The Threat of Hidden Anemia: Oxygen Transport in Hemoglobin and Global Iron Fortification Strategies

Some people experience shortness of breath and palpitations when climbing stairs, or dizziness and lightheadedness when riding public transportation. One reason for these symptoms is iron deficiency anemia. Generally, one-third of women suffer from iron deficiency anemia. Blood appears red because red blood cells contain hemoglobin (blood pigment). Hemoglobin has a unique property: in the lungs, where oxygen concentration is high, hemoglobin binds to oxygen, consuming it; when this oxygen-bound hemoglobin travels to tissues with lower oxygen concentrations, it releases the bound oxygen.

In other words, hemoglobin has the property of reversibly binding with oxygen depending on the oxygen concentration. Because of this property, hemoglobin plays a crucial role in transporting oxygen from the lungs to the whole body via the bloodstream. Hemoglobin bound to oxygen is bright red, while hemoglobin not bound to oxygen is dark red. This is the reason for the color difference between arterial and venous blood. Anemia generally refers to a condition where the hemoglobin content per 100 ml of blood is below 13 grams for men and below 12 grams for women.

Anemia reduces the supply of oxygen to vital organs. Hemoglobin contains iron, which plays a crucial role in the binding of oxygen to hemoglobin. The human body contains approximately 4 grams of iron, with one-quarter stored in the liver and spleen, and the remaining three-quarters circulating throughout the body as components of hemoglobin in red blood cells. When iron is deficient, hemoglobin cannot be produced, resulting in smaller, less vibrant red blood cells, fatigue, difficulty waking up in the morning, and swollen feet at night.

An average adult excretes about 1 milligram of iron per day through urine and sweat. Women are more prone to iron-deficiency anemia during menstruation due to physiological reasons. Additionally, some women experience disruptions to their iron balance during pregnancy and childbirth. Recently, many young women have developed iron deficiency due to incorrect weight loss methods. Iron deficiency is a gradual, cumulative process, so even without noticeable anemia, it can be quite severe. Treatment for iron deficiency includes iron supplements and dietary therapy.

Symptoms may disappear after taking iron supplements, but many recur. Consuming large amounts of iron-rich foods such as liver, spinach, wakame, nori, sesame seeds, and soybeans presents various problems with iron absorption and is not a simple matter. To address iron deficiency, European and American countries, under government guidance, have adopted methods such as adding iron to staple foods. Sweden mandated 3 mg of iron per 100 grams of flour starting in 1944, increasing this to 6.5 mg after 1970. As a result, the incidence of iron-deficiency anemia in menstruating women decreased from 25-30% to 5-10%.

Since 1941, the United States has mandated that 3.5 milligrams of iron be added to every 100 grams of flour, ensuring that 1000 grams of bread contains 17.5 to 27.5 milligrams of iron. Furthermore, Germany, Denmark, the United Kingdom, and other countries have also implemented iron fortification measures. Japan, in 1986, in response to a consultation with the Health and Sports Council, stipulated the required amount of iron in school meals; however, due to a generally poor understanding of iron deficiency, no effective countermeasures have been developed to date. Whey beverages fortified with iron and CPP are also mentioned.

This fortified beverage is a health-promoting product that adds CPP to improve the bioavailability of calcium, manganese, and added iron in whey beverages. It is made through lactic acid fermentation and sterilization packaging. Each bottle contains 250 ml and contains 76 mg of calcium and 12 mg of CPP.