Iron is a mineral found in meats, beans, and greens and is also one of the most common supplements I see female patients in my practice taking. Our levels of iron can become low for many reasons including inadequate dietary intake of this nutrient, blood loss as most of us experience monthly when ‘aunt flow’ comes to visit, bleeding problems, when a large demand is put on our body to produce blood during pregnancy, or if we are not absorbing iron because of a condition like celiac disease.
What Is Low Ferritin and Iron Deficiency Anemia?
What is the link between iron and all this talk about blood you might ask? Our body stores iron in a form called FERRITIN. Every time we have to make a new red blood cell (these cells actually only live 3 months so this happens every 90 days) we take iron from our ferritin stores to put in the middle of the red blood cell our body makes. Iron is important for these cells because it allows them to carry oxygen to our tissues. The first thing that starts to happen if we are low in iron is that our levels of ferritin, or the amount of iron we have in storage starts to dip. This is simply called low ferritin. When it gets too low our body cannot make red blood cells properly, which is called iron deficiency anemia. Early symptoms of low iron levels can be low energy, weakness, pale skin, headaches, cold hands and feet and progress to more serious symptoms like chest pain, shortness of breath, restless leg syndrome and cravings for strange substances like dirt or ice if iron deficiency anemia starts to develop. A simple blood test can show if you have low iron or iron deficiency anemia.
Most people can maintain their iron levels through nutrition and addressing issues such as heavy bleeding during menses, but iron supplements are available if levels drop too low, and your body needs more help increasing it’s ferritin stores than it can get from spinach. If you think your iron is low, it is best to get tested to see what your levels actually are before you start supplementing through your family doctor or Naturopathic Doctor. Iron is a substance that can build up in our body – and too much of it is not a good thing either which could happen when taking it in high doses.
Are You Taking The Right Supplement?
The recommended daily intake of elemental iron for an adult female is around 18mg per day, but higher amounts are recommended in iron deficiency anemia. There are many different forms of iron supplements available, and they contain various amounts of elemental iron - the component of iron that is available for absorption by the body. A popular form called ferrous gluconate contains 12% elemental iron for example, where-as ferrous sulfate contains 20% and ferrous fumerate contains 30%. They all have similar rates of absorption. In contrast, ferric ammonium citrate is the most commonly used supplement and is not absorbed as well as these other options. Ferrous bysglycinate is another form that I commonly recommend, which contains 20% elemental iron and is thought to be well absorbed because the amino acid that iron is bound to in this formula prevents it from becoming insoluble in the small intestine. There are other forms of iron supplements that are heme-based, which means that they are extracts from blood products that are very well absorbed and are generally reserved for patients with anemia. Side effects from iron supplements are largely constipation and GI upset, which happens when an iron product is not well absorbed and stays in the gut. Forms that have better absorption, like ferrous bisglycinate, may cause less GI upset for this reason.
Tips To Increase Iron Absorption
Iron supplements are best taken on an empty stomach if they can be tolerated as food can significant reduce absorption by up to 50%, and they should be taken with water or a juice that contains vitamin C like orange juice! Coffee and tea contains elements that can decrease iron absorption, while a dose of 200mg of vitamin C significantly enhances absorption. There is controversy about whether calcium can decrease absorption of iron, and if you are severely iron deficient I recommend avoiding calcium supplementation and dairy products close to the time you take your iron supplement. Factors like low stomach acid could also impair iron absorption! Come talk to a Naturopath if you have been taking iron and your levels just aren’t going up to get to the bottom of what is causing your health concerns.
- Dr. Sarah Penney, ND, MSc