Think you’re low on iron? Here’s what to do about it

Iron deficiency anemia is the most common nutrient deficiency in the world, with women and young children being the most affected.

Because iron is needed for many different functions in the body, deficiency symptoms can vary from individual to individual. The most common sign, however, is fatigue – even a slight drop in iron stores can make you feel lethargic and weak.

Here’s what to know about iron deficiency anemia – how to identify and treat it, as well as dietary strategies to maintain healthy iron stores.

Why do you need iron

Your body uses iron to make hemoglobin, a protein in red blood cells that carries oxygen from your lungs to your organs and other body tissues. Without adequate iron, your body cannot produce enough oxygen-carrying hemoglobin, which can make you feel tired and short of breath.

Iron is also needed to maintain skin, hair and nails, make hormones and connective tissue, and support the proper functioning of muscles and nerves. And the mineral plays a role in brain function and a healthy immune system.

Signs of iron deficiency anemia

Fatigue, fatigue with exertion, and dizziness are common signs of iron deficiency anemia. Pale skin, headaches, hair loss, brittle nails, and cold feet and hands can also occur.

Difficulty concentrating, irritability and increased susceptibility to infections are other signs of depleted iron stores. If left untreated, iron deficiency can also lead to low mood.

Iron deficiency is not always easy to identify. Some symptoms are those that you might attribute to a hectic lifestyle, stress, or lack of sleep. Also, keep in mind that signs of low iron can be caused by other health issues.

For these reasons, if you suspect you have low iron levels, see your doctor for a proper diagnosis.

Who is at risk?

Pregnancy increases iron requirements, creating an increased risk of iron deficiency anemia (this is also the case for infants and young children who grow rapidly). Menstruation also increases the risk of iron deficiency.

Vegetarians, vegans, and others whose diets don’t include many iron-rich foods can, over time, develop iron deficiency.

Gastrointestinal disorders that interfere with the body’s ability to absorb iron, such as celiac disease and inflammatory bowel disease, can lead to iron deficiency. Medications that reduce stomach acid can also suppress iron absorption.

Diagnose iron deficiency

Iron deficiency progresses in stages. Mild iron deficiency occurs when iron stores in the body, measured by a ferritin blood test, are depleted. Ferritin is a protein inside cells that stores iron.

Low ferritin indicates low iron stores and iron deficiency; you may or may not have anemia.

Iron deficiency anemia occurs when iron stores are depleted and hemoglobin decreases. It is diagnosed by a complete blood count (CBC), a test that measures the amount of hemoglobin. A low hemoglobin level indicates iron deficiency anemia.

Treat iron deficiency

Iron supplements containing 100 to 150 mg of elemental iron are needed to treat iron deficiency anemia; generally, diet alone or multivitamins cannot replenish iron stores. Elemental iron is the amount of iron in the supplement that is available for absorption; it is marked on the label.

Supplements containing “ferrous” forms of iron are often used to treat a deficiency. Higher doses of ferrous iron can cause stomach upset and constipation; other forms, such as polysaccharide-iron complexes, have fewer gastrointestinal side effects.

For mild iron deficiency, a low dose iron supplement (20 to 30 mg) may be sufficient to replenish iron stores.

Iron is best absorbed when taken on an empty stomach, two hours before or four hours after a meal. Taking iron with vitamin C — a glass of orange juice or a 250 mg vitamin C supplement — can also improve absorption. If you take a calcium supplement, take iron at another time of the day.

Once your doctor determines that your iron stores are replenished, which may take several months, high-dose iron supplements should be discontinued.

How to maintain your iron stores

Include iron-rich foods in your daily diet. Iron-rich pet foods, which contain highly absorbable “heme” iron, include lean beef, clams, oysters, mussels and sardines.

Plant foods contain “non-heme”, which is less well absorbed. Foods rich in this type of iron include navy beans, lentils, kidney beans, chickpeas, lima beans, cooked spinach, edamame, firm tofu, raisins, prune juice, cashews, pumpkin seeds, quinoa and fortified breakfast cereals.

To improve the absorption of non-heme iron, eat a food rich in vitamin C with each meal (eg strawberries, citrus fruits, kiwi fruit, peppers, cauliflower, tomato sauce).

A daily multivitamin and mineral supplement containing iron can also help maintain iron stores.

Leslie Beck, a dietitian in private practice in Toronto, is director of food and nutrition at Medcan. Follow her on Twitter @LeslieBeckRD

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