Iron Deficiency

The Functional Biological Activities of Iron

Iron was identified as a critical component of blood in the early 18th century and its value has become more apparent as time has progressed. Iron is found in the hemoglobin of red blood cells, which delivers oxygen from the lungs to the tissues. Oxygen is utilized in metabolism to produce energy. Hemoglobin is also involved in the removal of carbon dioxide from the tissues to the lungs. Additionally, myoglobin contains a small percentage of iron which is involved in producing energy for muscular work.

Iron is a part of some enzymes involved in oxidation reactions. It is also one of the most important nutrients for immune functions. Many human clinical trials and studies demonstrate the necessity for this important mineral.

Iron's Role in the Body

The development of red blood cells (erythropoiesis) in bone marrow.
Transfer of oxygen to the tissues for energy production.
Guarding immune function by maintaining white blood cell levels, antibody production and preventing infections.
Prevention of iron deficiency anemia.
Manufacture of amino acids, hormones, brain neurotransmitters and new cells.
Oxidation reactions as part of particular enzymes.
Cognitive functioning and motor activities.

Iron Absorption

Healthy adult men have about 3.6 grams total body iron. Women have a much lower amount, about 2.4 grams.

Iron is efficiently conserved by the body. Approximately 90% is recovered and reused every day. The rest is excreted, mainly through the bile. Dietary iron must be available to meet this 10% deficit, or iron deficiency will result.

Adults with normal hemoglobin values absorb an average 5% to 15% of the iron (heme and non heme) contained in food and supplements. Although absorption may be as high as 50% in those with iron deficiency anemia, this level of absorption is not common.

Most women with iron deficiency, but not anemia, probably have absorption efficiencies of 20% to 30%. Only about 2% to 10% of non heme iron in vegetables is absorbed, while 10% to 30% of iron (heme and non heme) in animal sources is absorbed.

Iron Deficiency & Anemia

Iron is an essential constituent of blood and muscle. When there is an inadequate intake or absorption of iron is compromised, iron deficiency can result.

Iron anemia is the world's most common nutritional deficiency disease. It is estimated that 30% of women and 10% of elderly persons are iron deficient.

Factors Contributing to Iron Deficiency:

Increased Iron Requirement
- Growth spruts of infants and adolescents
- Pregnancy where the daily iron requirement may double

Inadequate Iron Intake
- Diets low in animal proteins
- Athletes involved in endurance sports

Decreased Iron Absorption
- Following many gastrointestinal surgical procedures
- during chronic diarrhea or intestinal malabsorption

Blood Loss
- Menstrual blood loss, coupled with diets offering low or moderately low iron levels
- Gastrointestinal bleeding, even that caused by daily aspirin use,
is the primary cause of iron deficiency
- Volunteer blood donation

While iron deficiency develops insidiously and is often free of symptoms, iron anemia is accompanied by many troubling symptoms, including:

Symptoms of Iron Deficiency & Anemia
Weakness	Sore Tongue	Shortness of Breath
Fatigue	Loss of Appetite	Bleeding Gums
Nausea	Heart Palpitation	Light Headedness
Headaches	Lassitude	Subtle Behavioral Changes

Research Summary

Iron Deficiency Anemia High Risk Groups:

- Adolescents

- Elderly mem and women

- People who use asprin regularly

- People who donate blood more than three times a year

- People with diets that are low in both meat and ascorbic acid

- Women and especially those with a history of childbearing challenges

Iron protein succinylate may be the most effective oral supplement for correcting iron deficiency anemia (IDA). This form of iron has been studied in 1800 patients in three multi-center clinical trials to determine efficacy and tolerability. (Kopecke, 1995)

These studies showed the following effects in anemic adults after only 60 days of iron supplementation:

23% increase in percentage of red blood cells (hematocrit)
30% increase in oxygen carrying capacity of blood (hemoglobin)
6% increase in total number of red blood cells

Note: Medications that affect stomach acid secretion can interfere with iron absorption. Clinical studies show that the absorption of iron protein succinylate is not inhibited by H2 receptor antagonist drugs or by food intake.

