The Iron Age and Pregnancy

One recipe today – which maybe I’ll post in the middle to keep you interested – and lots of talk about nutrition, specifically iron intake and deficiencies in women.  So this might be boring if you’re not a)pregnant or b)a woman 🙂  It does refer to female runners as well, though, and maybe even a teenage male.  But you’ll just have to read on to find out how these are connected…

First, here are a few nice pictures taken from the Iron Age Hill Fort (called Barbury Castle although there are no ruins in sight) 5 minutes from our house (It’s a site that was first occupied about 2500 years ago and is now just a big trench and ridge in a large circle that is a place to hike).  The British Iron Age is considered to be from the first use of iron tools up until the Romanization of the southern part of England (around 800BC – first century AD.)  It’s the only picture I could think of that has anything to do with Iron 🙂

I have done A LOT of research on Fe — you can even say it goes back to my days at Nuclear Power School studying Ni-Cr-Fe cladding in a pressurized water reactor – and have emailed several friends lots of the details of some of the helpful things I have discovered in my quest to raise my iron levels.  I’m not going to reference web pages in this post but will just say that everything I discovered is on the internet, and I am no expert or doctor.  I just felt like I had compiled enough good information that someone might be interested by a small piece of it 🙂

I’ll try to keep my thoughts organized, but I think this will read more like a mystery novel than a coherent list of things about iron.  I am sure if you are pregnant and reading this, or just a woman, you may have struggled with low iron off and on throughout your life.  My first indication of anemia was as a midshipman during my plebe summer at the Naval Academy.  At that point I just went on iron supplements, along with the Milk of Magnesium doctors always prescribe with iron to combat its negative side effects, and took those for a short time.  I never really gave it another thought other than to avoid giving blood because I had been anemic.  Speaking of the teenage male – apparently low iron strikes a lot of young people in their late teens and early 20s due to dietary changes and such (away at college and in charge of their own food intake for the first time), as one of my friends shared about a young man that she knew.  I was sharing my own low iron issues a few years back and she mentioned a kid who wanted to eat dirt (as I did during the last pregnancy) and who was apathetic, lethargic, and depressed, and who eventually was passing out before they determined he had very low iron levels.  It can really be a dangerous thing and not easy to combat with today’s eating habits.

During my first pregnancy I started to munch on ice when I would finish my iced drinks.  The first time I opened up my iced coffee and started eating the ice was what tipped me off to my second pregnancy, and I constantly had iced drinks with number 3 and 4, enjoying the ice at the end the most.  It was not until my fifth pregnancy, though, that I started fixing myself drinks with ice filled to the top of the cup – just to soften up the ice enough to eat it.  I had one of those Venti Starbucks tumblers and would fill it with ice (and then water or tea or some mixture of juice, etc) at least 10 times a day, no joke.  Eventually my ice maker couldn’t keep up with me, and I started keeping bagged ice in the chest freezer in the garage.  I had run just to 16 weeks with that pregnancy and then had a day of contractions and such and was told by the OB to stop running since I had had a miscarriage at 16 weeks about a year earlier.  Looking back, I think it was probably related to my low iron levels, as I was having other symptoms related to low iron and magnesium – constant leg cramps being the most noticeable.  Some time in the middle of that pregnancy I started feeling absolutely exhausted – I would get up late (we had a mother’s helper living with us because my husband was gone so much on his submarine and gearing up for another six month deployment) make it through to lunch time and nap time, and then I would nap when the 2 year old napped.  After nap time I would come down to the couch and basically not get back up, with the exception of some dinner preparation done sitting at a stool at the kitchen island while having my helper run back and forth to the fridge or cupboard, until I went up to bed in the evening.  I was just SO wiped out, and I couldn’t even do any walking for exercise without contractions kicking in (and this was only at 5-6 months along.)

Finally one day I received a clear indication of the problem.  I was sitting in church in Hawaii – meaning it was an old elementary school cafeteria, windows and doors open for the breeze, and the school field being used by some local team for a softball game – when the dust rising from around the field as runners circled the bases started to make me salivate.  I wanted to eat the dirt.  I wanted to eat lots and lots of it, just gobble it up.  I can remember the sensation so clearly!  I called the OB the next day and went in for a blood test – and of course my iron levels were through the floor.  Wanting to eat non-food items is called pica and is a common sign of iron deficiencies.  The most common desires are for dirt and ice, although other people apparently like to eat paper and other weird things.

