If you are feeling fatigued or don't seem to have much energy or endurance, you should make sure that anemia is not a problem for you. There are many types of anemia, and iron-deficiency anemia is especially tricky to treat in chronic HIV and hepatitis C infections. Taking an iron supplement may seem like the easiest treatment, but in chronic infection you run the risk of overload (and you still won't improve your blood levels of iron) and opportunistic infection (those bugs like and need iron too!). You can ask your doctor about anemia and also ask if iron deficiency is a problem for you according to your laboratory tests.
A lab test will include iron, transferrin, and ferritin levels. At the start of an iron-deficiency problem, transferrin concentrations tend to rise, letting you know that it is time to work on reversing the problem before it becomes 'full-blown.' Even when iron levels are not noticeably declining, endurance can be impaired and a person may become restless, unfocused, and downright crabby. Progressing deficiency, when the blood doesn't carry enough iron, results in smaller red blood cells, and the color is not as bright; this is called 'microcytic and hypochromic' anemia. When this full-blown deficiency is seen, every cell in your body will feel the effect, showing up as headaches, fatigue, lack of endurance, and apathy. Iron deficiency also seems to change appetite in some people, making them crave clay, paste, and other strange substances that don't contain much iron. So much for the body telling you what you need!
Normally you will absorb around 10% of the iron that you consume. If you routinely eat meats, fish, and poultry, you are probably at a lower risk for this problem. But if you are a vegetarian, it may be more challenging to ensure that you get all the iron you need in a form your body can readily use. Also, iron-rich food sources tend to be more expensive in many cases. So if you are a vegetarian, are on a budget, or are just not eating iron-rich foods, you will need to be creative about where you get your iron.
Animal sources of foods have a ready-to-use form of iron, called heme-iron, that the body uses as is; we can absorb nearly one fourth of this type of iron. However, plant sources of iron tend not to be the heme variety; these sources are less bioavailable'unless you make sure that you combine foods to enhance the bioavailability by up to three times.
Plant sources of iron can be effective if you combine them with substances that enhance the absorption and form of their iron. Then you can use them nearly as efficiently as animal sources. The food factors we usually look for include sources of vitamin C, other acidic substances, and certain sugars. Vitamin C is the most readily available and easy to add. For instance, red beans are a great source of iron, and you can maximize its absorption when you add tomatoes to the mix. Remember that vitamin C is easily destroyed by heat and oxygen, though, so cut and add those tomatoes at the very end of cooking time to get the most out of them. The more vitamin C that is in the meal, the more iron will be available for your body's use.
Wheat is also a good source of iron, and you can make it more bioavailable by adding a source of vitamin C (see the accompanying recipe for bread pudding as an example). And while it shouldn't be your main source for the mineral, red wines tend to be rich in iron and have sugars that enhance absorption, making it a good once-in-a-while accompaniment to dinner.
Start by power-packing your breakfast or snacks. Try the accompanying iron-clad recipe for breakfast pudding to start your day with 50% or more of your iron needs.
Fields-Gardner is the director of services for Cutting Edge, an HIV nutrition company. She is a member of the International AIDS Society and the American Dietetic Association's Dietetic Practice Group on HIV and AIDS.