Is iron deficiency universal and profound in India? Is it due to dietary iron deficiency? With the Indian vegetarian diet, containing 8.5 mg iron/1,000 Kcal-energy, women who eat adequately (enough energy for a sedentary lifestyle), should have an iron intake of about 15 mg/day, matching their daily iron requirement (15 mg/day). Adult men with their lower iron requirement (11 mg/day), and those eating for an active lifestyle with higher energy intake, are even better off. Therefore, dietary iron deficiency is not the major problem. Nor is iron deficiency the common cause for deficiency anemia in India; it is only one cause. Other nutrients like vitamin B12, folate and protein are also important. Indeed, anemia itself may be over-diagnosed, since surveys using capillary blood will overestimate the prevalence of anemia, and there is some doubt that the hemoglobin cutoff to diagnose anemia is incorrectly high, overestimating its prevalence.
Therefore, when body iron deficiency occurs, it is less likely to be due to an iron-deficient diet, and more likely due to poor absorption of dietary iron. With poor, cereal-based diets, iron is not well-absorbed, because of a substance called phytate that is present in cereal grains, which binds tightly to dietary iron and impedes its absorption. Similarly, drinking tea or taking paan after meals also blocks iron absorption because of other inhibitory substances called polyphenols, which also bind iron tightly. Chronic body inflammation also blocks iron absorption from the intestine.
This iron absorption blockade can be overcome by eating fruits (vitamin C) with meals, or simply changing behavior, like avoiding tea with meals. Alternatively, dietary iron intake could be increased in a natural manner, by eating iron-rich grains like millets, which will increase iron intake naturally, and not excessively. It is laudable that there is interest in promoting millet consumption in India for adults and children: these ancient grains are good for us in many ways, and not just for their rich iron content. They are also high in calcium, zinc, magnesium, potassium, dietary fibre, and important vitamins such as thiamine, riboflavin, folic acid, and niacin.
