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The UNITED STATES and some other countries require a prescription on all medication sold from Mexico. They further require documentation in English and an invoice of all medicines sold for customs.  For these countries, Medicina Mexico is now delivering your medicines to Dr. Isaac Reyes, MD (Ced. Federal 644884) (Ced. Estatal 1537-02/05) along with the required documentation including documentation on each medication sold in English is from Wolters Kluwer.   Dr. Reyes upon receipt of your medication will issue a prescription and provide for shipping pursuant to your order.   If for any reason, Dr. Reyes fails to issue a prescription for a specific medication, then you will receive a refund or credit.

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Iron is an essential component in the physiological formation of hemoglobin, which are necessary for
adequate amounts effective erythropoiesis and the resulting ability to carry
oxygen in the blood.

Almost two-thirds of iron in the body is found in hemoglobin, the protein in red blood cells that carries oxygen to tissues.  Smaller amounts of iron are found in myoglobin, a protein that helps supply oxygen to muscle, and in enzymes that assist biochemical reactions.  Iron is also found in proteins that store iron for future needs and that transport iron in blood.  Iron stores are regulated by intestinal iron absorption

What foods provide iron?

There are two forms of dietary iron: heme and nonheme.  Heme iron is derived from hemoglobin, the protein in red blood cells that delivers oxygen to cells.  Heme iron is found in animal foods that originally contained hemoglobin, such as red meats, fish, and poultry.  Iron in plant foods such as lentils and beans is arranged in a chemical structure called nonheme iron.  This is the form of iron added to iron-enriched and iron-fortified foods.  Heme iron is absorbed better than nonheme iron, but most dietary iron is nonheme iron .  A variety of heme and nonheme sources of iron are listed in Tables 1 and 2.

Table 1:  Selected Food Sources of Heme Iron
per serving
% DV*
Chicken liver, pan-fried, 3 ounces 11.0 61
Oysters, canned, 3 ounces 5.7 32
Beef liver, pan-fried, 3 ounces 5.2 29
Beef, chuck, blade roast, lean only, braised, 3 ounces 3.1 17
Turkey, dark meat, roasted, 3 ounces 2.0 11
Beef, ground, 85% lean, patty, broiled, 3 ounces 2.2 12
Beef, top sirloin, steak, lean only, broiled, 3 ounces 1.6 9
Tuna, light, canned in water, 3 ounces 1.3 7
Turkey, light meat, roasted, 3 ounces 1.1 6
Chicken, dark meat, meat only, roasted, 3 ounces 1.1 6
Chicken, light meat, meat only, roasted, 3 ounces 0.9 5
Tuna, fresh, yellowfin, cooked, dry heat, 3 ounces 0.8 4
Crab, Alaskan king, cooked, moist heat, 3 ounces 0.7 4
Pork, loin chop, broiled, 3 ounces 0.7 4
Shrimp, mixed species, cooked, moist heat, 4 large 0.3 2
Halibut, cooked, dry heat, 3 ounces 0.2 1


Table 2: Selected Food Sources of Nonheme Iron
per serving
% DV*
Ready-to-eat cereal, 100% iron fortified, ¾ cup 18.0 100
Oatmeal, instant, fortified, prepared with water, 1 packet 11.0 61
Soybeans, mature, boiled, 1 cup 8.8 48
Lentils, boiled, 1 cup 6.6 37
Beans, kidney, mature, boiled, 1 cup 5.2 29
Beans, lima, large, mature, boiled, 1 cup 4.5 25
Ready-to-eat cereal, 25% iron fortified, ¾ cup 4.5 25
Blackeye peas, (cowpeas), mature, boiled, 1 cup 4.3 24
Beans, navy, mature, boiled, 1 cup 4.3 24
Beans, black, mature, boiled, 1 cup 3.6 20
Beans, pinto, mature, boiled, 1 cup 3.6 21
Tofu, raw, firm, ½ cup 3.4 19
Spinach, fresh, boiled, drained, ½ cup 3.2 18
Spinach, canned, drained solids ½ cup 2.5 14
Spinach, frozen, chopped or leaf, boiled ½ cup 1.9 11
Raisins, seedless, packed, ½ cup 1.6 9
Grits, white, enriched, quick, prepared with water, 1 cup 1.5   8
Molasses, 1 tablespoon 0.9 5
Bread, white, commercially prepared, 1 slice 0.9 5
Bread, whole-wheat, commercially prepared, 1 slice 0.7 4

*DV = Daily Value. DVs are reference numbers developed by the Food and Drug Administration (FDA) to help consumers determine if a food contains a lot or a little of a specific nutrient.  The FDA requires all food labels to include the percent DV (%DV) for iron.  The percent DV tells you what percent of the DV is provided in one serving.  The DV for iron is 18 milligrams (mg).  A food providing 5% of the DV or less is a low source while a food that provides 10–19% of the DV is a good source.  A food that provides 20% or more of the DV is high in that nutrient.  It is important to remember that foods that provide lower percentages of the DV also contribute to a healthful diet. 

