Update 2021: I share below the iron supplement we switched eventually to that finally normalized my lab results!
Iron deficiency is a surprisingly common problem. It certainly is a huge issue worldwide, but can also be seen in developed countries where deficiencies aren’t quite as common. Women especially need to take care that their iron levels are in the healthy range during their childbearing years. Loss of blood through monthly cycles, and/or through loss of blood through childbirth, can be problematic to many women. Children are also at risk for not meeting their iron needs when their bodies are growing so rapidly.
That’s what I learned when I found out that I had very low iron stores. Which is why, in my post on whether we should take supplements or not, I shared that I am currently on a good iron supplement. Today, I wanted to share some of the information I’ve found out about iron deficiency and iron absorption, so that if you felt you also could be low in iron, you could talk to your health care provider about your options.
Symptoms of iron deficiency
For me, being low in iron meant that I was “bone tired” – the type of fatigue you can no longer work through. My hair started falling out in unhealthy rates, my thyroid started slowing down because of the lack of iron, and I started to wonder if I was dying (No joke, it felt that bad). However, not everyone feels that badly, as symptoms can be mild. According to the Mayo Clinic, symptoms can be:
• “Extreme fatigue
• Pale skin
• Weakness
• Shortness of breath
• Chest pain
• Frequent infections
• Headache
• Dizziness or lightheadedness
• Cold hands and feet
• Inflammation or soreness of your tongue
• Brittle nails
• Fast heartbeat
• Unusual cravings for non-nutritive substances, such as ice, dirt or starch
• Poor appetite, especially in infants and children with iron deficiency anemia
• An uncomfortable tingling or crawling feeling in your legs (restless legs syndrome)”
If you experience some of these symptoms I’d definitely recommend getting your iron levels checked out by your doctor. I had just a few of these symptoms during my pregnancies, and my doctor (or in other pregnancies, midwife) would check and recheck my iron. But they always came back normal. Turns out they were doing the typical red blood cell count test, but my body was able to maintain normal hemoglobin counts despite my low iron stores. It was only when I went to a new doctor convinced that something was really, really wrong with me, that he ordered a test for my ferritin levels. When this is low, it generally indicates you have low amounts of iron stored in your body. And mine were desperately low. (You can read about the different testing available to doctors here)
Possible causes of low iron
What’s hard about being iron deficient is that there can be very different causes. Worldwide, worms or parasites can be the root cause, though that doesn’t seem to be as common in the U.S. My holistic doctor also told me that low iron was more common with his patient with thyroid issues. Any type of internal or external bleeding can make your iron levels get too low.
Eating a diet too low in iron is an obvious cause, but what some don’t know is that some can eat plenty of iron rich food, but not be absorbing it well. Once again it seems like there are many possible reasons for absorption issues. According to my doctor, causes of low absorption he has seen in his practice include, Celiac Disease, food intolerances, abnormal stomach acid, and bacteria overgrowths in the digestion tract. Not only that, but being low in other vitamins can help promote low iron.
And as I mentioned above, women are considered more vulnerable to being low in iron because of their monthly cycles. Working with a qualified and open-minded doctor in discovering the root cause of your iron deficiency is a blessing.
So as I have been working with my doctor to normalize this issue, I came across some really helpful information that I wanted to pass along to you, in the hopes that some of you would find it helpful as well.
The difference between heme and nonheme iron
Really quickly, it’s important to share that there is a difference between heme and nonheme iron. Heme is animal based iron, nonheme is plant based.
1. Consider heme iron sources
One of the first things I learned is that nonheme (plant based iron) is harder to absorb. For those who discover that they do have an iron deficiency, or who want to keep levels up with food, it’s important to note that heme (animal based) iron is going to be easier to absorb. According to a chart provided by the National Institute of Health, Chicken livers top the chart for iron, and beef liver is also high (read my post about the benefits of liver here). Oysters, beef, and dark meat from turkey, are also good sources. Nonheme iron sources include legumes, spinach, molasses, and grains (teff is a iron rich gluten-free grain). For just general health and iron status, I try to include liver in our weekly menu, as well as most of the foods in the above lists.
2. Watch out for tea and coffee
Tea and coffee have both been show to block the absorption of iron when drunk close to a meal. Drinking tea or coffee away from meals is a good idea when working to correct a low iron status. One study found that drinking it one hour before a meal is fine, but not one hour after. I also don’t take my (nonheme) iron supplement close to when I have had a cup of coffee or tea for this reason.
3. Dairy and iron absorption
Unfortunately, milk can also prevent the absorption of iron. Once again, when working to get iron levels up, drinking your milk away from meals, and when taking your iron supplements (if you are advised to take them) is a good idea.
4. Phytates and iron absorption
As long time readers know, I often use the “soak, sprout, or sourdough” method to baking whole grains for lower phytate levels. Phytates can block absorption of many minerals, and are present in whole grains. This is a key reason why nonheme iron is often not as absorbable. It’s one good reason to work at reducing phytates in grains and legumes.
5. Cooking in cast iron
I always wondered if the advice to cook in cast iron really did help with iron levels. The work of one man showed that placing a small piece of cast iron in the pots used to cook the daily food in villages with low iron statuses, did indeed normalize iron levels in the village! (You can read more about that here). I love my cast iron pans for many reasons, but this is another reason they can be helpful.
6. A well-balanced diet can help your iron levels as well
Just because you eat lots of iron-rich foods, does not necessarily mean you have high iron levels. An interesting study was done with the Inuit, who eat a high iron diet, yet suffer from low iron levels. Possible reasons for this could be that they are deficient in other needed vitamins for iron absorption and utilization of iron in the body, such as vitamin A, C, foliate, or riboflavin. (Parasites or helicobacter pylori infections could also be a factor.). All to say, eating a diet rich in a variety of nutrient dense foods could also help make sure that you are being able to absorb, and then use the iron from your food. Vitamin C is well known to help the absorption of iron, so eating vitamin C rich foods alongside your iron-rich foods could be helpful as well.
Too much iron isn’t good either
It’s also vital to mention that too much iron can not only be bad for you, it can be deadly. Children’s getting into iron supplements is a common cause of death (so if you have them in the house, make sure that children can’t get to them). Men and postmenopausal women can have the opposite problem of having too high of iron levels, and there are controversies over whether iron supplements or a good idea or not. You can read through a good overview of many of these issues here. All to say, if you don’t have an iron deficiency, you shouldn’t have to worry as much about drinking milk, tea, or coffee with a meal. In fact, if you eat a lot of iron-rich foods, some believe that it’s good that you don’t absorb all of the iron you consume.
The supplement my doctor had me on:
If your doctor recommends you take an iron supplement, you might consider asking them about the supplement my doctor had me on that finally made a difference in my lab results. It was Seeking Health’s Iron with Cofactors. They also carry a chewable version which I haven’t tried yet. I prefer to buy my supplements from Pure Formulas, after reading about the concerns of fraudulent supplements on Amazon, but you can also buy them on Amazon here. After trying several options, I was so glad that this was the right fit for me.
I’d love for you to add your thoughts and research on this important topic in the comment section!