I had suspected low iron a month or two earlier, so I started to eat more of everything I thought was full of iron – adding certain nuts and molasses to my oatmeal, lots of spinach, broccoli, etc.  But as I started to research iron intake I discovered that I had basically been shooting myself in the foot with the OTHER healthy things I was eating – like whole grains and tea.  Many foods severely inhibit your body’s absorption of iron, while others can increase your absorption substantially (which is why they often recommend having orange juice with your iron supplement – because Vitamin C is supposed to help absorption rates.)  But what they DON’T tell you is that there are TWO DIFFERENT TYPES OF FOOD SOURCES OF IRON – and this is the most important thing to take away from my post.  More on that in a second…

I did wonder also at this point – why this pregnancy (number 6 at the time if you counted my miscarriage) did I suddenly have such an issue? I wasn’t doing anything differently – or was I?  Well here’s what I discovered — I was running for the 5 months before we conceived, which I had never done before (except when I was at the Naval Academy.)  Runners can apparently crush red blood cells with a heavy heel strike, essentially just losing all that iron as they would have done had they bled it out or given blood.  (I no longer run with a heel strike, but at the time I did.)  So that was one difference.  If you’re a runner, and you’ve struggled with fatigue – I would highly recommend having your iron tested!!  Another thing was that I had had 6 menstrual cycles between pregnancies this time – when previously I there was only one between pregnancies – because my husband left on a 6 month deployment right before I miscarried.  Every time a woman has a cycle, she obviously needs to replenish her blood supply, which takes more iron.  This applies to a miscarriage as well – a major loss of blood.  So that was three strikes against me leading me to enter the pregnancy with diminished iron stores.

From all my reading I also found that once you are pregnant, actually BUILDING iron levels is nearly impossible.  Within the first few weeks, even before you know you are pregnant, your body is manufacturing blood to the point of increasing your body’s volume of blood by 1/3. (This is another reason you should be on prenatals if you think you may become pregnant.)  Our bodies are so amazing that at certain points in the pregnancy when you will need more iron FOR THE BABY, your body’s ability to absorb iron increases!  At other times in the pregnancy, its absorption potential decreases again, so even if you’re taking supplements to up your iron, your body may just be in the part of the pregnancy where you physically cannot absorb the amounts you need.

Here’s where the thing about the different types of iron becomes so important.  There are non-heme sources of iron (related to elemental iron and found in all plant/nut/vegetable/SUPPLEMENT sources) and there are heme sources of iron (iron obtained by eating an animal product.)  By the way – iron-fortified foods do not count as heme sources, even if they are an animal product, because they are fortified with elemental iron.  So what’s the big deal?  Heme sources can be ingested and will lead to an almost complete use of the iron by your body because they are already in the form your body needs (the animal’s body took elemental iron and turned it into useable iron for you!) REGARDLESS OF THE OTHER FOODS YOU EAT.  So you don’t have to worry about helping or hindering your body’s “absorption” of the iron.  Any supplements you take, or however much you eat of “iron-rich” foods, will do you no good if you’re not absorbing much of the iron.  Even if you try to help that absorption along, your body still is pre-programmed, specifically during pregnancy, to absorb at differing rates at particular times.

So as an aside here – you need to work on increasing your iron levels BEFORE YOU GET PREGNANT.  And I don’t mean through supplements – because I am not sure how these affect a nursing baby that could be counting on you for nutrition before you get pregnant with the next baby – I mean through heme sources of iron.  If you’re a vegetarian, then I don’t know what to tell you, but this is important – build up your iron stores because once you’re pregnant you’ll only be using it up and trying to maintain through diet and will not be able to recover from a deficit.

Once I had read these interesting things, I went straight to researching what the best sources of heme iron were.  Liver! Great! I love pate!!! BUT WAIT! I read more about liver and discovered it is universally (nowadays) prohibited for pregnant ladies.  It USED to be recommended by doctors during pregnancy (obviously because it’s one of the highest sources of heme iron) but then they determined that it could possibly contribute to birth defects, since it is SO HIGH IN VITAMIN A.  Apparently a Polar Bear liver has so much Vitamin A in it that it can kill a human who eats it!!! They are not sure how much Vitamin A is too much during a pregnancy, so they just recommend steering clear of it if possible.  Bummer.  So what’s next?  Turns out MUSSELS and cockles are super high in iron.  (Ever heard that song “Molly Malone”?  Being in an Irish band, it was one of our regulars :))  Anyway, in England I have found that doctors and people tell you not to eat ANY SHELLFISH during pregnancy, while in the US it’s RAW SHELLFISH which is on the list of no-nos.  Interesting.  Of course, shellfish, being a bottom dweller and a filter of the ocean, could tend to be high in heavy metals and contaminants I guess, but I always eat farm-raised mussels, and I have never seen a mercury warning against mussels – or any other kind of warning against them.  So I started eating mussels just about every day during my previous pregnancy.  I used to LOVE MUSSELS, but I can tell you now, I am just on  good terms with them and no longer love them (familiarity breeds contempt, right?)  The reason they are so high in iron, though, is because their bodies are simpler than those of other animals  —  they don’t HAVE a liver.  Other animals (like chickens, and like us) have a filter system for their bodies – and it’s the liver.  So you have to eat that animal’s liver to get the iron.  When you eat a mussel, though, you’re eating everything it’s eaten, which includes the iron from the ocean things it consumes.

