What are the main causes of iron deficiency. How can you recognize the symptoms of low iron levels. What are the best treatment options for iron deficiency.

Understanding Iron and Its Importance in the Body

Iron is a crucial mineral that plays several vital roles in maintaining our health and well-being. Its primary function is to help transport oxygen throughout our body, which is essential for providing energy for daily activities. Let’s delve deeper into the specific roles of iron in our body:

• Oxygen transport: Iron is a key component of hemoglobin, a complex protein in red blood cells that carries oxygen from the lungs to the rest of the body.
• Muscle function: Iron is present in myoglobin, a protein that stores oxygen in muscle cells and gives muscles their red color.
• Enzyme activity: Many enzymes throughout the body contain iron, including those involved in energy production.
• Immune system support: Proper functioning of the immune system relies partly on sufficient iron levels.

Given its importance, it’s crucial to maintain adequate iron levels in our body. But how much iron do we actually need?

Daily Iron Requirements

The average person needs to absorb about 1-1.5 mg of iron daily to stay healthy. However, we need to consume several times that amount because our bodies only absorb a fraction of the iron contained in the foods we eat. The Recommended Dietary Intake (RDI) for iron varies based on age, gender, and life stage:

• Adult males: 8 mg/day
• Women aged 19-50 years: 18 mg/day
• Pregnant women: 27 mg/day
• Breastfeeding women over 18 years: 9 mg/day
• Women aged 51 years and over: 8 mg/day

These recommendations highlight the increased iron needs for women during their reproductive years and during pregnancy.

Sources of Dietary Iron: Haem vs Non-Haem

Our diets contain two types of iron: haem and non-haem. Understanding the difference between these types can help us make informed dietary choices to meet our iron needs.

Haem Iron

Haem iron is found in animal tissues and is the most easily absorbed form of iron. Good sources include:

• Beef
• Lamb
• Kangaroo
• Chicken
• Fish
• Offal products (liver, kidney)

It’s worth noting that while offal products are rich in haem iron, pregnant women should limit their intake due to high vitamin A content, which can cause birth defects.

Non-Haem Iron

Non-haem iron is found in both animal and plant-based foods. It’s not as easily absorbed as haem iron, but it’s still an important source, especially for vegetarians and vegans. Good sources include:

• Iron-fortified breakfast cereals
• Wholegrains
• Legumes (beans and lentils)
• Dark green leafy vegetables (like broccoli)
• Dried fruits (raisins, prunes, apricots)
• Nuts and seeds

If you follow a vegetarian diet, you may need to consume almost twice as much dietary iron each day as non-vegetarians to meet your iron needs.

Iron Absorption: Factors That Help and Hinder

The amount of iron we absorb from our diet depends on various factors, including our body’s iron stores and the presence of certain substances in our food. On average, a healthy body absorbs around 18% of the available iron from a typical Western diet. However, this absorption rate can be influenced by several factors:

Factors That Enhance Iron Absorption

• Vitamin C: Consuming vitamin C-rich foods alongside iron-rich foods can significantly boost iron absorption.
• Meat proteins: The presence of meat in a meal can enhance the absorption of non-haem iron from plant sources.
• Acidic foods: Foods with a low pH, such as vinegar or citrus fruits, can increase iron absorption.

Factors That Inhibit Iron Absorption

• Tannins: Found in tea, coffee, and some fruits, tannins can reduce iron absorption.
• Calcium: High calcium intake can interfere with iron absorption.
• Phytates: Present in whole grains and legumes, phytates can bind to iron and reduce its absorption.
• Polyphenols: Found in certain vegetables, fruits, and spices, polyphenols can inhibit iron absorption.

Understanding these factors can help you make dietary choices that optimize your iron absorption.

Iron Deficiency: Causes and Risk Factors

Iron deficiency occurs when the body’s iron stores become too low. This can happen for various reasons and certain groups of people are at higher risk. Here are some common causes and risk factors for iron deficiency:

Inadequate Dietary Intake

Not consuming enough iron-rich foods is a primary cause of iron deficiency. This is particularly common among:

• Vegetarians and vegans who don’t properly plan their diets
• People with eating disorders
• Individuals on restrictive diets

Increased Iron Requirements

Certain life stages and conditions increase the body’s need for iron:

• Pregnancy: The growing fetus requires additional iron
• Adolescence: Rapid growth spurts increase iron needs
• Heavy menstrual periods: Can lead to significant iron loss
• Intense physical activity: Athletes may lose iron through sweat and have increased iron needs

Blood Loss

Chronic blood loss can deplete iron stores. This can occur due to:

• Gastrointestinal conditions like ulcers or inflammatory bowel disease
• Regular blood donation
• Certain medications that cause internal bleeding

Impaired Absorption

Some people may be unable to absorb iron effectively due to:

• Celiac disease
• Inflammatory bowel diseases like Crohn’s disease
• Gastric bypass surgery

Understanding these risk factors can help identify individuals who may need to pay extra attention to their iron intake or undergo regular screening for iron deficiency.

Recognizing the Signs and Symptoms of Iron Deficiency

Iron deficiency can develop gradually, and symptoms may not be apparent until the condition has progressed to iron deficiency anemia. However, being aware of the early signs can help in timely intervention. Here are some common symptoms to watch out for:

Early Signs of Iron Deficiency

• Fatigue and weakness
• Pale skin
• Shortness of breath
• Headaches
• Dizziness
• Cold hands and feet
• Brittle nails
• Unusual cravings for non-food items (a condition called pica)

Advanced Symptoms of Iron Deficiency Anemia

As iron deficiency progresses to anemia, additional symptoms may appear:

• Chest pain
• Fast heartbeat or shortness of breath
• Increased susceptibility to infections
• Restless legs syndrome
• Anxiety
• Depression

Do all these symptoms always indicate iron deficiency? Not necessarily. Many of these symptoms can be associated with other health conditions as well. Therefore, if you experience these symptoms persistently, it’s important to consult with a healthcare provider for proper diagnosis.

