Why Iron Deficiency Anemia Matters More Than You Think

Is your gut feeling sluggish? Beyond building red blood cells, iron plays a crucial role in our gut health and other essential body systems. Keep reading to discover how iron deficiency can impact your digestive system, how to recognize its potential signs, and tips to boost iron absorption. 

Why Are We Concerned About Iron Deficiency Anemia?

Iron deficiency anemia (IDA) is a very treatable condition, but it is shockingly affecting 30% of the American population and up to 42% of children. Our body utilizes iron for many functions, including energy production, immune function, blood production, cognitive function, oxygen transportation, and storage. Iron even plays a role in our gut and thyroid health. 

Individuals with iron deficiency may have fewer healthy bacteria in their gut (their microbiome). They may have an overgrowth or dysbiosis of harmful, pathogenic bacteria making up their microbiome. Iron is also needed to convert thyroxine (T4), the inactive form of thyroid hormone, into triiodothyronine (T3), the active form of thyroid hormone.

So, it is no surprise when someone is dealing with IDA; they are struggling with low energy, fatigue, constipation, shortness of breath, palpitations, mental focus difficulties, and bizarre food cravings (like dirt or ice chips)- this is known as Pica; hair loss, irritability, chills, weakness and many more. 

Iron Deficiency Is A Symptom, Not A Final Diagnosis

Once iron deficiency is identified, instead of just supplementing and replenishing iron, we must ask, “Why is this happening?” This often indicates that something more may be at play. Iron deficiency stems from three things: lack of iron availability, loss of iron (as in blood loss), or lack of absorption.

One of the most common causes of IDA is occult or hidden bleeding. Your provider may want to do a stool test called a fecal occult blood test to check for hidden blood in your stool, which could signify potential gastrointestinal (GI) bleeding. Other common conditions associated with IDA are people with gastrointestinal absorption issues, as in the case of Celiac disease, Crohn’s disease, inflammatory bowel disease, and individuals who have had gastric bypass surgery. 

Individuals taking medications such as anti-inflammatories, such as ibuprofen, naproxen, and aspirin, are prone to bleeding in the GI tract. Medications like proton pump inhibitors (PPIs), think azole like omeprazole or pantoprazole, reduce the pH in our stomach, making it harder to absorb certain nutrients. This makes it harder for our body to absorb iron from our diet, contributing to IDA. Additionally, females who are still menstruating can also lose a lot of blood during their periods and may need supplementation. 

Don’t Wait, Get It Checked Out

If you are experiencing any of the above symptoms or think you may have IDA, it is recommended that you reach out for professional help and ask for your levels to be assessed. Ask for a complete iron panel that includes: 

• A complete blood count (CBC)
• Serum iron levels
• Ferritin levels
• Transferrin
• Total iron binding capacity (TIBC)
• Transferrin saturation

Even if iron deficiency is not causing anemia, meaning that so far your body can compensate despite your depleted iron stores, it is still recommended to replace iron. Eventually, the body will run out of gas, worsening symptoms. 

Strategies to Maximize Dietary Iron Intake

Now that we know what IDA is, why we need iron to function, the signs and symptoms of IDA, and possible causes of IDA, what can we do about it?

The first thing is to go through your medication list and see if any of your medications have a side effect of bleeding or if you are on any medicines mentioned above that can lower iron absorption. Talk to your provider about how you can safely come off these medications if that is an option.

Next, we want to maximize dietary intake of iron. Iron recommendation changes by sex and age.

• For men above 19 and women above age 50- 8 mg of iron daily is recommended
• For women between ages 19 and 49- 18 mg of iron daily and 27 mg of iron daily when pregnant is recommended.

Iron from animal products (meat, fish, poultry), called heme iron, is easier to absorb. I like to add in some organ meats once a week, like liver, as they are jam-packed with iron. Plant sources of iron, non-heme, are not well absorbed. These include nuts, seeds, legumes, and spinach. It is always recommended to pair your high-iron foods, especially non-heme, with vitamin C; this allows your body to absorb iron more efficiently. To meet this requirement, consider orange juice, oranges, kiwi, strawberries, and lemons. 

Navigating Iron Supplementation: Tips and Precautions

For some who are really deficient and cannot absorb a lot of iron from food, supplementation may be necessary. Oral iron supplementation may work for some. When taking oral iron supplements, it is best to take them on an empty stomach with vitamin C and avoid things that decrease iron absorption, such as acid blockers, calcium supplements, dairy, tea, and coffee products. Other individuals with underlying digestion problems or severe iron deficiency and severe symptoms may require intravenous (IV) iron supplementation.

Before you begin any iron supplementation, seek guidance from a healthcare provider. I also do not suggest supplementing with iron unless you actually need it because excessive iron is harmful and can become toxic. Some studies have shown a potential link between excess oral iron supplementation and changes in the gut microbiome, which can lead to the growth of harmful or pathogenic bacteria, causing inflammation leading to potential damage to the gut lining.

Additionally, oral supplementation of iron comes with other problems, such as the well-known constipation, vomiting, or nausea, and is poorly tolerated by some individuals.

Moving Forward: Addressing Iron Deficiency Holistically

Iron deficiency is a genuine and very treatable condition. In that same breath, iron deficiency should be recognized as a sign or symptom rather than a final diagnosis. It is essential to get to the root cause as to why there is low iron in the first place. One of three things must be considered: lack of iron availability, loss of iron, or absorption. If you have signs and symptoms of iron deficiency anemia, see a health provider and check your iron levels. This is especially important for people with known gastrointestinal conditions such as IBS, Crohn’s disease, or Celiac disease. Oral supplements may not be well absorbed and often come with problems, and intravenous (IV) replenishment may be warranted. You are not alone and do not have to keep living in this fatigued state. Seek help and take steps to a healthier, more energized you. 

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