Constantly tired? You could be anaemic

About a medical condition widespread in women of Indian ethnicity

So, how much iron do you need?

BY JYOTHSNA R RAO

When Popeye the Sailor Man sang “I’m strong to the finich, ‘cause I eat me spinach” he was definitely on the right track. Iron (also found in spinach) is an essential micronutrient for the body as it helps to transport oxygen, fight disease and keep our brain and muscles functioning well.

Constant tiredness, a result of low oxygen supply to the vital organs

The majority of iron in the body is present in the protein haemoglobin, which transports oxygen around the body. Low haemoglobin from lack of iron leads to low supply of oxygen to important organs such as the lungs, causing extreme fatigue or tiredness, dizziness and shortness of breath. Lack of iron also causes substantial hair fall and in the extreme, a craving to eat non-food items such as dirt and ice. This is anaemia, a condition caused due to iron deficiency.

Anaemia is hugely prevalent in those of Indian ethnicity, more common in teenage girls and women of child-bearing age. In fact, 1 in every 2 Indian women is anaemic, an alarming statistic. The significant prevalence of anaemia led the Government of India to launch a public health campaign in 2018 titled “Anaemia Mukt Bharat”, which aims to reduce its pervasiveness by 30% by 2022.

How is anaemia diagnosed?

Usually, symptoms of tiredness and shortness of breath leads us to the GP clinic, where a routine full blood test picks up anaemia. More excitingly, scientists from the department of biomedical engineering at Georgia Tech and Emory University, Atlanta, have developed a new Smartphone app which promises to do away with invasive blood tests and, instead aims to use photos and an image-based algorithm to detect anaemia (see Figure 2). This development shows promise, especially from an Indian perspective, as it is mobile and can be used to detect anaemia in interior India where the prevalence of anaemia is high.

Can you improve haemoglobin levels from food?

Of course, you can! A common cause of anaemia, other than blood loss due to heavy periods in women and adolescent girls, is an inadequate diet or a daily diet low in iron-rich foods.Ensure that the food you eat has sufficient iron levels. Red meat, chicken and fish are all important sources of easily absorbable iron, a form known as heme iron. Generally, these foods help, but what about vegetarians? There is a common misconception that vegetarians are unable to reach adequate iron levels, compared to non-vegetarians, due to not eating meat; this is completely false! Plant-based foods also contain iron in a form known as non-heme iron, found in kale, spinach, pomegranate, plums, figs and broccoli. Legumes such as rajma, chana, lobia and grains such as brown rice are also rich sources of iron. Add them to your meals!

Enhance your absorption of iron:

Eat a ‘clever food combination’

Iron from foods needs to be well absorbed in the gut to raise haemoglobin levels. Some foods such as oranges, capsicum and tomatoes enhance the absorption of iron because they are rich in Vitamin C. So, a ‘clever food combination’ is rajma cooked in a tomato-based gravy. Beta-carotene found in pumpkin also helps to enhance iron absorption, adding roasted pumpkins to a brown rice salad is good.

Are there any foods that block iron absorption?

Unfortunately, yes. Foods that block absorption of iron are *insert drumroll* coffee and chai, favourite Indian lifelines! These contain tannins which inhibit the efficient absorption of iron. More depressingly, the more kadak the less your iron absorption. But there is a way to enjoy your cuppa: drink it a couple of hours after your meal!

Calcium, an important micronutrient for bones and teeth, found in dairy is also an inhibitor of iron absorption. In fact, calcium prevents absorption of both heme (meat-based) and non-heme (plant-based) iron. However, the good news is that your body understands its needs well and this inhibition is more applicable when calcium

Iron needs depends on the age, stage and gender. For example, growing infants, toddlers, and teenagers require more iron than their grandparents. Similarly, pregnant women need more iron and so do menstruating girls and women. (See table for recommended dietary intake).

What if iron-rich foods don’t work?

There are other ways to increase iron, through iron supplements which are commonly recommended by clinicians during pregnancy. In extreme cases, regular iron injections are given; sometimes a one-time iron infusion is suggested. These have to be under the advice of a registered medical practitioner. Dr Sanjivi Jayasinghe, a busy south-east Melbourne GP, sees a large number of Indian women with anaemia. She prefers an iron infusion and says, “We generally don’t do iron injections now, because if not done correctly, they can stain the skin and this can last for years. Infusions are better and given into a vein. The effectiveness, otherwise, is the same and lasts for about 18 months, though each woman is different.”

A word of caution!

Do not self-diagnose an iron deficiency; it needs to be diagnosed by a registered medical practitioner. Yes, we are all unique with personal nutrition needs, and general information sourced online does not address these. Seek guidance for diet modifications from a university-qualified professional, not Dr Google!

Dr Jyothsna R Rao is a university-qualified nutritionist with a background and expertise in human physiology, who has studied and lived in Australia for 19 years.

Recommended dietary intake (RDI) for iron

AGE IN YEARS RDI

4-8 10mg/day

14-18 Boys 11mg/day

14-18 Girls 15mg/day

19->70 Men 8mg/day

19-50 Women 18mg/day e.g. 1 cup rajma = 3.1mg (https://www.nrv.gov.au/nutrients/iron)

Some practical tips to improve your iron intake if you are vegetarian

n Keep pepitas, dried figs and apricots, fresh fruit such as peeled pomegranate at work to munch in between.

n Drink your chai 2 hours after a meal n Eat a variety of seasonal fruits and vegetable in a day n Swap white rice for brown rice n Combine legumes such as rajma and chana with tomatoes, tamarind and lemon (‘clever’ food combinations!) n Make hummus with tahini to pack an iron punch, team it with carrot sticks for another ‘clever’ food combination.

BY NEHA MALUDE

Vegan Holi seems like an oxymoron at first – how do you celebrate a festival in which you have to use ghee and milk to make sweets?

It’s not entirely impossible, as Sydneybased Swati Tiwari recently demonstrated.

“Three years ago, I went through a period of shock and depression when I realised the cruelty in the dairy industry,” Swati tells Indian Link about her journey with veganism. “You can imagine my despair because as Indians, milk goes in everything! That was the start, I think.”

In 2016, she created a Facebook group called Desi Vegans of Australia, a small community of like-minded people who want to explore this kind of lifestyle.

On 10 March, this group celebrated their first ‘vegan Holi’. “Holi is a festival of fun and forgiveness and a fresh start. Celebrating a festival in a kind, compassionate way is the best way to bring people together for a cause, to tell them that it is possible to avoid animal cruelty and still not compromise on the traditional flavours, not miss out on the fun,” Swati explains.

Of course, the question everyone asked was ‘Gujiya kaise banegi? Thandai kaise banegi?’

“We can’t imagine a life without milk, and so that was my chance to jump in and show everyone that it can be done.”

At this year’s Holi, she helped organise a Holi feast with papdi chat, gujiya, chole, pohe and samosa, accompanied of course by thandai. The difference? The entire spread was fully vegan, with milk alternatives and nuts in use.

So confident is Swati about her vegan recipes that she challenged us to a blind tasting, and guaranteed we wouldn’t know the difference.

Veganism is a way of life that seeks to avoid, as far as is feasible, any and all forms of exploitation of, and cruelty to, animals. Obviously, there were challenges on the way. Practising veganism isn’t easy, not at first at any rate.

“It was overwhelming because so many Indian recipes use animal products,” Swati agrees. “But even more overwhelming is the pain we put animals through. Pumping chickens with steroids, introducing hormonal changes in cows so they give us milk all year round. I couldn’t live with that anymore.”

But animal products percolate every aspect of modern life – clothes and accessories made of leather and wool, skincare and make-up products that are