Iron is vitally important for transporting oxygen around the body. It also plays an essential role in our immune function. Some people actually end up with too much, but many people don't get enough for a variety of reasons, and may become iron-deficient. Interestingly, the specific amount we need depends on many things. Why exactly is it so essential?
Too Little
The body typically will use its stored iron in the muscles, liver, spleen, and bone marrow, but when levels of stored iron in the body decrease and become too low for too long, iron deficiency anemia can set in - red blood cells become smaller and contain less hemoglobin.
When you don't get enough, you might notice some of the following signs: tiredness or extreme fatigue, weakness, headache, dizziness or lightheadedness, pale skin, breathlessness, arrythmia/irregular heartbeat, chest pain, fast heartbeat, shortness of breath, cold hands or feet, inflammation or soreness of your tongue, poor appetite, brittle nails, or unusual cravings for non-nutritive substances (this is called pica), such as ice, dirt or starch.
Too Much
As our red blood cells break down over time, the iron in hemoglobin molecules are released. Our bodies have no natural way to get rid of the extra, so it is stored in body tissues. We normally can keep up to 3-4 grams at once. An iron overload can be genetic or caused by blood transfusions, hemolysis, or excessive consumption of iron - either orally or by incorrect administration of a tube feeding formula (what we call enteral nutrition) or parenteral nutrition (when you can't use the GI tract and must get nutrition via IV). Too much iron can lead to changes in skin color (to grey or bronze) and/or a loss of menstrual cycle, sex drive, and erectile dysfunction. Clearly, more is definitely not better.
Risk Factors of Iron-Deficiency Anemia
We all need iron, but the amount needed depends on many factors! In general, needs increase during reproductive/child-bearing years due to blood loss during menstruation; requirements increase even further during pregnancy becuase plasma volume and red cell mass expand rapidly due to the dramatic increases in blood cell production. Children and adolescents also have high iron needs to fuel adequate growth. It makes sense, then, that young vulva owners will have the higest risk of developing iron deficiency anemia. Infants, especially those who were low birth weight or born prematurely, who don't get enough iron from breast milk or formula may be at risk of iron deficiency. Children need extra iron during growth spurts. If your child isn't eating a healthy, varied diet, he or she may be at risk of anemia. People who routinely donate blood may have an increased risk of iron deficiency anemia since donating blood can diminish your iron stores (by the way, if you're told that you can't donate blood because of low hemoglobin, ask your provider whether you should be concerned about this type of anemia). People who are unhoused or have food insecurity (as well as elders in our community) that may have a fixed or low income, a decreased and/or poor appetite, or simply eat an incomplete or insufficiently balanced diet (meaning low in fruits, vegetables, protein, and other good stuff we need). Of note, cow’s milk is low in iron and has calcium, so excessive dairy can cause it. Same with excessive amounts of daily caffeine and people who regularly take antacids. People who don't eat meat may have a greater risk of iron deficiency anemia if they don't eat other iron-rich foods; similar to this, people with eating disorders will likely not get enough iron in general as they don't have a healthy eating pattern and may not even be eating enough. Whew, that's a big list... but there's more!
There are certain things that are part of your medical history that may also contribute to your risk. If you have abnormally heavy bleeding during menstruation, are at increased risk of iron deficiency. Gastrointestinal disorders such as celiac disease, ulcerative colitis, Crohn’s, gastrectomy or intestinal resection, etc have an increased risk of iron deficiency because they require dietary restrictions and may even have malabsorption or blood loss in the Gl tract. That combo of low iron intake and high iron loss can lead to microcytic hypochromic anemia, reduced production of hemoglobin, or a negative iron balance. But that's not all! (Sorry... haha I did mention I looooove informercials)
Have a family history or a diagnosis of heart failure or cancer? Proper nutrition is absolutely essential for you! Malabsorption, malnutrition, and more can occur in these populations. Use of aspirin and oral anticoagulants might lead to chronic blood loss. There is also chemotherapy-induced anemia. However, chronic blood loss and deficiencies of other nutrients (for example, cancer-induced cachexia or anorexia) can worsen an iron deficiency in these populations.
