Many of the pregnant women I work with are concerned about anemia. They want to know whether they’re getting enough iron in their diets, and whether they should be supplementing.
Physiologic “anemia” in pregnancy is healthy and natural. Increased amounts of iron are needed to make additional red blood cells for your developing baby, and for your body’s preparation for blood loss at delivery. Anemia also results from the dilution of red blood cells as the fluid volume expands to nearly double the amount normally present before you were pregnant. It is evidenced by a gradual 2 gram drop in hemoglobin by the seventh month, followed by a gradual return to prepregnancy levels by 3-4 weeks postpartum. Iron stores (ferritin levels) also tend to drop.
While iron deficiency anemia is the most common type, it’s important to note that anemia can be caused by a number of factors. Also, vitality is a great gauge of well-being. If your hemoglobin is a little below normal but your iron stores are fine and you feel fit and healthy, you need not worry. Just make sure your diet is rich in foods high in iron and vitamin C.
Symptoms of Anemia
If you are truly anemic, you may experience the following symptoms.
Extreme exhaustion and weakness
Shortness of breath
Dizziness or faintness
Poor concentration and confusion
Feeling weary and run down with a lowered resistance to infection
Poor appetite and unusual cravings for non-food items
Iron Deficiency Anemia is Common
Whether or not you have the above symptoms, you are smart to be paying attention. The formation of additional red blood cells for both momma and baby, coupled with their dilution by increased fluid in the circulation, can often lead to iron deficiency anemia during pregnancy. It can be especially aggravated by:
A diet low in iron both before and/or during pregnancy
Severe nausea and vomiting
Being pregnant with multiple fetuses
Closely spaced pregnancies
Alcohol or drug addiction
Severe or chronic infection
Significant blood loss
More serious medical conditions
Treatment Options for Anemia in Pregnancy
Untreated anemia in pregnancy that becomes severe may increase the risk of harm to your baby. You may be more susceptible to infection, less likely to handle the stress of labor, the normal blood loss at delivery, and the needed healing during the postpartum period.
Treating iron deficiency anemia can be tricky because many sources of iron are not easily absorbed into your system and some products like coffee, soda, black tea, dairy foods, bran, antacids, calcium and magnesium supplements, and certain medications actually inhibit iron absorption. However, careful attention to diet and use of natural easily assimilated forms of iron have produced excellent results without the detrimental side effects of the commonly prescribed ferrous sulfate.
Ferrous sulfate is not only poorly absorbed, but also very constipating, can cause indigestion, black tarry stools, skin rashes, and is said to be hard on the digestive tract, liver and kidneys. Too much ferrous sulfate has been associated with serious complications and can produce the same deficiency state that it was prescribed to correct.
There are a number of ways anemia in pregnancy can be addressed without ferrous sulfate. I recommend combining several of the suggestions below to increase your chances of successfully increasing your hemoglobin and keeping it at a healthy level.
Get as much iron you can from your daily diet. Good food sources for iron (as well as other needed nutrients) include:
Organ meats like beef or chicken liver
Red meat and poultry
Shrimp, oysters and clams
Dark green vegetables like spinach (ideally boiled briefly to increase absorption), watercress, alfalfa, parsley, seaweed, collards, kale, turnip and dandelion greens
Seaweeds (kelp and dulse/kombu)
Beets and fresh raw beet juice
Fermented soy like tempeh
Legumes like red beans, chickpeas, lentils and split peas
Whole grains and fortified cereals
Seeds and nuts
Dried unsulphured fruits fruits like raisins, apricots, cherries, black mission figs and prunes
Black cherries and pomegranate
To further enhance iron absorption, eat iron-rich foods with foods high in vitamin C. For example, fresh organic uncooked grapefruit, oranges, vegetable or tomato juice, strawberries, blackberries, raspberries, mango, cantaloupe, papaya, tomato, red or green pepper, cabbage, broccoli, cauliflower, and leafy greens. Regular exercise will also help with absorption, as will cooking in cast iron.
Herbs and Tonics
Choose one or two of the following natural sources of iron to prevent iron deficiency, or alternate between a few.
Vegetarian Iron Tonic - Mix 1 Tbsp blackstrap molasses, 1 Tbsp brewers yeast, 1 Tbsp wheat germ, 1 Tbsp canola or coconut oil, and 4 oz orange, grapefruit or pomegranate juice. If you like warm drinks, try 2 Tbsp blackstrap in 1 cut hot water with fresh lemon juice. Drink 1-3 times daily.
Fresh Juice - Fresh beets and apples make a yummy absorbable, iron-rich juice. Drink 2 cups twice daily. You can add 1/2 to 1 ounce wheat grass juice, ½ cup of fresh parsley and/or other green leafies (except raw spinach) to boost the iron content.
Wheat Grass - Take no more than one ounce per day. If causes stomach upset, half the dose or add it to beet, carrot or other vegetable juice for the first week then take the full ounce by itself or in the vegetable juice.
Herbal Infusion - Steep up to 1 large handful of dried nettle leaf and/or red raspberry leaf in a quart of boiling water for at least 4 hours. For increased iron, you can add a pinch of dandelion root and/or a pinch of yellow dock root. Strain, and drink several times throughout the day. You can add a splash of lemon or lime juice, fresh mint, 1-2 Tbsp of blackstrap molasses or a dash of honey to taste.
Capsules - Take 3-4 capsules of freeze dried nettles or 8 capsules of seaweed daily.
Tinctures - For prevention, take a dropperful of yellow dock root or dandelion root tincture in orange juice. For treatment, take up to three dropperfuls 1-3 times daily.
Liquid Chlorophyll - Take 1-3 Tbsp per day depending on your individual requirements.
If You Decide to Take an Iron Supplement
If an iron supplement is needed, I recommend taking a non-sulfate whole food variety like ferrous gluconate or fumarate combined with vitamin C. 30-60 mg of elemental iron daily should suffice for those with normal iron stores, while higher doses may be needed if your iron stores are depleted. Your dose should be adjusted according to your lab results and individual needs. Take your supplemental iron daily until 2-4 months postpartum.
For optimal absorption, it is best to spread supplemental iron intake out over the course of the day to avoid stressing your system with the unabsorbed portions. Do not take with dairy foods, caffeine or soda with phosphates. Be sure to take it between meals on an empty stomach with 500 mg of vitamin C and bioflavonoids
Although it can take a few months to correct iron deficiency anemia, you should start to see an improvement in the lab values within two weeks of treatment. If not, try a different combination of natural iron sources. If there is still no improvement after another 2-4 weeks, your anemia may not be related to low iron and a more thorough medical evaluation is needed. If you are feeling overwhelmed, or do not even know what questions to ask, I can help you! You can just schedule a consultation with me here.
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