Iron Deficiency – Prevention and Management

As the name suggests, iron deficiency is low iron levels in the body. It is also called Sideropenia. Iron deficiency is the most common nutritional deficiency in the world. Iron deficiency is seen more in people of low-income countries. It is more prevalent in women and is due to blood losses through menstruation and pregnancies. It also affects pre-menopausal women, children and also men.

What is Iron Deficiency?

Iron is an essential nutrient to the body. It is a necessary component of haemoglobin, which makes red blood cells. It helps transport oxygen through the blood. Iron deficiency affects the delivery of oxygen. In addition, it also affects the overall quantity and quality of the blood cells. This condition leads to iron deficiency. 

Prolonged iron deficiency leads to anaemia. Hence, the term is ‘Iron Deficiency anaemia’ (IDA). You can use it interchangeably. Data suggests that almost 30% of the world population suffers from anaemia, and a significant part of the population suffers from IDA. 

Iron deficiency is not a life-threatening disease. However, it may lead to severe illnesses. For example, it causes fatigue and breathlessness. In addition, serious complications occur in the form of heart failure. But the good news is you can quickly treat or prevent iron deficiency with an iron-rich diet and supplementation in any form. 

Required Daily Intake of Iron

• Adult Men: 20mg
• Adult Women: 18mg
• Pregnant Women: 27mg
• Lactating Women: 9mg

Types of Iron Deficiency

As per research, there are two basic types of iron deficiency.

Absolute Iron Deficiency

Iron levels in the blood reduce in this type of anaemia.

Functional Iron Deficiency

Adequate iron is present in the body. However, it does not function normally. So although the levels may seem normal, you have anaemia.

Iron is present in RBC with myoglobin and other enzymes. It is also present as iron storage and transport forms. The approximate distribution of the iron in the body is as follows:

• RBC: 2 grams
• Myoglobin, cytochrome and catalase: 400 mg
• Storage form: Plasma iron-bound transferrin: 3-7 mg
• Storage form: Ferritin/ hemosiderin: 1 g (male) and 0.5 g (female)

Simple iron deficiency leads to anaemia in three stages. These stages are based on the extent of the depletion range of iron from the body. There are three stages in the development of anaemia.

Stage 1

The first stage is where the initial iron depletion takes place. After that, the iron storage in the liver, spleen and bone marrow are exhausted or used. 

Stage 2

There is a reduction in the iron storage in the RBCs at this stage. As a result, there is an increased risk of developing anaemia. It can be due to low haemoglobin levels. Low ferritin levels and high transferrin levels are the indicators of this stage. People experience extreme fatigue or tiredness. 

Stage 3

At the last stage, the haemoglobin levels drop very low. As a result, RBCs become less in number and small in size. It is an indication of a severe case of iron deficiency anaemia.

What are the causes of iron deficiency?

1. High Iron Requirements

At different stages of a person’s life, the body’s iron requirement varies. Generally, during periods of fast growth, the needs are higher. Childhood and adolescence are crucial periods of growth. Therefore, it is essential to ensure adequate intake of iron-rich foods. Additionally, during pregnancy and menstruation, iron requirements increase. In such cases, there is a risk of developing anaemia.

2. Low Iron Absorption

Studies suggest that some diseases and surgeries may impair iron absorption. If such conditions prolong, they may lead to iron deficiency. For example, people affected with celiac and Crohn’s diseases may be at risk. Additionally, people who have undergone gastric bypass surgery may not absorb iron. These conditions may restrict the intestine from absorbing iron completely.

Consumption of excessive antacids and antibiotics also contribute to reduced absorption. In addition, studies show that calcium inhibits iron absorption. Thus consumption of excessive dairy products inhibits iron absorption.

3. Blood Loss

Blood loss in any form may cause iron deficiency anaemia. It can occur due to various reasons. For example, it may result from blood loss due to injury, menstruation, etc.

Studies suggest that bleeding within the body is due to disorders like peptic ulcer, hernia and colorectal cancer. Women with a heavy period flow may be at high risk of anaemia. In some cases, overconsumption of medications may cause gastrointestinal bleeding. Other forms of blood loss may be through kidneys, blood donations etc.

4. Diet

Vegetarian and vegan foods have low-quality iron called non-heme iron. In contrast, non-vegetarian sources contain heme iron. Heme iron has a better rate of absorption. However, it does not mean that vegetarians are at higher risk. 

Studies suggest that the absorption of iron depends on several nutritional factors.

5. Vitamin C

It is an essential nutrient for iron absorption. Vitamin C rich foods may convert iron to an easily absorbable form. Therefore, inadequate intake of vitamin C rich foods contribute to anaemia.

6. Phytates

Nonheme iron absorption is disturbed by certain antinutrients. Phytates are antinutrients present in soybeans, black beans, and lentils. They reduce iron absorption when taken along with iron-rich foods. You can also find phytate in unrefined rice, cereals, mung beans, and split beans.