Diagnosing Iron Deficiency: Tests and Procedures

If iron deficiency is suspected based on symptoms or risk factors, several tests can be conducted to confirm the diagnosis. Here’s an overview of the common diagnostic procedures:

Blood Tests

Blood tests are the primary method for diagnosing iron deficiency. These may include:

• Complete Blood Count (CBC): This test measures various components of your blood, including hemoglobin and hematocrit levels.
• Serum Ferritin: This test measures the amount of ferritin, a protein that stores iron in your body. Low ferritin levels indicate depleted iron stores.
• Serum Iron: This test measures the amount of iron in your blood.
• Total Iron-Binding Capacity (TIBC): This test measures how well your blood can transport iron.
• Transferrin Saturation: This calculation helps determine how much iron is bound to transferrin, a protein that transports iron in your blood.

Additional Tests

In some cases, your healthcare provider might recommend additional tests:

• Stool Test: To check for hidden blood in the stool, which could indicate internal bleeding.
• Endoscopy or Colonoscopy: If internal bleeding is suspected, these procedures can help identify the source.
• Bone Marrow Biopsy: In rare cases, a sample of bone marrow may be taken to assess iron stores.

How are these test results interpreted? Generally, a combination of low hemoglobin, low serum ferritin, and low transferrin saturation indicates iron deficiency. However, interpretation can be complex and should be done by a healthcare professional.

Treatment Options for Iron Deficiency

Once iron deficiency is diagnosed, treatment typically focuses on replenishing iron stores and addressing the underlying cause. The approach to treatment can vary based on the severity of the deficiency and individual circumstances. Here are the main treatment options:

Dietary Changes

For mild cases of iron deficiency, dietary modifications may be sufficient. This involves increasing the intake of iron-rich foods such as:

• Lean red meat
• Poultry
• Fish
• Beans and lentils
• Dark green leafy vegetables
• Iron-fortified cereals and bread

It’s also important to consume these foods with vitamin C-rich items to enhance iron absorption.

Iron Supplements

In more severe cases or when dietary changes alone are insufficient, iron supplements may be prescribed. These typically come in the form of ferrous sulfate tablets. Key points about iron supplementation include:

• Dosage and duration are determined by your healthcare provider based on the severity of your deficiency.
• Iron supplements are best absorbed when taken on an empty stomach, but they can cause stomach upset in some people.
• It’s crucial to follow the prescribed dosage, as excess iron can be harmful.
• Keep iron supplements out of reach of children, as overdoses can be fatal in young children and infants.

Treating Underlying Causes

Addressing the root cause of iron deficiency is crucial for long-term management. This might involve:

• Treating gastrointestinal disorders
• Managing heavy menstrual bleeding
• Treating chronic diseases that interfere with iron absorption

Intravenous Iron

In some cases, such as severe anemia or when oral supplements aren’t tolerated, intravenous iron may be recommended. This method delivers iron directly into the bloodstream and can replenish iron stores more quickly than oral supplements.

How long does it take to correct iron deficiency? With proper treatment, iron levels typically improve within a few weeks, but it may take several months to fully replenish iron stores. Regular follow-up with your healthcare provider is important to monitor progress and adjust treatment as needed.

Preventing Iron Deficiency: Lifestyle and Dietary Strategies

While treatment is crucial for those already experiencing iron deficiency, prevention is equally important. By adopting certain lifestyle and dietary strategies, you can maintain healthy iron levels and reduce your risk of deficiency. Here are some effective prevention strategies:

Balanced Diet

Consuming a varied diet rich in iron is the cornerstone of prevention. Focus on including:

• Lean meats and poultry
• Fish
• Beans and lentils
• Tofu
• Dark green leafy vegetables
• Dried fruits
• Iron-fortified cereals and breads

Optimize Iron Absorption

Enhance your body’s ability to absorb iron by:

• Pairing iron-rich foods with vitamin C sources (e.g., citrus fruits, bell peppers)
• Avoiding tea or coffee with meals, as these can inhibit iron absorption
• Spacing out calcium-rich foods and iron-rich foods, as calcium can interfere with iron absorption

Regular Health Check-ups

If you’re at high risk for iron deficiency (e.g., pregnant women, vegetarians, endurance athletes), consider:

• Regular blood tests to monitor iron levels
• Discussing iron supplementation with your healthcare provider

Manage Chronic Conditions

If you have a condition that increases your risk of iron deficiency (e.g., celiac disease, inflammatory bowel disease), work with your healthcare provider to manage it effectively.

Cook in Iron Pots

Using cast iron cookware can increase the iron content of foods, especially when cooking acidic foods like tomato sauce.

Is preventing iron deficiency always possible? While these strategies can significantly reduce your risk, some factors (like genetic predisposition or certain medical conditions) may still lead to iron deficiency. Regular monitoring and a proactive approach to nutrition are key to maintaining optimal iron levels.

By understanding the importance of iron, recognizing the signs of deficiency, and implementing preventive strategies, you can take control of your iron health. Remember, if you suspect you might be iron deficient, it’s always best to consult with a healthcare professional for proper diagnosis and personalized advice.

Iron and iron deficiency – Better Health Channel

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Summary

Read the full fact sheet

• Iron is an important dietary mineral that is involved in various bodily functions, including the transport of oxygen in the blood.
• Dietary iron is found in both animal and plant products.
• Certain foods and drinks affect how much iron your body absorbs.
• Iron deficiency is when the stores of iron in your body are too low.
• Common causes of iron deficiency include not getting enough iron in your diet, chronic blood loss, pregnancy and vigorous exercise.
• Some people become iron deficient if they are unable to absorb iron.
• Iron deficiency can be treated by adding iron-rich foods to the diet.
• If you have iron deficiency anaemia, your GP (doctor) may recommend that you take iron supplements.
• Keep iron supplements away from children – overdoses can be fatal in young children and infants.

What is iron?

Iron is an important mineral hat is involved in various bodily functions, including the transport of oxygen in the blood. This is essential for providing energy for daily life.

Good sources of iron include red meat, offal and iron-fortified breakfast cereals.

Iron is lost from the body through sweat, shedding intestinal cells, and blood loss.

