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How can I improve my iron and calcium levels through diet?

Q: I am 4 months pregnant and my doctor has prescribed high dosage of iron and calcium tablets. My haemoglobin is 13.3. I have been taking wheat, ragi and rice daily with 3 types of fruits: apple, banana and pomegranate. I also take a lot of green leafy vegetables, pulses and dry fruits like almonds, apricot and dates. I hate to take tablets. How can I substitute these tablets through natural sources of iron and calcium.

A:Anaemia is inadequate level of haemoglobin (Hb) appropriate for age & sex of the individual and it is diagnosed in pregnant women when levels are less than 11.5 g/dl. It is twice as common in women than in men, especially during the childbearing years due to menstrual blood loss and pregnancies. The most common cause of anaemia in pregnancy is deficiency of iron (~85% cases) and folic acid. Even if a woman is not anaemic at the time of pregnancy, she may still develop anaemia as the pregnancy progresses due to increased demands of the developing baby. There are certain risk factors for women being anaemic and these include: poor nutrition, inadequate gap between pregnancies, persistent nausea or vomiting in early pregnancy and twin pregnancy. The loss of iron (elemental) with each normal menses is around 12-15 mg. A normal diet must include 1.5-2 mg/day of elemental iron to compensate for menstrual losses alone. In pregnancy, 500 mg of additional iron is needed by the mother (to expand her red cell mass) while another 500 mg is needed for the baby and placental tissues. Thus, on an average, an additional 3 mg/day of elemental iron must be absorbed from dietary sources. Iron is obtained from foods in our diet but only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested (i.e. the amount of iron absorbed by the body is only 10% of the total amount consumed), thus 30 mg/day needs to be consumed to meet the requirement. Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron. Iron in foods comes in two forms heme-iron (meat, poultry, fish) and non-heme or inorganic iron (vegetable source). Heme iron is highly available for absorption in contrast to non-heme iron. Vegetarians need more iron in their diets than non-vegetarians because the iron from plant foods is not as well absorbed as it is from animal foods. Vegetarians should choose several iron-rich plant foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc), fruits, nuts and seeds are rich sources of non-heme iron. The absorption of non-heme iron can be improved when a source of heme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair iron absorption as do inhibitors like bran, vegetable fiber, tannic acid found in tea, and phosphates. Restrict your consumption of milk so that you have an adequate appetite for iron-containing foods as milk doesn't contain any iron. It is for these reasons that all pregnant women are given iron and folic acid supplementation.

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