7. Polyphenols

They associate with nonheme iron in the gut and prevent absorption. In addition, one of the polyphenols, Tannic acid, is present in tea.

8. Calcium

Although the mechanism is still not precise, experts believe calcium hinders the absorption of both  heme and nonheme iron.

9. Others

Fad diets that are gaining popularity may also be a reason for an iron deficiency in an individual. Also, consumption of foods low in iron causes iron deficiency. For example, infants who consume cow’s milk as the primary food source are at a high risk of iron deficiency. That is because cow’s milk is a very poor source of iron.

Signs of Iron Deficiency

Iron deficiency is often left unnoticed. People realise the deficiency only when it leads to chronic anaemia. The symptoms of iron deficiency vary depending on the severity. It develops with time, age and health condition of the person. Here is the list of symptoms of iron deficiency.

1. Fatigue 

Iron is an oxygen carrier in our blood, and its deficiency might lead to decreased oxygen supply to the muscles. Additionally, it may also affect the tissues and the brain. It may cause reduced energy, causing tiredness. 

2. Shortness of Breath

There is poor oxygen transport due to iron deficiency, which may cause shortness of breath. It may affect normal daily activities like walking and climbing stairs. 

3. Irregular Heartbeat/Palpitations 

Low levels of haemoglobin may cause less oxygen supply. In that case, the heart has to work more to pump blood. As a result, it may lead to irregular heartbeats. If the condition continues, serious heart ailments may occur.

4. Compromised Immune Health

Research shows that low iron may affect the immune system. Iron deficiency makes people more prone to infections, colds, flu, etc. However, the exact mechanism is yet to be understood.

5. Pale Skin

Studies show that pale skin could be an essential symptom of iron deficiency. Iron deficiency is related to low RBC’s. Therefore, there may be a deficient blood supply, which may cause pale skin and eyelids.

6. Hairfall

Damaged skin and hair fall may occur due to the low oxygen supply to hair roots. Irregular hair loss in both men and women, in large amounts, is a sign of iron deficiency. In addition, studies suggest that anaemia may cause alopecia in men and women.

7. Sore Mouth

Iron deficiency may cause dryness, swelling and soreness in and out the mouth. In addition, it also causes cracks. Studies suggest that anaemia can result in reduced saliva secretion.

8. Headaches

Frequent and recurrent headaches are a sign of iron deficiency. Studies suggest that anaemia can lead to migraines. In addition, low iron levels may lead to deficient oxygen delivery to the brain. Furthermore, anaemia can also affect nerve impulses.

9. Spoon-Shaped Nails

Studies suggest severe iron deficiency may cause spoon-shaped nails, also known as koilonychia. It causes the nails to crack and break easily. 

10. Other Signs

Some other potential signs of iron deficiency are:

• Depression
• Restlessness
• Loss of appetite
• Strange cravings for chalks, dirt, ice.

How to Diagnose Iron Deficiency?

Blood Test

• Complete Blood Count (CBC) is a primary diagnostic test for detecting iron deficiency. The test helps check the quantity of RBC. Less CBC count indicates iron deficiency. 
• Peripheral Blood Smear helps understand the morphology of the RBC (shape and size). Smaller sizes indicate iron deficiency. 
• Haemoglobin Test checks haemoglobin levels in the blood. Low haemoglobin levels in the blood indicate iron deficiency anaemia.
• Serum Iron checks the amount of iron present in the blood.
• Ferritin measures the amounts of iron stored in the body.
• Total Iron-Binding Capacity: Transferrin carries iron throughout the body. This test quantifies the amount of transferrin in the blood. 

Other Advanced Tests

The first step is a blood test. After it confirms iron deficiency anaemia, doctors perform further tests. These advanced tests help to identify the causes. 

• Endoscopy helps to find internal bleeding. Doctors do it to examine the digestive tract.
• Faecal Occult Blood Test helps to identify the presence of blood in stools. 
• Pelvic Ultrasounds checks if bleeding is due to excessive menstrual flow. 

Treatment and Prevention

Iron-rich Foods

You may prevent iron deficiency through good dietary habits. Consumption of iron-rich foods may boost the iron levels in the body. Some of the iron-rich sources are eggs, meat, and seafood. Additionally, green-leafy vegetables such as spinach and dry fruits like apricots are beneficial. Nuts, seeds, beans, tofu, iron-fortified cereals also contain iron. 

The body absorbs iron better from meat sources than plant sources. However, antinutrients may also disturb iron absorption. Therefore, you should avoid having antinutrient foods like tea, coffee, dairy products with iron-rich foods. These foods contain tannins, oxalic acids and phytic acids, which are antinutrients that attach to iron and prevent absorption.

Vitamin C is essential for iron absorption. Studies suggest that vitamin C increases non-heme iron absorption in the body. Non-heme iron comes from vegetarian sources. So, it is suitable for vegetarians and vegans. Some vitamin C sources include citrus fruits, bell pepper, broccoli.

Iron Supplements

Iron supplements may increase the iron content in the body. But you should start these supplements only with a doctor’s prescription. These tablets, when consumed regularly, may restore iron levels. They may be absorbed better when taken on an empty stomach. You can safely consume them on alternate days. However, in some cases, they may cause side effects like:

• Nausea
• Stomach pain
• Diarrhoea
• Constipation
• Black stools 

Communicate with the doctor if you experience any of these.

Intravenous Iron

Healthcare experts recommend intravenous iron to some patients. For example, you will need them if iron absorption in the stomach is poor. In addition, people who experience side effects from oral supplementation can also have intravenous iron. Furthermore, pregnant women with iron deficiency can also take IV iron. However, you may require multiple transfusions.

Blood Transfusion

Blood transfusion is for patients with severe iron deficiency. Healthcare professionals recommend blood transfusion to patients who are actively bleeding. However, it may not improve the person’s overall iron content in the long run.

When to Consult a Doctor?

People often ignore the symptoms of iron deficiency. But, you should consult a physician if you experience one or more signs of anaemia. If left untreated, it may lead to heart ailments, pregnancy-related complications and depression. In addition, you should immediately consult a healthcare professional in case of profuse bleeding. Similarly, you should never ignore skin rashes and pale skin.

Summary

Although iron deficiency is prevalent among people due to poor dietary habits, it may result from non-dietary practices also. However, the primary cause for anaemia is iron deficiency.  Therefore, healthy dietary habits play a significant role. For example, you should eat iron-rich foods with vitamin C to improve absorption. Diagnosis of iron deficiency is crucial. If you notice any symptoms, consult a doctor. Treatment through supplements should be medically prescribed and monitored.

Frequently Asked Questions (FAQs)

Q. How can you tell if your iron is too low?

A. Most people fail to realise if they have iron deficiency. However, it is prevalent these days. You can understand if you have an iron deficiency by noticing a few symptoms. For example, you will feel extreme weariness, weakness, pale complexion, chest discomfort, and shortness of breath. These are some of the indications and symptoms.

Q. How can I raise my iron levels quickly?

A. You can boost your iron levels by eating a well-balanced diet rich in vitamins, minerals, and iron. In addition, you can eat some iron-rich foods like spinach, kale, meat, eggs, fish, raisins, grapefruits, strawberries, oranges, and tomatoes.

Q. Are eggs high in iron?

A. Eggs are a good source of iron. However, they also include phosphoprotein, an iron-binding molecule that can reduce iron absorption in the body. As a result, research shows that the iron in eggs is often poorly absorbed by the human body.

Q. What drinks are high in iron?

A. Some fruits and vegetable juices can help you load up on your Iron needs. Few among them are spinach juice, pumpkin juice, prune juice, beetroot juice, flax and sesame seed smoothie, and cocoa and beef liver smoothie.

Q. Can low iron cause anxiety?

A. Yes. Low iron levels may cause anxiety. Haemoglobin is a protein that permits red blood cells to transmit oxygen to your tissues and muscles. However, iron is essential for haemoglobin production. Therefore, less oxygen reaches your cells when your iron levels are low. It prevents haemoglobin from operating correctly and often result in anxiety.

Q. Does lack of iron cause weight gain?

A. Yes, a lack of iron in the body causes the thyroid gland to become inactive. The thyroid gland secretes enzymes that keep the metabolism of the body healthy. The absence of an active thyroid gland results in a disrupted enzyme release. It adversely affects the body’s metabolism, and the body fails to burn calories as effectively. That gradually leads to an increase in body weight. 

Q. Does Low iron make you hungry?

A. No, low iron does not make you hungry. Instead, it decreases your appetite. Iron is crucial to regulate ghrelin and leptin, which are appetite-regulating hormones. Iron deficiency spikes hormone levels. An increased release of ghrelin and leptin decreases the appetite. 

Q. What are the side effects of taking iron pills?

A. Taking supplements in the form of iron pills can help your body maintain healthy iron levels. Iron supplements are typically safe. However, if consumed excessively, they can cause constipation, tooth discolouration, heartburn, and a metallic aftertaste. The daily iron supplement dosage should not exceed 17 mg.

Q. Does taking iron affect your period?

A. Taking iron does not have any significant effect on periods. But, as per experts, you should consume iron supplements during menstruation to make up for the blood loss. Additionally, iron deficiency can result in irregular and stopped menstruation. Therefore, you should take adequate iron for a normal blood flow every cycle.

Q. Is lack of sleep causing anaemia?

A. Sleeping less has no significant contribution to anaemia. However, studies stipulated that sleep quality might deteriorate while already in the iron-deficiency anaemia stage.

Q. Can low iron cause sleep issues?

A. Haemoglobin and short sleep periods are related to the same brain region. Therefore, it raises the possibility of a common mechanism in developing anaemia and insomnia. Furthermore, living with a chronic disease like anaemia can cause significant stress, disrupting sleep.