Ellen Swary
Diet Instruction: High-Iron Diet
March 13, 2014
Description of Patient and Diagnosis
Allie is a 21 year-old female who is 5 feet 5 inches (165 cm) and weighs 124 pounds (56
kg). Allie is a college student who is active in her studies and loves to run and has recently been
diagnosed with iron deficient anemia due to her Celiac’s Disease. Because she is always on the
go, Allie tends to consume lots of pre-packaged, fast-food meals and lacks fruits and vegetables
in her diet.
Allie has recently been feeling very fatigued and occasionally is short of breath, dizzy or
has headaches. After doing a physical exam as well as running some blood tests, her doctor
found her hemoglobin level to be at 8.0 g/dL, indicating moderate anemia, and a hematocrit level
below 36%, which is an indicator of anemia. Her doctor has referred her to a Registered Dietitian
in order to help her improve her eating habits and anemia status.
Discussion of the Disease
A. Etiology- Causation or origination of disease
Anemia is a disease, which occurs when an individual’s blood does not have enough
healthy red blood cells. Anemia can be temporary, or long term, and can range from mild to
severe cases. This can occur in a few circumstances, including when the body does not make
enough red blood cells, bleeding causes loss of red blood cells more quickly than the body can
replace them, or when the body destroys red blood cells.
Red blood cells are contained within hemoglobin, which is the red, iron-rich protein that
gives blood its red color. Hemoglobin allows red blood cells to carry oxygen to the lungs and
carry carbon dioxide from other parts of the body to the lungs to be expelled from the body. In
order for the body to make enough blood cells, certain vitamins, minerals and nutrients are
needed for proper function. Three important vitamins and minerals to consider are iron, vitamin
B12, and folic acid. Essentially, without these three components, the body can’t effectively carry
oxygen throughout the body, making it difficult for individuals to live their daily life.
Individuals with Celiac’s Disease are prone to inflammation and damage to the lining of
the intestine, which can prevent the absorption of iron, vitamin B12 and folic acid. Additionally,
poor diet (where there is a lack of vegetables and fruits rich in vitamins, minerals and iron) and
blood loss (heavy menstrual periods) can also contribute to symptoms of anemia.
B. Diagnostic Measures
Suspicion of anemia may result due to general findings in a physical examination and
medical history, which may include tiring easily, pale skin and lips, or a fast heartbeat.
Additionally, it can be detected through medical examination and blood tests that measure the
concentration of hemoglobin and the number of red blood cells. A complete blood count (CBC)
should be conducted in order to measure the red blood cells, white blood cells and platelets, this
will include measurements of hemoglobin, hematocrit and mean corpuscular volume, which can
help indicate whether a patient is anemic or not. Other blood tests can indicate the status of iron
levels, including the serum ferritin, serum iron, and total iron binding capacity, which are also
indicators for anemia. Below are the lab values summarized, which would indicate an individual
to be anemic:
Severity of anemia can be measured through hemoglobin levels:
Severity
Hemoglobin Concentration
Mild Anemia
9.5-13.0 g/dL
Moderate Anemia
8.0-9.5 g/dL
Severe Anemia
<8.0 g/dL
A diagnosis of anemia can be clarified if hematocrit levels fall below:
 39% for adult men
 36% for adult non-pregnant women
 33% for adult pregnant women
The following chart summarizes iron levels that would be normal, but if lower or higher may
indicate anemia (depending on the specific type)
Test
Serum Ferritin
Serum Iron
Total Iron Binding Capacity
Level (for women)
12-150 ng/mL
High- hemolytic anemia
Low- iron deficient anemia
60-170 mcg/dL
High- hemolytic anemia or Vitamin B12
Low- iron deficient anemia or anemia of
chronic disease
High- iron deficient anemia
Low- anemia of chronic disease
C. Treatment
i. Medical, surgical and/or psychological treatment
The status of Allie’s anemia is not harmful enough for surgical treatment, but medical
treatment may be necessary. Oral iron supplements are often recommended for anemic patients.
Depending on the severity, age, and weight, the doctor can prescribe a oral supplement in doses
ranging from 60-200mg. Oral iron supplementation is the best way to restore iron levels for
people who are iron deficient, but this should only be used when dietary measures have failed. In
extreme cases, procedures including blood transfusions and blood and marrow stem cell
transplants may be needed. Evaluating Allie’s diet and making adjustments where necessary
would be beneficial for beginning her treatment plan.
ii. Medical Nutrition Therapy
Using a nutrient calculator while reviewing Allie’s 24-hour recall, it is evident that she is
lacking in her iron intake as well as her total caloric needs. With someone who always on the go
and busy in school, it is important that she consumes the right balance of foods in order to
receive the proper amount of calories on a daily basis.
The following calculations show Allie’s energy needs based on her height, weight, age and
activity level:
Harris Benedict:
Women: 655+ (9.56 x kg) + (1.85 x cm) – (4.68 x age)
655+ (9.56 x 56) + (1.85 x 165) – (4.68 x 21)
= 1400 kcalories
Physical Activity Level: 1.4
1400 x 1.4 = 2,000 kcalories
Additionally, it is recommended that someone Allie’s age should consume at least 18 mg
of iron daily in their diet. It is also important to consider that due to her Celiac condition,
consuming more than 18 mg of iron would be beneficial to Allie’s health, due to complications
with absorption of iron in relation to this disease. Setting an initial goal of receiving 18 mg of
iron through her diet would be helpful.