About one third of the world’s population is iron deficient. Menstruating women are at greater risk than men and postmenopausal women of iron deficiency. It is thought that up to 5% of the Australian population has iron deficiency anaemia.

Roles of iron in the body

Some of the many roles of iron in the body include:

• Oxygen transport – red blood cells contain haemoglobin, a complex protein that carries oxygen from the lungs to the rest of the body. Haemoglobin is partly made from iron, and accounts for about two thirds of the body’s iron.
• Myoglobin – a special protein that helps store oxygen in muscle cells. Myoglobin contains iron and is responsible for the red colour of muscle.
• Enzymes – many enzymes throughout the body contain iron, including those involved in energy production. Enzymes are catalysts (increase the rate of chemical reaction) that drive many cell functions.
• Immune system– proper functioning of the immune system relies, in part, on sufficient iron. The immune system helps us fight infection.

The average person needs to absorb just a small amount of iron each day to stay healthy (around 1 mg for adult males and 1.5 mg for menstruating females). To achieve this, however, we need to consume several times that amount. This is because our bodies absorb only a fraction of the iron contained in the foods we eat.

The Australian Recommended Dietary Intake (RDI) for iron is the amount of dietary iron required to meet the needs of most of the population. This amount is different for different age groups and life stages.

Types of iron in our diets

The 2 types of iron found in our diets are:

• Haem iron – found in animal tissue such as beef, lamb, kangaroo, chicken and fish. Offal products such as liver and kidney are particularly rich in haem iron (however pregnant women should avoid eating too much offal as it contains large amounts of vitamin A, which can cause birth defects). This form of iron is most easily absorbed by the body.
• Non-haem iron – found in animal tissue, animal-based products and plant foods such as dried beans and lentils. Good vegetarian sources of non-haem iron include iron-fortified breakfast cereals, wholegrains and legumes (beans and lentils). If you are vegetarian and have no animal tissue in your diet, you may need almost twice as much dietary iron each day as non-vegetarians. Plant-based sources of iron include: dark green leafy vegetables such as broccoli, raisins, nuts, prunes, dried apricots, seeds, dried beans and peas, and iron-fortified cereals, breads and pastas.

How much iron do we absorb from our diet?

How much iron you absorb from your diet depends on how much iron your body is storing.

The healthy body absorbs around 18% of the available iron from a typical western diet (which includes animal foods) and about 10% from a vegetarian diet. However, you may be absorbing much less than that, even if your diet includes iron-rich foods.

The most significant influence on iron absorption is the amount of iron already stored in your body. The body stores iron in various places, including the liver. If your stores are high, your body absorbs less iron from the foods you eat. Conversely, low iron stores increase your ability to absorb iron.

Dietary factors affecting iron absorption

Certain foods and drinks affect how much iron your body absorbs.

To boost iron absorption:

• Consume vitamin C (found in fruits and vegetables).
• Include animal protein (haem) with plant (non-haem) sources of iron, such as meat with beans – for example, beef and kidney beans in a chilli con carne.
• Cook plant sources of iron (such as vegetables). In most cases, cooking increases the amount of available non-haem iron in vegetables. For example, the body absorbs 6% of the iron from raw broccoli, compared to 30% from cooked broccoli.

Foods and drinks that reduce your body’s ability to absorb iron:

• Soy proteins can reduce absorption from plant sources.
• Tea, coffee and wine contain tannins that reduce iron absorption by binding to the iron and carrying it out of the body.
• Phytates and fibres found in wholegrains such as bran can reduce the absorption of iron and other minerals.
• Inadequate vitamin A in your diet could lead to iron deficiency because vitamin A helps to release stored iron.
• Calcium and phosphorus reduce the absorption of plant-sourced (non-haem) iron.

High-risk groups for iron deficiency

One in 8 people aged 2 years and over does not consume enough iron on average to meet their needs. If you do not have enough iron in your body, it is called being ‘iron deficient’. This can make you feel tired and lower your immunity. Including iron-rich foods in your diet can help.

People who are at an increased risk of iron deficiency, include:

• babies given cow’s or other milk instead of breastmilk or infant formula
• toddlers, particularly if they drink too much cow’s milk
• teenage girls
• menstruating women, especially those who have heavy periods
• women using an IUD (because they generally have heavier periods)
• pregnant women
• breastfeeding women
• people with poor diets such as people who are alcohol dependent, people who follow ‘fad diets’, or people with eating disorders
• people who follow a vegetarian or vegan diet
• Aboriginal Australians
• athletes in training
• people with intestinal worms
• regular blood donors
• people with conditions that predispose them to bleeding, such as gum disease or stomach ulcers, polyps or cancers of the bowel
• people with chronic diseases such as cancer, autoimmune diseases, heart failure or renal (kidney) disease
• people taking aspirin as a regular medication
• people who have a lower than normal ability to absorb or use iron, such as someone with coeliac disease.

Stages and symptoms of iron deficiency

Most of your body’s iron is in the haemoglobin of your red blood cells, which carry oxygen to your body. Extra iron is stored in your liver and is used by your body when your dietary intake is too low.

If you don’t have enough iron in your diet, your body’s iron stores get lower over time.

This can cause:

• Iron depletion – when haemoglobin levels are normal, but your body only has a small amount of stored iron, which will soon run out. This stage usually has no obvious symptoms.
• Iron deficiency – when your stored and blood-borne iron levels are low and your haemoglobin levels have dropped below normal. You may experience some symptoms, including tiredness.
• Iron deficiency anaemia – when your haemoglobin levels are so low that your blood is unable to deliver enough oxygen to your cells. Symptoms include looking very pale, breathlessness, dizziness and fatigue. People with iron deficiency anaemia may also have reduced immune function, so they are more vulnerable to infection. In children, iron deficiency anaemia can affect growth and brain development.

Symptoms of iron deficiency anaemia in children

The signs and symptoms of iron deficiency anaemia in children may include:

• behavioural problems
• repeat infections
• loss of appetite
• lethargy
• breathlessness
• increased sweating
• strange ‘food’ cravings (pica) like eating dirt
• failure to grow at the expected rate.

