Why Is My Iron Low? Understanding Iron Deficiency and What To Do

Feeling constantly tired, weak, or looking paler than usual? You might be experiencing the effects of low iron. Iron is a vital mineral that plays a crucial role in numerous bodily functions, and iron deficiency is surprisingly common, affecting around one-third of the global population. Understanding why your iron might be low is the first step towards addressing it and restoring your health and energy levels.

This comprehensive guide will explore the essential role of iron in your body, delve into the common causes of iron deficiency, outline the symptoms to watch out for, and discuss effective strategies for prevention and treatment. Whether you suspect you might be iron deficient or simply want to learn more about this important nutrient, this article will provide you with the information you need.

The Vital Roles of Iron in Your Body

Iron is far more than just a mineral; it’s a workhorse nutrient involved in keeping your body functioning at its best. Here are some of its key roles:

• Oxygen Transport: This is arguably iron’s most well-known function. Iron is a core component of hemoglobin, a protein found in red blood cells. Hemoglobin is responsible for picking up oxygen in your lungs and transporting it throughout your body to every cell, tissue, and organ. Without sufficient iron, your body can’t produce enough hemoglobin, leading to reduced oxygen delivery.

• Muscle Function (Myoglobin): Similar to hemoglobin, myoglobin is another protein that contains iron. However, myoglobin is found in muscle cells and its primary role is to store oxygen locally within the muscles. This stored oxygen is readily available for use during physical activity and muscle contraction. Myoglobin also contributes to the reddish color of muscle tissue.

• Energy Production: Iron is essential for numerous enzymes involved in energy production within your cells. These enzymes act as catalysts in various metabolic processes that convert food into usable energy. Iron deficiency can impair these enzymatic reactions, leading to fatigue and low energy levels.

• Immune System Support: A healthy immune system relies on adequate iron levels to function optimally. Iron is involved in the growth and activity of immune cells, helping your body fight off infections and illnesses effectively. Iron deficiency can weaken the immune system, making you more susceptible to infections.

A platter of food containing apricots, peanuts, broccoli and other forods.

Alt text: A vibrant platter showcasing iron-rich foods including dried apricots, peanuts, broccoli florets, and other nutritious whole foods, emphasizing dietary sources for increasing iron intake.

How Much Iron Do You Need? Recommended Daily Intake

The amount of iron your body needs daily isn’t a one-size-fits-all number. It varies based on age, sex, and life stage. The Recommended Dietary Intake (RDI) is designed to meet the needs of most healthy individuals within each group. It’s important to note that the RDI reflects the amount of iron you need to absorb, not necessarily the amount you need to consume. Your body only absorbs a fraction of the iron present in food.

Here’s a breakdown of the Australian recommended daily iron intake, which provides a good general guideline:

Note: Iron in breast milk is highly absorbable, while formula iron is less so, hence the higher iron content in infant formulas.

Dietary Sources of Iron: Haem vs. Non-Haem Iron

The iron in your diet comes in two main forms, which differ in their sources and how easily your body absorbs them:

• Haem Iron: This type of iron is found exclusively in animal tissues such as:

  • Red meat (beef, lamb, kangaroo)
  • Poultry (chicken, turkey)
  • Fish and seafood
  • Organ meats (liver, kidney) – consume in moderation, especially during pregnancy due to high vitamin A content.

  Haem iron is significantly more bioavailable, meaning your body absorbs it much more efficiently (around 15-35%) compared to non-haem iron.

• Non-Haem Iron: This type of iron is present in both animal and plant-based foods, including:

  • Animal products: Eggs, dairy (in smaller amounts)
  • Plant-based sources:
    • Legumes (lentils, beans, chickpeas)
    • Dark leafy green vegetables (spinach, broccoli)
    • Iron-fortified cereals and grains
    • Nuts and seeds
    • Dried fruits (raisins, apricots, prunes)

  Non-haem iron is less readily absorbed by the body (typically 2-20% absorption rate) and its absorption can be influenced by other dietary factors. Vegetarians and vegans need to pay close attention to their non-haem iron intake and strategies to enhance absorption.

