Sunday, January 26, 2014

Vitamin Rich Food and IBD - Iron

Dietary Iron with Crohn's and Colitis


The previous post on vitamin and mineral deficiencies and IBD covered the major deficiencies that impact those with Crohn’s Disease and Ulcerative Colitis.  As noted in that post, a routine (annual) workup on potential deficiencies is warranted, with more regular monitoring if there are recurrent and high impact deficiencies.  The post discussed multivitamins, but good nutrition through diet, if the foods are tolerated, is a better alternative in many cases.  While those with deficiencies in multiple areas should consult a clinical dietician (ideally a Registered Dietician) for overall diet help, there are some key foods that can supplement target areas.

The most likely deficiency to be encountered is iron.  The amount of iron necessary for healthy individuals varies based on age, gender, and pregnancy status.  Additionally, the amounts noted are for healthy individuals – those with IBD may need additional iron to counteract increased loss and malabsorption.

Age
Males
(mg/day)
Females
(mg/day)
Pregnancy
(mg/day)
Lactation
(mg/day)
7 to 12 months
11
11
N/A
N/A
1 to 3 years
7
7
N/A
N/A
4 to 8 years
10
10
N/A
N/A
9 to 13 years
8
8
N/A
N/A
14 to 18 years
11
15
27
10
19 to 50 years
8
18
27
9
51+ years
8
8
N/A
N/A
Source:  US NIH (1)

It should also be noted that iron toxicity can occur at 45mg/day – care should be taken to not go above or even approach this limit without doctor’s approval.  Unlike many other vitamins, not all iron is absorbed equally.  Heme iron, that bound in hemoglobin and available from animal sources, is more easily absorbed than non-heme iron from vegetable sources.  Up to 35% of heme iron and 20% of non-heme iron is absorbed by healthy individuals (and as low as 2% of non-heme iron).  Because of this, vegetarians frequently have a more difficult time with iron regulation than non-vegetarians, though it is still very possible to maintain adequate levels with a carefully planned vegetarian diet. (2,3)  Iron absorption is further effected by what it is taken in with – Vitamin C and meat meat proteins positively impact non-heme iron absorption, while tea, calcium, legumes, and whole grains negatively impact absorption.  This can be used for more careful dietary planning – taking that calcium supplement with your chicken isn’t the best idea, and tea may be better off well after dinner.  Additionally, adding lean protein with a vegetable can have a positive synergy.(4)

What foods have the best iron availability?  On the heme side, organ meats tend to have the highest values, and on the non-heme side, fortified cereal products have the highest.  While Rice Krispies, Cheerios, and Cap’N’Crunch come in at half of the USRDI per serving, and chicken liver hits over 50%, having chicken livers and cereal for dinner isn’t necessarily a meal plan. 


Food
mg/Serving

Source
Ready-to-eat cereal, 100% iron fortified, ¾ cup
18
100
Non-heme
Chicken liver, pan-fried, 3 ounces
11
61
Heme
Oatmeal, instant, fortified, prepared with water, 1 packet
11
61
Non-heme
Soybeans, mature, boiled, 1 cup
8.8
48
Non-heme
Lentils, boiled, 1 cup
6.6
37
Non-heme
Oysters, canned, 3 ounces
5.7
32
Heme
Beef liver, pan-fried, 3 ounces
5.2
29
Heme
Beans, kidney, mature, boiled, 1 cup
5.2
29
Non-heme
Ready-to-eat cereal, 25% iron fortified, ¾ cup
4.5
25
Non-heme
Beans, lima, large, mature, boiled, 1 cup
4.5
25
Non-heme
Blackeye peas, (cowpeas), mature, boiled, 1 cup
4.3
24
Non-heme
Beans, navy, mature, boiled, 1 cup
4.3
24
Non-heme
Beans, pinto, mature, boiled, 1 cup
3.6
21
Non-heme
Beans, black, mature, boiled, 1 cup
3.6
20
Non-heme
Tofu, raw, firm, ½ cup
3.4
19
Non-heme
Spinach, fresh, boiled, drained, ½ cup
3.2
18
Non-heme
Beef, chuck, blade roast, lean only, braised, 3 ounces
3.1
17
Heme
Spinach, canned, drained solids ½ cup
2.5
14
Non-heme
Beef, ground, 85% lean, patty, broiled, 3 ounces
2.2
12
Heme
Turkey, dark meat, roasted, 3 ounces
2
11
Heme
Spinach, frozen, chopped or leaf, boiled ½ cup
1.9
11
Non-heme
Raisins, seedless, packed, ½ cup
1.6
9
Non-heme
Beef, top sirloin, steak, lean only, broiled, 3 ounces
1.6
9
Heme
Grits, white, enriched, quick, prepared with water, 1 cup
1.5
8
Non-heme
Tuna, light, canned in water, 3 ounces
1.3
7
Heme
Turkey, light meat, roasted, 3 ounces
1.1
6
Heme
Chicken, dark meat, meat only, roasted, 3 ounces
1.1
6
Heme