What affects iron absorption?

Iron absorption refers to the amount of dietary iron that the body obtains and uses from food.  Healthy adults absorb about 10% to 15% of dietary iron, but individual absorption is influenced by several factors.

Storage levels of iron have the greatest influence on iron absorption.  Iron absorption increases when body stores are low. When iron stores are high, absorption decreases to help protect against toxic effects of iron overload .  Iron absorption is also influenced by the type of dietary iron consumed.  Absorption of heme iron from meat proteins is efficient.  Absorption of heme iron ranges from 15% to 35%, and is not significantly affected by diet.  In contrast, 2% to 20% of nonheme iron in plant foods such as rice, maize, black beans, soybeans and wheat is absorbed.  Nonheme iron absorption is significantly influenced by various food components.

Meat proteins and vitamin C will improve the absorption of nonheme iron.  Tannins (found in tea), calcium, polyphenols, and phytates (found in legumes and whole grains) can decrease absorption of nonheme iron].  Some proteins found in soybeans also inhibit nonheme iron absorption.  It is most important to include foods that enhance nonheme iron absorption when daily iron intake is less than recommended, when iron losses are high (which may occur with heavy menstrual losses), when iron requirements are high (as in pregnancy), and when only vegetarian nonheme sources of iron are consumed.

What is the recommended intake for iron?

Recommendations for iron are provided in the Dietary Reference Intakes (DRIs) developed by the Institute of Medicine of the National Academy of Sciences.   Dietary Reference Intakes is the general term for a set of reference values used for planning and assessing nutrient intake for healthy people.  Three important types of reference values included in the DRIs are Recommended Dietary Allowances (RDA), Adequate Intakes (AI), and Tolerable Upper Intake Levels (UL).  The RDA recommends the average daily intake that is sufficient to meet the nutrient requirements of nearly all (97–98%) healthy individuals in each age and gender group.  An AI is set when there is insufficient scientific data available to establish a RDA.  AIs meet or exceed the amount needed to maintain a nutritional state of adequacy in nearly all members of a specific age and gender group.  The UL, on the other hand, is the maximum daily intake unlikely to result in adverse health effects.  Table 3 lists the RDAs for iron, in milligrams, for infants, children and adults.

Table 3: Recommended Dietary Allowances for Iron for Infants (7 to 12 months), Children, and Adults
7 to 12 months 11 11 N/A N/A
1 to 3 years 7 7 N/A N/A
4 to 8 years 10 10 N/A N/A
9 to 13 years 8 8 N/A N/A
14 to 18 years 11 15 27 10
19 to 50 years 8 18 27 9
51+ years 8 8 N/A N/A

Healthy full term infants are born with a supply of iron that lasts for 4 to 6 months. There is not enough evidence available to establish a RDA for iron for infants from birth through 6 months of age.  Recommended iron intake for this age group is based on an Adequate Intake (AI) that reflects the average iron intake of healthy infants fed breast milk.  Table 4 lists the AI for iron, in milligrams, for infants up to 6 months of age.

Table 4:  Adequate Intake for Iron for Infants (0 to 6 months)
Age (months)Males and Females (mg/day)
0 to 6 0.27

Iron in human breast milk is well absorbed by infants.  It is estimated that infants can use greater than 50% of the iron in breast milk as compared to less than 12% of the iron in infant formula.  The amount of iron in cow's milk is low, and infants poorly absorb it.  Feeding cow's milk to infants also may result in gastrointestinal bleeding.  For these reasons, cow's milk should not be fed to infants until they are at least 1 year old.  The American Academy of Pediatrics (AAP) recommends that infants be exclusively breast fed for the first six months of life.  Gradual introduction of iron-enriched solid foods should complement breast milk from 7 to 12 months of age.  Infants weaned from breast milk before 12 months of age should receive iron-fortified infant formula.  Infant formulas that contain from 4 to 12 milligrams of iron per liter are considered iron-fortified.

Data from the National Health and Nutrition Examination Survey (NHANES) describe dietary intake of Americans 2 months of age and older.  NHANES (1988-94) data suggest that males of all racial and ethnic groups consume recommended amounts of iron. However, iron intakes are generally low in females of childbearing age and young children.