Optimizing Iron Absorption from Your Diet

Simply eating iron-rich foods isn’t always enough. Several factors can influence how much iron your body actually absorbs. Here’s how to maximize iron absorption and what to be mindful of:

Foods and Practices That Enhance Iron Absorption:

• Vitamin C: Consuming vitamin C-rich foods alongside non-haem iron sources significantly boosts absorption. Vitamin C converts non-haem iron into a more absorbable form. Good sources include:

  • Fruits: Oranges, lemons, strawberries, kiwi, berries
  • Vegetables: Capsicum (bell peppers), broccoli, tomatoes, cabbage

• Pairing Haem and Non-Haem Iron: Including even a small amount of haem iron (meat, poultry, fish) in a meal with non-haem iron sources can enhance the absorption of the non-haem iron. For example, adding some beef to a lentil stew.

• Cooking Plant-Based Iron Sources: Cooking vegetables generally increases the bioavailability of non-haem iron. For instance, cooked spinach provides more absorbable iron than raw spinach.

Foods and Practices That Inhibit Iron Absorption:

• Soy Proteins: Soy products can reduce non-haem iron absorption.

• Tannins in Tea, Coffee, and Wine: These beverages contain tannins that bind to iron in the digestive tract, hindering its absorption. It’s best to avoid drinking tea, coffee, or wine with meals, especially those rich in iron.

• Phytates and Fibres in Wholegrains: Phytates, found in wholegrains, legumes, nuts, and seeds, and high fiber intake can also reduce iron absorption. Soaking or fermenting grains and legumes can help reduce phytate content.

• Calcium and Phosphorus: High intakes of calcium and phosphorus, particularly from dairy products, can interfere with non-haem iron absorption. It’s advisable to consume dairy products at different times from iron-rich meals, if possible.

• Vitamin A Deficiency: Adequate vitamin A is needed to help release stored iron in your body. A deficiency in vitamin A can indirectly contribute to iron deficiency.

Why Is My Iron Low? Common Causes of Iron Deficiency

Understanding the reasons behind low iron levels is crucial for effective management. Iron deficiency can develop due to a variety of factors, often a combination of several.

Stages of Iron Deficiency:

Iron deficiency progresses through stages:

• Iron Depletion: This is the initial stage where your body’s stored iron levels are decreasing, but hemoglobin levels are still normal. Often, there are no noticeable symptoms at this stage.

• Iron Deficiency: Iron stores become significantly depleted, and hemoglobin production starts to decline, leading to lower than normal hemoglobin levels. Symptoms like fatigue may begin to appear.

• Iron Deficiency Anemia: This is the most severe stage, characterized by very low hemoglobin levels, meaning your blood can’t carry enough oxygen to your body’s tissues. Symptoms become more pronounced and can significantly impact daily life.

Symptoms of Iron Deficiency Anemia:

Symptoms can vary in severity depending on the stage of deficiency, but common signs include:

• Fatigue and Weakness: Persistent tiredness and lack of energy are hallmark symptoms.
• Pale Skin: Reduced hemoglobin levels can cause noticeable paleness, especially in the face, gums, and inner eyelids.
• Shortness of Breath: Oxygen deficiency can lead to breathlessness, particularly during exertion.
• Dizziness and Lightheadedness: Insufficient oxygen to the brain can cause dizziness and lightheadedness.
• Headaches: Frequent headaches can be associated with iron deficiency.
• Cold Hands and Feet: Poor circulation due to reduced oxygen delivery can result in cold extremities.
• Brittle Nails: Nails may become thin, brittle, or spoon-shaped (koilonychia).
• Pica: Unusual cravings for non-food items like dirt, ice, or clay.
• Restless Legs Syndrome: An uncomfortable urge to move the legs, especially at night.
• Poor Appetite (especially in children): Iron deficiency can affect appetite.
• Increased Susceptibility to Infections: A weakened immune system makes you more prone to getting sick.
• Behavioral Problems (in children): Irritability, difficulty concentrating, and developmental delays.
• Delayed Growth and Development (in children): Iron is crucial for growth.

Causes of Iron Deficiency in Adults:

• Inadequate Dietary Iron Intake: This is a primary cause, especially for individuals following restrictive diets, vegetarians/vegans who don’t plan their meals carefully, or those with limited access to diverse, nutrient-rich foods. Chronic fad dieting can also contribute.

