Popeye

In order to grow well en become as strong as Popeye spinach is a must-eat, as every child knows. In fact, spinach does contains lots of iron, 2-4 times as much as other iron-rich vegetables. Apple syrup (traditional Dutch treat: very thick syrup made of apple juice) contains 3 times as much, but who eats 100grams of that on a daily basis. There’s quite some iron in meat, too, not as much as in spinach, but in a better available form. Human milk contains iron as well, not too much, in different forms and accompanied by a protein (lactoferrin) that prevents the iron being eaten by gut pathogens. This is one of the reasons breastfed children have fewer intestinal infections. (Infant formula contains an exces of iron, due to its poor availability and is thus a great food source for pathogens causing intestinal infection.) The iron content of human milk is relatively low, but it suffices for maintaining iron levels during the exclusive breastfeeding period, without feeding the gut germs. For most children this works out just fine, but not for some. In order for the child to have enough iron with these small amounts in his mom’s milk he needs to be term born at 3kg or more, without complications that cause hemorrhage (forceps, vacuum birth) and the cord be allowed to stop pulsing before being clamped. According to the outcomes of the Yang et al study in countries in Europe, Africa, Middle and South America boys with a birth weight under 3 kg are at highest risk for anemia with exclusive breastfeeding. Based on the high prevalence of anemia in American infants (especially those of Hispanic origin) the American Academy of Pediatrics (AAP) developed new recommendations for prevention of iron deficiency and iron-deficiency anemia stating that “exclusively breastfed term infants [should] receive an iron supplementation of 1 mg/kg per day, starting at 4 months of age.” Not all physicians agree, as vocalized by Furman (2011), because it does not take into account the preventable causes for anemia and the enhanced risk of intestinal infections due to too much dietary iron. Chapparro (2009) states that iron supplements are not needed for children without the obeve mentioned risk factors and who are optimally exclusively breastfeed and that those children will have enough iron for the first 6-8 months of life.
Yang Z, Lönnerdal B, Adu-Afarwuah S, Brown KH,
Chaparro CM, Cohen RJ, Domellöf M, Hernell O, Lartey A, Dewey KG: Prevalence and predictors of iron deficiency in fully breastfed infants at 6 mo of age: comparison of data from 6 studies Am J Clin Nutr 2009 89: 5 1433-1440
Lydia M. Furman: Exclusively Breastfed Infants: Iron Recommendations Are Premature. Pediatrics 2011; 127:4 e1098-e1099; doi:10.1542/peds.2011-0201B
Camila M. Chaparro: Setting the Stage for Child Health and Development: Prevention of Iron Deficiency in Early Infancy J. Nutr. 2008 138: 12 2529-2533