Month: February 2020

If you’re a woman in her menstruation years, there’s a chance you may be iron deficient. As one of the most common nutrient deficiencies worldwide, monthly menstruation makes women in this stage of life more susceptible—particularly for those who have very heavy periods. 

It’s important then to ensure that you’re getting sufficient iron from the foods you’re eating. However, when it comes to making sure we’re getting enough dietary iron, it’s not always as simple as just adding in more iron-rich foods. We also need to consider bioavailability, which involves various factors that influence how much iron our body can actually absorb and use. 

There are two main types of iron in food:

1. Haem iron – this is the form of iron found in animal foods such as red meat and liver
2. Non-haem iron – this is the form of iron found in plant foods such as lentils and green leafy vegetables.

Haem iron is more bioavailable than non-haem iron, which means that your body is more readily able to absorb it. However, there are things we can do (and not do) to significantly enhance our ability to absorb more of the non-haem iron from our plant-based sources. Here are some strategies to help with this:

• Pair your iron-rich plant foods with a source of vitamin C – vitamin C rich foods include citrus fruits, kiwifruit, strawberries, capsicum and lightly cooked (rather than boiled until they are soggy) Brassica vegetables such as broccoli and cabbage
• Chew your food well to help stimulate stomach acid production 
• If you feel nourished by good quality red meat, including these foods with your plant-based sources of iron will help to improve the non-haem iron absorption
• Avoid drinking tea and coffee with iron-containing foods, as the tannins in these drinks can bind to the iron and significantly hinder absorption
• Minimise or avoid the use of antacids where possible
• Avoid calcium supplements with iron-rich meals
• Avoid fibre supplements with iron-rich meals

Our body is also working behind the scenes to do its best to keep our iron levels where they need to be. The liver plays a key role in this and it’s here where our body stores some extra iron so it can be released for use when needed. The liver also produces a substance called hepcidin that tells the body when to absorb more iron (when our iron stores are getting low) and when to absorb less iron (when our iron stores are high enough). How clever is that? 

You could think of hepcidin like a bouncer or security guard at a bar, and your liver as the manager. When the bar is full (your iron stores are high), the manager (liver) sends more bouncers (more hepcidin) to block off the entrances to the bar (the sections on the gut wall through which iron can be absorbed across into the circulation) to stop or reduce the amount of people (iron) from entering. To carry on with this analogy, when the bar is fairly empty and they are wanting to get more patrons in (iron stores are getting low), the manager (liver) allows the bouncers to take a break (less hepcidin), so people can freely enter the bar as they arrive (more dietary iron can be absorbed across the gut into the circulation). This helps to ensure that we’re able to absorb and use iron more efficiently from our food when we need to, and it also helps to safeguard us from absorbing too much iron, because if excess amounts build up inside of us this can be very problematic. This is one of the many reasons it’s so important to take such precious care of your liver. It plays so many vitals roles in every aspect of your health! 

Although we have this incredible regulatory mechanism, our body can only adjust our iron absorption to a certain extent and if we consume way too much or way too little on an ongoing basis, it’s not going to be able to offset it. Some people also have a genetic condition called haemochromatosis, where their body absorbs and stores too much iron.  Some of the symptoms of iron overload/excess can be similar to symptoms of iron deficiency, so this is why it’s very important to have your iron stores checked via a blood test before commencing iron supplementation. 

If iron levels are low and an iron supplement is needed, taking the supplement every second day may actually help to promote better absorption because of the acute increase in hepcidin that iron supplementation can trigger. However, your health care practitioner will be best placed to advise what is best for you, based on your personal circumstances and iron levels. 

For more about iron deficiency and what to do if you think you may be low in iron, check out my blog here. 

Ever wonder if iron deficiency might be behind your persistent fatigue?

Iron is a mineral that is critical to so many aspects of our health yet, it’s a nutrient that many people don’t get enough of. In fact, it’s the most common nutritional deficiency worldwide most often affecting women throughout the menstruation years (particularly those with very heavy periods), pregnant women and children.

