Hemoglobin is an iron-rich protein substance that is present in red blood cells(RBC). It gives the red color and also helps blood to carry oxygen throughout the body. When there is not enough hemoglobin in a person’s blood, the condition is referred to as “Anemia” and the person is said to be “Anemic“.
During Pregnancy, our body makes more blood to provide nutrients and supply oxygen to the baby. Iron is required to produce red blood cells, those are needed to make the additional blood. When we don’t supply the iron needed by our body, then we become anemic. Anemia can make us weak and feel tired. If not treated properly, it can cause serious complications. Anemic pregnant woman has a higher risk of pre-term delivery, low birth weight and other adverse effects risking mom & baby.
Recommended Hemoglobin levels vary trimester-wise during Pregnancy. So, let your Gynecologist take the call.. Generally, all Gynecologists will order regular blood works and identify iron deficiencies earlier. Follow up with your doctor & if he/she identifies it to be an Iron-deficiency Anemia and asks you to take iron supplements along with more iron-rich food, then that’s my case and this post might shed some light for you..
Types of Iron:
There are 2 forms of dietary Iron – 1. Heme Iron from meat, poultry, fish and seafood 2. Non-heme Iron from plants, dairy products and Iron supplements. Heme Iron is easily absorbed by our body. Non-heme iron must be broken down by our body before absorption. Non-Heme Iron present in Egg yolks, vegetables, fruits, grains, nuts, seeds and iron-fortified food products are better absorbed, if taken along with Vitamin C rich food like Oranges, strawberries, tomatoes, bell peppers, broccoli and sweet potatoes. Non-Heme Iron absorption is inhibited by polyphenols, phytates in tea and coffee and calcium in dairy products or supplements. Food and Nutrition Board (FNB) confirms that other dietary components have less effect on the bioavailability of heme than nonheme iron. But, Calcium might reduce the bioavailability of both nonheme and heme iron.
How to take Iron supplements ?
If your doctor prescribes 2 iron tablets a day, don’t take it together. Split & take to increase iron absorption. I was prescribed 2 and I took 1 in the morning and 1 in the evening. I swallow the tablet using lemon juice(just squeeze half a lemon in water) as lemon provides the required Vitamin C for better iron absorption. You can also have it with Orange juice. Or just eat orange or strawberry or gooseberry after having Iron tablet. Or have tomato chutney(link) or any tomato based dish in the immediate meal to increase iron absorption.
Iron is best absorbed on an empty stomach but taking iron supplements in empty stomach might cause stomach pain, nausea or diarrhea in some people. If you experience any of these, you can take iron tablet after a simple meal or snack. But do not consume following Iron inhibitors (like calcium, polyphenols, phytates) 1 hour before and after taking iron supplements or iron-rich food. My doctor just told me to avoid tea, coffee, milk & milk products in this 2-hour window.
- Research says that 50 Milligrams or less of calcium doesn’t have any significant effect on Iron absorption. But more than 300 Milligrams of calcium is said to inhibit the absorption of iron in our body. And that’s the reason calcium-rich dairy products (especially milk – 1 cup milk has 300mg calcium) should not be consumed with iron supplements. Other calcium rich foods include yogurt, cheese, figs, sesame seeds.
- Avoid polyphenols rich food like cocoa (chocolates), coffee, tea & green tea.
- Avoid phytates rich food like walnuts, almonds, sesame seeds – Just avoid combining with iron rich food but you can eat them separately as they are rich in nutrients.
- Please note that minimal calcium present in non-dairy products will not have any significant effect on Iron absorption. So, no need to dig down the calcium levels of each food and complicate your meal plan. For example, broccoli has both iron and calcium. But broccoli’s iron will not be blocked by calcium present in broccoli, as it just has 43mg calcium(<50mg).
- Never combine your calcium or Multivitamin pill (containing calcium) with your iron pill. Calcium in pills/supplements will have higher concentration that might inhibit the absorption of iron in our body. Take iron pill separately for better absorption.
Cooking in Iron utensils to get iron ?
We have a tradition to cook food in iron vessels. Modern science has proved that, when you cook food in iron vessels, it reacts with the metal surface and iron gets released in the food. Start cooking in iron vessels for better iron mining. You shall buy ordinary iron vessels. Cast iron pans come with pre-seasoning and is easy to use and maintain. To know more about iron & cast-iron cook wares, my recommendations, how to wash it without soap? how to main it without rust? Please watch the below video. If you are interested in reading text than watching video, click here to read my post on Iron & cast-iron maintenance.
Pregnant woman need 27 mg of iron each day. Breastfeeding woman(who has not yet got their periods) need 9 to 10mg of iron daily. Women need more iron than men because we lose blood each month during our period. A normal adult woman need 18mg of iron each day, whereas Men require just 8mg of iron daily. Teenage girls require 15mg whereas boys require 11mg of iron daily. These Recommended Dietary Allowances(RDA) are provided by Food and Nutrition Board (FNB)(link). Following are some examples of iron-rich foods,
- Red meats – Goat, Ham, Beef
- Poultry – Chicken, Turkey
- Organ meats, especially liver
- Sea food mainly shellfish like Clams, Oysters & Mussels.