Complications
Mild iron deficiency anemia usually doesn't cause complications. However, left untreated, iron deficiency anemia can become severe and lead to health problems, such as a rapid or irregular heartbeat. Your heart must pump more blood to compensate for the lack of oxygen carried in your blood when you're anemic. This can lead to an enlarged heart or heart failure. In pregnant women, severe iron deficiency anemia has been linked to premature births and low birth weight babies. But the condition is preventable in pregnant women who receive iron supplements as part of their prenatal care. In infants and children, severe iron deficiency can lead to anemia as well as delayed growth and development. Additionally, iron deficiency anemia is associated with an increased susceptibility to infections.
Iron-Rich Foods & Prevention of Iron-Deficiency Anemia
You can reduce your risk of iron deficiency anemia by choosing iron-rich foods! How do we know what is rich in iron? Well, first of all, there are two types of iron: heme and non-heme. Heme iron comes from animal foods and is better absorbed. Non-heme is better absorbed with vitamin C and/or heme iron foods. In general, iron absorption is increased when simultaneously consumed with vitamin C, such as citrus, strawberries, tomato, capsicum. On the other hand, calcium hinders iron absorption, so try to consume sources of calcium at alternate times than sources of iron and vitamin C. Think about it like this: you wouldn't want to drink orange juice, spinach, or milk together! So don't consume your iron source such as spinach, your vitamin C source such as OJ, and a calcium source such as dairy, at the same time. Also tea, coffee, wine, phytates (present in grains and beans) can have the same effect of decreasing iron absorption.
A more scientific explanation of the role of iron in our diet is that heme iron has higher bioavailability than nonheme iron, and other dietary components have less effect on the bioavailability of heme than nonheme iron. In addition to vitamin C, meat, poultry, and seafood can enhance nonheme iron absorption, whereas phytates and certain polyphenols in some nonanimal foods (such as cereals and legumes) have the opposite effect. Then, unlike other inhibitors of iron absorption, calcium may lower the bioavailability of both nonheme and heme iron like mentioned before. But in general, as long as you're eating a well-balanced and varied diet, you likely don't have much to worry about.
So - what are some examples of iron-rich food sources? The heme iron foods would be seafood, beef liver, canned sardines, lean red meat, chicken, and other poultry and meats. Non-heme sources include chickpeas, nuts & seeds, lentils, dark green leafy vegetables such as broccoli collard greens Swiss chard and spinach, whole-grain bread, oats, tofu, dried fruit such as raisins, apricots, bananas, and iron-fortified cereals, breads and pastas.
Remember, you can enhance your body's absorption of iron by drinking citrus juice or eating other foods rich in vitamin C at the same time that you eat high-iron foods. Vitamin C in citrus juices, like orange juice, helps your body to better absorb dietary iron. Vitamin C is also found in leafy greens and broccoli (notice they're also on the iron list!), kiwi, tomatoes, grapefruit, oranges, tangerines, peppers, strawberries, melons, and more.
In the event you do need further evaluation by a dietitian, or another other provider, please don't hesitate to reach out! We are specialists are trained in healthy eating and the treatment of medical nutrition therapy. A dietitian can help make sure you are getting all the necessary vitamins and minerals from the foods you eat. Plus, iron is in many multivitamins or specific mineral supplements and in supplements that contain only iron. Iron in supplements is often in the form of ferrous sulfate, ferrous gluconate, ferric citrate, or ferric sulfate. Dietary supplements that contain iron will more than likely say that they should be kept out of the reach of children because accidental OD is actually a leading cause of fatal poisoning in children - not cool. Again, please reach out to us if you need guidance on any supplements!
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