into your system. This is somewhat more difficult for vegetarians (since all nonmeat forms of iron are nonheme, and therefore less well absorbed), but it's certainly not impossible. Here are some tips:

  • Choose iron-rich foods.—Lean meats, fish, and poultry are still the best iron sources for meat eaters. For those of you who aren't willing to eat a steak once a week, foods like beans and legumes, greens, whole grains, and dried fruits will provide iron, albeit in a less absorbable (nonheme) form.
  • Choose more "C".—]]>Vitamin C]]> , which helps trap and dissolve iron, can improve the absorption of nonheme iron. "Including a vitamin C-rich food with meals is a good way for vegetarians to get more iron," says dietitian Joi Augustin, MS, RD. Try broccoli, tomatoes, green and red peppers, orange juice, grapefruit, strawberries, cantaloupe, mangoes, papayas, and baked potatoes. Vitamin C comes in so many colors and flavors that it's easy to choose.
  • Remember that little things add up.—Choose iron-enriched rice, pasta, and breads; switch to an iron-fortified cereal for breakfast; add dark (blackstrap) molasses or raisins when baking. It may sound like an old wives' tale, but cooking in an iron skillet, especially with high-acid foods like tomatoes, can contribute a little extra iron, too.
  • Avoid excess coffee, tea, or chocolate with meals.—These beverages contain substances that inhibit the absorption of nonheme iron. "I'd stay away from coffee or tea immediately after meals," says Augustin. "You could be losing almost 50% of the iron you just ate."
  • Supplement with ferrous sulfate or a multivitamin.—For those of us who simply can't get enough iron from foods, supplementation may be a viable alternative. Ask your healthcare provider or nutritionist what supplement is best for you. Make sure that you don't take iron supplements at the same meal as calcium supplements, because calcium interferes with iron absorption.

Good Dietary Sources of Iron

  • Meats
    • Lean beef (top or bottom round, pot roast, sirloin, tenderloin)
    • Lean pork, lamb, veal
    • Liver, organ meats (These choices are high in cholesterol.)
  • Fish
    • Clams
    • Oysters
    • Sardines
    • Shellfish (shrimp, lobster)
    • Tuna
  • Poultry
    • Chicken
    • Turkey
  • Eggs
  • Beans/Legumes
    • Black-eyed or split peas
    • Beans (black, kidney, lima, navy, lentils, soybeans)
  • Vegetables
    • Dark, leafy greens (Beet greens, kale, spinach, turnip greens)
    • Asparagus, bok choy, broccoli
  • Fruits
    • Dried fruits/juices
    • Apricots
    • Dates
    • Prunes
    • Raisins
  • Grains
    • Iron-fortified cereal (45% of the daily value or more)
    • Whole-grain or iron-enriched foods
    • Breads, muffins
    • Pasta
    • Rice
    • Bran
    • Oatmeal
    • Wheat germ
  • Other
    • Blackstrap molasses
    • Brewer's yeast
    • Tofu

Quick Fajitas With Pico de Gallo

Reprinted with permission from the National Cattlemen's Beef Association

This recipe will give you a real 1-2 iron punch: iron-rich red meat and lots of vitamin C from the lime juice and tomatoes!

Servings and Times

Time:45 minutes

Ingredients and Preparation

Boneless beef top sirloin steak or flank steak, cut ¾ inch thick1 pound
Flour tortillas (each about 8 inches), warmed8
Fresh lime juice2 tablespoons
Vegetable oil2 teaspoons
Garlic cloves, crushed2
Pico de Gallo
Diced zucchini½ cup
Seeded, chopped tomato½ cup
Chopped fresh cilantro¼ cup
Prepared picante sauce or salsa¼ cup
Fresh lime juice1 tablespoon


  1. Combine marinade ingredients. Place beef steak in plastic bag; add marinade, turning to coat. Close bag securely and marinate in refrigerator 20 to 30 minutes, turning once.
  2. Meanwhile, prepare Pico de Gallo. In medium bowl, combine all ingredients; mix well.
  3. Remove steak from marinade; discard marinade. Place steak on grill over medium coals. Grill 12 to 16 minutes for rare to medium doneness, turning once.
  4. Trim fat from steak. Carve steak crosswise into slices; serve in tortillas with Pico de Gallo.