• Blood Loss: Chronic blood loss is a significant cause of iron deficiency. Common sources include:

  • Heavy menstrual periods (menorrhagia) in women.
  • Regular blood donation.
  • Frequent nosebleeds.
  • Gastrointestinal bleeding from ulcers, polyps, hemorrhoids, or cancers in the colon or stomach.
  • Certain medications like aspirin and non-steroidal anti-inflammatory drugs (NSAIDs) can increase the risk of gastrointestinal bleeding.

• Increased Iron Needs: Certain life stages increase iron requirements:

  • Pregnancy: The growing fetus and placenta demand significant iron.
  • Breastfeeding: Iron is transferred to breast milk.

• Exercise: Athletes, especially endurance athletes, are at higher risk due to:

  • Increased red blood cell production to support higher oxygen demand.
  • Iron loss through sweat.
  • Foot strike hemolysis (red blood cell breakdown from repetitive impact).

• Malabsorption: Conditions that impair iron absorption in the gut can lead to deficiency:

  • Celiac disease
  • Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
  • Bariatric surgery

Causes of Iron Deficiency in Babies, Children, and Young People:

Children are particularly vulnerable to iron deficiency due to their rapid growth and development. Key risk factors include:

• Prematurity and Low Birth Weight: Premature babies have lower iron stores at birth.
• Exclusive Breastfeeding Beyond 6 Months Without Iron-Rich Solids: Breast milk iron stores deplete around 6 months, and solid foods should be introduced to meet iron needs.
• High Cow’s Milk Intake in Young Children (<2 years): Cow’s milk is low in iron and can interfere with iron absorption. It can also contribute to blood loss in the gut in some infants.
• Low or No Meat Intake: Children who don’t consume meat may be at risk if their overall diet isn’t carefully planned to include other iron sources.
• Vegetarian and Vegan Diets: Require careful planning to ensure adequate iron intake from plant sources and to optimize absorption.
• Poor Diet in the Second Year of Life: Toddlers can become picky eaters, leading to inadequate iron intake.
• Gastrointestinal Diseases: Conditions like celiac disease can impair iron absorption.
• Lead Poisoning: Lead can interfere with iron absorption and red blood cell production.

Age-Specific Causes in Children:

• Babies < 6 months: Maternal iron status during pregnancy is crucial for fetal iron stores. Low birth weight and prematurity are major risk factors.
• Babies 6 months – 1 year: Iron stores deplete, and inadequate iron-rich solid food introduction is a common cause.
• Children 1-5 years: Prolonged breastfeeding without sufficient iron-rich solids and high cow’s milk intake can contribute.
• Teenagers: Rapid growth spurts, menstruation in girls, and fad dieting increase iron needs and risk of deficiency.

Preventing Iron Deficiency: Strategies for All Ages

Preventing iron deficiency is often easier than treating it. Adopting these strategies can help maintain healthy iron levels:

Prevention in Babies:

• Maternal Iron-Rich Diet During Pregnancy: Ensure adequate iron intake during pregnancy to build up baby’s iron stores.
• Iron Testing During Pregnancy: Routine screening for anemia during pregnancy is important.
• Breastfeeding or Iron-Fortified Formula: Breast milk is ideal, but if formula feeding, choose iron-fortified options.
• Avoid Cow’s Milk Before 12 Months: Delay cow’s milk and other fluids that can displace iron-rich foods.
• Timely Introduction of Solids (Around 6 Months): Start with iron-fortified infant cereal and pureed meats as first foods.

Prevention in Young Children:

• Include Lean Red Meat or Alternatives: Offer iron-rich foods like lean red meat 3-4 times per week, or alternatives like poultry, fish, eggs, legumes, nuts, and seeds.
• Vitamin C-Rich Foods: Serve vitamin C-rich fruits and vegetables at meals to enhance iron absorption.
• Encourage Solid Foods at Mealtimes: Limit sugary drinks and excessive milk intake that can fill up toddlers and reduce appetite for iron-rich foods.
• Address Diarrhea and Parasites: Promptly treat diarrhea and intestinal parasites, which can deplete iron stores.
• Manage Fussy Eating: Seek advice from a dietitian or healthcare provider for strategies to manage fussy eating and ensure adequate nutrient intake.

Prevention in Teenagers:

• Educate About Iron Importance: Talk to teenagers about why iron is crucial for their health and energy.
• Encourage Iron-Rich Foods: Promote iron-rich breakfast cereals, breads, and include meat, poultry, or fish in evening meals.
• Non-Haem Iron Sources for Vegetarians: If vegetarian, emphasize legumes, dark leafy greens, fortified foods, and pairing with vitamin C.
• Moderate Tea and Coffee Intake: Limit tea and coffee, especially with meals.