It is necessary for Allie to increase her consumption of fruits and vegetables as well as
consider combining certain food choices to optimize the iron absorption for her body. While the
RDA for someone’s Allie’s age is 18mg, consuming more iron would be beneficial in her case.
Iron overload would likely only be of concern if supplementation were to be implemented into
her daily intake. It is vital that Allie learn some key factors that will influence the absorption of
her iron, as well.
Meat proteins and vitamin C will improve the absorption of nonheme iron, which is
found in plant sources. Allie should get about 75mg or more of vitamin C per day. To put that
into perspective, 1 medium sized orange has about 70 mg of vitamin C. Additionally, tannins,
calcium, polyphenols and phytates (found in legumes and whole grains) can decrease the
absorption of nonheme iron. Heme iron comes from animal sources, is more readily absorbed
than nonheme, and is not significantly affected by other foods in the diet.
24-Hour Recall
2 scrambled eggs
Chobani Greek Yogurt
Mcdonald’s Chicken Nuggets
Mcdonald’s Medium French Fries
Gluten free penne pasta
Tomato Basil pasta sauce
Kashi Peanut Butter Granola Bar
Naked Strawberry Banana Fruit Smoothie
Total Calories: 1,780 Kcalories
Total Iron: 3 grams
Assessment
 Age: 21
 Height: 165 centimeters
 Weight: 56 kilograms
 Previously diagnosed with Crohn’s Disease
 Hemoglobin level to be at 8.0 g/dL - indicating moderate anemia
 Hematocrit level below 36% (anemic)
Diagnosis
 Inadequate iron intake related to food choices as evidence by 24-hour recall.
 Inadequate energy intake related to food choices as evidence by a 24-hour recall.
Intervention
 Goal: Increase iron intake to a minimum of 18 grams (RDA) by incorporating iron rich
foods into the client’s diet. Educate them on good food combinations and food choices to
allow for proper iron intake and absorption.
 Goal: Increase caloric intake to around 2000 kcalories per day and balance of nutrients to
allow for adequate energy needs. Educate the client on proper caloric needs and provide
menu ideas.
Monitor & Evaluate
 Monitor client compliance with new food suggestions and evaluate changes in energy
level. Continue regular check-ups in order to assess whether adjustments in the diet or
oral supplements are necessary.
iii. Prognosis
Although the outcome of anemia depends on the cause, if treated and cared for
appropriately through diet and supplementation, if necessary, then the outcomes are likely to be
good. In Allie’s case, however, other complications may result due to her status of Celiac’s
Disease.
References
Anemia and Iron-rich Foods. (2010, May). Retrieved from
http://my.clevelandclinic.org/disorders/anemia/hic-anemia-and-iron-rich-foods.aspx
Anemia : Diagnostic Procedures | Florida Hospital. (2013). Retrieved from
https://www.floridahospital.com/anemia/diagnostic-procedures
Anemia: MedlinePlus Medical Encyclopedia. (2011). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000560.htm
Anemia | University of Maryland Medical Center. (2013, September 18). Retrieved from
http://umm.edu/health/medical/reports/articles/anemia
Celiac disease - sprue: MedlinePlus Medical Encyclopedia. (2012, February 19). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000233.htm
Dietary Supplement Fact Sheet: Iron — Health Professional Fact Sheet. (2007, August 24).
Retrieved from http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
Iron deficiency anemia: MedlinePlus Medical Encyclopedia. (2013, March 3). Retrieved from
http://www.nlm.nih.gov/medlineplus/ency/article/000584.htm
Nahikian-Nelms, M. (2011). Nutrition therapy and pathophysiology. Belmont, CA: Wadsworth,
Cengage Learning.
Vitamin C — Health Professional Fact Sheet. (2013, June). Retrieved from
http://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/#h2
What Are the Signs and Symptoms of Anemia? - NHLBI, NIH. (2012, May 18). Retrieved from
http://www.nhlbi.nih.gov/health/health-topics/topics/anemia/signs.html
Good Sources of Iron
Good Heme Sources: animal sources that are better absorbed in the body
 Beef (chuck roast, lean ground beef)
 Turkey
 Tuna
 Eggs
 Shrimp
 Lamb
Good Nonheme Sources (from plants):
 Cereals (check labels for enrichment)
 Beans (kidney, lima, Navy)
 Tofu
 Lentils
 Spinach
 Quinoa
 Peanut butter
 Brown rice
 Dried Fruit
 Beans: White, Lima, Soy
Combining nonheme iron sources with a source of vitamin C will help with absorption, for
example, it would be good to consume an orange at breakfast with iron fortified breakfast cereal.
Good Sources of Vitamin C
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Citrus fruit: oranges, grapefruit, Clementine’s
Kiwi
Canataloupe
Orange Juice
Green & Red Peppers
Strawberries
Broccoli
Tomato juice
Spinach (cooked)
Additional education on reading a nutrition facts panel may also be helpful for Allie to
monitor the amount of calories she is consuming and knowing the iron content of some of her
foods. An example nutrition facts panel (below) could be used for demonstration: