IRON DEFICIENCY — identification of deficiency and how to support optimal iron levels

Written By heather sharp Heather Sharp

Iron deficiency is a common nutritional deficiency particularly in women, often due to menstruation and the loss of iron through menstrual blood. Iron deficiency is often suspected when someone feels tired but is best identified through a thorough understanding of an iron studies blood test.  Deficiency is often identified from a low ferritin level (iron stored in the body) suggesting there is insufficient iron stores to meet the body’s needs. A ‘normal’ range of ferritin will say anywhere between 30-200ug/L, though optimally I like to see it around 50 – 100ug/mL for a female and 100 - 200 ng/mL for a male. Anything below 30 indicates iron deficiency.

Unfortunately, we are often only made aware of deficiency if we are below the ‘normal’ range of ferritin, however, even a ‘normal’ range cannot be relied upon. It is also essential to consider other iron markers, namely serum iron, transferrin (iron transporter) and transferrin saturation levels, all available through your GP. Essentially even if you have normal ferritin, you may have low iron in the blood or low transferrin saturation, indicating insufficient iron is able to bind and be transported to your cells.  In addition, inflammation and infections can also provide false iron levels and impair release of iron from storage.  Please seek the advice of a health professional when interpreting blood results as we understand the intricacies and the nuances of laboratory markers and their influences.

Causes of iron deficiency

Whilst an obvious cause of low iron is heavy menstrual bleeding and/or inadequate intake from the diet, it’s important before increasing dietary or supplemental iron to consider other potential causes, some of which are listed below:

·       Being vegetarian or vegan

·       Having digestive issues can result in poor absorption of iron

·       Some medications such as heartburn medications, some antibiotics, NSAIDs e.g., nurofen and aspirin can cause a chronic iron deficiency.

·       Drinking large amounts of tea, coffee and green tea (especially with meals), can hinder absorption of iron in the gut. 

·       Lack of key nutrients: the absorption of iron depends on the support vitamins A and C, and Vitamin B2. 

·       A condition Pyrrole's disorder which can cause elevations of copper, interfering with how both iron and zinc are transported and utilised in the body

·       Coeliac disease

·       Crohn’s disease

·       Internal bleeding

·       Endometriosis

·       H Pylori

·       Guardia

·       Low stomach acid

·       Gut dysbiosis

·       H Pylori infection

·       Pancreatic and intestinal disorders, Celiac disease,

·       Pregnancy can also cause low iron as the demands are high

·       You don’t make enough red blood cells – due to a genetic or bone marrow disease.

common signs and symptoms associated with iron deficiency: 

·       Fatigue

·       Headaches

·       Weakness

·       Restless legs

·       Pale skin

·       Pale conjunctiva

·       Shortness of breath

·       Hair loss

·       Irregular heartbeat / palpitations

·       Poor restless sleep

·       Cold hands and feet

Why is iron so important and where can we get iron in the diet?

Iron is required for many bodily functions, the most well-known being its role in oxygen transport around the body through creation of red blood cells. Iron also supports normal cognitive function, helps maintain immunity and assists in the conversion of food to energy, amongst other benefits.

Dietary iron occurs in two forms:

1.      non-heme iron which comes from plant-based foods such as legumes, fruit, vegetables and pulses

2.      heme iron which comes from animal-based foods such as meat, poultry and fish.

Heme iron is much more bioavailable than non-heme iron, meaning it is more easily absorbed and utilised by the body.

Plant-based sources of iron:

·       green leafy vegetables: spinach, kale and silverbeet

·       lentils (soak them to remove some of the phytates which inhibit absorption)

·       beans

·       tofu

·       tempeh

·       soybeans

·       seeds: pumpkin, sesame, hemp, chia and flaxseeds

·       nuts and nut butter almond, cashew, pine nuts and macadamia

·       oats, spelt, amaranth

·       quinoa

·       Herbs (parsley, coriander, nettle, watercress

·       Cacao 

·       Dried fruit.

Animal sources of iron:

·       chicken liver

·       oysters

·       salmon

·       chicken

·       beef

·       turkey

·       sardines

·       kangaroo

·       duck

How much iron should we be consuming each day?

The recommended daily intake (RDI) for women aged between 19 – 50 years old is 18mg/day. To give you some perspective 100g of raw spinach roughly contains roughly 1.2mg of non-heme iron and there is roughly 11mg of heme iron in 100g of chicken liver (Nutrition Australia, 2020). That said we also obtain iron through our bodies own ability to recycle red blood cells.

How to increase absorption of iron:

Certain foods promote or inhibit the absorption of iron in the body, including polyphenols, phytic acids found in legumes, wholegrains, and tannins found in black tea. It is important to avoid or properly prepare these foods when consuming with iron-rich foods to ensure your body can absorb the iron sufficiently.

1. Limit iron inhibitors: Phytates & Tannins Phytates are compounds found in plant-based diets (legumes, brown rice and whole-grain wheat products) that impair iron absorption. Soak legumes and wholegrains in water to remove phytates

   Tannins – in tea, coffee - consume away (2 hours) from iron

2. Avoid consuming milk, calcium supplements or antacids at the same time as iron supplements or iron rich food

3. Include Vitamin C rich foods (oranges, strawberries and tomatoes) in the same meal as iron-rich foods, to support increased iron absorption.

4. Iron supplementation: Take iron supplements on an empty stomach, for better absorption. If iron supplements cause stomach cramps, nausea, and diarrhoea, you may need to take iron with a small amount of food to avoid this problem.