Iron Deficiency

Iron Deficiency: Understanding Whether You Need an Iron Supplement

Iron’s primary role is in making hemoglobin (the part of red blood cells that carries oxygen!) but it is also crucial for cell growth and differentiation (especially important in pregnancy), neurotransmission, immunity and heart function. Every single cell in our bodies needs iron for proper development and function. Because it’s primary role is to help carry oxygen, it’s use is prioritized for making red blood cells above all else. This means that if we are lacking, we get start to get dysfunction in other systems before anemia actually shows up on our lab work.

Anaemia is defined as having low hemoglobin. Having low iron levels is the most common reason for this, but it is also possible to have low iron stores (and symptoms!) without anaemia. Symptoms of iron deficiency can include fatigue, poor concentration/“brain fog”, hair loss, brittle nails, restless legs, reduced exercise tolerance, anxiety and low mood/depression.

Those who are pregnant, young children, menstruating folks and athletes have higher chances of being iron deficient. Blood loss due to menstruation, increased demands for blood and oxygen (pregnancy, growth and development, intense exercise training), and challenges with absorption are all possible reasons for reduced iron in these groups. Menstruation, abnormal uterine bleeding and blood loss from gastrointestinal bleeding, are the most common causes of low iron in high income countries.

Considering how important iron is and how common it can be to have a deficiency, shouldn’t we all be supplementing?

Unfortunately, it’s not that simple. Iron is incredibly tightly regulated in our bodies because as helpful as it is, too much iron can be hazardous to our health. Excess iron can interact with oxygen to produce oxidative stress and damage to cells and membranes. There’s some evidence that higher levels of iron can be associated with several chronic diseases including diabetes. Our bodies have a lot of safety mechanisms around absorption of iron because excess is quite dangerous – and we don’t have a very good exit strategy if we over-do it (besides bleeding!)

A lot of the iron that isn’t absorbed from our food (which is the majority!) travels through our intestines and is available as a nutrient for some of our bacteria in the colon. Every bacteria has its own iron needs – some of our less desirable bacteria, like E. Coli and Salmonella, are big lovers of iron. Our healthy bifidobacteria, in contrast, have low iron requirements.

We know our diet can influence our microbial environment, and iron content is no exception. Having a good microbial environment can actually help with iron absorption by reducing inflammation. Lower inflammation means we have less of the iron regulating hormone hepcidin.

So how can we ensure we are having enough iron?

Testing is important. This is one of the main lab tests we run if you are feeling tired. Iron testing is important and we can’t tell your needs based on symptoms alone. It’s often reported that young vegans and vegetarians are at higher risk for low iron – but this isn’t always the case. Similarly, women who eat red meat may still have levels that are lower than ideal. Iron metabolism is complex - let’s test and make sure you are set up to feel your best!

How do we optimize your iron absorption?

Foods are a great way to increase your iron intake if you aren’t sure you need to supplement. Although iron from animal products (heme iron) is more readily absorbed, it is also possible to achieve great iron levels on a plant-based diet provided you have a varied and thoughtful meals and good gut (and overall) health.

Avoid having too many iron absorption inhibitors around your iron containing foods or supplements. There are some compounds in foods that reduce the absorption of iron. Calcium inhibits both heme and non-heme iron (so iron from plants and animals), while polyphenols (found in coffee, tea and legumes), and phytates (found in some plant-based foods) inhibit non-heme iron. Thankfully, vitamin C can help increase the absorption AND overcome the effects of other dietary inhibitors.

A diet high in vegetables will help you absorb the iron from plant-sources. We can also increase our intake of iron containing foods like legumes, whole grains, leafy greens, seeds and nuts!

Mix it up and keep your diet varied. If you want to take it a step further, you could try cooking in a cast iron pan for a little extra boost.

Although some of us require supplementation, always talk to your naturopathic doctor or MD about your lab work before heading to the supplement shop. You can book an appointment with one of our NDs here.