Should You Feed Your Baby Iron Fortified Foods?

After my interview with Dr. Cate Shanahan, author of Deep Nutrition: Why Your Genes Need Traditional Food and Food Rules: A Doctor’s Guide to Healthy Eating, I invited Dr. Cate to share a guest post with us on a topic of her choosing. She’s written us a fabulously insightful two part series on iron fortification in infant and toddler foods. I hope you enjoy! And, thanks Dr. Cate!

We hear all the time how iron deficiency is associated with a wide variety of health problems in children and adults. Perhaps the most worrisome is the association with lowered intelligence, which can occur in children who have low iron but won’t show up on blood tests because iron levels are not usually tested until a child is diagnosed with anemia (low blood counts).

To avoid low iron levels, the American Academy of Pediatricians advises doctors to make a blanket recommendation that between ages 6 and 24 months, when iron stores run out and children aren’t getting that much iron in their foods, parents buy iron-fortified formula and cereal. Breastfed babies, who can become deficient even earlier, are to be given supplemental iron after 4 months of age. The assumption behind this widespread practice has been that a little extra iron is harmless to your baby, so why not go ahead and get that extra iron in however you can.

A friend of mine recently prompted me to question that assumption. As a new father to a bouncing baby boy, Patrick Vlaskovits (who runs the popular & websites), received the usual advice from his pediatrician to fortify his son’s diet with iron.

But the doctor’s recommendation didn’t jibe well with Patrick’s evolutionary approach: if babies are meant to be fed breastmilk and breastmilk is naturally low in iron and even contains chelators that bind to iron so to minimize free iron in the gut, perhaps babies sensitive GI tracts may be harmed by iron. This made him worry that that extra iron, even a little extra iron, might not be so healthy for his little guy, and so asked me if I would be willing to do a little investigating.

I’m glad he did. The results of my investigation has convinced me to withhold any recommendation to parents about feeding their children iron-fortified foods until first checking iron levels. Supplementing iron when iron levels are already normal can lead to serious health problems. Below are five that have the most supporting evidence behind them:

  • Lowered IQ. When researchers studied the delayed effects of just a little extra iron in early life (between ages 6-12 months), the results were unmistakable. Half of the babies in the study had been given iron-fortified cereal, while half got unfortified cereal. Most of the children had normal iron levels, and among this majority, at the time of the intervention, their intelligence tests were evenly matched. Ten years after the intervention, however, both groups were given intelligence tests again, and this time members of the iron-fortified group scored an average of 11 points below the children who received no supplementation. (source)
  • Bacterial infection. Iron fortified foods have been shown in multiple studies to promote the growth of intestinal pathogens and alter intestinal and systemic immune function. In children with fragile health (i.e. HIV or malaria), iron appears to increase mortality rates. What follows are the most pertinent quotes from the article: “ Iron treatment has been associated with acute exacerbations of infection, in particular, malaria.” “Oral iron supplementation in the tropics in children of all ages … has been associated with increased risk of clinical malaria and other infections including pneumonia.” “In studies of the [prevention] of Pneumocystis carinii in patients with HIV disease, 30 mg of elemental iron daily for 6 mo was shown to be associated with excess mortality” “Parenteral [intravenous] iron treatment is associated with life-threatening sepsis when given in the early neonatal period.” (source)
  • Early atherosclerosis, or “fatty streaks.” A Finnish study found that excess iron stores was a stronger risk for heart attack than hypertension or cholesterol levels. (source) We have no comparable data on children because nobody is looking for an association.
  • Cancer. One study found a correlation between maternal iron supplementation in pregnancy and the most common childhood cancers: leukemia and lymphoma (source). Several studies show that children with the iron storage disease hemochromatosis, who have only slightly higher-than normal iron levels, suffer significantly higher rates of these cancers. Similar studies in adults have found increased rates of the most common adult cancers: breast and prostate. (source 1 ; source 2).
  • Stunted growth. According to an extensive review of the effects of iron on the crucial skeletal developments in early life “iron supplementation in young children without iron deficiency may jeopardize optimal height and weight gains.” (source)

All this sounds rather scary. And you might be wondering how something so simple as a little extra iron could be responsible for so many diverse problems with a child’s health and development. Stay tuned to part 2 of Should You Feed Your Baby Iron Fortified Foods to answer that question and help you make the decision with greater confidence.

