What are the dietary and lifestyle management strategies for iron deficiency anemia?

From the Guidelines

Dietary and lifestyle management of iron deficiency anemia should prioritize increasing iron intake and absorption, particularly through combining iron-rich plant-based foods with vitamin C sources to enhance non-haeme iron absorption, as evidenced by a systematic review and meta-analysis 1.

Key Dietary Recommendations

• Consume iron-rich foods such as lean red meat, poultry, fish, beans, lentils, tofu, dark leafy greens (spinach, kale), fortified cereals, and dried fruits.
• Pair these foods with vitamin C sources (citrus fruits, bell peppers, tomatoes) to enhance iron absorption, as vitamin C is a powerful enhancer of non-haeme iron absorption 1.
• Avoid consuming coffee, tea, calcium supplements, or antacids with iron-rich meals as these inhibit absorption.

Lifestyle Modifications

• Regular physical activity is beneficial but avoid intense exercise during severe anemia.
• Stay well-hydrated and get adequate sleep to support recovery and red blood cell production.
• Address underlying causes such as heavy menstrual bleeding, gastrointestinal bleeding, or malabsorption conditions, and consider a gluten-free diet for patients with celiac disease to improve iron absorption 1.

Supplementation

• For supplementation, ferrous sulfate (325 mg) taken 1-3 times daily between meals is typically recommended, though ferrous gluconate or ferrous fumarate are alternatives that may cause less gastrointestinal distress.
• Take supplements with vitamin C (orange juice or a 250 mg vitamin C supplement) to improve absorption.
• Expect to continue supplementation for 3-6 months after blood values normalize to replenish iron stores, and consider intravenous iron therapy if iron stores do not improve 1.

Underlying Cause Management

• In individuals with inflammatory bowel disease and iron-deficiency anemia, treat active inflammation effectively to enhance iron absorption or reduce iron depletion 1.
• For patients with unexplained iron deficiency anemia, consider fast-track secondary care referral for further investigation, including bidirectional GI endoscopy or radiological scanning, to rule out underlying pathological abnormalities such as GI malignancies 1.

From the FDA Drug Label

DESCRIPTION Each tablet contains 324 mg of ferrous gluconate, equivalent to 38 mg of elemental iron, providing 211% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. CONTAINS: Each tablet contains 324 mg of ferrous sulfate, equivalent to 65 mg of elemental iron, providing 362% of the U.S. recommended daily intake (RDI) of iron for adults and children 4 and older. Dietary Supplement

The management for iron deficiency anemia in terms of diet and lifestyle includes:

• Increasing iron intake through supplements, such as ferrous gluconate or ferrous sulfate, which provide a significant percentage of the U.S. recommended daily intake (RDI) of iron 2, 3
• Dietary supplements can be used to manage iron deficiency anemia 3 However, the provided drug labels do not give specific dietary and lifestyle management strategies for iron deficiency anemia beyond supplementation.

From the Research

Dietary Management

• Increase dietary intake of iron-rich foods, such as meat, fish, and poultry, as these are good sources of heme iron which is more easily absorbed by the body 4, 5
• Consume foods high in ascorbic acid (vitamin C), such as citrus fruits and bell peppers, as these can enhance iron absorption 5
• Fortify foods with iron, especially in developing countries where iron deficiency is prevalent 4
• Avoid consuming tea and coffee with meals, as these can inhibit iron absorption, and instead consume them between meals 5

Lifestyle Management

• Identify and treat underlying diseases that may be causing iron deficiency anemia, such as celiac disease or gastrointestinal ulcers 4, 6
• Consider oral iron supplements, with a daily dose of 100-200 mg of elemental iron, to help replenish iron stores 6
• In cases where oral iron supplements are not effective or cause side effects, intravenous iron therapy may be necessary 7, 6
• For individuals with dietary restrictions, such as those with celiac disease, it is essential to follow a strict gluten-free diet to prevent iron malabsorption 4

Special Considerations

• In pediatric patients, pregnant women, and the elderly, iron deficiency anemia may have unique characteristics and require specialized management 4
• In developing countries, iron deficiency anemia is a significant public health problem, and efforts to increase dietary iron intake and fortify staple foods with iron are crucial 4, 8