Most of the iron in the body is within haemoglobin in red blood cells, which carries oxygen throughout the body. Our body also stores iron in a protein called ferritin. Both ferritin and haemoglobin can be tested in the blood but it’s ferritin that’s used as a marker of our iron status. Haemoglobin levels are used to assess whether anaemia is present—low levels can result from a severe iron deficiency, but other nutritional deficiencies can cause anaemia too so low haemoglobin isn’t specific to iron only.

Symptoms of iron deficiency can include:

• Fatigue
• Shortness of breath, particularly on exertion (for example, you might feel very out of breath and possibly lightheaded after walking up some stairs or a hill, and this doesn’t seem to reflect your level of fitness)
• Poor memory and concentration
• Increased susceptibility to infections
• Restless legs syndrome
• Brittle hair or hair loss
• Brittle and spoon-shaped nails
• Poor appetite
• Cravings to eat ice

Iron deficiency occurs gradually and in stages (unless there is blood loss that is sudden and significant). 

Stages 1 – 2

These stages involve moderate to severe depletion of iron stores, however, symptoms of deficiency usually aren’t yet apparent.

Stage 3

By this stage, you are likely experiencing some symptoms of iron deficiency (such as tiredness) however iron deficiency anaemia is not present.

Stage 4

By this stage you have progressed to iron deficiency anaemia – your red blood cells are now hypochromic (pale) and microcytic (smaller than normal), and haemoglobin levels are low so your capacity to transport oxygen throughout the body is reduced and you will be experiencing symptoms. 

With any health challenge my goal is always to get to the heart of what’s going on, and the same is true with iron deficiency. While an iron supplement may be needed to restore your iron levels if you are deficient, this may not necessarily be the only action that is required; there could be other strategies and changes that are needed to address an underlying problem or to prevent the deficiency from persisting or reoccurring in future. For this reason, it’s really important to understand what has caused the iron deficiency. 

Some potential contributors to iron deficiency can include:

• Inadequate dietary intake of iron
• Increased iron requirements, which may make it difficult to obtain enough through food – for example, due to increased blood volume during pregnancy, during the adolescent growth spurt, or for athletes (particularly those who do a lot of vigorous activity, such as endurance sports and long-distance running)
• Undiagnosed (untreated) coeliac disease – chronic iron deficiency can sometimes be the only symptom a person with coeliac disease experiences
• Increased iron losses due to heavy menstrual periods
• Blood loss – if there is blood in stools, this must be investigated by a medical doctor
• High calcium intake or calcium supplementation taken with iron-rich foods, as the calcium competes with iron for absorption
• Excessive intake of other dietary substances that can inhibit iron absorption, such as too much fibre
• Long term use of antacids and proton pump inhibitor (PPI) medications, which are used for heartburn and reflux
• Parasitic infections

So, what can you do if you think you might be low in iron?

The first step is to visit your GP to discuss your symptoms. They can arrange a blood test to check your iron stores if needed – this test is called ‘iron studies’. If iron deficiency is chronic and unexplained, your GP may also order some further tests to investigate the cause (such as a test for coeliac disease). 

It’s vital to have your iron levels checked via a blood test before starting an iron supplement as the body isn’t able to readily excrete excess amounts of iron and if too much builds up this can be problematic for your health. Some people have a genetic condition called haemochromatosis, where their body absorbs and stores too much iron, and some of the symptoms of iron overload can actually be similar to those of iron deficiency. 

If an iron deficiency is confirmed through your blood test, an iron supplement is usually needed for at least a few months to help replenish your body’s iron stores. For some people, iron supplements can contribute to digestive symptoms such as constipation, however there are a few strategies to try if you have had this experience in the past and are concerned. Liquid iron supplements or iron supplements made with a form of iron called iron bisglycinate are often well tolerated, and another option is to try taking it every other day to see if this improves tolerance. For personalised advice on what is right for you, please consult with your health care provider. 

For more about iron in food and bioavailability, check out my blog here.