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Q #1: Best Way to Get Iron

What foods contribute to iron, or what foods can give me iron. Can it only be from pills? (October, 2000)

A: Diana Peabody, RD responds:

Iron is found in many foods. There are basically two types of iron in food, heme iron and non-heme iron. Heme iron is absorbed much more efficiently and is found in meat, poultry and fish. Non--heme iron is not absorbed as well and is found in vegetables, fruits, grains and eggs. However, the absorption of non-heme iron can be increased by eating some foods high in vitamin C or a small amount of meat at the same time. It is not usually a good idea to take iron pills when you have HIV unless you are sure you have an iron deficiency. Too much iron in the system feeds bacteria and can be toxic. It is especially important to avoid iron pills if you have liver disease like hepatitis.

The following is a list of foods high in iron:

Heme iron: beef, pork, chicken, turkey, fish.
Non-Heme iron: Fortified breakfast cereal, especially bran flakes, cream of wheat, baby pablum, oatmeal, enriched pasta, whole wheat bread, raisins, dark green leafy vegetables like spinach, legumes (dried beans, lentils and peas), tofu, eggs, molasses, prune juice, nuts.

To increase iron absorption, eat foods high in vitamin C like fresh fruit, especially citrus fruit (oranges, grapefruit, lemons), vegetables, or fruit juice at the same time as foods containing non-heme iron.

Some foods have substances in them that inhibit iron absorption. Oxalates in spinach, phytates in legumes and whole grains, tea and coffee decrease iron absorption. This can be overcome somewhat by adding the vitamin C foods.

A: Donna Tinnerello, MS, RD, CD/N responds:

Another way to offset iron deficiency is to cook with iron cookware -- iron from the cookware is bioavailable, that is, humans can use it to replete iron stores. Vegetable iron (non-heme) beans cooked in an iron pot with tomato sauce or other vitamin C foods is a heavy duty dose of iron.

But as Diana cautioned, too much iron is not always a good thing.

Q #2: Iron & Multi-Vitamins

I currently take the Source Of Life multi-vitamin. I pick it up at Whole Foods here in Dallas. I'm concerned about something that I read recently, that too much iron can speed up the process of HIV. What would be considered too much iron? And what could you suggest as a SAFE multi-vitamin? There are so many! It's really beginning to confuse me, frustrate me, and give me a headache. (September, 1999)

A: Charlie Smigelski, RD responds:

HIV infection causes a degree of gut cell changes, resulting in modest malabsorption of all vitamins, minerals, and even essential fats. Add to this reduced intake capacity the higher needs of HIV+ people to meet expanded T-cell production every day, as well as the needs of many to deal with the side effects of medicines, and you end up with a long list of suggested supplements. (For my supplement recommendations for most HIV+ people, see the Q&A on Lipodystrophy.)

The best places to get HIV-specific supplements are the regional Buyers Clubs. In your area, I would use the one in Houston, which is one of the best in the country. Visit Houston Buyers Clup. The Jarrow Multivitamin (iron free) is a great basic one to use.... it contains extra Vitamin C, E, and B-complex.

The RDA for iron is 15 mg for a man. That is enough to have in a supplement. Iron does not hasten HIV progression. It just rusts (oxidizes) too easily and you don't need the corrosion. And that's not a joke!

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