Causes of iron deficiency in adults

In adults, some of the common causes of iron deficiency include:

• Not getting enough iron in your diet (also known as ‘inadequate dietary intake’). There are many reasons why someone’s dietary intake of iron could be too low, for example due to a poorly balanced vegetarian diet, chronic fad dieting or having limited access to a wide range of fresh foods.
• Blood loss – iron deficiency easily occurs in situations of chronic (ongoing) blood loss. Common causes include heavy menstrual periods, regular blood donation, regular nosebleeds, other chronic conditions that involve bleeding (such as peptic ulcers, polyps or cancers in the large intestine), and certain medications, particularly aspirin.
• Increased need for iron – if you are pregnant or breastfeeding your body needs more iron. If this increased need isn’t met, iron deficiency can quickly occur.
• Exercise – athletes are prone to iron deficiency because regular exercise increases the body’s need for iron in several ways. For example, hard training promotes red blood cell production (which requires iron), and iron is lost through sweating.
• Inability to absorb iron – healthy adults absorb about 10 to 15% of dietary iron, but some people’s bodies are unable to absorb or use iron from food.

Causes of iron deficiency in children

Major risk factors for the development of iron deficiency in children include:

• prematurity and low birth weight
• exclusive breastfeeding beyond 6 months (not introducing solids)
• high intake of cow’s milk in young children less than 2 years of age
• low or no meat intake
• vegetarian and vegan eating
• poor diet in the second year of life
• possible gastrointestinal diseases
• lead poisoning.

Babies, children and teenagers undergo rapid growth spurts, which increase their need for iron. The main causes of iron deficiency in children by age group include:

• Babies less than 6 months old – newborns receive their iron stores in the uterus (womb), which means the mother’s diet during pregnancy is very important. Low birth weight or premature babies are at increased risk of iron deficiency and will need iron supplements (under medical supervision only). See your doctor for further advice.
• Babies aged 6 months to one year – a baby’s iron stores run low in the second half of their first year. Iron deficiency can result if their diet doesn’t include enough iron-rich solid food. At around 6 months, 2 servings a day of plain, iron-fortified infant cereal mixed with breastmilk or infant formula can start to be given. Plain pureed meats can soon be offered with other solids, once your baby is used to the cereal. Late introduction of solids into the baby’s diet is a common cause of iron deficiency in this age group.
• Children aged one to 5 years – breastmilk contains a small amount of iron, but prolonged breastfeeding can lead to iron deficiency, especially if breastmilk replaces solid foods in the diet. Low-iron milks such as cow’s milk, goat’s milk and soymilk should not be given until 12 months of age. Children who drink milk in preference to eating solid foods are in danger of iron deficiency.
• Teenagers – adolescent girls are at risk because of a number of factors, including growth spurts at puberty, iron loss through periods (menstruation) and risk of under-nutrition due to fad dieting that restricts eating.
• In general – gastrointestinal disorders, such as coeliac disease, are a rare but possible cause of anaemia in children.

Suggestions for parents – babies

Some suggestions to prevent iron deficiency in babies less than 12 months of age include:

• Have an iron-rich diet during pregnancy. Red meat is the best source of iron.
• Tests to check for anaemia should be conducted during pregnancy. If your doctor prescribes iron supplements, take them only according to instructions.
• Breastfeed your baby or choose iron-fortified infant formulas.
• Don’t give your baby cow’s milk or other fluids that may displace iron-rich solid foods before 12 months of age.
• Don’t delay the introduction of solid foods. Start giving your baby pureed foods when they are around 6 months of age. Fortified baby cereal made with iron-fortified infant formula or breastmilk is generally the first food to offer. This is because of its iron content, but also because its texture is easy to change. Introduce soft lumpy foods or mashed foods at around 7 months.

Suggestions for parents – young children

To prevent iron deficiency in toddlers and preschoolers:

• Include lean red meat in their diet 3 to 4 times a week. Offer meat alternatives such as dried beans, lentils, chickpeas, canned beans, poultry, fish, eggs and small amounts of nuts and nut pastes. These are important sources of iron in your child’s daily diet. If your family follows a vegan or vegetarian diet, you may need to seek advice from a dietitian to ensure you are meeting all your child’s dietary needs.
• Include vitamin C in their diet as this helps the body to absorb more iron. Make sure your child has plenty of foods rich in vitamin C like oranges, lemons, mandarins, berries, kiwifruit, tomatoes, cabbage, capsicum and broccoli.
• Encourage solid foods at mealtimes and take care that toddlers are not ‘filling up’ on drinks between meals.
• Remember that chronic diarrhoea can deplete your child’s iron stores, while intestinal parasites such as worms can cause iron deficiency. See your doctor for prompt diagnosis and treatment.
• Fussy eaters may be at risk due to poor intake or lack of variety in the foods they eat. Seek advice from your dietitian, local doctor or child health nurse on how to manage a fussy eater.

Suggestions for parents – teenagers

To prevent iron deficiency in teenagers:

• Talk to your child about the importance of iron. Help them become informed enough to make their own responsible food choices.
• Encourage iron-rich foods and meals, such as iron-fortified breakfast cereals and breads, and serve meat, poultry or fish with the evening meal.
• Offer good sources of non-haem iron such as dried beans, lentils, peas, broccoli, spinach, beans, fortified cereals, breads and whole grains if your child wants to avoid red meat or become vegetarian. Vitamin C-rich foods should also be encouraged, such as fruits or vegetables with meals.
• Encourage only moderate amounts of tea and coffee, as these can interfere with iron absorption.

Diagnosis of iron deficiency

Make an appointment with your doctor if you think you may be iron deficient. Diagnosis aims to exclude other illnesses that can have similar symptoms, such as coeliac disease.

Diagnosis methods include:

• physical examination
• medical history
• blood tests.

Treatment for iron deficiency

Treatment for iron deficiency depends on your iron status, and the underlying cause:

• If you have iron depletion , your doctor will give you information about including iron-rich foods in your diet. You will have another blood test in around 6 months to check that your iron level has improved.
• If you have iron deficiency , your doctor will give you dietary advice and closely monitor your diet. They will encourage you to have iron-rich foods and discourage you from having foods and drinks (such as bran, tea and coffee) that can interfere with iron absorption with meals. They will regularly review your iron status and may prescribe supplements.
• If you have iron deficiency anaemia , your doctor will prescribe iron supplements. It may take 6 months to one year for your body to restock its iron stores. Your iron levels will be regularly reviewed with blood tests.
• If you have an underlying problem that is causing your iron deficiency, it is very important that the cause is investigated. If it is a medical cause, it is important that it be treated appropriately.

Don’t self-diagnose iron deficiency

Since iron supplements are available without prescription, it can be tempting to self-diagnose, but this is not recommended because:

• Having too much iron in the body can be toxic and even fatal.
• Fatigue, paleness, dizziness and breathlessness are symptoms of many other health conditions, not just iron deficiency anaemia. Some of these other conditions are serious. Incorrectly self-diagnosing and self-medicating can be dangerous and can waste valuable time in getting the treatment you need. Getting the right treatment in the early stages of a disease offers a greater chance of recovery. So always visit your GP if you think you could be iron deficient.
• Iron supplements won’t help the symptoms if iron deficiency anaemia isn’t the problem. And you could be spending money on tablets you or your child don’t need.
• Taking an iron supplement when you don’t need it can interfere with your body’s absorption of other minerals, including zinc and copper.
• About one in 300 people have haemochromatosis, which is an inherited condition that prompts the body to absorb more iron than usual. Excess iron damages the body’s tissues and increases the risk of cancers and heart disease. People with haemochromatosis need to limit how much iron they consume.

Do not self-diagnose or give your child over-the-counter iron supplements, because an overdose of iron can cause death. In infants and young children, 20 mg per day is the safe upper limit – most iron supplements contain around 100 mg per tablet.

It is important to keep iron supplements tightly capped and away from children’s reach, as iron tablets are often mistaken as lollies by children.

If you suspect an iron overdose, call your doctor or the Victorian Poisons Information CentreExternal Link on 13 11 26 immediately (24 hours, 7 days) or visit your local hospital emergency department.

Iron supplements

If you’ve been advised to take iron supplements, keep in mind that:

• The most common side effect of iron supplements is dark coloured or black stools (poo), so don’t be alarmed by this change to your bowel habits.
• Other common side effects include nausea, vomiting, constipation and diarrhoea. See your doctor for advice but, generally speaking, treatment involves lowering the recommended dose for a short time to give the body time to adjust.
• Iron supplements should be taken on an empty stomach, if possible.
• Supplements should be taken exactly as advised by your doctor. The human body isn’t very good at excreting iron and you could poison yourself if you take more than the recommended dose.

Where to get help

• Your GP (doctor)
• Dietitians AustraliaExternal Link Tel. 1800 812 942
• Victorian Poisons Information CentreExternal Link Tel. 13 11 26 (7 days, 24 hours) – for advice about poisonings, suspected poisonings, bites and stings, mistakes with medicines and poisoning prevention advice.

• IronExternal Link, 2014, Nutrient Reference Values for Australia and New Zealand, National Health and Medical Research Council, Australian Government.
• IronExternal Link, Office of Dietary Supplements, National Institutes of Health, USA.
• HemochromatosisExternal Link, MedlinePlus, National Institutes of Health, USA.
• IronExternal Link, MedlinePlus, National Institutes of Health USA.
• Iron overdoseExternal Link, MedlinePlus, National Institutes of Health, USA.
• Iron deficiency anaemiaExternal Link, MedlinePlus, National Institutes of Health, USA.
• Australian Dietary GuidelinesExternal Link, 2013, National Health and Medical Research Council, Australian Government.
• IronExternal Link, in Australian Health Survey: Usual nutrient intakes, 2011–12, 2015, Australian Bureau of Statistics.

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Reviewed on: 06-01-2022

Iron-Deficiency Anemia: Symptoms, Causes, and More

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Having low levels of iron can mean you have iron-deficiency anemia. It can occur for many reasons, including not consuming enough iron or experiencing blood loss.

Anemia occurs when you have a decreased level of hemoglobin in your red blood cells (RBCs). Hemoglobin is the protein in your RBCs that’s responsible for carrying oxygen to your tissues.

Iron-deficiency anemia is the most common type of anemia. It occurs when your body doesn’t have enough iron, which your body needs to make hemoglobin. When there isn’t enough iron in your blood, the rest of your body can’t get the amount of oxygen it needs.

While the condition may be common, many people don’t know they have iron-deficiency anemia. It’s possible to experience symptoms for years without knowing the cause.

In women of childbearing age, a common cause of iron-deficiency anemia is a loss of iron in the blood due to heavy menstruation or pregnancy. A poor diet, or certain intestinal diseases that affect how the body absorbs iron, can also cause iron-deficiency anemia.

In this article, we take a closer look at symptoms and causes of iron deficiency, and how to treat the condition.

The symptoms of iron-deficiency anemia can be mild at first, and you may not even notice them. According to the American Society of Hematology (ASH), most people don’t realize they have mild anemia until they have a routine blood test.

The symptoms of moderate to severe iron-deficiency anemia can include:

• general fatigue
• weakness
• pale skin
• shortness of breath
• dizziness
• strange cravings to eat items with no nutritional value
• a tingling or crawling feeling in the legs
• tongue swelling or soreness
• cold hands and feet
• fast or irregular heartbeat
• brittle nails
• headaches

According to the ASH, iron deficiency is the most common cause of anemia. There are many reasons that a person might become deficient in iron. These include:

Inadequate iron intake

Eating too little iron over an extended amount of time can cause a shortage in your body. Foods such as meat, eggs, and some green leafy vegetables are high in iron. Because iron is essential during times of rapid growth and development, pregnant women and young children may need even more iron-rich foods in their diet.

Pregnancy or blood loss due to menstruation

Heavy menstrual bleeding is a common cause of iron-deficiency anemia in women of childbearing age. So is pregnancy, because your body needs more iron during this time in order to create enough oxygen for the baby.

Internal bleeding

Certain medical conditions can cause internal bleeding, which can lead to iron-deficiency anemia. Examples include a stomach ulcer, polyps in the colon or intestines, or colon cancer. Regular use of certain pain relievers, such as aspirin, can also lead to bleeding in the stomach.

Inability to absorb iron

Certain disorders or surgeries that affect the intestines can also interfere with how your body absorbs iron. Even if you get enough iron in your diet, celiac disease or intestinal surgery such as gastric bypass may limit the amount of iron your body can absorb.

Endometriosis

If you have endometriosis, you may have heavy blood loss during menstrual periods. You may not even know you have endometriosis because it occurs hidden in the abdominal or pelvic area outside of the uterus.

Genetics

Some conditions — like celiac disease — that can make it difficult to absorb enough iron are passed down through families. There are also genetic conditions or mutations that can add to the problem. One of these is the TMRPSS6 mutation.

This mutation causes your body to make too much hepcidin. Hepcidin is a hormone that can block your intestines from absorbing iron.

Other genetic conditions may contribute to anemia by causing abnormal bleeding. Examples include Von Willebrand disease and hemophilia.

Anemia is a common condition and can occur in both men and women of any age and from any ethnic group. Some people may be at greater risk of iron-deficiency anemia than others, including:

• women of childbearing age
• pregnant women
• people with poor diets
• people who donate blood frequently
• infants and children, especially those born prematurely or experiencing a growth spurt
• vegetarians who don’t replace meat with another iron-rich food
• teenagers who have a greater need for iron in periods of rapid growth
• adults over age 65
• people exposed to lead in their environment or water
• high performance and endurance athletes like marathon runners

If you’re at risk of iron-deficiency anemia, talk to a doctor to determine if blood testing or dietary changes could benefit you.

Pregnancy, significant menstrual bleeding, endometriosis, and uterine fibroids are all reasons that women are more likely to experience iron-deficiency anemia.

Heavy menstrual bleeding occurs when a woman bleeds more or longer than typical during menstruation. According to the Centers for Disease Control and Prevention (CDC), typical menstrual bleeding lasts for 4 to 5 days and the amount of blood lost ranges from 2 to 3 tablespoons.

Women with excess menstrual bleeding typically bleed for more than 7 days and lose twice as much blood as normal.

A pelvic ultrasound can help a doctor look for the source of excess bleeding during a woman’s period, such as fibroids. Like iron-deficiency anemia, uterine fibroids often don’t cause symptoms. They occur when muscular tumors grow in the uterus.

While they’re not usually cancerous, fibroids can cause heavy menstrual bleeding that can lead to iron-deficiency anemia.

A doctor can diagnose anemia with blood tests. These include:

Complete blood count (CBC) test

A complete blood count (CBC) is usually the first test a doctor will use. A CBC measures the amount of cellular or cell-related components in the blood, including:

• red blood cells (RBCs)
• white blood cells (WBCs)
• hemoglobin
• hematocrit
• platelets

A CBC provides information about your blood that’s helpful in diagnosing iron-deficiency anemia. This information includes:

• the hematocrit level, which is the percent of blood volume made up of RBCs
• the hemoglobin level
• the size of your RBCs

In iron-deficiency anemia, the hematocrit and hemoglobin levels are low. Also, RBCs are usually smaller in size than normal.

A CBC test is often performed as part of a routine physical examination. It’s a good indicator of a person’s overall health. It may also be performed routinely before a surgery. This test is useful to diagnose this type of anemia because most people who have an iron deficiency don’t realize it.

Other tests

Anemia can usually be confirmed with a CBC test. Your doctor might order additional blood tests to determine how severe your anemia is and help determine treatments. They may also examine your blood through a microscope. These blood tests will provide information, including:

• the iron level in your blood
• your RBC size and color (RBCs are pale if they’re deficient in iron)
• your ferritin level
• your total iron-binding capacity (TIBC)

Ferritin is a protein that helps with iron storage in your body. Low levels of ferritin indicate low iron storage. A TIBC test is used to reflect the amount of transferrin that’s carrying iron. Transferrin is a protein that transports iron.

Certain at-home test kits can check iron levels as well as ferritin levels and TIBC. You can buy a testing kit online through LetsGetChecked here.

Tests for internal bleeding

If your doctor is concerned that internal bleeding is causing your anemia, additional tests may be needed. One test you may have is a fecal occult test to look for blood in your feces. Blood in your feces may indicate bleeding in your intestine.

Your doctor may also perform an endoscopy, in which they use a small camera on a flexible tube to view the linings of your gastrointestinal tract. Here are the two types:

• An EGD test, also called an upper GI endoscopy, allows a doctor to examine the lining of the esophagus, stomach, and upper part of the small intestine.
• A colonoscopy, also called a lower GI endoscopy, allows a doctor to examine the lining of the colon, which is the lower portion of the large intestine.

These tests can help identify sources of gastrointestinal bleeding.

If you need help finding a primary care doctor, then check out our FindCare tool here.

Most cases of iron-deficiency anemia are mild and don’t cause complications. The condition can usually be corrected easily. However, if anemia or iron deficiency is left untreated, it can lead to other health problems. These include:

Rapid or irregular heartbeat

When you’re anemic, your heart has to pump more blood to make up for the low amount of oxygen. This can lead to an irregular heartbeat. In severe cases, it can lead to heart failure or an enlarged heart.

Pregnancy complications

In severe cases of iron deficiency, a child may be born prematurely or with a low birth weight. Most pregnant women take iron supplements as part of their prenatal care to prevent this from happening.

Delayed growth in infants and children

Infants and children who are severely deficient in iron may experience delayed growth and development. They may also be more prone to infections.

How your iron-deficiency anemia is treated will depend on how severe the problem is and what caused it in the first place. Most forms of this condition involve a lack of iron in your diet, or problems with your body absorbing the iron you do consume. Below are some options for treatment.

Iron supplements

Iron tablets can help restore iron levels in your body. If possible, you should take iron tablets on an empty stomach, which helps the body absorb them better. If they upset your stomach, you can take them with meals. You may need to take the supplements for several months. Iron supplements may cause constipation or black stools.

