Iron: Essential Nutrient Overview and Interactions

Iron Fact Sheet

Functions of Iron

70% of iron in the body is used to produce myoglobin and heamoglobin; the former being a protein used to store oxygen in muscles and the latter is protein in RBCs used to transport oxygen to body tissues from the lungs (Zhang, 2014 pp.750-760).

Deficiency signs and symptoms

They include unusual fatigue, paleness of skin, shortness of breath, headache and dizziness, heart palpitations, drying of hair and skin. Iron deficiency commonly leads to anemia and resultant fatigue is due to low production of RBCs which help in transportation of oxygen to muscle tissues for energy production (Wu et al, 2016 pp.171-177). This results in heart palpitation as the organ has to work strenuously to compensate for low oxygen supplied. Hemoglobin supply defines the color of blood and low levels reduce red quality of blood thus making skin pale (Zhang et al, 2014 pp124).

Therapeutic uses and supplemental doses

Considering a pregnant woman is suffering from deficiency of iron, the WHO recommends that a nutritional therapist prescribes about 30-60 mg of elemental iron taken with folic acid (400 µg) (Von et al, 2015 p.659). The dosage is consistent and the therapist could prescribe an alternative, ferrous sulfate heptahydrat ( 300mg ), ferrous gluconate (500mg) or ferrous fumarate (180mg), also taken daily. Therapeutic objectives include puerperal sepsis prevention, low birth weight prevention, maternal anemia prevention and prevention of neural tube defects (Munoz et al, 2017 pp.233-247).

Dietary sources

Iron rich food include spinach, liver and other organ meats, legumes, red meat, pumpkin seeds, quinoa and shellfish. Iron in shellfish for instance is about 28mg for every 100 grams. This is about 155% of its RDI (Kiss et al, 2015 pp.575-583). Unlike iron found in plants, shellfish has heme iron which the body absorbs faster and more readily. As regards the need to maximize intake of iron into the body from legumes, always take them with foods which have a lot of Vitamin C (Camaschella, 2015 pp.1832-1843).

RNIs for various age groups (UK students) or EU RDAs (Ireland students)

Toxicity level and symptoms

Taking of below 20 mg/kg of iron is not hazardous. Taking quantities beyond up and until 60 mg/kg causes tolerable symptoms. Beyond this point, consumption is highly toxic and can lead to death. Note that thresholds vary in different salts, all which have different iron formulations (AlDallal, 2016 p.2).

Interaction with other nutrients and other drugs

Absorption of non heme iron in the body is reduced in human suppose inorganic salt or milk with considerable calcium is taken (Khambalia et al, 2016 pp.1211-1221). The process with which it reduces absorption of iron is complicated. A study was done before to monitor this phenomenon involving partially purified ingredients of calcium and low iron bioavailability fortified into a simple meal. Increasing phosphate and calcium reduced iron intake but addition of either one in a single instance had no impact. Hallberg et al showed that meal consisting of 3.8 mg iron and 10 mg calcium when affected by CaCl of 40-600 mg would reduce dosage of calcium by upto 300 mg in non heme iron intake from the same meal. Inhibitory was even higher when calcium was added before being baked and was related to higher quantities of phytate in the rolls made (Moretti et al, 2015 pp.1981-1989). Two postulates were made thus. First, Calcium added into dough checked phytate degradation through fermentation and subsequent baking. Secondly, phytate reduced non heme iron intake directly when ingested. This complex relationship is not fully understood and further research is recommended (Mischler et al, 2018 pp.369-377).

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Discussion

In prompting interaction of iron with other nutrients and drugs, its relationship with calcium was adopted where significant quantity of calcium consumed reduced non heme iron absorption into the body. There is a previous study with findings on addition of a third control nutrient which influences action of calcium on iron intake. Limitation is seen when the author mentioned that the process is quite complicated and the full comprehension is not understood even by his peers. Morgan and Hartle (2016 pp.918-1) came up with two postulates to explain his observations in the baked roll experiment in the explanation of iron intake using phytate action. This is a headway in trying to establish the true nature of relationship between iron intake and Calcium. Bearing in mind assertions that the relationship is complex to understand, this is a step in the right way. Comprehensive insight into this relationship will help come up with new possibly better ways of regulating and monitoring iron intake into the body through calcium action (Finn et al, 2017 p.733).

