Iron Deficiency- The number one deficiency in the world!

red blood cell

Iron Deficiency- The number one deficiency in the world!

Iron is one of the most abundant metals on Earth and is essential to most life forms. The World Health Organization reports that iron deficiency is the number one nutritional disorder in the world. One in four women in the US is thought to be deficient. Iron deficiency is the leading cause of fatigue in women aged 15 to 50 years old. Even mild iron deficiency, well before frank anemia develops, may detract from optimum functioning of the body and mind. That being said, excess iron can cause long-term damage and even death. This month’s newsletter discusses the importance of this nutrient, and how to avoid deficiency and excess.

Why is iron important in the body?:
Iron is involved in many functions within the body. Most importantly, it is part of hemoglobin, the oxygen-carrying molecule within red blood cells, and is therefore essential for delivering oxygen to cells throughout the body. In fact, much of the body’s iron is bound to hemoglobin molecules. Additional iron is stored in the liver, bone marrow, spleen, and muscles.
Iron is a part of myoglobin, an oxygen-carrying molecule found in muscle cells, which provides oxygen to the muscle cells at the start of activity.
Iron is also a part of many enzymes needed for biochemical reactions in our bodies. It is needed for the creation of energy within our cells. It is required for liver detoxification. It is needed within the brain for the serotonin system which contributes to mood and sleep.

What is iron deficiency anemia?:
Anemia is a state of decreased red blood cells and/or hemoglobin. It can result from blood loss, excessive blood cell destruction, or deficient red blood cell production. Among nutritional causes of deficient red blood cell production are iron, Vitamin B12, and folic acid deficiencies.
Anemia is undetected in many people, and the symptoms may be vague and generally develop quite slowly. Most commonly, people report feeling weak and fatigued and sometimes having poor concentration. Other symptoms of anemia include: pale skin, nail beds and mucous membranes (commonly, the lower lid of the eye is pulled down to check), brittle hair and nails, rapid pulse, shortness of breath, cold hands and feet, dizziness and faintness. Other signs include: increased infections, poor sleep, depressed mood, sore and inflamed tongue (glossitis), canker sores, cracks at the corners of the mouth, restless leg syndrome, ringing in the ears, and headache.
Interestingly, some people with iron deficiency exhibit a disorder called pica. This is characterized by the consumption of non-food substances (such as dirt, paper, grass, and hair).

Up to 80% of the world’s population is deficient in iron, while only 30% have frank anemia. When iron stores drop significantly, red blood cells decrease in size and color and, eventually, hemoglobin levels begin to drop. Routine laboratory testing tests only for frank anemia- the last marker of iron deficiency. It is therefore important for people at risk of iron deficiency to request an “iron panel” which will test for deficiencies even if red blood cell production is not yet affected. In my practice, a patient presenting with fatigue will be referred to his/her medical doctor for, among other tests, a full “anemia panel” which evaluates the three common nutritional causes of anemia (iron, B12, and folic acid deficiency). Once an anemia has been diagnosed, its cause should always be sought out and corrected, whether it be heavy menstruation or a bleeding stomach ulcer.

Who is susceptible to iron deficiency?:
1) Menstruating women are highly susceptible to iron deficiency because of the loss of iron each month during menses. The demand for iron in menstruating women is nearly twice that in men. Teenage females between the ages of 12 and 19, as well as perimenopausal women have the highest occurrence of iron deficiency with some studies reporting 40% of the women in these groups as being deficient.
2) The elderly (after age 65, but especially after age 80) are also at increased risk because of a decrease in stomach acid which is required to absorb iron and often because of decreased food intake in general. Anemia in the elderly is also often caused by B12 deficiency for many of the same reasons. Anemia has been found to be linked with increased mortality.
3) Vegetarians, vegans, and those with low protein intake are susceptible.
4) Those with digestive problems resulting in increased transit time of foods through the gastrointestinal tract (such as those with Celiac disease and Crohn’s disease) are at increased risk.
5) Pregnant women require double the amount of iron as non-pregnant women. According to some studies, 50% of women not taking iron supplements are deficient at some point in their pregnancy. Iron is required for optimum fertility (as iron is involved in the manufacture of estrogen and progesterone), proper placenta development, prevention of low birth weight babies and pre-term labor, and to enhance the iron stores of the baby through the first six months to one year of life. I advise all female patients planning to get pregnant to have their iron levels tested.
6) Women after childbirth are susceptible because of the large amount of blood loss which can be associated with delivery.
7) Athletes loose iron through sweat, digestive bleeding, and bruising which occurs as a result of their intense, impact-laden activity. Iron deficiency, even at mild degrees, impairs exercise performance since iron is required for transporting oxygen to the muscle cells and is involved in the cells’ use of the oxygen.
8) Those who have undergone surgery, have had an injury involving blood loss, or have a bleeding gastric ulcer or severe hemorrhoids are at high risk for deficiency.
9) Those with kidney failure, and particularly those on dialysis, are at high risk of iron deficiency due to increased loss of iron and decreased formation of red blood cells.
10) Children between the ages of one and four experience rapid growth and often lack adequate iron sources in their diets and are therefore susceptible to deficiency. Their iron requirement is 10mg per day- as much as an adult male! Healthy, full term infants have
enough iron stores to last between 6 months and 1 year. Anemia during this period of life can impact development of the nervous system and brain and lead to cognitive and physical developmental delays. It can also decrease growth rate and weight gain.
11) Teens are also at high risk of deficiency because of rapid growth, high activity levels, and poor eating habits. In female teens, menstrual blood loss contributes greatly to deficiency states. Teenage males between the ages of 13 and 16, and teenage females between the ages of 12 and 19 have been found to be a high risk group.