Researchers also examine specific groups within the NHANES population.  For example, researchers have compared dietary intakes of adults who consider themselves to be food insufficient (and therefore have limited access to nutritionally adequate foods) to those who are food sufficient (and have easy access to food).  Older adults from food insufficient families had significantly lower intakes of iron than older adults who are food sufficient.  In one survey, twenty percent of adults age 20 to 59 and 13.6% of adults age 60 and older from food insufficient families consumed less than 50% of the RDA for iron, as compared to 13% of adults age 20 to 50 and 2.5% of adults age 60 and older from food sufficient families.

Iron intake is negatively influenced by low nutrient density foods, which are high in calories but low in vitamins and minerals.  Sugar sweetened sodas and most desserts are examples of low nutrient density foods, as are snack foods such as potato chips.  Among almost 5,000 children and adolescents between the ages of 8 and 18 who were surveyed, low nutrient density foods contributed almost 30% of daily caloric intake, with sweeteners and desserts jointly accounting for almost 25% of caloric intake. Those children and adolescents who consumed fewer "low nutrient density" foods were more likely to consume recommended amounts of iron.

Data from The Continuing Survey of Food Intakes by Individuals (CSFII1994-6 and 1998) was used to examine the effect of major food and beverage sources of added sugars on micronutrient intake of U.S. children aged 6 to 17 years.  Researchers found that consumption of presweetened cereals, which are fortified with iron, increased the likelihood of meeting recommendations for iron intake.  On the other hand, as intake of sugar-sweetened beverages, sugars, sweets, and sweetened grains increased, children were less likely to consume recommended amounts of iron.

When can iron deficiency occur?

The World Health Organization considers iron deficiency the number one nutritional disorder in the world.  As many as 80% of the world's population may be iron deficient, while 30% may have iron deficiency anemia.

Iron deficiency develops gradually and usually begins with a negative iron balance, when iron intake does not meet the daily need for dietary iron.  This negative balance initially depletes the storage form of iron while the blood hemoglobin level, a marker of iron status, remains normal.  Iron deficiency anemia is an advanced stage of iron depletion.  It occurs when storage sites of iron are deficient and blood levels of iron cannot meet daily needs.  Blood hemoglobin levels are below normal with iron deficiency anemia.

Iron deficiency anemia can be associated with low dietary intake of iron, inadequate absorption of iron, or excessive blood loss.  Women of childbearing age, pregnant women, preterm and low birth weight infants, older infants and toddlers, and teenage girls are at greatest risk of developing iron deficiency anemia because they have the greatest need for iron.  Women with heavy menstrual losses can lose a significant amount of iron and are at considerable risk for iron deficiency.  Adult men and post-menopausal women lose very little iron, and have a low risk of iron deficiency.

Individuals with kidney failure, especially those being treated with dialysis, are at high risk for developing iron deficiency anemia.  This is because their kidneys cannot create enough erythropoietin, a hormone needed to make red blood cells.  Both iron and erythropoietin can be lost during kidney dialysis.  Individuals who receive routine dialysis treatments usually need extra iron and synthetic erythropoietin to prevent iron deficiency.

Vitamin A helps mobilize iron from its storage sites, so a deficiency of vitamin A limits the body's ability to use stored iron.  This results in an "apparent" iron deficiency because hemoglobin levels are low even though the body can maintain normal amounts of stored iron.  While uncommon in the U.S., this problem is seen in developing countries where vitamin A deficiency often occurs.

Chronic malabsorption can contribute to iron depletion and deficiency by limiting dietary iron absorption or by contributing to intestinal blood loss.  Most iron is absorbed in the small intestines.  Gastrointestinal disorders that result in inflammation of the small intestine may result in diarrhea, poor absorption of dietary iron, and iron depletion.

Signs of iron deficiency anemia include:

  • feeling tired and weak
  • decreased work and school performance
  • slow cognitive and social development during childhood
  • difficulty maintaining body temperature
  • decreased immune function, which increases susceptibility to infection
  • glossitis (an inflamed tongue)

Eating nonnutritive substances such as dirt and clay, often referred to as pica or geophagia, is sometimes seen in persons with iron deficiency.  There is disagreement about the cause of this association.  Some researchers believe that these eating abnormalities may result in an iron deficiency.  Other researchers believe that iron deficiency may somehow increase the likelihood of these eating problems.