Reference

Zhang, C., 2014. Essential functions of iron-requiring proteins in DNA replication, repair and cell cycle control. Protein & cell, 5(10), pp.750-760.

Zhang, D.L., Ghosh, M.C. and Rouault, T.A., 2014. The physiological functions of iron regulatory proteins in iron homeostasis-an update. Frontiers in pharmacology, 5, p.124.

Wu, A.C., Lesperance, L. and Bernstein, H., 2016. Screening for iron deficiency. Policy Statement, 23, pp.171-177.

Von Haehling, S., Jankowska, E.A., Van Veldhuisen, D.J., Ponikowski, P. and Anker, S.D., 2015. Iron deficiency and cardiovascular disease. Nature Reviews Cardiology, 12(11), p.659.

Muñoz, M., Acheson, A.G., Auerbach, M., Besser, M., Habler, O., Kehlet, H., Liumbruno, G.M., Lasocki, S., Meybohm, P., Rao Baikady, R. and Richards, T., 2017. International consensus statement on the peri‐operative management of anaemia and iron deficiency. Anaesthesia, 72(2), pp.233-247.

Camaschella, C., 2015. Iron-deficiency anemia. New England journal of medicine, 372(19), pp.1832-1843.

Kiss, J.E., Brambilla, D., Glynn, S.A., Mast, A.E., Spencer, B.R., Stone, M., Kleinman, S.H. and Cable, R.G., 2015. Oral iron supplementation after blood donation: a randomized clinical trial. Jama, 313(6), pp.575-583.

Alpers, D.H., Young, G.P., Tran, C.D., Mortimer, E.K., Gopalsamy, G.L., Krebs, N.F., Manary, M.J., Ramakrishna, B.S., Binder, H.J., Brown, I.L. and Miller, L.V., 2017. Drug-development concepts as guides for optimizing clinical trials of supplemental zinc for populations at risk of deficiency or diarrhea. Nutrition reviews, 75(3), pp.147-162.

AlDallal, S., 2016. Iron deficiency anaemia: a short review. J Cancer Res Immunooncol, 2(106), p.2.

Khambalia, A.Z., Aimone, A., Nagubandi, P., Roberts, C.L., McElduff, A., Morris, J.M., Powell, K.L., Tasevski, V. and Nassar, N., 2016. High maternal iron status, dietary iron intake and iron supplement use in pregnancy and risk of gestational diabetes mellitus: a prospective study and systematic review. Diabetic Medicine, 33(9), pp.1211-1221.

Moretti, D., Goede, J.S., Zeder, C., Jiskra, M., Chatzinakou, V., Tjalsma, H., Melse- Boonstra, A., Brittenham, G., Swinkels, D.W. and Zimmermann, M.B., 2015. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood, 126(17), pp.1981-1989.

Mischler, R.A., Armah, S.M., Craig, B.A., Rosen, A.D., Banerjee, A., Selzer, D.J., Choi, J.N. and Gletsu-Miller, N., 2018. Comparison of oral iron supplement formulations for normalization of iron status following roux-en-y gastric bypass surgery: a randomized trial. Obesity surgery, 28(2), pp.369-377.

Finn, K., Callen, C., Bhatia, J., Reidy, K., Bechard, L. and Carvalho, R., 2017. Importance of dietary sources of iron in infants and toddlers: lessons from the FITS study. Nutrients, 9(7), p.733.

Morgan, S. and Hartle, J.W., 2016. Absorption of Iron in Caco-2 Cells Evaluated by Ferritin Upregulation from Five Dietary Supplement Iron Sources. The FASEB Journal, 30(1_supplement), pp.918-1.

Julián-Almárcegui, C., Heath, A.L.M., Harvey, L., Sarria, B. and Huybrechts, I., 2016. Intake and dietary sources of heme and non-heme iron in children and adolescents: Recommendations for preventing iron deficiency. In Handbook of nutrition and diet in leukemia and blood disease therapy (pp. 371-398). Wageningen Academic Publishers.

Lim, K., Booth, A., Szymlek-Gay, E., Gibson, R., Bailey, K., Irving, D., Nowson, C. and Riddell, L., 2015. Associations between dietary iron and zinc intakes, and between biochemical iron and zinc status in women. Nutrients, 7(4), pp.2983-2999.