Iron deficiency is very commonly seen within our clinic and like everything surrounding health first education and awareness around what is going within iron deficiency is essential for you to become empowered in your health. Embarking on a journey to understand and address iron deficiency requires more than just adjusting your dietary iron intake. In this comprehensive guide, we delve into the intricacies of iron health, exploring the often-overlooked factors that contribute to deficiency and offering a holistic approach to restoration.
First, what is iron deficiency ?
Iron deficiency is a condition characterized by insufficient levels of iron in the body to meet its physiological needs. Iron is a crucial mineral that plays a central role in various physiological processes, with one of its primary functions being the production of hemoglobin. Hemoglobin is a protein in red blood cells responsible for transporting oxygen from the lungs to the rest of the body.
When the body lacks an adequate amount of iron, it can lead to a depletion of iron stores, a condition known as iron deficiency. If iron deficiency progresses, it can further develop into iron deficiency anemia, a more severe condition where the body lacks a sufficient number of healthy red blood cells.
Common symptoms of iron deficiency include fatigue, weakness, pale skin, shortness of breath, dizziness, and difficulty concentrating. If left untreated, iron deficiency can impair cognitive function, compromise the immune system, and lead to more severe conditions like iron deficiency anemia.
How can a Nutritionist help within iron deficiency ?
Working 1:1 with a practitioner can assist in firstly thoroughly and accurately interpreting blood pathology to assess what is going on in you individual case. We then also through clinical case taking look into all of your health history and signs and symptoms which have led you to where you are. This allows us to then address the root cause of your iron deficiency rather than either making it worse or creating unintended side effects, for reasons expanded on below. So this means that supplementation is not always recommended, and if it is, it is very specific to the individual.
So here are major things to be aware of within iron deficiency that you can educate yourself around.
1. It’s not just about eating the correct amount and form of iron.
Although this is important, iron deficiency isn't just about what's on your plate. While insufficient intake of iron-rich foods contributes, several factors play a role. From poor gut function and heavy menstrual bleeding to hormonal imbalances, the root causes vary. Merely consuming iron won't resolve the issue if it doesn't address the underlying reasons. For instance, if a parasitic infection is draining your iron, supplementing may exacerbate the problem. Individualized support is key, and understanding the root cause is essential for a lasting solution.
2. The importance of optimal iron absorption
Iron absorption is a coordinated dance involving supportive and competing nutrients. Supporting actors like vitamin C, copper, and certain B vitamins aid absorption. Foods like grass-fed beef liver provide a natural ensemble of these nutrients. On the flip side, calcium, zinc, caffeine, and tannins compete for attention. Timing matters—separate iron from zinc supplements, dairy, and coffee by at least an hour. Probiotics like Lactobacillus plantarum 299v may steal the show, enhancing iron absorption and calming inflammation, a key player in absorption reduction.
3.Navigating iron supplementation
Supplementing iron demands a nuanced approach. Proper blood pathology interpretation is crucial, looking beyond just ferritin levels. This is something that we recommend working with a practitioner on.
However, when supplementation is required, most off the shelf iron supplements (hello Ferrograd - C and Maltofer) are not the way to go, and here’s 2 major reasons why;
1. Not all iron is created equal.
When supplementing, iron comes in different forms. For example with ferrous sulfate (which is found in Ferrograd-C), the iron molecule is bound to another molecule called sulfuric acid, which limits absorption. Whereas ferrous bisglycinate, is bound to 2 glycine molecules and actually blocks other molecules such as fibre from limiting absorption. It also is better absorbed through the digestive tract and has double the bioavailability of ferrous sulphate (meaning you absorb at least twice the amount of iron) (Bumrungpert et al., 2022).
2. The dosage is too high.
Both of these supplements contain upwards of 100mg of elemental iron, however the body can only absorb 24mg to 40mg within a 24-48 hour period. This is due to a molecule called hepcidin that is released to prevent iron overload or too much iron being absorbed. Meaning that excess iron is not absorbed which = inflammation and extra strain on the liver.
Not to mention the digestive side effects from forms such as ferrous sulfate, including constipation, nausea and bloating.
Supplementation is not something to mess with, just because supplements are ‘natural’.
3. A note on iron infusions
Just as we've emphasised in our exploration of iron deficiency, it's crucial to unveil the underlying patterns before taking action, as iron is a mineral subject to tight regulation for very good reasons. More isn't necessarily better in the realm of iron.
An iron infusion involves the intravenous administration of iron directly into the bloodstream, as opposed to oral supplementation, and is primarily used to address iron deficiency anaemia.
The advantages of iron infusions include:
- Efficient improvement of iron levels.
- Effectiveness in cases where oral supplements prove inadequate.
- Restoration of iron levels depleted by blood loss, a situation unmanageable through supplementation alone.
- Suitability for individuals with conditions like Inflammatory Bowel Disease (IBD), where oral iron absorption is compromised as the infusion bypasses the digestive tract.
However, these benefits are balanced by certain drawbacks, including but not limited to:
- Potential pro-inflammatory effects in anaemic patients (Vinchi et al., 2019).
- Elevated levels of non-transferrin-bound iron, which may encourage pathogen growth and increase the risk of infection, as certain microbes thrive on free iron (Shah et al., 2021).
- The risk of iron overload, as the body lacks mechanisms to eliminate excess iron, leading to its storage in body tissues, potentially causing significant harm.
- The possibility of hypersensitivity or allergic reactions.
As evident, the path to restoring iron levels is not without careful consideration. This underscores the importance of addressing the root causes of iron deficiency and optimising iron stores at an early stage, as indicated by a downward trend in pathology results. Such an approach is essential for restoring iron with minimal risks and ultimately enhancing your quality of life.
Dosages of iron infusions can be over 1000mg, even up to 2500mg, compared to 24mg per 24-48 hours with oral iron supplementation. When we interpret the amount of protective mechanisms the body has from iron overload, the full impact iron infusions can have is still unknown and this is why individualised consideration is so necessary for everyone before looking into iron infusions and careful monitoring is required afterwards to ensure optimal absorption from foods.
So as you can see, iron deficiency is a lot more complex than what it may seem, and this is for good reason as a protective mechanism in the body. If you learnt anything form this post be sure to let us know or if you need some individualised support book with one of our practitioners here.
Bumrungpert, A., Pavadhgul, P., Piromsawasdi, T., & Mozafari, M. R. (2022). Efficacy and Safety of Ferrous Bisglycinate and Folinic Acid in the Control of Iron Deficiency in Pregnant Women: A Randomized, Controlled Trial. Nutrients, 14(3), 452. https://doi.org/10.3390/nu14030452
Shah, A. A., Donovan, K., Seeley, C., Dickson, E. A., Palmer, A. J. R., Doree, C., Brunskill, S., Reid, J., Acheson, A. G., Sugavanam, A., Litton, E., & Stanworth, S. J. (2021). Risk of Infection Associated With Administration of Intravenous Iron: A Systematic Review and Meta-analysis. JAMA network open, 4(11), e2133935. https://doi.org/10.1001/jamanetworkopen.2021.33935
Vinchi, F., Castagna, A., Costa da Silva, M., Busti, F., Marchi, G., Sparla, R., Muckenthaler, M. U., & Girelli, D. (2019). Intravenous iron promotes low-grade inflammation in anemic patients by triggering macrophage activation. Blood, 134(Supplement_1), 957–957. https://doi.org/10.1182/blood-2019-132235