We all need iron. It is a vital component of your red blood cells, and these little guys are responsible for carrying oxygen around the body and delivering it to the tissues, so they play a HUGE role in your energy levels. Most people are aware that one of the most obvious signs of iron deficiency is fatigue. However, you may not realise that iron plays some other unexpected roles in your body. It is required for a robust immune system (which helps keep you protected from colds, flus and infections), it is required for stable moods and good mental health, and you need it for proper thyroid function as well as healthy skin and nails.
Iron deficiency is the most common nutrient deficiency in the world, and for some people, it can be a mineral that is difficult to keep at a good level, even when special care is taken to include iron-rich foods in the diet. It is not uncommon for women in particular to experience recurring (and often unexplained) low iron levels.
In my clinic, I am always interested in looking a bit further when a patient comes in telling me that they have low iron, especially if they have experienced several episodes of low iron levels. Unfortunately the main approach with conventional medicine tends to be to simply keep topping up iron levels with supplements or even iron infusions (iron directly supplied into the bloodstream via injection). But as a naturopath I like to put my Sherlock Holmes hat on and ask the question ‘why is this happening?’
So, how can I tell if I am iron deficient?
First of all, if your iron levels are low, the most obvious sign is usually tiredness, and often you may feel short of breath or find that you struggle to perform physical activity or exercise.
However, there are often some more unusual or easily overlooked symptoms of iron deficiency that you may not realise can be related to low iron levels. These include:
- Brittle nails
- Chronic headaches
- Low moods
- Cravings for unusual things – eg ice, or even laundry starch!
- Frequent infections
- A sore, inflamed tongue
- Heavy periods, as well as clotting with periods. This can end up being a bit of a ‘chicken and egg’ situation, as low iron levels can contribute to heavy periods, and then heavy periods deplete your body’s iron stores even further.
- In children, behavioural problems such as hyperactivity may indicate an iron issue
Am I getting enough iron?
The recommended daily intake (RDI) for men is around 8mg of iron per day, women who are having a menstrual cycle require significantly more, around 18mg per day. And pregnant women can need up to 27mg per day, to allow for their increased blood supply and also to help build the baby’s levels. Children and teenagers need a good supply of iron as well, to keep up with their rapid growth.1
To give you an idea of how much iron is contained in the foods that you are eating, 100g of grilled beef steak contains 3.3mg iron, and 100g of baby spinach will give you around 1.75mg (although the iron in the steak comes is far easier for your body to absorb and utilize). Iron can be found in the following foods:
- Red meat
- Dark green leafy vegetables such as spinach and kale
- Pumpkin seeds
- Chicken & turkey
Is it that simple?
Unfortunately it is not always that easy. As with other nutrients, there is more to the iron equation than just what you take in. Some diet and lifestyle factors can actually interfere with your body’s ability to absorb the iron you eat – even if you are getting enough of it in your food. Or they can disrupt the way your body stores iron. For instance:
- Certain medications can interact with iron to either inhibit its absorption – these include antibiotics, medications for reflux, and some painkillers.
- Exposure to heavy metals such as lead, nickel, mercury or cadmium can also cause issues with iron levels.
- Some nutrients can even compete with iron to be absorbed, meaning that these nutrients are all vying for the same pathway into your body (like too many people crowding for the one lift in a building). This can result in a reduced capacity to absorb iron. Nutrients that compete with iron include some forms of zinc, magnesium and calcium (so go easy on the dairy!). This can potentially be an issue if you are taking lots of different self-prescribed supplements (something I don't recommend).
The good news is that other nutrients have the ability to enhance your body’s ability to absorb and utilize iron – the most well-known of these is vitamin C, but iron also works in co-operation with nutrients such as folate and selenium.
Why are my iron levels ALWAYS low?
If you experience recurring episodes of low iron levels, or your levels don’t stay put for very long even when you eat iron-rich foods and/or take a supplement regularly, and you have ruled out some of the scenarios listed above, then that is when it can be a good idea to dig a little deeper. However, these tend to be uncommon, so please don’t immediately assume this is what is going on!
- Some doctors will run a test for coeliac disease (a condition that leads to damage of the bowel and can cause nutrient absorption issues). If you have coeliac disease in the family and/or you experience chronic iron problems it is a good idea to ask your doctor for a check to see if you are at risk.
- Long-term issues with iron levels can actually be linked to chronic diseases such as autoimmune conditions, due to the role iron plays in the inflammatory processes.2
- It may be a clue that your body is dealing with an infection of some sort. Your body is smart – it realises that some infective agents such as bacterial invaders need iron to survive – so it ‘hides’ the iron in your body as much as possible.
- Poor stomach acid production may also be a factor in poor iron absorption – so if you have ruled everything else out and your iron levels are persistently low, then addressing your gut function should always be taken into consideration.
Should I supplement?
It is not a good idea to go out and take an iron supplement without having your iron levels checked first (particularly if you are male). A condition called hemochromatosis, which is an inherited disorder that causes you to store far more iron than you need, affects around 1 in 200 people, and if you have this condition it can actually be quite dangerous to take an iron supplement.
However, if you don’t have this condition, and you are a vegetarian/vegan, are pregnant or you habitually experience low iron levels then taking an iron supplement may be a good idea for you, once you have established your baseline requirements. This can be done through your doctor, and functional pathology testing is available through the clinic too.
It pays to keep in mind that not all supplements are created equal. The form of iron you take can make a big difference to how much your body is able to absorb and utilise the iron in that supplement, as well as whether you experience side effects (poor-quality iron supplements are notorious for causing nausea and constipation).
1 NHMRC (2005). Nutrient reference values for Australia and New Zealand: including recommended dietary intakes. Canberra. P.187-191.
2 Ganz, T., & Nemeth, E. (2009). Iron sequestration and anemia of inflammation. Seminars in hematology, 46(4), 387-93.