What happens when you do everything right, and your toddler still ends up with iron deficiency? This is a question posed to many parents with toddlers or preschoolers. After you describe a child’s food habits, a pediatrician might order a blood test to check for iron deficiency. If the results come back deficient, or even trending towards anemia, you might have no idea what to do. The pediatrician may provide the standard recommendation that a child be limited to 24 ounces of milk (animal or plant) a day. That is the sweet spot for getting enough Vitamin D without harming iron intake. However, milk may just be one problem, and an organic diet might make things worse.
Organic is not always better
When it comes to whole foods such as vegetables and fruits, organic is often a better choice. However, it’s important to note that the nutrition facts of a regular apple and organic apple are the same. Organic really just means it adheres to certain guidelines (PDF). Many of these are more environmentally sustainable, such as a reduction in pesticide use (but they are still used), crop rotation, and such. Wrapped up in the term organic can also be philosophical things like living wages, no-till farming, and heirloom or locally-adapted cultivars of plants. In general, going organic is fine, but realize that it’s not a perfect label.
However, there is an underreported concern to going organic: nutritional deficiencies. Many organic foods are not enriched, or enriched to a much lower degree than their conventional cousins. For example, let’s look at a toddlerhood staple: Cheerios.
If you look at the nutrition facts, you’ll see the vitamin and mineral mix is diverse and expansive. In the ingredients, there is a section called Vitamins and Minerals, which explains the nutrition facts. This is an example of an enriched product.
Here’s an organic version from Cascadian Farm, makers of many tasty, organic products:
A wholesome cereal and great for the morning. However, the nutrition facts seem lacking compared to Cheerios, and the reason is enrichment. If your toddler is eating this as a snack, they are missing out on an easy way to get things like iron, zinc, and some vitamins.
This is a common issue in the world of organic food products like cereal, bread, and pasta. A common refrain in the whole foods world is it’s because processing strips the nutrients from the product, but that’s not entirely correct. Grains like oats, barely, and wheat don’t have a lot of iron to begin with. Processing oats doesn’t remove much, though refined wheat flour is nutrient-poor. Enrichment not only adds some (not all) back, it also alters the profile to cover things that are just lacking.
Whole grains are great, but they are not perfect. Which leads us to the next issue.
Toddlers, simply put, are picky. Even those who aren’t picky don’t have the experience or self-control to cut back on personal favorites for a more balanced diet. When they scream “eggmeal” and the dinner table has something other than oatmeal on it, you’ll hear about it. Parents only have so much stamina for these fights. Plus, the evidence is that all a parent can do is put healthy food on the table and let the child decide to eat or not. In a house that follows policy, it isn’t a battle worth having. They want a second cup of milk at dinner? Sure. More orange slices? Why not. Dried cherries. Have at it.
But if you are going completely organic, you could find yourself with a kid missing out on nutrients. The Recommended Daily Allowance of nutrients has the word “daily” baked right in it. Yet daily isn’t really necessary, especially for the micro-nutrients like iron. Since the body stores iron in various organs, there is a supply ready to use when the body needs more. The issue is when the diet is continually deficient, which reduces these stores. So rather than thinking daily, try weekly. Over a week, does your child get enough iron? Or drinks the right amount of milk? A varied diet with a full nutritional profile can help a lot. The Choose My Plate program has recommendations for toddlers and preschoolers.
But what if we don’t eat…
Of course, when it comes to iron (and others minerals and vitamins like B12), if your family has a dietary preference that excludes some or all animal proteins, you have to find another way around it. To be frank, the best source of iron is the iron of another animal. The iron, called heme iron, is already stored in a form that can be used by the human body, rather than elemental or some other way. Liver is nature’s iron supplement. Red meat in general will provide a lot of iron, as will dark poultry meats. Oysters also provide a lot as well.
But if you are one of many families that are pescetarian, vegetarian, or vegan, a major source of iron is shut off from you. Pescetarians can get it from shellfish, but that can be a problem if you have cultural, religious, or medical reasons to avoid it. Tuna and salmon work, but because of mercury concerns they can only be a small portion of the diet each week. So that leaves non-heme iron, or iron found in plants and fungus.
The issue with non-heme iron is it’s harder to absorb. So even if a serving of spinach has the same amount of elemental iron as two servings of beef, you’ll need to eat more spinach to get the same amount of iron. And while leafy greens are great for many nutrients and vitamins, they aren’t so great for iron. In addition to being a form that the body has a problem absorbing, leafy greens have other components that bind to the iron before the body has a chance to grab it. While someone who eats meat and seafood may absorb 15% or more of the iron they eat, it can be as low as 5% for those who rely entirely on non-heme iron, especially leafy greens.
So if you are vegetarian or vegan, you need to work harder to get the iron you need. The Catch-22 of course is that many vegetarians and vegans do so for concerns of animal welfare and reduced environmental impact. So of course, organic foods offer the appeal of being better for the environment, the field workers, the farmers, etc. Taken together with the reduced availability of iron from plants, this leads to problems like iron-deficient toddlers.
There are workarounds
First, read labels. Not all organic products are free of enrichment. Breakfast cereals and breads are a great way to get many of the micro-nutrients that are missing. But you might need to make trade-offs. If you can’t find organic enriched products, you might need to consider non-organic versions, like Cheerios.
For whole foods or homemade meals, and if your child isn’t picky, beans are a good source of iron and other minerals as well. Chickpeas, lentils, and soybeans can all be used to bolster the dinner plate. And tofu is a vegan product that has a high level of non-heme iron. Plus, it’s flexible enough to be added to many dishes, or even blended into a smoothie.
Another way to increase the availability of the iron your kid does eat is to make sure there is plenty of Vitamin C at the meal. Whether it’s a glass of orange juice, orange slices, strawberries, or something else high in ascorbic acid, it will help their body process the non-heme iron and absorb it.
One thing to avoid, at least without consultation with your pediatrician, are iron supplements. Too much iron can be toxic, so just assuming there is a lack of iron isn’t a good idea. A simple blood test can check iron stores, at which point your doctor can make recommendations. If your child is prescribed supplements, you should make sure to follow all instructions from the physician. Iron supplements can cause some side effects that are unpleasant, like constipation.
At the end, your child’s health is the most important thing. As an adult, you are solely responsible for the food your child eats. But we all know that cooking everything from scratch is impossible, so you need to get convenience or ready-to-eat foods. If you rely on the organic label, be aware that you might be unwittingly opening the door to nutritional deficiency.