So here’s the recipe I promised for “halfway through the post” which is really much further along than halfway, but I had to wait til I got to the punchline (mussels.)  They were handing it out at the Guinness Factory in Dublin when we were touring it in May, and I was also able to find it on their website here.

• 1kg fresh Irish Mussels in their shells
• 300ml cream
• 200ml fish stock
• 330ml GUINNESS® extra stout
• 1 bay leaf
• Knob of butter
• 1 Tablespoon of chopped fresh dill
• 1 medium onion – diced
• 1 large carrot – diced
• 1 large celery – diced
• Juice of half a lemon

In a saucepan place the butter, onion, carrot and celery and fry for 2-3 minutes, being careful not to overcook. Add the GUINNESS®, fish stock, bay leaf and simmer until reduced by half. Add the cream and reduce by half again. Add the Mussels and cook for 2 – 3 minutes until all the shells have opened, then add the dill and lemon juice.

I don’t have a nice picture for you, but there’s a lovely one on their website 🙂

If you need to incorporate more heme sources of iron into your diet and hate shellfish, then don’t trust what you’ve always heard — do your research and find out exactly what the high sources of iron are.  (People always think “red meat,” but if you’re not pregnant and can eat liver, chicken liver is much higher in iron than beef liver.)  Anyway, why am I now eating so much ice again, I ask myself?? Well I certainly know the answer and will confess it right here – I have dropped off on my mussel consumption, although I had kept it up pretty well to at least 3 days a week between the last pregnancy and this one.  This time I didn’t have ANY cycles between pregnancies and was pregnant about 3 months after the baby turned one (which is about two months longer between pregnancies than I normally have), so that can’t be the contributing factor to low iron this time.  I definitely did a good job of maintaining a good store of iron, because my initial blood tests showed HIGH iron levels (a first for me.)  I didn’t even want to eat ice! The one time I did it hurt my teeth.  Then in March I had a test showing low iron – right around the time I was occasionally starting to eat a piece of ice here and there.  Not a lot of iced drinks easily available here in England, and if I wanted iced tea in places I’d have to get a glass full of ice and pour hot tea over it – thereby melting most of my ice.  In April I started to be sad when all the ice was melted, and by May (30 weeks) I was really enjoying eating ice at home in my drinks.  By June now, I’m back to eating about 4 cup-fuls of ice a day (the big cups) and buying bagged ice 😦  They prescribed me iron supplements in April, but I didn’t fill the prescription and have just been trying to eat more mussels.  I had dropped down to maybe twice a week when I was in my first few months of pregnancy – since, really, morning sickness and mussels? No thank you.  Then I started back at 3-4 times a week, but it was nothing close to the 7 days a week I had been eating them during the last pregnancy when I discovered I had a serious problem.  Back then I had my mother’s helper to kick me in the shin if I didn’t eat them (and to fix them for me so I would), and now it’s me doing everything by myself most days. Also, it’s hard to find a time of day to eat them because it should be first thing, but I don’t really want them right after a run 😦  Excuses, I know. I’m working on it.

Personally, I usually just steam the mussels which I keep in the freezer (most of the simple ones to buy are already cooked and then frozen, sometimes in their shells and sometimes already shelled).  Often they will end up boiling a bit instead of steaming because they don’t take up much room in my pot, so the small amount of water in a pot with shelled mussels translates to boiled mussels.  I’ll drain off the water and add some butter, cooking wine, and maybe some garlic salt and whatnot.  Then I just toss them around in that a bit and eat them as quickly as possible.  Other days I’ll just make a dish of butter for dipping, with a squirt of lemon juice in it.  When feeling particularly adventurous (or just sick of my normal mussels) I have stuck them into pastas or leftover rice, and once I even baked them in a dish with bloody mary mix from the fridge.  I get really desperate for new and tastier ways to eat them.  Hopefully this information will be useful to someone who has been struggling with an iron deficiency – I know I would have appreciated knowing some of these things years ago!!

My blood was drawn today for routine 36 weeks tests they do here, so we’ll see what my iron is doing now.  In case you read a previous entry and are wondering about my “measuring small” at this week’s appointment, I was referencing my “fundal height” – the measurement of the height of my uterus basically.  I was scheduled for the OB because of this and went in today for a scan, where it was discovered the baby is growing perfectly fine and along the growth curve, and all my pockets of amniotic fluid are there and look great.  I measured 1-1/2 cm LESS today than I did on Wednesday, so I think the measurement must depend on who is doing it.  I had always heard that the cm measurement matches up roughly with how many weeks pregnant you are.  Well I just checked out a chart of fundal heights and discovered my number to be just about average for 36 weeks.  I guess the midwife was just concerned because the measurement hadn’t changed in two weeks.  Also on the chart, however in the 95th percentile from weeks 32-35, the measurement barely changes from 34-34.8cm in those weeks.  So really, it was nothing to get worked up over.  But it was still nice to have the extra ultrasound to have everything checked out.

Do you have an iron deficiency and, if so, any tips on ways to combat it?

Can you give me any good ideas for new ways to eat mussels???