You’d be surprised how many of our clients have low iron and iron deficiency, so today’s post is dedicated to the symptoms, causes and solutions for low iron. It might seem odd considering the fact that the majority of Canadians are omnivores (i.e. eat meat). But when you take into account that only about 10 to 30 percent of iron consumed is actually absorbed, that is, if you have a well functioning digestive and intestinal system, the picture starts to become a bit more clear.
We’ve also had clients experience symptoms of deficiency but still technically be within what would be considered a normal range on blood tests. By the time they are flagged by their family doctor or realize they have low iron their symptoms might already be quite dramatic. In fact, check out Mandy’s experience from a few years back here.
Luckily, there’s actually a lot you can do to increase your iron levels and either overcome or prevent deficiency.
Iron is needed to make hemoglobin, which is the substance in red blood cells that carries oxygen throughout the body. Iron is also needed to make DNA, for growth and repair (i.e. skin, hair, nails), it helps with detoxification and helps make neurotransmitters. As a result, common symptoms of low iron are fatigue, brain fog, heart palpitations, shortness of breath, bruising easily, low thyroid, depression or low mood, low immunity, hair loss and brittle nails.
The average adult stores about 1 to 3 grams of iron in his or her body, men more so than women. About 1 mg of iron is lost every day through the loss of skin cells and the cells lining the gastrointestinal tract, and then an extra milligram or so is lost during menstruation. Much of the body’s iron is in hemoglobin, so that oxygen can circulate throughout the body, and some is stored in ferritin throughout the cells of the body. Ferritin is a protein where iron is either stored or released depending on the body’s requirements - and ferritin is the first look at what your iron levels are like in a blood test.
Interestingly though, and likely for our own protection, we have no physiological mechanism of iron excretion unlike say, magnesium or potassium, which can be excreted by the kidneys. Because iron is so important, the body hoards and recycles it from old red blood cells. Absorption is the only means with which iron levels are maintained. Basically, a feedback mechanism exists that enables us to enhance absorption when we’re deficient and decrease absorption if we have iron overload. (Cool, eh?)
As was mentioned above, only about 10 to 30 percent of iron consumed is used by the body. The iron we absorb is a mix of heme iron (the kind you get from meat, highly absorbable) and non-heme iron (the kind you get from plants, often not as easily absorbed), or from supplements.
One of the common causes of iron deficiency is low absorption. Adequate stomach acid (HCl) is needed for optimal absorption so being on acid blockers for heartburn, GERD or acid reflux of any kind will affect iron levels, especially if taken at the same time as an iron supplement or an iron-rich meal. A few common signs of low HCl include acid reflux and heartburn (which you can read about here), bloating following meals and nausea.
If you have an overgrowth of pathogens like unhealthy bacteria or candida in your gut, they, like us, thrive off of iron and will eat it. Your body is incredibly smart and will actually transfer available iron into ferritin to starve these pathogens. Therefore, if you have inflammation or infection you may have good ferritin levels but not have a lot of circulating or usable iron, leading to symptoms of deficiency.
There are a few things that block the absorption of iron. This includes tannins like those found in tea, coffee and wine. If you’re trying to get your levels back up you should ideally keep high tannin foods separate from iron supplements or iron-rich foods by about 3 hours.
Phytates, found in high amounts in grains, nuts and legumes, also decrease absorption of iron. This is why deficiency may be a concern for vegans or vegetarians who rely on these foods as a source of iron. Soaking, fermenting or sprouting these foods decreases the phytates to enhance the absorption of iron.
Lead has a major impact on iron metabolism since it’s taken up by the same absorption mechanisms and competes with it for absorption. However, even the highly beneficial minerals you eat every day compete with iron, including: magnesium, zinc, manganese, calcium and those found in dairy products. If you’re supplementing with iron, it’s best to take it away from other minerals or dairy foods so they don’t interfere with absorption. This is why getting your iron in a multivitamin/mineral formula can actually be counterintuitive.
Firstly, if you suspect you have an iron deficiency based on any of the symptoms listed above, it’s important to get your levels tested. While you're at it, here are some other important blood markers to test. Even if they’re on the lower end of normal it’s a good idea to consider and address the root causes. Like we mentioned, we often have clients with very low levels, enough to experience symptoms, but who haven’t been flagged by their doctor because they’re still technically within the “normal” limits.
Make sure to get a copy of your results from your doctor!
At the same time, you don’t want to supplement with iron if your levels aren’t actually low because high iron can be equally dangerous.
If your levels are low, consider some of the root causes we’ve listed above. More often than not, a deficiency is due to the causes above vs simply a lack of dietary iron. It is of course important though to start by making sure you’re getting enough from dietary sources. This includes a mix of heme and non-heme sources.
If you’re deficient, you likely need to consider supplementation to get your levels back up to a healthy level. Prescription iron is usually ferrous sulfate but many people experience nausea or constipation when they take it.
We promise that this does not always have to be the case!! In all of the clients we’ve ever suggested iron to, we’ve never received the complaint it’s resulting in constipation. The brand and types of iron you use matters big time!
Vitamin C greatly enhances iron absorption by chelating (binding) with it to transport it to cells. It’s a good idea to combine iron supplements with a dietary or supplemental form of vitamin C, preferably as ascorbate or citrate. Some iron supplements will also include vitamin C for this reason.
Written by: Natalia Bragagnolo, RHN
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