Essentially, all iron compounds severely irritate the stomach, causing pain and heartburn. They also affect the lower GI tract, causing constipation. Because of these unpleasant reactions, many people discontinue the use of dietary supplements to correct iron deficiency and anemia.

Ultimate Iron Pro

Ultimate Iron Pro allows the benefits of iron supplementation without unpleasant side effects.

Ultimate Iron-Pro is a proprietary form of ferric iron (FE+++) bound with a chemically modified protein (casein) by a process called succinylation which dramatically stabilizes the complex. This process offers a unique health benefit that distinguishes it from other iron compounds. Ultimate Iron-Pro provides gastro-protection through bypassing the gastric mucosa in the stomach. This allows it to be dissolved in the intestine (duodenum) where it is rapidly absorbed in an alkaline or neutral pH environment.

Each Vegetarian Capsule of Ultimate Iron Pro Contains
Iron Protein Succinylate (IBS)	18 mg.	100% RDA
Vitamin C (Ascorbic Acid)	120 mg.	200% RDA
Folic Acid	400 mcg.	100% RDA

Recommended Usage
One capsule of Ultimate Iron-Pro per day (with or without a meal) is the recommended level for general use. For supplementation beyond this level, check with your health care provider for a biochemical assessment test to determine your iron status. If necessary, your doctor can recommend an increased level of supplementation.

Factors Affecting the intestinal absorption of iron, especially nonheme iron

The Foods From Which Iron Is Derived

Animal proteins enhance absorption. The substance responsible for this improved absorption, termed Meat Factor, is unknown.
Vitamin C (ascorbic acid) increases absorption of iron making it more soluble, especially in the case of nonheme iron.
Cirus fruits or juices rich in viatamin C can help enhance absorption.
Whey protein (lactalbumin) may also improve absorption. (Borsch, 1994)
Although the iron content of human milk is very low, it is highly bioavailable because of the presence of milk lactoferrin which enhances absorption.
Tannins in teas can reduce nonheme iron aborption.
Other foods which contain complexing agents, such as phytates and oxylates, inhbit absorption.
Note: The presence of an adequate amount of calcium helps to remove phosphates, oxalates, and phylates that would otherwise combine with iron and inhibil absorption.
Recommended: Hydoxyapatite Calcium Complex or Coral Calcium

The Degree of Gastric Acidity

Gastric acidity enhances solubility and, therefore, the bioavailability of iron derived from foods.
achlorhydria (lack of gastric acid secretion), hypochlorhydria (inadequate acid secretion), or the administration of alkaline substances, such as antacids, can interfere with nonheme iron absorption by not permitting the solubilization of iron in gastric and duodenal fluids.
H2 receptor antagonistic drugs inhibit absorption.
Note: H2 receptor antagonist drugs or food intakes have not been shown to reduce absorption of iron protein succinylate as found in:
Ultimate Iron Pro

Food Enrichment Compounds

The availability of iron from various compounds used in the enrichment of food varies widely according to their chemical composition. Compounds such as ferrous pyrophospyate (used widely in products like breakfast cereals because it does not add a grey color to the food), ferrous citrate, and ferrous tartrate are poorly absorbed.
Iron is usually added to baby food in an elemental form, the absorbability ow which depends on the iron particle size.

Intestinal Mobility

Increased intestinal mobility decreases iron absorption by decreasing contact time and also by rapidly removing the chyme form the area of highest intestinal acidity.
Poor fat digestion leading to steatorrhea also decreases iron absorption, as well as the absorption of other cations.

Physiologic States

Physiologic staes such as pregnancy and growth, which demand increased blood formation, stimulates iron absorption.

