Updated May 19th 2021
Are you constantly tired? Do you feel weak? Do you have brittle nails and hair? What about shortness of breath or weak concentration? If you answered yes to any of these, you might be iron deficient (or anemic, just keep reading) and not even know it. Did you know iron deficiency is one of the most common nutrient deficiencies in the world? Iron is a vital mineral and here’s a few reasons why.
Carries oxygen in our blood
Two thirds of our bodies iron is found in red blood cells and is referred to as hemoglobin. In muscle cells, it’s referred to as myoglobin. (Naka Herbs, Web. 2008). Hemoglobin is a protein that transports oxygen throughout the body, delivering it to our tissues, and in order to do this effectively, requires iron.
Required for enzymes
Iron is a building block for many enzymes including those required for our metabolism. Iron is also important for the creation of neurotransmitters in the brain. Neurotransmitters are chemical messengers that send signals from one neuron to another. Neurotransmitters such as dopamine are also required for circadian rhythm; our natural sleep-wake patterns.
Important for the growth of babies and children
Iron is a nutrient we focus on when introducing solids to babies. This is because during the third trimester of your pregnancy, your body passed iron onto your baby. These iron stores protect your baby for about 6 months. After 6 months, their iron stores begin to decline and they need to consume iron from solids alongside breastmilk. Breastmilk itself contains a low amount of iron but contains an enzyme, lactoferrin, as well as vitamin C that helps increase the absorption. Iron from animal foods is much better absorbed than plant foods (as you’ll read below). Recent evidence also demonstrates low iron levels in children and iron-deficiency anemia is most common in children age 6-24 months when their nervous system is rapidly developing.
Iron-deficiency anemia in children also increases the risks for cognitive impairment, ADHA and restless leg-syndrome. It is associated with impaired and disordered sleep as well. Iron-deficient infants and those with iron-deficiency anemia tend to wake more frequently at night and are described by their parents as being restless.
Lost in athletes and menstruating women
The need for oxygen is higher in athletes and those who are physically active. Because iron is needed for hemoglobin to carry oxygen, those who are physically active need more iron. Myoglobin, in our muscles, also requires iron. Iron can be lost during physical performance in sweat and hemolysis (the breakdown of red blood cells) cited here. Women loose blood monthly during menstruation and so, have higher iron needs than men. This is especially true for female athletes.
Vegetarians and vegans needs more iron
Iron found in plant foods is referred to as non-heme iron. Animal iron is called heme iron and has a higher absorption rate than non-heme. Non-heme iron has a very low absorption rate and is further impacted by certain substances in these plant foods. Phytates, oxalates, polyphenols and phosphates all inhibit iron absorption. Phytates are found in nuts, legumes and soy. Oxalates are found in spinach, rhubarb and beets. Polyphenols are compounds found in tea, red wine and coffee. Phosphates are found in sodas, which should be avoided anyway, due to their lack of nutritional value and high sugar content.
More is needed during pregnancy
During pregnancy, the need for iron increases to help build the blood supply needed for the placenta and growing fetus. Blood work is done early in pregnancy to check iron levels and then again after 24 weeks to re-check. The iron is checked again as typically women have enough stored iron (ferritin) to last about 6 months. For this reason, it is not only important to take an iron supplement during pregnancy but also before pregnancy to ensure adequate iron stores and hemoglobin levels. Typically, the range for hemoglobin levels during pregnancy (and women in general) is 120-160 g/L. Around 6 months (24 weeks) typically a drop is seen to below 120g/L.
Because the type of iron impacts absorption and because you may have entered into pregnancy already deficient, it’s important to work with a Naturopath or a Functional Medicine Doctor to have your iron levels tested and supplemented accordingly.
Lack of iron leads to deficiency
When not enough iron is consumed, we don’t have enough in our hemoglobin and begin to experience iron deficiency symptoms. The first stage of iron deficiency is called “iron depletion” followed by “iron- deficiency without anemia” and the final stage is “iron-deficiency anemia”. The below symptoms can be seen in iron-deficiency anemia but also might be seen in earlier stages of iron deficiency.
- Shortness of breath
- Brittle nails
- Brittle hair
- Extensive hair loss
- Weakness
- Tiredness
- Easily bruised
- Dark circles under the eyes
- Pale skin
- Cold hands and feet
- Poor concentration
- Heavy menstruation
Iron deficiency can also occur with sub-optimal intake of certain vitamins such as B12 and folate. When this occurs, the shape of hemoglobin is altered and its ability to carry oxygen is impaired. This is referred to as vitamin-deficiency anemia. Anemia can also be a results of genetic conditions.
If you suspect you might be iron deficient, speak with your primary care provider and have your blood work done. Not only should you have your hemoglobin tested (the primary go-to) but your ferritin levels (which measure the amount of iron your body has stored) should be tested as well. The reason is, as our hemoglobin levels drop, our body pulls from our back-up supply; what has been stored in our body. So in theory, you could have normal hemoglobin levels but your stores could be close to depleted meaning in a few short months (or weeks depending on your activity level), you’ll likely experience more symptoms and they will be more severe.
To correct an iron-deficiency anemia, you can supplement with iron. When choosing an iron supplement, be sure to select one that is non-constipating as this is an unfortunate side-effect of many irons on the market. Some of my favourites that I have used personally include Floradix/Floravit, Blood Builder and Vital F. It’s also best to use this under your primary care providers (ideally a Naturopath or Functional Medicine Doctor) supervision as you can in fact, consume too much iron. They might suggest a protocol that includes cycling off the iron every few months, have you take as the bottle directs, or change your dose entirely. This is why it’s best to know your numbers before you begin supplementing.
As with any other health concerns you might have, always do your research and speak to your most trusted health care provider to determine what is best for your individual needs.
References:
Dosman, C., Witmans, M., & Zwaigenbaum, L. (2012). Iron’s role in paediatric restless legs syndrome – a review. Paediatrics & child health, 17(4), 193–197. https://doi.org/10.1093/pch/17.4.193
J Dev Behav Pediatr. Author manuscript; available in PMC 2014 Feb 1.Published in final edited form as:J Dev Behav Pediatr. 2013 Feb; 34(2): 120–128.doi: 10.1097/DBP.0b013e31827d5848
Ji, X., Grandner, M. A., & Liu, J. (2017). The relationship between micronutrient status and sleep patterns: a systematic review. Public health nutrition, 20(4), 687–701. https://doi.org/10.1017/S1368980016002603
Moturi, S., & Avis, K. (2010). Assessment and treatment of common pediatric sleep disorders. Psychiatry (Edgmont (Pa. : Township)), 7(6), 24–37.
Peirano, P. D., Algarín, C. R., Chamorro, R. A., Reyes, S. C., Durán, S. A., Garrido, M. I., & Lozoff, B. (2010). Sleep alterations and iron deficiency anemia in infancy. Sleep medicine, 11(7), 637–642. https://doi.org/10.1016/j.sleep.2010.03.014