People with chronic infectious, inflammatory, or malignant disorders such as arthritis and cancer may become anemic.  However, the anemia that occurs with inflammatory disorders differs from iron deficiency anemia and may not respond to iron supplements.  Research suggests that inflammation may over-activate a protein involved in iron metabolism.  This protein may inhibit iron absorption and reduce the amount of iron circulating in blood, resulting in anemia.

Who may need extra iron to prevent a deficiency?

Three groups of people are most likely to benefit from iron supplements:  people with a greater need for iron, individuals who tend to lose more iron, and people who do not absorb iron normally.  These include:

  • pregnant women
  • preterm and low birth weight infants
  • older infants and toddlers
  • teenage girls
  • women of childbearing age, especially those with heavy menstrual losses
  • people with renal failure, especially those undergoing routine dialysis
  • people with gastrointestinal disorders who do not absorb iron normally

Celiac Disease and Crohn's Syndrome are associated with gastrointestinal malabsorption and may impair iron absorption.  Iron supplementation may be needed if these conditions result in iron deficiency anemia.

Women taking oral contraceptives may experience less bleeding during their periods and have a lower risk of developing an iron deficiency.  Women who use an intrauterine device (IUD) to prevent pregnancy may experience more bleeding and have a greater risk of developing an iron deficiency.  If laboratory tests indicate iron deficiency anemia, iron supplements may be recommended.

Total dietary iron intake in vegetarian diets may meet recommended levels; however that iron is less available for absorption than in diets that include meat.  Vegetarians who exclude all animal products from their diet may need almost twice as much dietary iron each day as non-vegetarians because of the lower intestinal absorption of nonheme iron in plant foods.  Vegetarians should consider consuming nonheme iron sources together with a good source of vitamin C, such as citrus fruits, to improve the absorption of nonheme iron.

There are many causes of anemia, including iron deficiency.  There are also several potential causes of iron deficiency.  After a thorough evaluation, physicians can diagnose the cause of anemia and prescribe the appropriate treatment.

Does pregnancy increase the need for iron?

Nutrient requirements increase during pregnancy to support fetal growth and maternal health.  Iron requirements of pregnant women are approximately double that of non-pregnant women because of increased blood volume during pregnancy, increased needs of the fetus, and blood losses that occur during delivery.  If iron intake does not meet increased requirements, iron deficiency anemia can occur.  Iron deficiency anemia of pregnancy is responsible for significant morbidity, such as premature deliveries and giving birth to infants with low birth weight.

Low levels of hemoglobin and hematocrit may indicate iron deficiency.  Hemoglobin is the protein in red blood cells that carries oxygen to tissues.  Hematocrit is the proportion of whole blood that is made up of red blood cells.  Nutritionists estimate that over half of pregnant women in the world may have hemoglobin levels consistent with iron deficiency.  In the U.S., the Centers for Disease Control (CDC) estimated that 12% of all women age 12 to 49 years were iron deficient in 1999–2000.  When broken down by groups, 10% of non-Hispanic white women, 22% of Mexican-American women, and 19% of non-Hispanic black women were iron deficient.  Prevalence of iron deficiency anemia among lower income pregnant women has remained the same, at about 30%, since the 1980s.

The RDA for iron for pregnant women increases to 27 mg per day.  Unfortunately, data from the 1988–94 NHANES survey suggested that the median iron intake among pregnant women was approximately 15 mg per day.  When median iron intake is less than the RDA, more than half of the group consumes less iron than is recommended each day.

Several major health organizations recommend iron supplementation during pregnancy to help pregnant women meet their iron requirements.  The CDC recommends routine low-dose iron supplementation (30 mg/day) for all pregnant women, beginning at the first prenatal visit.  When a low hemoglobin or hematocrit is confirmed by repeat testing, the CDC recommends larger doses of supplemental iron.  The Institute of Medicine of the National Academy of Sciences also supports iron supplementation during pregnancy.    Obstetricians often monitor the need for iron supplementation during pregnancy and provide individualized recommendations to pregnant women.

Some facts about iron supplements

Iron supplementation is indicated when diet alone cannot restore deficient iron levels to normal within an acceptable timeframe.  Supplements are especially important when an individual is experiencing clinical symptoms of iron deficiency anemia.  The goals of providing oral iron supplements are to supply sufficient iron to restore normal storage levels of iron and to replenish hemoglobin deficits.  When hemoglobin levels are below normal, physicians often measure serum ferritin, the storage form of iron.  A serum ferritin level less than or equal to 15 micrograms per liter confirms iron deficiency anemia in women, and suggests a possible need for iron supplementation.

Beans, black, mature, boiled, 1 cup

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