Diet

Diets that include the following foods can help treat or prevent iron deficiency:

• red meat
• dark green, leafy vegetables
• dried fruits
• nuts
• iron-fortified cereals

Additionally, vitamin C may help your body absorb iron. If you’re taking iron tablets, a doctor might suggest taking the tablets along with a source of vitamin C, such as a glass of orange juice or citrus fruit.

You may also need to consider things you eat or drink that can lower your iron levels or decrease absorption of iron, like black tea.

Treating the underlying cause of bleeding

Iron supplements won’t help as much if excess bleeding causes the deficiency. A doctor may prescribe birth control pills to women who have heavy periods. This can reduce the amount of menstrual bleeding each month.

If your bleeding is caused by an injury, tear, or other internal problem, surgery could be required to stop the bleeding.

In the most severe cases, a red blood cell transfusion or intravenous iron can replace iron and blood loss quickly.

When caused by inadequate iron intake, iron-deficiency anemia can be prevented by eating a diet high in iron-rich foods and vitamin C. Mothers should feed their babies breast milk or iron-fortified infant formula.

Iron-deficiency anemia is the most common type of anemia. It occurs when your body doesn’t have enough iron. Potential causes include not eating enough iron-rich foods, blood loss due to menstruation, and inability to absorb iron.

If you suspect you have an iron deficiency, see a doctor. They can diagnose anemia with blood tests.

Don’t try to diagnose and treat iron-deficiency anemia by yourself. You could end up with too much iron in your blood which can cause other health conditions, including constipation and even liver damage.

how to understand that you have an iron deficiency and how to diagnose it

Everyone knows how important it is to maintain a normal level of hemoglobin (a sufficient amount of iron in the body is needed). After all, it is iron in our body that is responsible for delivering oxygen to all organs and removing carbon dioxide from there. But how to understand if your hemoglobin is normal if you haven’t reached the doctor yet? Here are 10 symptoms to watch out for.

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Anemia or iron deficiency in the body is a condition in which the content of hemoglobin and red blood cells decreases in the blood. Anemia usually develops during pregnancy or is the result of a recent surgical intervention. Iron deficiency can also accompany oncology, as well as a number of chronic diseases, including diabetes, tuberculosis, kidney disease, HIV, and more. Signs of iron deficiency for various reasons are usually the same: fatigue, headache, weakness, frequent fainting, pale skin and leg cramps.

How to diagnose iron deficiency in the body

There are proven ways to diagnose iron deficiency in the body. If you are familiar with the above symptoms, this is a reason:

• to contact a therapist with complaints;
• take a clinical blood test to determine the level of hemoglobin, as well as the number, size and quality of red blood cells in the blood;
• take a biochemical blood test to determine the level of C-reactive protein, alanine aminotransferase, aspartate aminotransferase;
• take an analysis for the content of serum iron in the blood;
• test for the content of ferritin and transferrin in blood serum;
• if you suspect a lesion of the gastrointestinal tract, as prescribed by a doctor, do gastroscopy and colonoscopy;
• on the recommendation of a doctor to do an ultrasound of the abdominal organs;
• as prescribed by the doctor to do an ECG.

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Drowsiness

If you sleep for the usual number of hours, but feel more tired, if you start to feel sleepy during the day, if even on weekends, after sleeping, you do not feel a surge of strength – this is an alarming bell. Fatigue, weakness and drowsiness are one of the main signs of iron deficiency in women, men and children.

Concentration problems

What other signs of iron deficiency are there? Of course, distraction. Did you carefully read the recipe, go to the refrigerator to get the right products, and realize that you don’t remember half of the list? Do you often find yourself in a colleague’s office but forgot what you wanted to ask? You watch a movie, but after half an hour you can’t tell your friend what it’s about? Run to the doctor – perhaps this is anemia!

Geophagy

This incomprehensible word means a recurring irresistible desire to immediately devour something inedible. Chalk, earth, sand – it doesn’t matter. If you are not pregnant (in this state, such things are within the normal range), then such a strange need may be a sign of a lack of iron in the body.

Shortness of breath

Caught up with the bus, and then for half an hour could not breathe, swallowed air, felt dizzy? Your organs just don’t have enough oxygen! Shortness of breath can also be one of the signs of iron deficiency during pregnancy.

Very pale skin

White patches of skin are perhaps not the most obvious sign of iron deficiency in men and women. Aristocratic pallor is fashionable, and then there are naturally white people. Checking if there is any danger here is simple: if after exercising in the gym or after any other physical activity your cheeks turn red, everything is in order. And if you remain marble-white – sound the alarm.

Unexplained muscle pain

Surely you are familiar with the pain that occurs after a more intense exercise. But when these pains occur “out of the blue”, this may well be a sign of a lack of iron in the body. So if you spent the whole day lying on the couch, and in the morning you feel like you were unloading trucks, take a blood test.

Brittle nails

Even the most stylish manicure will not help hide thin, brittle nails if you have a lack of iron in your body. It is quite dangerous if you notice depressions and spoon-shaped depressions on your nails. This is already a completely obvious symptom of iron deficiency anemia

Frequent infections

A symptom of iron deficiency in a woman, man or child can be frequent colds. So stop blaming a colleague who turns on the air conditioner and check your health!

Restless Leg Syndrome

If you cannot sit still at the table, but constantly shift one leg to the other and back, twist them into a rope, rearrange them closer and further, think about it: this is one of the signs of iron deficiency in the body!

Cold hands and feet

What other signs of iron deficiency should I look out for? On constantly cold hands and feet. It’s hot outside, but you still have icy hands? Can’t sleep because you can’t get warm? This shouldn’t be!

Attention! Some signs of iron deficiency in the human body can be carefully masked. For example, if you smoke, your iron is almost always normal or even elevated. The reason is simple: the body, suffering from smoke, increases the production of hemoglobin. But this does not mean that everything is in order! When meeting with nicotine, hemoglobin cells deteriorate and can no longer transport oxygen. But a blood test is not able to distinguish a working hemoglobin molecule from a non-working one, so there may be an increased level of hemoglobin in it, but in fact you do not have enough of it! So be sure to tell your doctor that you smoke. I mean, you’re quitting already, right?

