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Iron Deficiency – What is it?

steel fork, nails and screws on white paper

Iron Deficiency – Iron is an essential mineral involved in many enzyme functions needed for energy production, healthy metabolism, support overall cellular health and to maintain general wellbeing.

Iron is needed to produce a protein in our body called hemoglobin which is found in red blood cells. Hemoglobin carries oxygen from your lungs and transports it throughout your body supplying oxygen to your brain, tissues, muscles, and cells. When we have, insufficient iron levels our bodies cannot produce enough hemoglobin and therefore we starve our body of oxygen which is also known as anemia.

What are the symptoms of iron deficiency?

Iron deficiency anemia is when hemoglobin levels are so low that the blood is unable to carry oxygen to the cells making us feel fatigued and low energy. Naturopath’s look for koilonychia as a sign of anemia which you can look for right now to determine if you may have an iron deficiency. Koilonychia is also known as spooning of the nails which are flat or concaved nail beds and are accompanied with thin nails. Ridges in the nail (vertical lines) can indicate low stomach acid and therefore impacts the assimilation of iron and other essential vitamins and nutrients.

Other signs and symptoms of Iron Deficiency are:

• Chronic fatigue
• Restless legs, inability to stop moving
• Pale skin
• Shortness of breath
• Hormonal imbalances
• Yawning whilst exercising
• Muscle soreness
• Low appetite
• Poor sleep quality
• Poor concentration, learning difficulties
• Sores on mouth and tongue
• Mood changes
• Spooned thumbnails
• Heart palpitations
• Low blood pressure
• Dizziness, fainting
• Pale lower eyelid
• Pale and sore gums

Who is at risk?

Iron deficiency anemia affects more women than men due to a monthly menstrual cycle, pregnancy, and breastfeeding. However, there are many factors that can increase the risk factors of anemia in both male and female such:

• Vegetarian or vegan diet (animal sources are high in protein and iron).
• Athletes or increased exercise (damage to red blood cells).
• History of kidney failure.
• Dialysis treatment (removal of iron from the body).
• Irritable Bowel Syndrome (decreased absorption of iron).
• High intake of antacids (calcium block iron absorption).
• Calcium and zinc bind and inhibit absorption.
• Donating blood on a regular basis.
• Green tea EGCG inhibits Iron absorption.
• Sufferers of Irritable Bowel Disease due to decreased absorption as well as increase loss of bleeding.

Iron Deficiency – How do I know if I am anemic?

Determining your iron levels are easy to do through a blood test and should be checked routinely if you have any of the above risk factors. Your general practitioner can test for serum ferritin (iron-storage and transferrin saturation which is the amount of iron being transported in the body.

You can also go through various symptom pictures. Look into your bottom eyelid, it should be a nice red with visible capillaries. A pale lid indicates poorly oxygenated blood. Other physical signs are pallor, fatigue, weakness, and shortness of breath.

What are the daily recommendations for iron?

Life Stage Age Male (mg/day) Females (mg/day)
Infants 0-6 months 0.27 0.27
Infants 7-12 months 11 11
Children 1-3 years 7 7
Children 4-8 years 10 10
Children 9-13 years 8 8
Adolescents 14-18 years 11 15
Adults 19-50 years 8 18
Adults 51 years and older 8 8
Pregnancy All ages – 27
Breastfeeding All ages 10

What foods can I eat to enhance iron?

There are two different forms of iron found in food sources: heme and nonheme.

In animal-based foods, iron is attached to proteins called heme and is classified as a heme iron source. This includes dairy products, meat, poultry, and fish. Great sources also include chicken liver, oysters, dark meats of chicken and turkey and beef liver.

In plant-based foods, the iron is not bound to heme and is the classified and nonheme source. Great sources of nonheme iron include legumes, almonds, beet green, swiss chard, spinach, sesame seeds, and dandelion greens.
Heme iron is better absorbed in the body which is around 15-35% compared to nonheme sources sitting around 2-20%.

Iron deficiency – How to increase iron absorption?

