This came to me privately. FYI:

Tradition Wisdom:  iron-deficiency anemia as measured by blood levels, is
associated with many problems (like those listed by Dr. Zimmer), THEREFORE
iron-deficiency anemia is the CAUSE of the problems, and iron-deficiency
anemia is caused by a diet too low in iron, THEREFORE supplemental iron is
the CURE.  Since human breast milk is low in iron, THERE MUST BE SOMETHING
WRONG WITH IT, so babies need iron supplementation after 4 months or so,
when their fetal stores are used up.

New Perspective:  iron-deficiency anemia as measured by blood levels, is a
SYMPTOM of underlying problems for which iron withholding by the body is
part of the CURE (just like fever is part of the body's adaptive response to
infection because it prevents the microorganisms from taking up iron),
THEREFORE iron-deficiency anemia is not an illness to be treated, but a sign
that there are other problems, such as parasites or bacterial infections,
which the body is trying to cope with, iron-deficiency anemia is not caused
by a diet too low in iron, THEREFORE supplemental iron is NOT the CURE, but
rather makes the situation worse by thwarting the body's attempts to cure
itself.  Since human breast milk is low in iron, we should assume that there
is a good adaptive evolutionary reason for it, like preventing infections in
breastfed infants, so babies do not need supplemental iron.

The new perspective comes out of work by a number of people, but chiefly Dr.
Eugene Weinberg, a medical microbiologist at Indiana University School of
Medicine, who was the first to discover the adaptive role of fever in curing
infections by preventing microorganisms from taking up iron from the blood.
They just can't absorb iron when the internal tempature is too high.  He
then went on to show that in addition to mounting a fever defense, the body
also hides the iron inside cells (instead of in the blood) where the
microorganisms can't get to it.  So to the doctor, the patient's blood seems
iron-deficient, even though the cellular stores may be more than sufficient.
Just as doctors no longer recommend fever reducing drugs for low grade
fevers, the hope is that doctors will realize that iron supplements to
anemic women only exacerbate the underlying problem.

My speculation is that pregnant women generally have compromised (lowered)
immune systems to try to reduce the chance of reacting against the foreign
tissue growing in their bodies (the baby), and thus their bodies try
desperately to protect them from infection by keeping all the iron hidden
away from the bloodstream.  That's why so many pregnant women are anemic.
The ones who are extremely anemic probably have an additional ongoing
infection or parasites, so their bodies are storing even more iron away from
the bloodstream.  Yes, this has consequences, such as tiredness and
paleness, but the balance is in favor of keeping the infection under
control.  Just as fevers have consequences -- they make you feel crummy, and
too high fevers can cause brain damage and death.  Too much iron hoarding by
the body can lead to serious medical problems, but the cure is to fix
whatever condition is causing the body to hoard the iron, not dumping more
iron into the body.

That's my understanding of the issue, in a nutshell, and the relevance to
lactation of course is that doctors are telling breastfeeding moms they need
to supplement with iron because their breast milk is inadequate in this
mineral.

K
Kathleen B. Bruce, BSN, IBCLC, LLLeader
Co-Owner Lactnet, LLLOL, Corgi-L
LACTNET WWW site: http://www.mcs.com/~auerbach/lactation.html