Question

Iron: Case scenario

Laura is a 21-year-old student at a small university just outside of Sydney. She is an average student in the classroom, but excels in track and field competitions. Laura is about to start her final year at university, and she wants to maintain the track and field records that she has earned over the past few years. Laura has recently become a vegetarian. Although she still eats eggs and dairy products, she avoids all other animal products. Laura begins every morning by running before class.

Recently, Laura has not been feeling too well. She has noticed that it is much harder to gather the energy for class every day. At first, she noticed it only once a month, while she was menstruating, but now she feels tired and weak more often. She gets particularly tired after running sprints. At the beginning of the year, she set the pace for her team, but now she finds it difficult to keep up.

At first, she thought she was just tired and stressed from such an active lifestyle, but now she is noticing other symptoms, which are causing her to be a bit more worried. She is now experiencing shin splints (persistent pain in the shins). Lately, she has looked pale. She gets frequent headaches and finds herself to be much more irritable. This may be because she has been having trouble sleeping. This winter has also been particularly cold, and Laura can't seem to warm up. Initially, Laura's symptoms were not severe enough for her to worry, so she put off seeing the doctor. However, she now tends to get more bruises than she used to, and when she gets cut, it takes much longer to heal. When she does get a cut, it often becomes infected. Laura decides it is finally time to see her doctor, who sends her for a blood test.

Laura calls the surgery for her results and finds out that her iron is low. Before discussing this with her doctor, she goes to the chemist and buys iron supplements. She takes a 60 mg supplement before every meal and again before going to bed. She makes sure to swallow the supplement with a glass of orange juice, because she knows vitamin C enhances iron absorption. She also tries to eat more iron-rich foods without changing her vegetarian diet. She loves spinach and, having read that it is high in iron, finds a way to incorporate it into most meals.

Laura quickly begins to feel better; but this doesn't last for long. After one month, her symptoms return and additional symptoms develop. Laura has noticed that she was constipated when she first began increasing her iron, but lately she has had nausea and diarrhoea. She feels just as weak and lethargic as before, and her occasional cuts and scrapes continue to become infected easily. Laura begins to wonder: if not an iron deficiency, then what is wrong with her? She knows something has to change, but needs help figuring out what to do.

Case Scenario: Questions

1.   Why might Laura's symptoms have returned even after changing her iron consumption?

2.   Laura experiences many symptoms that eventually bring her to the doctor. Which of these are indicative of iron deficiency?

3.   At first, Laura only experiences symptoms during menstruation. Explain why this is.

4.   When Laura discovers that her iron is low, she immediately makes dietary changes. What misconceptions does she have about iron intake and absorption?

5.   What general advice can you give Laura to improve her health and improve her vegetarian diet to contain enough iron?

Answer 1

1.Common causes of iron deficiency in adults include not getting enough iron in your diet, chronic blood loss, pregnancy and vigorous exercise. Some people become iron deficient if they are unable to absorb iron. Iron deficiency can be treated by adding iron-rich foods to the dietary and in this case Laura has changed her diet and iron deficiency may also be caused due to vit B 12 deficiency which she obtained from food before she became a vegan.So it may be due to her diet and has to consult a doctor to find the exact reason rather than the chemist to take proper dosage of iron supplements according to her need.The iron deficiency may be due to other reasons

2.symptoms include fatigue,paleness,lack of healing, tiredness,shin splints,lethargy

3.because there is more loss of iron during menstruation

4.changing diet only may not help she has to consult the doctor and take iron supplements and do accordingly changing diet alone won't help because there are other reasons also that contribute to iron deficiency.Good iron diet helps improve conditions

5.include diet like

• Eat plenty of iron-rich foods, such as tofu, green and leafy vegetables, beans and iron-fortified cereals and breads.
• Eat and drink vitamin C-rich foods and drinks.
• Avoid drinking tea or coffee with your meals, as they can affect iron absorption

For vegetarians who eliminate meat, anemia can be due to an iron deficiency. For vegans, who give up all animal products including dairy, eggs, and even honey, anemia can also be caused by vitamin B12 deficiency so include more these items also.