You Don’t Have to be Anemic to be Iron Deficient

Jan 13, 2022 | Health Conditions

Iron Deficiency is One of the Most Common Nutrient Deficencies in Women  

Iron deficiency anemia currently affects 1.2 billion people. Iron deficiency occurs before iron deficiency anemia, and it is at least twice as common. Iron deficiency is when there are low stores of iron that do not meet the body’s requirements without affecting red blood cells. Once the red blood cells are affected it becomes anemia. Iron deficiency is poorly recognized by western medicine practices because of suboptimal reference ranges and the guidelines around lab testing.

 

Why is Iron so Important?

Iron is an essential mineral needed for many vital functions in the body. Iron is needed to make hemoglobin, the oxygen carrier in red blood cells, that transport oxygen from your lungs to all other tissues and organs. Without enough iron, your body will not receive the oxygen it needs to function properly. Iron is also a cofactor for many enzymes including enzymes needed for mitochondrial function.

  

Symptoms of Iron Deficiency

Iron deficiency can be subtle, and symptoms can worsen over time. Most of the time iron deficiency is not treated until an individual becomes anemic. Symptoms of iron deficiency include:

  • Fatigue
  • Irritability
  • Dizziness
  • Headaches
  • Trouble concentrating
  • Brittle nails
  • Restless legs syndrome
  • Hair loss
  • Pale skin
  • Short attention span
  • Shortness of breath
  • Cold hands and feet
  • Rapid heartbeat
  • Poor appetite
  • Difficulty exercising

These symptoms can be caused by other health conditions as well, so it is important to get the right diagnosis before initiating treatment.

Diagnosis of Iron Deficiency

Lab testing is the best way to assess for iron deficiency and iron deficiency anemia. CBC and ferritin are the most common lab tests run to assess iron stores. However, ferritin can be falsely elevated with certain conditions and in some cases, does not provide the whole picture. If this is the case, an iron panel can be run to directly test iron levels in the body. The CBC will used to determine if anemia is present.

 

 

What Causes Iron Deficiency?

  1. Increased Need for Iron
    • Children and pregnant women tend to require higher amounts of iron because there is extra demand for oxygen and red blood cells to facilitate growth. Athletes also have an increased need for iron.
  2. Blood Loss
    • With blood loss comes loss of iron. Losing blood can be due to heavy menstrual flow, regular donation of blood, or internal bleeding.
  3. Decreased Intake
    • Iron levels can be low because an individual is not consuming enough iron in their diet. Vegan and vegetarian diets are typically low in iron.
  4. Reduced Ability to Absorb Iron
    • Those with H. pylori or low stomach acid will not be able to absorb iron as well because gastric acid is needed to convert iron into its more absorbable form. This is also the case with chronic use of antacid and acid blocking medication.
    • Medical conditions affecting the intestines like Celiac disease or IBD (crohn’s and colitis) reduce the absorption of iron due to damaged mucosa, villus atrophy, chronic inflammation, and upregulation of hepcidin.
    • Many other nutrients like calcium, polyphenols, and phytates inhibit iron absorption making it even more difficult to increase iron stores. Certain medications also decrease iron absorption.
    • Dysbiosis or bacteria overgrowth can reduce the amount available to be absorbed because the bacteria feed on the iron.

 

Treatment & Prevention 

If you are experiencing any of the above symptoms, or you know of a reason why your iron might be low (diet, health conditions, medications etc.), getting routine blood work allows you to see and track your iron levels.

Finding out why you are iron deficient is key to preventing further blood or iron loss. Once this is determined and addressed, the most common treatment is to supplement with iron. There are two common forms of iron, heme and nonheme iron. Some forms are more easily absorbed than others and oral consumption of certain forms has been associated with gastrointestinal side effects.

Those at greater risk for iron deficiency should talk to their naturopathic doctor or functional medicine practitioner to see if further support is warranted. Your practitioner will monitor your iron levels through lab work to ensure iron levels do not become too high.  

Even if you are not anemic, correction of an iron deficiency will improve symptoms.

 

If you experience any of the symptoms and are looking to get test your iron levels, please book a consultation here. 

 

 

References:

1. Al-Naseem A, Sallam A, Choudhury S, Thachil J. Iron deficiency without anaemia: a diagnosis that matters. Clin Med. 2021;21(2):107-113. doi:10.7861/clinmed.2020-0582

  1. 2. Coates A, Mountjoy M, Burr J: Incidence of iron deficiency and iron deficient anemia in elite runners and triathletes. Clin J Sport Med 27:493–4986, 2017. doi: 10.1097/JSM.0000000000000390