by Diana Arundell – University qualified Naturopath and Nutritionist
If you have been diagnosed with iron deficiency, it’s not just enough to take a supplement for a few months and wait and see what happens. As with any imbalance in the body, it’s always best to identify the cause so the issue can be resolved most accurately. Otherwise just treating the symptom may rely on taking a supplement or medication permanently and if underlying issues aren’t addressed, further health concerns downstream can result. In the case of iron deficiency not being resolved, eventually organs such as the thyroid which rely upon good iron status for correct functioning, will gradually start to struggle and when this happens it can further compromise other systems. For example suboptimal thyroid function can flow on to reduced digestive function and metabolic dysfunction resulting in a vicious circle of often subclinical issues that can leave the individual feeling well below par.
Simply testing haemoglobin in the blood is not enough to give a comprehensive understanding of what is happening with iron levels in the body. By the time haemoglobin is low, the whole iron picture is in a bad way. Ferritin is the storage form of iron and more often than not is the marker measured when asked for a blood test to check iron levels. Requesting iron studies gives a more comprehensive look at circulating iron, saturation and how much iron is available in back up stores. The ferritin stores are used foremost to produce haemoglobin and red blood cells so if iron levels are low, these things are built up before the ferritin stores, so sometimes it can take a few months to see improvement in ferritin. Many people will feel almost immediately better if they are iron deficient and begin supplementing with the correct form of bioavailable iron at the correct dose.
A comment about reference ranges – blood test reference ranges are obtained from 95% of the population and when we consider the reality that 95% of the population is not really ‘healthy’ we need to consider the bell curve within the reference range to find a more accurate optimal range of function or nutrient status.
Iron deficiency signs and symptoms include (but not limited to): fatigue, ‘heavy legs’, headaches, breathlessness, light headedness, pale conjunctiva and mucous membranes, poor circulation, nail pitting, palpitations, easy bruising, hair loss, craving crunching ice or excessively craving crunching hard, raw vegetables such as carrots or celery (a form of PICA) . Heavy menstrual flow both contributes to iron loss and is a sign of low iron. Once iron stores are replete, menstrual flow reduces and sometimes there’s also significant improvement in menstrual cramping.
Once iron deficiency has been diagnosed, its then time to establish why it occurred. The three main areas to consider are: 1. Is there enough iron rich food coming in through the diet? 2. If there is enough dietary iron, why is it not being absorbed? 3. Where is the leak/source of iron loss? Dietary iron intake commonly is the first port of call and then absorption and blood loss needs to be investigated. Poor iron absorption can be due to caffeine/tannins interfering with absorption, competitive mineral uptake by zinc and/or calcium, poor digestive acid production by the stomach/use of antacid medication, gut bugs/parasites can deplete iron or phytates in a vegetarian diet can also impede absorption. Blood loss may be obvious or completely unknown and this needs to be identified as sometimes unknown blood loss can be due to a tumour. The gastro intestinal and reproductive tracts are often the systems involved in blood loss leading to iron deficiency. EG. Inflammatory bowel disease, ulceration, bowel tumours, heavy menstrual flow, shorter menstrual cycles and fibroids are some of the more common culprits.
Food sources are always best to support nutritional status although when a significant deficiency is present, supplemental form can be utilised to correct the deficiency and then dietary sources relied upon to maintain good nutritional status. Dietary sources of iron include lean red meat, and most animal meat, dried organic apricots, silverbeet/spinach, shellfish, liver, green leafy vegetables, tofu, lentils, beans, molasses. Haem-iron which is the form of iron found in animal products is better absorbed than the non-haem iron found in vegetarian sources. There are substances in vegetables and grains called phytates and oxylates that can reduce the absorption of minerals from these food groups. Vitamin C improves the absorption of iron so red and orange vegetables and fruit are good to eat with iron rich food. Eg Tomatoes, orange juice.
Iron supplements are available in many forms such as tablets, liquids, transdermal creams and intravenous infusion. Many stronger over the counter iron supplements are a sulphate form which can create harder stools and constipation in many. Other tablets are in phosphate form which is often not strong enough or well absorbed and may result in minimal improvement in iron levels. Clinically I have found the liquid forms more suitable for children and practitioner range amino acid chelate or bisglycinate forms better for shifting ferritin levels in adults. There are some people with iron deficiency who will benefit most from an iron infusion. This option bypasses the gut so poor absorption and constipation are also bypassed. Good digestive health will need to be addressed however for long term ongoing iron absorption.
Recent research suggests taking iron supplements every second day (pulsing the dose) is better to enhance absorption, and iron supplements are best taken away from other supplements, especially zinc as it competes with absorption. Caffeine and tannins in tea and coffee significantly interfere with iron absorption so should be avoided or at least separated 1-2 hours away from iron rich meals or supplements if trying to boost iron levels.
Those that may need more iron than the rest include pregnant women or those wanting to conceive, athletes, children, teens – especially menstruating young women. Young women often ‘diet’ leading to a reduced intake of iron and this combined with a time of intense physical growth and menstruation more often than not results in low iron. It’s very difficult to boost iron levels once a woman is pregnant as the significant increase in blood volume leads to dilution of iron in the blood so it’s really important to have optimal iron stores prior to conception.
Iron deficiency is extremely common and unfortunately the underlying cause is rarely addressed. It’s important to treat both the cause and the symptom of all health issues including vitamin/mineral deficiencies and simply supplementing without addressing the underlying cause can be detrimental long term for the individual. Iron can also be toxic if taken for too long at high doses so always work alongside a qualified health professional when considering supplements.
Diana Arundell is a university-qualified naturopath and consults from her Avoca Naturopath clinic. She has a special interest in fertility and pregnancy health, digestive health, immune function and
family wellness programs. She was a nutrition lecturer at Macquarie University for 10 years, and is an accredited Journey Practitioner.