(photo by sean dreilinger)


  1. Ki Vick says

    Does this mean you shouldn’t feed your child liver as one of their first foods? I know many “traditional” food movements encourage raw liver and lightly cooked egg yolk as the first food for a child. But if iron is to be avoided, isn’t liver high in iron? Or is it just supplemental iron?

    • says

      The studies showed supplemental iron to be a problem. They did not do studies on naturally iron-rich foods so on that level we have no reason to worry. Also, since iron-rich foods supply the full complement of nutrients that babies need to utilize iron in the body, the iron will likely be removed from the bloodstream more rapidly and less likely to cause the free radical reactions you will read about in part 2. Finally, the digestive tract is able to absorb iron more efficiently when it comes from foods than when it comes from supplementation, so any GI issues are far less likely if not prevented by giving your baby iron-rich foods.

      One think you want to avoid, however, is overcooking liver to the point that it’s rubbery. Part two will show an illustration exemplifying what happens in your blood when you have excess iron, and it also represents the kinds of reactions you can get from overcooking iron-rich foods.

  2. Cathy S says

    I hope you will delve into the other side of the story in your next post. I also would be curious as to the difference of feeding your child natural sources of iron versus chemical sources of iron. Low iron can also cause a myriad of problems. Even though my iron is normal (low normal), I am supplementing my iron for restless leg syndrome to get it at a more optimal level. Too much iron is bad, but too little is bad too, is my understanding. Also, when I’m pregnant, weakness and dizziness are common complaints unless I supplement with iron, even though my iron is technically “normal” (low normal).

  3. Susan says

    Dr. Jay Gordon, a fabulous pediatrician who loves the dubious distinction of having be fired from all the major TV networks, has said for years that if all exclusively breastfed babies are low in iron at 9 months of age, and they all bounce back to “normal” iron levels at 15 months without any supplementation, perhaps there is a reason for this.

    As a former IBCLC (International Board Certified Lactation Consultant) I am reminded over and over again that “it’s not nice to fool Mother Nature.”

  4. says

    I’m really glad to read this. Docs here push to give your kids supplemental iron, but I have always refused. I say- kids are supposed to be drinking breastmilk! If breastmilk doesn’t have much iron in it and exclusively breastfed babies have lower iron, then by golly, maybe they don’t need as much iron as “the books say”.
    I actually read somewhere that the Aboriginies (I think) are all officially anemic. They have low iron naturally, and when they were supplemented with iron to get their iron to the “right levels”, they started getting sicker and sicker. Not everyone needs the same amount of iron in their blood. The aboriginies apparently need less iron and do better when they’re “anemic”, and babies, if they naturally have lower iron when breastfed, then maybe that’s what’s best for them!!!

    Just as a note- delayed cord blood clamping makes babies have a higher level of iron when they’re older. Thats yet another reason why I don’t donate cord blood, and instead, delay cord clamping after birth.

  5. Kathleen K says

    After much reading and research for my personal medical issues, I’ve come to a conclusion about supplementation: it is ok in extreme cases of deficiency, but it is far better in the long run to correct the diet. You aren’t going to get excess iron from too much liver or spinach. You will stop eating those foods before that happens, as your body’s needs and cravings change. Eat REAL food.

  6. Liz says

    I have also read that iron level tests are based on the levels of formula fed babies. Could you address what is considered to be a “normal” level of iron for breast fed babies. It just seems silly to me that breast milk would leave a child lacking in nutrients. My daughter’s doctor has recommended supplements in the past, but one look at the ingredients in the supplement had me saying “No Way!”.
    I am glad this article has been written.
    Thank you!

  7. says

    Iron levels are based on population averages and this can include both formula and breast fed babies. There’s a real lack of good science in the entire nutrition field because no effort is ever made to optimize anyone’s diet before surveying their blood values. The whole field of nutrition suffers from this and so our definition of normal values of every nutrient could be way off.
    Nature leaves breast milk low in iron because, presumably, babies don’t need it for the first 4-6 months when they are exclusively breast fed. After that age, various meats and naturally iron-rich foods should be introduced. Liver is a great starter food. Part 2 will have more info on this, so stay tuned!

  8. K. Ann Seeton via Facebook says

    hmmm, do we screen to know that the particular child is neither a carrier for nor homozygous for hemachromatosis (excuse the spelling)? It is only healthy to supplement iron for those whose bodies need it and not everyone does.

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