  • Vitamin C (ascorbic acid): Vitamin C strangely enhances the absorption of nonheme iron by reducing ferric iron (fe3+) to ferrous iron (Fe2+) and forming an absorbable, iron-ascorbic acid complex.
  • Combining Iron-rich foods with Vitamin C- for example having a steak and salad (iron) with asparagus, red capsicum, and drizzle lemon and olive oil on top (vitamin C).
  • Avoid inhibitors of iron such as phytic acid (green tea and black tea, grains, rice, tofu, peas, peanuts), calcium and soy protein.
  • Synergistic (works together to enhance action) nutrients include B2, B12, copper, folic acid, and selenium.
  • Increase bitters before you eat like dandelion, ginger, and gentian. These herbs can stimulate hydrochloric acid in your stomach to breakdown and assimilate iron.
  • Increase acidity with apple cider vinegar, lemon, lime or grapefruit juice.
  • Avoid cold drinks with meals and go for hot /warm water with some of that stuff listed above in it.
  • Vitamin B12 combines with iron hemoglobin in the blood. Natural sources of Vitamin B12 are found in beef, chicken, salmon, and liver. Vegetarian sources of Vitamin B12 can be obtained in Nori sheets (sushi) or Shitake mushrooms.

What is the best Iron supplementation?

Not all iron supplements are created equal so it is always best to discuss your needs with your health care professional before supplementation.

The most common forms are:

  • Ferrous sulfate and fumarate- these are inorganic (non-haem) forms which are commonly found in generic supplements. Ferrous sulfate may cause constipation, therefore, trying to use food as your main source of iron is far better than this supplementation.
  • Iron Phosphate and iron amino-acid chelate are better absorbed with less burden on the gastrointestinal tract.

The best way to enhance iron absorption is to use food combining along with natural plant-based multivitamins which contain Vitamin C and the synergistic vitamins and minerals can significantly improve iron deficiency.

What if I have too much iron?

Hereditary hemochromatosis is a disorder of iron metabolism resulting in iron accumulation in the liver, heart and other tissues. It is the most common genetic disorder in Australia, effecting about 1 in 200 people of northern European origin. It presents simular to anaemia such as fatigue, irregular heartbeat, feeling unwell but has distinctive sore joints, unexpected weight loss and erectile dysfunction. If you have a family history of hemochromatosis or signs, you can talk to your general practitioner about testing for it. Your GP can test for the amount of iron in your blood or they may decide to do genetic testing to see if you are a carrier of the gene.

Treatment

Treatment is simple such blood donation at your local red cross to reduce your blood levels. You may also be recommended to reduce heme food sources such as red meats, chicken and fish and avoid foods high in vitamin C with high iron foods. It is also recommended to limit alcohol consumption to protect your liver that can become damaged when iron stores are high.

If you do have hemochromatosis and taking a multi-supplement that would increase absorption, avoid taking it with foods that are rich in iron such as meat, poultry, seafood, and certain vegetables. Take with foods such as smoothies, yoghurt and fruits where possible.

References

Saunders, A et al, Iron and vegetarian diets, Medicine Journal of Australia, 2013, Vol.4
Linus Pauling Institute 2017, Micronutrient information centre: iron,
Hallberg L, The role of vitamin C and iron absorption, International Journal of Vitamin and Nutrition Research, 1989, vol. 30.
Winter W et al, The molecular biology of human iron metabolism, Laboratory Medicine, 2014, vol. 45
Zhang C, Essential functions of iron-requiring proteins in DNA replication, repair and cell cycle control, Protein Cell, 2014, vol.5
Bhaskaram, P, Immunobiology of mild micronutrient deficiencies, British Journal of Nutrition, 2001, vol.85
Semba R, Bloem M, The anemia of vitamin A deficiency: epidemiology and pathogenesis, European Journal of Clinical Nutrition, 2002, vol.56
Kelkitli E et al, Serum zinc levels in patients with iron deficiency anemia and its association with symptoms of iron deficiency anemia, Annual Haematology, 2016, vol.95
Hurrell et al, Iron bioavailability and dietary reference value, American Clinical Nutrition, 2010, vol.91
Jauregui-Lobera et, al. Iron deficiency and cognitive functions. Neuropsychiatric Disease Treatment, 2014, vol. 10.
Health Direct 2017, Haemochromatosis, Australian Government Department of Health