Iron

Why is Iron so important?

Iron is a mineral which is relied on for many different biological processes including:

• Transportation of Oxygen: Hemoglobin are iron-rich red blood cells that carry oxygen throughout the whole body.
• Storage of oxygen: Oxygen is cleverly stored in the muscles to be used locally when needed, iron is required for this function.
• Energy production: Iron is a big player in the “krebs cycle” the processed happening in side the cellular matrix to produce ATP (the bodies energy currently)
• Amino acid & hormonal production: Iron is involved in several enzyme reactions which lead to the production of certain amino acids like collagen and hormones.
• Neurotransmitters: Iron influences the synthesis and signalling of several neurotransmitters including dopamine, noradrenalin, adrenaline and 5-hydroxytryptamine which have a profound effect on stress management, mood, sleep.
• Immunity: Iron is an integral part of immune function including the production of immune cells like T-cells. Low iron has been linked with poor immunity.

Common symptoms of iron deficiency

• Pale skin tone
• Brittle nails & hair
• Ridges on nails (longitudinal)
• Dizziness
• Fatigue
• Headaches
• Constipation
• Irritability
• Cold hands and feet
• Low concentration/brain fog
• Low appetite
• Hair loss
• Digestive disorders
• Heavy menstrual bleeding
• Sore gums/mouth (inflammation)
• Difficulty swallowing
• Depression
• Restless leg syndrome
• Pica (the desire to eat non-food items like clay and soil)...yes you read that right

Yikes…that's a lot!‍

Not too little and not too much

It is more common for me to treat iron deficiency (in-sufficient iron levels) especially in the high risk groups
‍

• Menstruating women (especially teens)
• Vegetarians and vegans
• Athletes
• Pregnant women
• Those with inflammatory bowel disease, gastric bleeding, coeliacs disease or nutrient malabsorption
• Those who drink too much caffeine

However, iron can also accumulate in the body to unhealthy levels. Having too much iron has just as many health consequences as having too little. A genetic condition called Haemochromatosis leads to an over-absorption and lack of excretion of excess iron. This leads to iron deposits on organs and can cause heart issues, liver disease and diabetes.

In range…but am I?

The best way to understand if you are iron-deficiency or have too much iron is to test your blood. There are several metrics when getting your “iron studies” tested:

• Serum Iron: Measures the amount of circulating iron
• Transferrin: A blood plasma glyco-protein produced by the liver which regulates iron absorption into the blood.
• Transferrin Saturation: The value of serum iron divided by the total iron-binding capacity of the available transferrin
• Ferritin: Ferritin is stored iron in the liver

Ferritin is the metric whereby most people measure low which deem them iron deficient.

The range for Ferritin is 20-200ug/L (depending on age and gender). This range is gargantuan!

‍Blood test ranges are based on population data rather than healthy function levels. Iron deficiency is the top nutritional disorder in the world according to WHO. Therefore you may be “in range” but this doesn't mean you have desired iron levels for optimal function. Naturopathically speaking, we want iron levels over 50 ug/L to have proper function. If you are below 30 ug/L it is likely this will be greatly affecting your function and below 20 ug/L is far too low.

90% of women who I see are below 50 ug/L

Iron supplements (are not all made the same)

It is very common to see digestive issues with iron deficiency or visa versa. This means that replenishing iron stores are not as simple as taking iron supplements. Iron in supplement form can cause digestive problems usually seen as constipation but just because you aren’t constipated doesn't mean the iron isn’t wreaking havoc in your guts.

Iron makes a mess in your gut! With a mess in your gut… good luck absorbing iron…

Please consult with a naturopath before supplementing with iron, I have patients who have been taking iron supplements for years and not only is it not improving their ferritin but it was causing such an issue in their stomach that they stopped being able to naturally absorb iron from their food.

Types of iron supplements:

‍Prescription iron‍

This is what will be prescribed by your GP usually called Ferrograd which is a synthetic form of iron and usually will cause constipation and other digestive problems.

Off the shelf iron supplements

A run of the mill iron supplement plucked off the shelf. Common forms are Spatone or Floradix. These can work well for some people, but it is more designed to maintain healthy iron levels rather that replenishing a deficiency. This is because it will either contain a low-amount of iron, be in a less bioavailable form or lack co-factors which improve iron absorption.

Practitioner-only iron supplements

The gold standard of iron supplementation, utilised to either replenish iron deficiency, maintain a healthy amount of iron or supplement the diet when there is a higher demand for iron (endurance athletes, heavy menstrual bleeding).

IUD (Intrauterine device) or OCP (Oral contraceptive pill)

This is not an iron supplement obviously… but is a common strategy used by GPs to improve iron levels by simply stopping menstrual bleeding. Without being too blunt…this is a really lazy/silly/backwards strategy and causes far more issues than it solves.

Just because you consume it doesn't mean you absorb it

Iron is highly affected by mal-absorption. Things that can cause poor absorption include
Caffeine: caffeine will completely block iron absorption. Either skip the coffee or have it away from iron-rich foods and especially iron supplements

Just because you absorb it, doesn't mean you store it

Ok, you’ve promoted your absorption of iron, wells its not over yet.. Now you need to store it! Ferritin is the metric on blood tests results which is referring to stored iron (mostly in the liver), this is the metric that is typically “low” that diagnoses patients with iron deficiency anaemia

Iron-Rich foods

Food contains 2 different forms of iron. Iron from a plant-based source is called non-haem iron which is absorbed less well than haem iron at 17%. Haem iron is from an animal source that is absorbed better at 25%.

The body wants to achieve homeostasis with iron levels, it will increase absorption when deficient and reduce absorption if it becomes overloaded which can be toxic for the body.

Haem Iron

This is animal derived iron sources, this iron is the most bioavailable form of iron. Including red meat, organ meats, seafood and poultry

Non-Haem Iron

Plant based forms of iron which are harder for the body to absorb, and therefore you need more to get an equivalent amount to haem iron. Including: wholegrains, nuts, seeds, leafy greens and legumes.

RDI (Recommended Daily Intake) for Iron

• Adult men - 8mg/day
• Adult women (19-30) - 18mg/day
• Adult women (51+ years) - 8mg/day

Foods which inhibit iron absorption

Certain minerals, phytates and polyphenols (tannins) are food groups which inhibit the absorption of iron. Coffee is the most well known and most potent inhibitor of iron absorption. Other foods are grains, beans, nuts and seeds.

Minerals zinc and manganese both compete with iron for absorption. These nutrients are best separated if wanting to optimise absorption.

Foods which improve iron absorption

Vitamin C, fruit sugars, Vitamin A and beta-carotene all can improve the absorption of iron. Gastric acid is also integral for iron absorption, if someone is deficient in gastric acid production it is likely their absorption of iron will be compromised.

Food sources of iron

Get on to it

If you are in one or many of the high-risk groups for iron deficiency or you are experiencing the signs and symptoms it is a good idea to get your iron tested. This can be done through your GP or your naturopath.

If you believe you may be suffering from iron deficiency or unsure if you are getting enough iron in your diet, book yourself in for an appointment to get your iron tested and review your nutritional sources of iron.

Iron can be one of the simplest ways to get you feeling like yourself again!
Or maybe you have never known what it feels like to have adequate iron levels!

Sources:

• WHO world wide prevalence of anemia
• http://apps.who.int/iris/bitstream/handle/10665/43894/9789241596657_eng.pdf;jsessionid=810440E84A8E796EBB01B389C124F50D?sequence=1
• Trickey, Women, Hormones & the Menstrual Cycle
• Braun & Cohen, Herbs and Natural Supplements, an Evidence Based-Guide