Looking at the table above, it is easy to see how intake iron levels can be below the recommended  values for those with IBD.  Liver is high in fat and may be avoided for that reason, and the fortified cereals are sometimes avoided by those with lactose intolerance (not much fun eating plain Rice Krispies).  Lean meats, while good for you in general, have well below the recommended allowance. Finally, many with IBD have reported difficulties with beans and soy – two excellent sources of iron.  Instead of the standard recommendations that you’ll get from your dietician, here are a few creative ways to supplement your iron if you have IBD (note – the numbers below assume the 18mg/day level of iron – adjust accordingly if you are in a different category):

·         Peanut Butter Rice Krispy Treats (http://www.ricekrispies.com/recipes/peanut-butter-treats).  These puppies are easy to make and pack approximately 23% of the USRDA for iron into each treat.
·         Subway 6” Roast Beef Sub with Spinach.  Adding spinach instead of iceberg lettuce brings this sandwich up to 30% of the daily iron allowance.   
·         Orange Juice with Your Flintstones.  The ascorbic acid (one form of Vitamin C) in OJ can improve absorption of non-heme iron by up to 9%.  A small glass of OJ instead of a glass of water can help.
·         Skip the Egg White Omelette.  Most of the iron in eggs is in the yolk (and Vitamins D, B-12, and B-6). 
·         Build-Your-Own Energy Bar.  You Bars (http://www.youbars.com) allow you to customize the contents of your energy bar – great for those with specific dietary needs, and it’s easy to hit a bar with 13% of the USRDA of iron.  If they are too pricey for your needs – you can make your own at home.
·         Apple Crisp.  Instead of apple pie, try apple crisp.  An enriched oatmeal version has 23% of the iron you need per serving, and it tastes great (http://allrecipes.com/recipe/apple-crisp-with-oat-topping/). 
·         BlackJack Brisket.  Blackstrap molasses (not to be confused with light or dark molasses) is a sucrose-free extract from sugar can, containing lots of iron in addition to calcium, potassium, magnesium, selenium, and B-6.  Brisket is likewise high-iron.  Add them together in a delicious recipe (http://allrecipes.com/recipe/blackjack-brisket/) – skipping the beer – you get a whopping 66% of your RDA for iron.

 As with everything, iron is only one item to balance.  Eating a diet of pure Rice Krispy treats isn’t nutritionally sound, and the suggestions above are meant as creative additions to a well-rounded diet. 

Bottom Line


·         Those with IBD may need more than the normal USRDA for iron due to malabsorption and bleeding loss.
·         Not all iron is absorbed the same.  Meat-based iron is easier to absorb than vegetable-based.
·         Taking vitamin C and iron together is helpful.  Taking calcium supplements and iron together is not.
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2.       Miret, Silvia, Robert J. Simpson, and Andrew T. McKie. "Physiology and molecular biology of dietary iron absorption." Annual review of nutrition 23, no. 1 (2003): 283-301.
3.       Tapiero, H., L. Gate, and K. D. Tew. "Iron: deficiencies and requirements."Biomedicine & pharmacotherapy 55, no. 6 (2001): 324-332.

4.       Institute of Medicine. Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium and Zinc. Washington, DC: National Academy Press, 2001

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