Diagnosing Iron Deficiency: When to See a Doctor

If you suspect you or your child might be iron deficient, it’s essential to consult a doctor for proper diagnosis and management. Don’t self-diagnose or self-treat with iron supplements without medical advice.

Diagnosis typically involves:

• Physical Examination: Doctor will check for signs of paleness, brittle nails, etc.
• Medical History: Discussing your symptoms, diet, menstrual history (for women), and any risk factors.
• Blood Tests: Blood tests are crucial to confirm iron deficiency and assess its severity. Common tests include:
  • Hemoglobin and Hematocrit: Measure red blood cell levels.
  • Serum Ferritin: Measures stored iron levels.
  • Serum Iron and Transferrin Saturation: Assess iron circulating in the blood.
  • Total Iron Binding Capacity (TIBC): Measures the blood’s capacity to carry iron.

Treating Iron Deficiency: Restoring Healthy Iron Levels

Treatment for iron deficiency depends on the stage and underlying cause.

• Iron Depletion: Dietary advice to increase iron-rich foods is usually sufficient. Follow-up blood tests are needed to monitor progress.

• Iron Deficiency: Dietary changes are crucial, along with close monitoring of iron status. Your doctor may recommend iron supplements if diet alone isn’t enough. Foods and drinks that hinder iron absorption should be limited with meals.

• Iron Deficiency Anemia: Iron supplements are typically prescribed to replenish iron stores quickly. It may take several months to a year to fully restore iron levels. Regular blood tests are necessary to monitor progress and adjust treatment.

• Addressing Underlying Causes: It’s vital to identify and treat the root cause of iron deficiency, such as heavy menstrual bleeding, gastrointestinal bleeding, or malabsorption issues.

The Risks of Self-Treating Iron Deficiency

While iron supplements are available over-the-counter, self-treating iron deficiency is strongly discouraged due to potential risks:

• Iron Overload (Toxicity): Excessive iron can be toxic and even fatal, especially in children.
• Misdiagnosis: Symptoms of iron deficiency anemia can mimic other serious health conditions. Self-treating can delay proper diagnosis and treatment of the actual underlying problem.
• Ineffective Treatment: If iron deficiency isn’t the cause of your symptoms, supplements won’t help and you’ll waste money.
• Mineral Imbalances: Unnecessary iron supplementation can interfere with the absorption of other essential minerals like zinc and copper.
• Haemochromatosis Risk: In individuals with hemochromatosis (a genetic condition causing iron overload), iron supplements can be dangerous.

Iron Supplement Safety:

• Keep Iron Supplements Out of Reach of Children: Iron tablets can look like candy and are highly toxic to children. Overdose is a medical emergency.
• Seek Immediate Medical Help for Suspected Overdose: Contact poison control or go to the emergency room immediately if you suspect an iron overdose.

Iron Supplements: What You Need to Know

If your doctor prescribes iron supplements, keep these points in mind:

• Common Side Effects:
  • Dark or black stools (normal and harmless).
  • Nausea, vomiting, constipation, or diarrhea (less common). If side effects are bothersome, talk to your doctor. They may adjust the dose or recommend taking supplements with food (although food can slightly reduce absorption).
• Take on an Empty Stomach (If Tolerated): Iron is best absorbed on an empty stomach. However, if you experience stomach upset, you can take it with a small amount of food. Avoid taking it with dairy, tea, or coffee.
• Follow Doctor’s Instructions: Take supplements exactly as prescribed and for the duration recommended by your doctor. Don’t exceed the recommended dose.

Where to Get Help

If you are concerned about iron deficiency, please consult your doctor for diagnosis and personalized advice. They can assess your iron status, identify any underlying causes, and recommend the most appropriate course of action.

In Conclusion:

Understanding why your iron might be low is the first step towards regaining your energy and well-being. By recognizing the importance of iron, being aware of the causes and symptoms of deficiency, and adopting preventive dietary strategies, you can take proactive steps to maintain healthy iron levels. Always consult with a healthcare professional for diagnosis and treatment to ensure safe and effective management of iron deficiency.