DEAR DR. BLONZ: My daughter has been having heavy periods, and she also has iron-deficiency anemia. She told me she takes oral contraceptives, but these do not seem to be helping much. What iron supplement would you recommend? -- N.N., Portland, Ore.
DEAR N.N.: Heavy periods are not unusual, especially in teens who are not yet ovulating regularly and in women approaching menopause. Having said that, I am not a medical doctor, as you know, so keep in mind that other factors can be involved. If your daughter routinely experiences heavy periods, especially those that last longer than a week, it would be wise to have her check with her physician or gynecologist. Do this before you resort to iron supplements.
As for iron, the most efficient way to get it into the body is through food. The body does not efficiently absorb dietary iron, the one exception being the heme iron that is present in meats. Assuming she is not a vegetarian, a reasonable first step would be to include lean meats in your daughter's diet.
In terms of supplements, iron comes in two forms: ferrous and ferric. Of the two, the ferrous form is better absorbed, and it tends to be less irritating to the stomach.
The difficulty with iron supplements is that iron doesn't dissolve easily, and it must be in solution before it can be absorbed. Studies have shown iron supplements tend to work best when they are taken with a glass of orange juice on an empty stomach. This can be a problem for some, however, because iron supplements may irritate an empty stomach.
Whenever your daughter takes her iron pills, try to include acidic foods such as citrus juices or tomato sauce. Even a vitamin C (ascorbic acid) pill will help. The presence of the acid helps to get the iron into solution and maximize the amount your body will absorb.
As all this being said, I want you to be very aware that excess iron intake can be dangerous. Do not start your daughter on iron without first consulting her physician, and make sure that you keep all supplements out of the reach of children.
DEAR DR. BLONZ: What is the difference between a vegetable and a fruit? Also, I'm interested in becoming a certified dietary manager; what are the requirements for this, and how would I go about getting certified? -- S.F., Richmond, Calif.
DEAR S.F.: A vegetable is an edible part of a plant with a soft stem, including leaves (lettuce), roots (carrot), bulbs (garlic), stalks (celery), seeds (peas), tubers (potato) and flowers (cauliflower). A fruit is the mature ovary in a flowering plant -- that fleshy part of the plant that contains the seeds. This means that tomatoes, eggplants, peppers and squashes are technically fruits, even though they are commonly thought of as vegetables.
As for your interest in becoming a certified dietary manager, there are a number of resident and correspondence schools for this field. Once you have the credentials, there are career requirements and a nationally recognized credentialing exam involved with gaining and maintaining certification. For more information, contact the Association of Nutrition and Foodservice Professionals (anfponline.org).
Send questions to: "On Nutrition," Ed Blonz, c/o Universal Uclick, 1130 Walnut St., Kansas City, MO, 64106. Send email inquiries to firstname.lastname@example.org. Due to the volume of mail, personal replies cannot be provided.