Understanding Iron Deficiency

Although there are a handful of different types of anemia, Iron deficiency anemia is the most common. It can be caused by blood loss, either large or continuous small losses, hypothyroidism and many long-term illnesses like cancer. It can be caused (although less often) by low iron intake, such as that of vegan and vegetarian diets. Gastrointestinal conditions, such as Crohn's and Colitis, may impair iron absorption, regardless of how much is consumed. There are also some medications that increase red blood cell count and therefore may cause iron deficiency, if iron stores are not concurrently 'stocked up'. Iron deficiency is also common during pregnancy and in breastfed or low-iron formula-fed infants. Some of the symptoms of iron deficiency anemia include fatigue, pale face, dry skin and brittle nails, constipation, headaches, dizziness, loss of appetite and decreased immunity. Without iron, red blood cells cannot carry enough oxygen to other cells in the body. Without this oxygen, the cells cannot function properly. In severe cases of iron deficiency, heart palpitations and breathlessness are observed, as these cells fight for more oxygen.

Many believe that because plants or herbs are natural, there are no safety issues with taking as much as you want, when you want. Unfortunately, this could not be further from the truth. Most pharmaceutical medications are based on the action of a particular botanical or specific constituent of a botanical substance. That being said, these herbal remedies can be just as effective as some drugs and equally as dangerous.

Diagnosing An Iron Deficiency 

When a patient walks into my office with unusual fatigue, iron deficiency is on my list of possible causes, but it is certainly not the ONLY option on my list. I say this because all too often, I see people in the health food store treating themselves for iron deficiency (anemia) based solely on the fact that they are significantly fatigued. Iron deficiency is fairly easily diagnosed and should not be treated until such a diagnosis has been made. Too MUCH iron can be toxic to the body and can even result in significant damage to the liver. It can be fatal in children. In addition, high levels of iron will reduce zinc absorption and cause deficiencies in this mineral. Individuals should not be supplementing with iron unless they have had their iron levels tested and know they are low. Blood tests for iron levels are covered by OHIP when ordered by your MD. Serum ferritin, serum iron and total iron binding capacity are three blood tests that are often combined to determine if you have a form of anemia, and what form you have. Serum ferritin, specifically, is a good indicator of the body's iron stores and is often used to diagnose iron deficiency anemia.

Treatment Options For Iron Deficiency 

If you have recently discovered that you are iron deficient, be sure to talk to your doctor about how much iron you should be supplementing with on a daily basis. It will almost definitely require a higher dose than you will find in your typical multivitamin. You may be asked to get anywhere from 100-300 mg/day, or more. Ask your MD or Naturopath about the different forms of iron, as some are more easily absorbed than others, and some forms tend to cause constipation or nausea. Make sure to avoid foods high in oxalic acid, such as rhubarb, spinach, chard, beets, chives, parsley and chocolate. Coffee and tannins found in tea can also inhibit iron absorption. Also, make sure to separate your iron supplement from any high fibre or calcium rich foods or supplements, as these can also reduce absorption (from food sources of iron, as well!). Try to separate calcium and fibre intake from iron intake by about 2 hours, if possible. This will ensure there are few counteractive effects. Take iron supplements on an empty stomach with vitamin C or a glass of orange juice, as this will help to increase absorption. Consider cooking food in cast-iron pots, as foods will absorb some of the iron from the cookware.

Consuming An Iron-Rich Diet

Iron is found in the diet in two forms: heme iron and non-heme iron. Heme iron is contained in animal products and considered to be more highly absorbed than it's non-heme counterpart. Lean red meats are probably the highest sources of this type of iron. Non-heme iron comes from vegetables, grains and beans (plant sources). There are some natural ways to increase iron absorption, especially important if you are eating mostly non-heme iron sources. Making sure to pair iron rich foods (heme or non-heme) with foods rich in vitamin C is one such way. As mentioned earlier, vitamin C can significantly improve iron absorption.

How Much Iron Should I Take?

The average individual should aim to get anywhere from about 8 -45 mg of iron daily (men and post-menopausal women fall at the lower end of this scale). As you may have noticed, this differs significantly from the amounts that those who are clinically deficient are aiming to get. These smaller amounts can be obtained easily via diet. Ready-to-eat cereals and instant oatmeal tend to be fortified with iron. Black-strap molasses is another good source of non-heme iron, as are most beans, such as kidney beans, soybeans, and lentils. Beef, dark turkey, oyster, clams and chicken liver are all also high sources of heme iron. If you suspect you are iron-deficient, by all means, confirm your suspicions via blood work, but do not supplement, aside from eating the aforementioned foods or taking a simple multi, with higher dosages of iron until you know for sure.