The Iron Fish Solving a Global Health Problem

A social enterprise is helping to tackle the global problem of iron deficiency anaemia one iron fish at time

Anaemia is one of the biggest health challenges in the world today, affecting a staggering two billion people worldwide—over 30 percent of the world’s population—according to the World Health Organization. Largely caused by iron deficiency, it can have serious consequences if left unchecked, particularly for pregnant women and young children living in developing countries or in poverty, where access to an iron-rich diet is limited. 

Iron is found in red blood cells, which store and carry oxygen around the body and when the blood lacks a healthy amount, it can cause fatigue and dizziness. In more severe cases, it can cause failure to thrive, stunting, delayed cognitive development, health complications in pregnancy, and can even be fatal. It not only costs lives, but an estimated loss of US $70 billion in the global economy each year, with people unable to work.

Lucky Iron Fish CEO Gavin Armstrong

A Canadian social enterprise, led by founder and CEO Gavin Armstrong, has come up with an ingenious way to tackle the problem in the simple, everyday act of cooking—and that’s where Lucky Iron Fish comes in. The idea is simple: an iron ingot shaped like a fish that you immerse in boiling water, soups or broth for about 10 minutes. A consistent and safe amount of iron (6-8mg) is released from the fish, without changing taste or colour. When used at least three times a week, the ingot provides enough of the element to help alleviate iron deficiency.

The idea was born in the rural communities of Kandal Province in Cambodia, one of the most hard hit countries when it comes to iron deficiency in the world. A Canadian PHD student, Dr. Christopher Charles, spent time here at part of his doctoral studies and found children with physical and mental developmental difficulties and women suffering from fatigue and headaches. He identified a potential solution—a small iron ingot that you cook with. 

Women wanted to cook with it because they thought it would make them lucky

Its first iteration was a small iron disc, but that did not entice women in the community to want to cook with it. “They said: ‘That's disgusting. Why would I put that in my food?’, but after some research, he discovered that fish are lucky in Cambodian culture,” Armstrong says. This was the key turning point. “Then women wanted to cook with it because they thought it would make them lucky. And then they felt the positive impacts of using the product and attributed that to the fish. So they would say ‘it really is lucky. I don't have headaches on fainting anymore. My kids are doing better in school’. And that's where the name Lucky Iron Fish comes from.”

Altering the shape, according to cultural sensibilities, had the impact they hoped for. Armstong says, “in our first clinical trials, we saw a compliance rate of 94 percent compared to the supplement group, which had about 32 percent. So it was a much higher uptake.” Independent clinical tests have shown that regular use of the Lucky Iron Fish can improve iron in the blood and reduce the prevalence of clinical iron deficiency anaemia by 46-80 percent, with a compliance rate in many diverse communities of 85 percent; markedly higher than iron pills at 30-50 percent.

From its Cambodian origins in 2012, Lucky Iron Fish has now had a global impact and is sold in 85 countries. In one of those countries, India, they have released a bespoke version: a leaf, thanks to its majority vegetarian population who were “hesitant to even put a fake fish into their pot”. 

“When you look at an average household size of four and a half people, and are where we've distributed units, we are counting our impact as over 850,000 people around the planet and looking to get to one million as quickly as we can,” Armstrong adds. Purchasing a fish also benefits the communities most in need too, with Lucky Iron Fish’s Impact Fund. “We take a portion of every sale and we put it into a fund to provide free units to communities, educational programmes, diagnostic equipment, or help cover distribution costs. So it's become a much more holistic impact approach,” says Armstong.

Unlike iron cookware or supplements, the iron fish is proven to release consistent amounts every time. “There are no side effects, including metallic taste, or it doesn't cause nausea or anything like that. It's a very gentle dose of iron,” says Armstrong, citing that pills can cause these unwanted side effects if supplements or pills are misused. “The concept of the product is simple, but the design is complex.”

There are economic and environmental benefits too. Firstly, supplements and pills are costly to buy, particularly for poorer families, whereas a Lucky Iron Fish lasts five years. Good news for those who find themselves short under Coronavirus lockdowns, as pills are usually distributed through health clinics in the developing world, which women have to walk long distances to reach. And if you add up a monthly purchase of pots of pills, the single-use plastic tally adds up. “The environmental impact is much smaller, because it's a reusable product,” says Armstrong. 

So could this approach work for other deficiencies? It’s something that is often asked of Armstrong. “It's something I would love to start looking into. There are other micronutrient challenges that we face. Zinc deficiency is a large one. So I've often wondered, is there a fish that can have multiple nutrients in it? Is there a fish that could sterilize water?” 

Watch this space.