Inside each of our red blood cells is an iron-containing protein called hemoglobin. Iron is the crucial component of hemoglobin, as it is what binds oxygen from the lungs, carries it through the bloodstream to every cell in the body. Our cells use this oxygen to make the energy we need to do every single action in the body; from making hormones, to maintaining our immune system, to wiggling our toes.
Iron deficiency is the most common nutrient deficiency in the world. It is diagnosed when there are insufficient stores of iron to meet the body’s iron requirements. Iron deficiency occurs in people who consume a diet low in iron, in people who have difficulty absorbing iron, through blood loss, and with increased iron demand. For these reasons, the highest risk of deficiency is seen in vegans, vegetarians, people on acid-blocking medications or with digestive conditions, women with heavy periods, and during pregnancy and breastfeeding.
To determine your iron status, we measure something called ferritin in the blood. Normal adult ferritin is defined as falling within the broad range of 5-272 ug/L, but iron deficiency can be diagnosed when ferritin falls below 30 ug/L. However, research shows ferritin is optimal at 70-100 ug/L, as we see improvement of associated symptoms when with supplementation up to this ferritin level.
Prolonged or severe iron deficiency reduces our ability to make hemoglobin, and this can lead to iron deficiency anemia, which is defined as having a haemoglobin of <120g/L in women and <130g/L in men. Iron deficiency does not always cause anemia, but low iron does warrant treatment prior to progressing to anemia.
Symptoms of iron deficiency and anemia are largely the same, with anemia being more severe. Fatigue is the most common sign, but other symptoms such as poor memory and concentration, depression, headaches, hair loss in women, and a weak immune system also occur with insufficient iron. In children, iron deficiency can present as poor cognitive development, behavioural concerns, and ADHD.
Iron in Pregnancy
Iron requirements increase substantially during pregnancy. Maternal blood volume increases significantly to provide the energy needed for a baby’s growth and development in utero, and this requires extra iron.
It is crucial to optimize iron during pregnancy and breastfeeding. Maternal iron deficiency anemia increases the risk of poor pregnancy outcomes, including premature delivery and low birth weight, and during breastfeeding it increases the risk of postpartum depression and early breastfeeding cessation.
Health Canada recommends taking 20mg of iron daily throughout pregnancy, and this dose can be adjusted based on ferritin and hemoglobin levels. Dr. Hilary suggests that iron should be supplemented throughout both pregnancy and breastfeeding, with regular lab testing to ensure safety and adjust the dose of a supplement according to each individual’s needs.
Treating Iron Deficiency
Iron deficiency can be improved with dietary changes, but it most often requires supplementation.
Liquid iron supplements are typically well-tolerated, gentle on digestion, and effective for raising iron levels. The dose of a liquid supplement can be easily adjusted when needed, and liquids are more well-absorbed than capsules, which can be challenging for some people to break down.
Ferrous gluconate is specific type of iron found in both liquid and tablets that does not cause constipation or indigestion. Iron tablets are an excellent alternative option for patients who are on-the-go, or who find a liquid supplement challenging to fit into their daily routine.
Iron supplements that contain B vitamins, food sources of vitamin C such as citrus and berries, and antioxidants such as beetroot and spinach, provide a well-rounded and effective approach to treating iron deficiency.
Dr. Hilary’s Lifestyle changes to support healthy iron levels
Focus on iron-rich foods, including meat, fish, dark leafy greens, brown rice, beans, nuts and seeds and iron-fortified cereals.
Avoid consuming foods that block iron absorption within two hours of an iron supplement or eating iron-rich foods. These include black tea, coffee, cocoa, and calcium-rich foods such as dairy, almonds, and broccoli.
Increase foods that boost iron absorption, including foods high in vitamin C and beta carotene. These vitamins are found in yellow, orange and red fruits and vegetables, such as grapefruit, oranges, bell peppers, beets, carrots, squash and tomatoes.
Talk to your doctor if you are taking acid blocking medications (proton pump inhibitors, antacids), as they impair iron absorption.
Heal the gut lining to improve absorption of iron in the small intestine.
Ask for annual blood work to test your ferritin level and other iron markers when warranted. Aim for an optimal ferritin level of 70-100 ug/L.
Optimal iron status is essential to our overall wellness. Regular lab testing allows us to adjust the diet and supplements to achieve and maintain healthy levels. If you are taking a supplement, choose one that provides an easily absorbed, gentle combination of iron, B vitamins, and nutrient-rich food extracts to enhance the absorption, digestion, and effects of iron in the body. Liquid iron supplements provide well-rounded solution for optimizing iron levels to improve energy and overall health.
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