What are the daily requirements for iron?:
Infants between 7 and 12 months of age require 11mg/day of iron.
Toddlers from ages 1 to 3 require about 7mg/day.
Between ages 4 and 8, 10mg of iron a day is recommended.
Ages 9 to 13 require 8mg a day.
Between ages 14 and 18, males require 11mg/day and females require 15mg/day.
Women ages 19 to 50, require 18mg/day.
Men 19 years old and upwards, require 8mg of iron a day.
Pregnant women require about 27mg of iron.
Lactating women require about 10mg a day.

What are the dietary source of iron?:
The best sources of iron are known as “heme iron” and are derived from animal products:
liver and other organ meats, lean red meat, poultry, fish, and shellfish (particularly oysters). Iron from these sources is readily absorbed in the intestines at a rate of between 15 and 35%.
Vegetarian, “non-heme” sources, are less well absorbed, at a rate of 2 to 20%. These include dried beans and peas, legumes, nuts and seeds, whole grains, dark molasses, green leafy vegetables, dried fruits (raisins, prunes, apricots). Bear in mind that green leafy vegetables and whole grains contain oxalates and phytates which can actually reduce iron absorption unless they are lightly steamed or cooked. Many foods are fortified with iron.
Factors that increase iron absorption are: vitamin C, B12 and folic acid, fructose and glucose, amino acids and proteins.
Factors that interfere with iron absorption include: calcium, vitamin E, zinc, magnesium, manganese, excess copper, caffeine, oxalates and phytates, carbonates (found in carbonated beverages), phosphates (found in soft drinks and processed foods), fiber, and protein deficiency.

When supplementation is necessary:
When iron deficiency is marked, or frank anemia is detected, I often recommend supplementation to my patients. Many iron supplements are constipating (especially in pregnancy). I generally recommend a supplement called Floradix; a liquid supplement derived from highly absorbable herbal sources of iron.
Please note that iron supplements (like all other medication and supplements) should be kept out of the reach of children.

How much is too much?:
Excessive iron can be toxic since free iron reacts to produce free radicals within the body. These highly active molecules can damage DNA, protein, fats, and other components of our cells. Iron toxicity occurs when iron intake exceeds the capacity of our bodies to bind free iron. High iron stores are linked with increased risk of heart disease, cancer, and Alzheimer’s disease. High blood concentrations of iron can damage organs (particularly the heart, liver, and brain) and can cause serious long-term organ damage and even death. In fact, one of the leading causes of poisoning deaths in children under six is eating large quantities of multivitamins or iron supplements intended for adult use. Symptoms of iron-overload disease (mostly a hereditary condition known as hemochromatosis) are skin discoloration, diabetes, and liver damage.
You should not take iron supplements unless you have an iron deficiency.
In my practice, I recommend a multi-vitamin containing iron (and copper- another mineral which can be toxic at high amounts) to menstruating women, children, and teens. In men and post-menopausal women, I generally prescribe iron-free supplements (unless there is evidence of an iron deficiency).

Bottom line:
If you’re experiencing unexplained fatigue (and/or some of the other symptoms mentioned above) or if you’re in a group which is at risk of iron deficiency, it’s a good idea to have your iron levels evaluated periodically. Never supplement iron if you are not deficient (small amounts in a multi-vitamin are usually fine). But do make sure to get enough from a healthy, varied diet.

Please Note: This information is for educational purposes only. Consultation with a licensed health care practitioner is recommended for anyone suffering from a health ailment. You are free to use the information in this newsletter or pass it on to others, but please keep it intact and credit it to Dr. Leat Kuzniar, ND.

Dr. Leat Kuzniar ND
Dr. Leat Kuzniar ND

Dr. Kuzniar is a board member of the New Jersey Association of Naturopathic Physicians and is also a member of the Gastroenterology Association of Naturopathic Physicians. She currently holds a State of Vermont Naturopathic Physician license (as New Jersey does not yet offer licensing for Naturopathic doctors).