Somaye Fatali

Background: Iron deficiency is the most common nutritional deficiency in the world. Iron deficiency anemia may be associated with various symptoms, and most patients are treated with oral supplements or infusion therapy. In recent years, importance of nutrition in the improvement of Iron deficiency anemia has been highlighted. Based on the Iranian Traditional Medicine, foods have major effects on prevention and treatment of diseases. Material and Methods: In this study Traditional Persian Medicine (TPM) books such as Canun of Avicenna, Kamil al-Sinaa alTibbiya and Makhzan al Advieh were assessed and the information about blood-producing foods and their effect on improving iron deficiency were investigated. Results: There are some foods, which can be effective in iron deficiency anemia. Some of these foods have animal origin such as eggs and meat and some have plant origin such as chickpeas, grapes and figs. Conclusion: According TPM, Nutritious foods and Blood humor-producing foods are the right options for iron supply. Also, these foods can help iron deficiency through various mechanisms alone or with medication. 6 * Corresponding Author: Mitra Mehrabani, Herbal and Traditional Medicine Research Center, Kerman University of Medical Science, Kerman, IR Iran. Email id mmehrabani@gmail.com Somaye Fatali et.al., Dietary recommendation for Iron Deficiency Anemia in Persian Medicine Published online in http://ijam.co.in ISSN No: 0976-5921 direct, and SID. All the information about bloodproducing foods was gathered and classified. Finally, the data were evaluated. Results According TPM, food compounds, which are digested in the gastrointestinal system, spread among body organs or transform into energy in the body (17). When food enters the stomach, it is converted into a substance, called chylos. Then, it moves towards the liver through the mesenteric vein and converts to metabolites, known as humor. Humor is distributed throughout the body via vessels and is converted to the organs after some processing (20, 21). Liver produces 4 humors including blood, phlegm, yellow bile, and black bile. Blood humor, as the predominant humor, is an essential part of nutrition, growth and replaces the consumed energy in the, body(14, 15, 18). There are some foods, which can produce more blood humor by the liver after digestion (16, 18). These foods are categorized into Table 1. Energy, protein, and iron content of blood-producing foods in 100 gram of each medicinal food were showed in Table 1 (22, 23). In TPM, some foods (Kathir-Al-Ghaza) have more absorption in the body, in other words, they produce humors more than other food types (24, 25). And also there are some foods which produce Blood humor (Movalled-E-Dam). These foods lead to the production of more blood humor in the body. Of course, not all of these foods have high levels of nutrient or iron (24, 26). Foods which are on top of the list, includes egg, wheat, raisin, and barely, are highly nutritive and contribute to blood production. Conversely, some foods with low energy level, low protein content, and low iron level (e.g. watermelon, pomegranate, jujube, and shrimp) are at the bottom of the list. In TPM, in addition to the type of food, the dishes in which the food is cooked also affects our health (14). Cooking in iron pots can improve iron deficiency anemia (27, 28). Old folks told us to place iron nails or any piece of iron materials to a clay or ceramic pot when we cook food (27, 28). As shown in one study, children whose food was cooked in iron pots had a lower rate of anemia and increased growth than children who had cooked in aluminum pots. They concluded that providing iron cookware to families in less developed countries may be a useful way to prevent iron deficiency anemia (27). Discussion According to TPM, blood humor is used to meet an individual's daily needs and maintain metabolic reactions, growth and development (19). Production of good blood humor is attributed to the digestion of healthy foods, because, despite the proper function of the gastrointestinal system, humor cannot be produced adequately if nutrients have a poor quality. Production of good blood humor can lead to an increase in blood used by the organs. Foods with this criterion have a high nutritional value (Kathir-Al-Ghaza) and bloodproducing food (Movalled-E-Dam). According to Table 1, these foods can help produce blood humor. Nutritional foods have high energy and protein levels for blood humor production. Therefore, these foods can be a proper choice for growth, development and improvement of body’s metabolic system. On the other hand, some nutritional sources, such as watermelon and pomegranate, have low iron content, they show hepatoprotective activities. Additionally, they have antioxidant and anti-inflammatory effects in the liver (29). As mentioned above, liver plays a fundamental role in the production of blood humor. It also has a major contribution to the absorption and storage of iron, production of hemoglobin, and function of the bone marrow. The liver adjusts iron absorption from the gastrointestinal tract by hepcidin and apo-transferrin. Overall, 30% of ferritin storage and 15% of hemoglobin production occur in the liver(30, 31). Therefore, the consumption of these foods prepare the raw materials needed for the production of blood humors and, also, help the liver to absorb more iron extracted from the gastrointestinal tract and also store more iron in the liver. In TPM, the foods are categorized according to the duration of digestion and the quality of the produced blood. Some foods, such as egg and bird meat, are suitable for the recovery of patients, as digestion of these foods is simple and can ameliorate weakness. Therefore, they can be used when the patient experiences weakness and gastrointestinal disorders. Some foods (e.g. beef and meat of some birds), which produce viscous blood and have a long digestion time, are suitable for athletes and people with physical activity. On the contrary, cheese with moderate iron content is not a blood-producing food, as it has no hepatoprotective activity and its scarce overuse can lead to liver dysfunction (17). On the other hand, some foods with a high nutritional value show blood-producing activities and have a moderate to high iron level. These foods, such as egg, meat, barely, and raisin, can be used for people with more nutritional needs (e.g., pregnant and breastfeeding women). Recent studies have also shown the efficacy of these foods on IDA. The raisin is a source of vitamin C, B-12, and iron, which has an important role in treatment of anemia by increase the numbers of RBCs (32). Another study showed that the combination of jaggery with raisins as a better natural dietary supplement to overcome IDA without prominent side effects as observed with oral and parenteral iron preparations (33). About the grape molasses, a study found that in non-anemic individuals, iron absorption from grape molasses was comparable to ferrous sulfate. Therefore, grape molasses is an effective source of iron in preventing iron deficiency anemia (34) Investigating the effects of chickpea on anemia, animal studies in female rats showed that chickpea seed is an effective source of iron supplementation for IDA in mice and can be developed as a functional product to overcome malnutrition-induced iron deficiency (35). And also clinical study demonstrated that egg consumption plays an essential role in protecting the