F&N Bulletin Vol 23 No 1b - United Nations University

Iron-deficiency anemia in young working women
The bioavailability of iron in a typical Indian meal is
extremely low. A meal of ragiballs, potato, and tea has
an iron bioavailability of only 0.9%. A meal of rice, dal,
potato, and milk raises the bioavailability of iron to 4.5
% [16]. To our knowledge there are no studies on the
bioavailability iron in Indian fermented foods, such as
iddli, dosai, appam, or dhokla. Our study found that
the mean hemoglobin status of the women increased
by 1.20 g/dl when an average of 20 to 30 iddlis were
consumed per subject per week. It would be desirable
to determine whether intermittent or once-weekly
consumption of iddlis would be sufficient to raise
hemoglobin levels.
It is well known that cereals have a high content of
phytic acid, a significant inhibitor of dietary iron. We,
therefore considered a culturally accepted, habitually
practiced, and traditional food-processing procedure,
namely, autofermentation of cereals and pulses. Fermented
foods such as iddli, dosai, and appam are
eaten practically every day as a breakfast food or as
a tiffin (snack food) at tea time in affluent South
Indian households. Our surveys revealed that the poor
households made iddlis only once or twice a week, but
in large quantities. Hence, we decided to capitalize on
this established food practice in this region of India.
Gibson et al. [17, 18] in Malawi described several
dietary interventions to prevent zinc deficiency, of
which fermentation was the simplest and most effective
at the household level. Several other studies, mostly
conducted in Africa, have shown the effectiveness of
reducing the phytic acid content of maize, sorghum,
other millets, or dry pulse grains by the simple process
of soaking the cereals in water for a few hours to
overnight [19, 20].
Iddli, a fermented food which is eaten daily for
breakfast, is very simple for most South Indians to
prepare. Generally, one measure of raw rice, one measure
of parboiled rice, and one measure of black gram
dal (Phaseolus mungo Roxb.) are the main ingredients
for iddli. The rice and black gram dal are washed and
soaked separately in about two inches of water for
about 6 to 8 hours. The rice is coarsely ground and the
pulse is finely ground, and both are mixed well. Salt
and baking soda (sodium bicarbonate) are added to
taste. The batter is allowed to ferment overnight (10
to 12 hours), which makes the batter sour and lowers
its pH. The batter is poured into greased molds and
steamed in either a pressure cooker or iddli steamer
for 8 to 10 minutes. The steamed dumplings are served
with spicy lentil soup and coconut chutney. Raw ingredients
of 2 kg of rice grain plus 1 kg of blackgram dal
would yield about 60 to 70 iddlis.
The low-income families use much less of the expensive
pulse but add more baking soda. It would be useful
to conduct in vitro and in vivo studies on the bioavailability
of iron from different iddli recipes. The most
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practical, cost-effective, and sustainable recipe could
then be promoted to the employers as their contribution
to the employees’ lunch at the workplace.
Since the women claimed to eat from two to eight
iddlis at once, the equivalent of 100 g of raw rice plus
pulse (for two iddlis) to 400 g of raw rice plus pulse
(for eight iddlis) would be consumed per iddli meal.
At presurvey, iddlis were the packed Monday lunch
for most of the women. At postsurvey, iddlis were
still a Monday treat, but the quantity consumed was
far greater.
An even simpler method to increase the bioavailability
of iron for cereals would be to soak the cooked
rice in water overnight, drain off the water the next
morning, add curd (yogurt), and take it to work as
a packed lunch. Although, as stated earlier, this was
considered to be something that very poor people
did, our IEC poster to promote this practice did not
find favor. We were told that all the cooked food
was consumed on the same day so that there was no
leftover cooked rice. Our advice to cook more rice for
steeping later was not well received.
Gibson et al. [17, 18] recommended soaking maize,
the staple cereal of Malawi, as the most practical
method of reducing the level of phytic acid. Svanberg
[21] lists the advantages of soaking and fermentation of
nontannin and high-tannin cereals, which supported
our IEC attempt to popularize the “curd-steeped rice
lunch” for working women in South India.
Most plant-based foods contain some phytase
enzymes, which hydrolyze phytic acid to inorganic
orthophosphate and myoinositol, However, phytase
is in a dormant state in dry grains and pulses and is
activated by moisture. Phytate reductions may be as
high as 98% for a variety of fermented products based
on cassava, cocoyam, maize, sorghum, rice, soybeans,
cowpeas, and lima beans consumed in West Africa,
depending on the conditions of preparation, storage,
and cooking [22].
According to Gibson and Ferguson [17], other
advantages of fermentation are that it reduces the
amount of fuel required for cooking, improves the
safety of food by inhibiting the growth of diarrheal
pathogens, and produces antimicrobial substances.
Commercial phytase enzymes can be prepared from
Aspergillus oryzae or A. niger that are stable over a
fairly wide range of pH (3.5–7.8) and temperature.
However, they are extremely expensive [23].
We found that an enhancer such as gooseberry juice
is an excellent way to increase the mean hemoglobin
levels of our target working women. Other recent
studies have shown that guava fruit was successful in
raising the hemoglobin levels of college women in a
short time [24]. In fact, in the present study, gooseberry
juice proved to be superior to the fermented food,
producing a mean hemoglobin increase of 1.20 g/dl,