Getting enough iron and avoiding anaemia (part 2) - Tips for boosting your iron absorption, Iron supplements

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Tips for boosting your iron absorption

The amount of iron we absorb from our food varies between about 1% and 30%. It depends to a large extent on the other nutrients and phytochemicals present in a meal. To increase absorption:

  • Have vitamin C at the same time as iron-rich foods, for example a glass of orange juice with your breakfast cereal, broccoli with stir-fried tofu, or strawberries after beans on toast.
  • Avoid tea, coffee and cocoa for an hour either side of meals. The polyphenols in these drinks reduce iron absorption.
  • When you have an iron-rich food such as lentils, don’t always have it with wholegrain products such as wholewheat pasta or brown rice. These high-fibre foods contain phytate, which binds to iron, so less is absorbed.
  • Have sourdough bread. The phytate level is reduced when the dough is fermented, so the absorption of iron and other minerals is improved.

Iron supplements

You will need to take iron supplements during pregnancy only if blood tests show that you have low levels of iron. Depending on how low your haemoglobin (Hb) level is, you may be advised to take a supplement containing between 100mg and 200mg. In some countries, including the USA and France, women are routinely advised to take iron supplements, but in the UK it is argued that if your iron levels are normal then taking high doses of iron may actually be harmful. However, it’s still fine to take a multivitamin and mineral supplement containing iron, as it will have a much lower dose – around 15mg.

The best way to take iron supplements

  • Take your supplement on an empty stomach, an hour before a meal.
  • Have a glass of orange juice at the same time to increase absorption.
  • Don’t have tea, coffee or prune juice with your supplement.
  • Don’t take other medicines, supplements or antacids at the same time.

Some women find that taking the prescribed supplements, which are usually ferrous sulphate, causes unpleasant side effects such as nausea and constipation. This is more likely to be the case if you’re taking more than 100mg of ferrous iron per day. If you do have problems then it may help if you take a lower dose, take supplements only every other day, or take them with meals. Ideally, supplements shouldn’t be taken with food, because the iron interferes with the absorption of other minerals such as zinc, but it’s better than not taking the supplements because they make you feel awful.

Alternatively, you could switch to a different iron supplement. Talk to your GP or midwife first, as they may be able to offer iron in a different form, for example iron gluconate. Or you could choose a supplement yourself, such as Spatone™, which appears to cause fewer side effects but can still be effective in treating anaemia. The downside of choosing a different supplement is that you’ll have to pay for it yourself – though if it makes you feel better, it’s generally worth it.

Cord clamping

When your baby is born the umbilical cord will be clamped and cut, and the timing of this can have a significant effect on the baby’s iron levels. In the past the umbilical cord was usually clamped straight away after a baby was delivered. It was thought that delaying this beyond about 30 seconds would increase the risk of the baby developing jaundice and the mother haemorrhaging after delivery. Newer research shows this isn’t the case. Another reason given for clamping sooner rather than later was that it protected the baby from being exposed to the hormones given to the mother to speed up labour and delivery of the placenta.

However, it has been found that a newborn’s blood volume can be boosted by a third if the cord isn’t clamped for three minutes after birth and the baby remains connected to the mother’s blood supply. As a result, delaying clamping reduces the risk of iron deficiency and anaemia in the baby. It also allows the transfer of vital stem cells.

Due to growing evidence that the benefits of delayed clamping outweigh the drawbacks, the Royal College of Midwives published new guidelines at the end of 2012. Midwives are now encouraged to clamp the umbilical cord three to five minutes after delivery. As this advice was issued relatively recently, some midwives may not be in the habit of delaying clamping, so you might want to talk to your midwife about it and maybe put it into your birth plan. Bear in mind that delaying clamping isn’t always possible, for example if the baby needs immediate support or the cord is around the baby’s neck and needs to be cut straight away. Also, when a baby is born prematurely or by caesarean, it may be better to cut the cord earlier than three minutes after delivery. However, for the majority of babies it now seems that delaying clamping is the best option.

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