Toxicity

the major cause of iron overload is hereditary hemochromatosis and, quite rarely, blood transfusions. Long term ingestion of large amounts of iron or frequent blood transfusions can lead to abnormal accumulation of iorn in the liver.

It is generally suggested that people with iron deficiency anemia (IDA) supplement with the minimum amount of iton needed to restore levels to the mid-normal range. Since excess iron in the body can generate free-radical reactions, supplemental iron should be used sparingly. The use of antioxidants, including Vitamin E, is advised.

Technical information on iron absorption

The human body contains iron in two major pools:
(1) functional iron in hemoglobin, myoglobin and enzymes, and
(2) storage iron in ferritin, hemosiderin, and transferrin (a transport protein in blood).

Dietary iron exists in two chemical forms: Heme Iron and Nonheme Iron

Heme iron is found in hemoglobin, myoglobin and some enzymes. It is obtained from animal sources and absorbed across the brush border (mucosa) of intestinal absorbing cells (enterocytes) after it is digested.

Heme iron represents only 5 to 10% of the dietary intake of iron for individuals who consume a mixed diet. Its absorption, however, may be as high as 25%, compared with only 5% or less, for nonheme iron. The absorption of heme iron is affected only minimally by the composition of meals and gastrointestinal secretions.

Once heme iron enters the cytosol, ferrous iron is enzymatically removed from the ferroporphyrin complex. The free iron ions combine immediately with apoferritin. Ferritin serves as both an intracellular store and a ferry that carries bound iron from the brush border to the basolateral membrane of the absorbing cell. The final step of absorption occurs at the basolateral membrane of the absorbing cell, the same as for nonheme iron, by an active transport mechanism.

Nonheme iron is found predominately in plant foods and in some animal foods. Vegans must ingest and absorb sufficient amounts of non heme Iron in order to meet dietary requirements. The efficiency of nonheme iron absorption appears to be controlled by the intestinal mucosa, which allows iron to enter the blood.

Nonheme Iron must proceed through three steps before entry into blood circulation:

In the first step of absorption, nonheme iron must be digested free from plant sources and enter the duodenum and upper jejunum in a soluble (and ionized) form.
The absorbed ions then combine with apoferritin to form ferritin complexes that move across the cell by diffusion.
Final absorption is achieved by active transport through the basolateral membrane.

Biochemical Assessment Tests to Determine Iron Status

There are different biochemical assessment tests to determine iron status. the best indicator of iron stores is a measurement of serum ferritin levels. Other tests evaluate serum iron, hemoglobin, hematocrit levels, total iron binding capacity (TIBC) and erythrocyte protoporphyrin, mean corpuscle volume (MVC), transferrin saturation and serum iron concentration. Erythrocyte protoporphyrin is the precusor for heme iron. When blood levels are elevated, it means there are low levels of heme iron being manufactured. Recently the protoporphyrin heme (P/H) ratio has been evaluated and may be more successful in determining iron deficiencies compared to other measurements. (Madan, 1999)

Commonly, hemoglobin concentration, percent transferrin saturation and serum iron are not successful at determining iron deficiencies. There are situations where the blood tests are normal, but individuals have iron defu=iciency symptoms. Iron availability from storage forms may be completely depleted. This occurs beacuse these individuals may have higher normal hemoglobin levels.

Selected References:

Madan N, Prasannaraj P, russian, et. al., Monitoring oral iron therapy with protoporphyrin/heme rations in pregnant women. Ann Hematol. 1999:78 (6) 279-283 (Abstract)

Mahan, I Kathleen, Scott-Stump, Sylvia E., "Krause's Food, Nutrition and Diet Therapy 10th Edition", W.B. Saunders Co., 2000. p. 125.

Kopecke, W, Sauerland, MD, Meta analysis of efficiency and tolerability dta on iron protein succinylate in patients with iron deficiency anemia of different severity. Arzneim Helforschung. Nov. 43(11):1211-6, 1995.