The Hidden Epidemic: Iron Deficiency in South Asian Communities

Written by: Lakshita Kutnikar | Edited by: Nathan Hahn

Spirit days at my high school were a time for fun and creativity, each one bringing its own unique themes. One year, we had a White Lies Day, where students wore shirts with playful lies written on them. My choice? “I am not iron deficient.”

At first, it was just a lighthearted joke. But, as the day unfolded, I noticed how many girls, also of South Asian descent, pointed at my shirt and laughed, saying, “Same here!” That moment of humor slowly gave way to a deeper realization. Why did so many of us find it relatable? And why had such a prevalent and life-threatening condition become so easy to dismiss as a joke?

The Cultural Context

Iron deficiency anemia, a condition marked by a lack of healthy red blood cells to carry oxygen, disproportionately affects South Asian communities. The reasons are as much cultural as they are biological.

Dietary Habits

My favorite South Asian dish is Pav Bhaji, a flavorful mash of spiced vegetables served with buttery bread rolls. This dish is irresistibly tasty, though not exactly iron-rich. South Asian diets, while incredibly rich in flavor, spices, and traditions, rely heavily on plant-based foods. Vegetarianism is common due to cultural or religious practices, and like many South Asians, my diet often lacks red meats, which are a primary source of heme iron.

Instead, much of the iron intake in South Asian diets comes from non-heme sources, such as spinach and grains. So, why is iron deficiency still a problem, even for those who consume iron-rich plant-based foods? As the article Dietary Iron highlights, non-heme iron is less bioavailable than heme iron from animal products. Putting it into perspective, approximately 25% of dietary heme iron is absorbed, compared to just 5–12% of non-heme iron. This stark difference in absorption rates makes vegetarian diets a significant risk factor for iron deficiency.

Tea and Iron Absorption

If you’ve grown up in a South Asian household, you’ve likely smelled the fragrant aroma of chai brewing in the morning. Chai is a beloved staple, consumed by over 80 million Indians daily. Yet, this cultural cornerstone comes with a hidden cost. Tea, like coffee, contains tannins that significantly reduce iron bioavailability. Within the digestive tract, tannins can easily bind with iron in plant-based foods, which makes them unavailable for absorption. Though this effect doesn’t cause significant harm in people with healthy iron levels, it could be problematic for those with iron deficiency, as explained in “What are Tea Tannins”. While it is true that we can’t stop generations’ worth of tradition, we can consume less tea.

Cultural Attitudes Toward Health:

Women’s health often takes the backseat in South Asia. Symptoms like fatigue, dizziness, or weakness are often dismissed as a part of a busy lifestyle. For women, the stigma surrounding health concerns can make seeking medical attention feel like an unnecessary burden. Additionally, Chapple, in her research regarding iron deficiency anemia in women of South Asian descent, notes that heavy menstrual bleeding, a significant risk factor for iron deficiency, is often mismanaged. Some women avoid “hot” foods like meat, fish, and eggs during their menstrual cycles, further depleting their iron stores. This practice, rooted in the belief that menstrual blood is impure, underscores the deep cultural stigmas that prevent proactive healthcare measures.

Breaking the Cycle

Awareness is the first step to change. Neglecting conditions like iron deficiency is not just a health issue but a cultural one. Many steps that can be taken to address iron deficiency more effectively. First, though it is often looked down upon to eat red meats in South Asia, encouraging the consumption of iron-rich foods such as lentils, spinach, fortified cereals, and vitamin C-rich foods (like citrus fruits) can improve iron absorption. Also, educating families about avoiding tea or coffee during meals can make a significant difference. Additionally, by destigmatizing health discussions and promoting regular screenings, especially for women, we can tackle the issue of iron deficiency before it becomes more severe.

The next time I see someone laugh about their iron deficiency, I’ll think of my White Lies Day shirt. Instead of smiling and brushing it off, I’ll start a conversation. I’ll tell them how I learned that our shared laughter masked a serious health issue, one rooted in our culture and traditions. And I’ll share how small steps, like adding more vitamin C to our meals or rethinking when we drink chai, can make a big difference.

Because sometimes, what starts as a joke on a spirit day can spark a much-needed conversation, and maybe even change a life.

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