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An expert told how to recognize iron deficiency in the body and what it leads to Thematic applications

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05. 05.2022 16:08

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Irina Nevinnaya

Brittle nails, dull hair, muscle weakness and fatigue – we often write off all these spring troubles to fatigue and vitamin deficiencies and rarely take action, hoping that the coming summer and future vacation will correct the situation. Still, it’s better not to let go of the problem, hoping that it will “go away on its own,” since the listed (as well as some other) symptoms may indicate iron deficiency anemia, and it must be treated,” an expert from the CMD Center for Molecular Diagnostics of the Central Research Institute of Epidemiology told Rossiyskaya Gazeta. Rospotrebnadzor Ekaterina Antipova.

How does iron deficiency manifest itself?

The clinical picture of iron deficiency is due to a lack of iron in the tissues. The activity of many enzymatic systems of the body decreases (sideropenic syndrome), tissues are not provided with oxygen in sufficient quantities (asthenic syndrome). As a result, a person experiences discomfort, his well-being noticeably worsens.

Asthenia is indicated by symptoms such as muscle weakness, fatigue, drowsiness, headaches and dizziness, efficiency decreases – not only the tolerance for physical activity and performance worsens, patients complain of a decrease in attention, learning ability. They come to the doctor and say: “Nothing hurts me, but I have no strength for anything.”

One has to look for the cause and pay attention to more specific symptoms: pallor of the skin and mucous membranes, for example.

And sideropenic syndrome is characterized by such signs as dry skin, a tendency to form cracks and “seizes” in the corners of the mouth, pigmentation of the color of coffee with milk. Nails become soft and brittle, sometimes transverse striation occurs. Some patients have very specific manifestations: for example, a person says that he began to like the “chemical” smells of varnish, paint, acetone, and even car exhaust. Or he is irresistibly drawn to gnaw chalk or coal (this happens in pregnant women). Another unusual symptom is the effect of “blue sclera” (with a lack of iron, collagen synthesis in the sclera is disturbed, they become thinner and acquire a bluish tint).

In a word, there are so many symptoms that, of course, you need to understand them with a doctor. I note that the pronounced symptoms of iron deficiency appear only after the depletion of its reserves in the body, and this, of course, requires immediate action.

But since there are so many symptoms, how to confirm that it is iron deficiency?

Of course, with the help of laboratory tests. The first screening test that your doctor will definitely prescribe is a complete blood count. Based on its results, we can evaluate the level of hemoglobin, hematocrit, the concentration of hemoglobin in erythrocytes (with iron deficiency anemia, these indicators are usually reduced), as well as the number and average volume of erythrocytes.

If suspicions of anemia are confirmed, more detailed studies will be required: serum ferritin (the main form for storing iron in the body), transferrin (the main iron transporter), serum iron and some other tests.

Why does iron deficiency occur? Who is at risk?

Iron deficiency anemia is one of the most common diseases in the world. At risk are pregnant women, women after childbirth and during breastfeeding, as well as young children. Since it is these periods of life that are considered the most “iron-consuming”, they require more attention and control.

But the causes of iron deficiency may be different: for example, due to blood loss (gastrointestinal bleeding, blood loss during menstruation and childbirth, and even in some cases, constant blood donation. In addition, in some diseases of the stomach and intestines, iron absorption is impaired – it is worse absorbed.Finally, the banal reason is insufficient intake of iron with food, which happens in vegetarians.

In any case, iron deficiency sooner or later makes itself felt.Only by understanding its cause, we can fully help the body.

How to increase the level of iron in the body?

The main ways are to increase the intake of iron with food, take iron supplements orally (that is, through the mouth) or parenterally (through intravenous infusions – droppers). In especially severe cases, hemotransfusion (blood transfusion) is possible.

The WHO recommendation is that the optimal dose of iron for the treatment of iron deficiency anemia is 120 mg daily. In children, the dose depends on age: from 3 mg / kg per day in children under three years old, up to 45-60 mg per day in three-year-olds and older.

It is important to understand: the doctor calculates the individual dose of drugs and the duration of treatment.

By the way, there is scientific evidence that treatment with low doses of iron supplements and short courses (2 weeks per month) is more effective and easier to tolerate than a more intensive course when high doses of drugs are taken several times a day.

Speaking of iron medicines, it is worth mentioning the existence of two groups of drugs – those containing ferrous and ferric iron. More than one study has been conducted comparing these groups, and ultimately the experts tend to conclude that there is no significant difference between them.

I will only note that ferric iron preparations are easier to tolerate, as they have a more pleasant taste, so they are more often prescribed to children and adolescents.

Should I take iron supplements?

All dietary supplements (as well as iron supplements) should only be taken as directed by a physician. Independent, uncontrolled intake can lead to complications. This is due to the fact that with violations of iron metabolism, it may not be absorbed and deposited in various organs and tissues.

Very often we treat “biological supplements” lightly, meaning something “useful”, but not affecting the body as a medicine, and therefore we allow them to be taken without prior testing and consultation with a specialist. You can’t do that.

Is it possible to do without drug therapy by simply adjusting the diet?

The problem of iron deficiency is most often a nutritional problem. So the answer is yes, in most cases you can improve the situation by providing adequate, balanced nutrition.

The daily iron requirement for an adult is about 1-2 mg, for a child – 0.5-1.2 mg. A typical daily diet provides 5 to 15 mg of iron per day. In the intestines, only 10-15% of the iron supplied with food is absorbed.

The most iron-rich foods of animal origin: beef, lamb, liver, fish, cottage cheese, chicken meat. They contain heme (bivalent) iron, which is well absorbed. Iron from plant products (cereals, vegetables, fruits) is non-heme (trivalent), it is absorbed worse. Therefore, we must take care that animal food is on our table in sufficient quantities.

By the way, ascorbic acid (vitamin C) and folic acid can increase the bioavailability of iron from plant foods. They form a soluble compound with iron, which is well absorbed in the gastrointestinal tract.

Also, for a balanced diet, including pregnant women, it is necessary to have a sufficient amount of proteins, fats, carbohydrates, vitamins, micro- and macroelements in the diet.

Nutrition plays an important role in the fight against iron deficiency.