- Fish & Shrimp
- Dark, leafy green vegetables (such as broccoli, kale, spinach, cabbage, Brussel sprouts)
- Green Beans & Peas
- Nuts(especially Peanuts) and seeds(especially Pumpkin seeds)
- Lentils(Paruppu vagaigal) and Legumes(Payaru/sundal vagaigal)
- Indian Millets and Quinoa
- Dried Apricots, Dates, Raisins, Prunes
Sometimes iron absorption is affected because of deficiencies of Vitamin D and B12. Though you take iron rich food, your body couldn’t absorb it, if Vitamin D is low.
Vitamin D sources,
- Get exposed to 45 mins of sunlight daily(minimum 25 mins at a stretch).
- Mushrooms fried in oil or butter. Vitamin D is fat-soluble, so include some fat like oil or butter..
- Fatty fishes like Salmon(Kaalaa Meen), Sardines(Mathi Meen), Herring(Kendai Meen), Tuna(Soorai Meen), Rainbow Trout(Freshwater fish- Nanneer Meen), Tilapia(Jilaebi Kendai), Mackerel(Keluthi Meen), Hilsa(Oolum/O0li), Sword fish(Vaala Meen)..
- Egg yolks
- Red meat such as goat, lamb, beef(Maattu Iraichi), pork(Pandri Iraichi)
- Milk fortified with Vitamin D
Vitamin B12 sources,
- Dairy products – Milk, Yogurt & Cheese – Don’t club this with iron-rich food. Take this 2 hours before or after eating iron-rich food as it is rich in calcium which inhibits iron absorption.
- Poultry – Chicken breast, Turkey
- Fishes – Trout(Freshwater fish- Nanneer Meen), Salmon(Kaalaa Meen), Tuna(Soorai Meen), Haddock, Herring(Kendai Meen), Sardines(Mathi Meen), Cod(Panna(i) Meen)
- Shellfishes – Clams(Matti), Oysters(Sippi) & Mussels(Sippi Meen)
- Beef(Maattu Iraichi) & Ham(Pandri Iraichi)
How I increased my HB(hemoglobin) level ?
I travelled to India in the beginning of my third trimester and tested low levels of Hemoglobin & high levels of blood sugar. Pls click here to see how I dealt with my Gestational Diabetes Mellitus(GDM) or simply called Pregnancy sugar. With the help of my Gynecologist and Dietician, I framed an outline of my meal plan as to what to eat to increase iron. The below pointers worked for me.. Discuss with your doctor or dietician and plan yours..
👉Have iron tablet with half or one lemon squeezed into water.. Vitamin C increases iron absorption.. U can even squeeze some orange or just have 2 slices of orange or a gooseberry followed by any iron intake..
👉Don’t take iron tablet within 1 hour of drinking milk, as calcium tends to reduce iron absorption..
👉In empty stomach, have 1/3 cup cup grated(or just cut) beetroot(uncooked) with half lemon squeezed over it .. Add 4 soaked and peeled peanuts(optional) and few raisins(soaked) to it..
👉Take 4 dates daily..
👉Take 1 cup pomegranate, 1 apple & 1 gooseberry daily..
👉Have country chicken (click here for recipe) once or twice a week.. Country Chicken liver once a week – only one piece – only during last trimester & should be avoided during first trimester due to preformed vitamin A present in it, which is not good for fetal development..
👉Have goat spleen/Suvarotti (click here for recipe) once a week – just 1 – only during last trimester.. Note – this is not goat liver..If this is not available, you can have goat liver(click here for recipe) once a week.
👉Have fish (click here for grilled fish recipe) weekly once.. Make sure to choose fish with less mercury or just avoid large Predator fish as they will have more Mercury content.
👉Have 2 eggs daily, but only one yolk..
👉Take goat leg soup once in 10 days..
👉Have Moringa soup or drumstick leaves stir fry or kootu (click here for recipe) in alternate days..
👉Include Curry leaves idli powder or just grind curry leaves with gooseberry, water, salt and pepper/jeera and optionally squeeze few drops of lemon juice. Drink in empty stomach or in brunch time..
👉Have legumes – 1 cup sundal daily evening..
👉Have more veggies and greens daily.. Click here to view my collection of keerai/greens recipes.
👉Include whole urad dal with skin – as Kali or idli powder or dal makhani.. Use urad dal with skin in griding idli batter.
👉Have millets thrice a week.. Pearl millet/Kambu & Barnyard millet/kuthiraivaali are rich in iron.. Click here to view my collection of Millet recipes.
👉Include pulses/dal daily in any one meal..
👉Cook in iron/cast iron pan..
Though it is said that oxalic acid in Spinach binds with iron which blocks its absorption, my doctor asked me to eat variety of greens as they provide numerous minerals required for healthy fetal growth. Eat healthy, homecooked food with more varieties for a well-balanced and nutritious diet. Include fresh fruits (not juices), fresh veggies and drink more water. Hope you found this post useful. Wish you a happy and safe delivery.. Click here to view my collection of Lactation recipes, which might be useful post delivery. Come back after 6 months and click here to view my baby food charts 🙂 Happy parenting 🙂
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