As already described above, vitamin C (ascorbic acid) is a strong enhancer of dietary iron absorption since it is a ferrireduc- tant. Other organic acids (citric, malic, tartaric, and lactic) can have enhancing effects; generally, acidic gastric secretions are thought to help promote iron absorption, particularly since DMT-1 is a proton-coupled transporter. Other food factors can block nonheme iron absorption, for example, phytic acid. Even small amounts (5–10 mg) inhibit iron absorption by 50% (Food and Nutrition Board, 2001). Polyphenols, which are found in fruit and vegetables, coffee and tea, as well as in wine, are also potent inhibitors of iron uptake. Certain drugs may reduce iron absorption, including antacids and pro- ton pump inhibitors that decrease acid in the stomach. Since metals often share transport pathways, competition between cations can occur, especially between zinc and iron. On the other hand, because copper is required for ferroxidases that promote iron uptake (hephaestin, ceruloplasmin), copper-deficiency anemia can arise (Gulec et al., 2014).
In surveys of the US population, it has been reported that men intake an average of 16–18 mg/day and that women take in about 15 mg/day (Food and Nutrition Board, 2001). Of course, strong dietary influences such as those described above factor into the final amount of iron absorbed, but generally men consume more than the recommended amount of iron while women take in less. Thus, iron-deficiency anemia during pregnancy is of particular concern. Iron supplements are avail- able to prevent and treat iron deficiency but their use should be discussed with a health care provider. An over-the-counter multivitamin/multimineral supplement typically contains about 18 mg of iron, which is above the recommended amount.
Iron fortification programs have been implemented to prevent iron deficiency in many countries, but are controversial due to the extent that high iron can cause oxidative stress and place people who have inherited or acquired overload diseases at risk despite benefit to the population as a whole (Allen, 2002). In the age of personalized care and precision medicine, given the significant health impact of iron it is important for one to know and keep track of their individual iron status since iron deficiency can be reversed through changes in diet and supplementation, while iron overload can be limited through these measures as well.
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