NAMASTE AND WELCOME TO THE WAY UP NEWSLETTER!
Lets get on with
WHAT YOU NEED TO KNOW ABOUT IRON DEFICIENCY
This newsletter is coming to you because I am tired of all the costly misunderstanding about iron deficiency; tired of patients who are iron deficient being told by their doctors they are fine because they do not have anemia. I am tired of seriously iron deficient patients discontinuing their iron pills every time they hear from the media about the over hyped risks of iron excess.
I diagnose iron deficiency in my patients quite commonly and have only seen a problem with excess iron a handful of times. Iron excess is a genetic problem called hemochromatosis occurring mostly in men who are of Northern European background, when it does occur. It rarely develops from the excess supplementation of iron.
I have found that those prone to iron deficiency either by dietary habits, faulty absorption, or some other unknown malfunctioning or risk factor will almost never be able to accumulate excess iron. Indeed, even with supplementation, they have difficulty achieving the security of mid normal levels. I have had to refer a few patients for IV administration of iron because they either could not achieve adequate levels by oral dosages, or they had intolerable side effects from the oral iron.
WHO IS AT RISK FOR IRON DEFICIENCY?
Iron deficiency is a significant global problem. It is essential we address the iron issue so as to attend to those at risk. Did you know that one third of the worlds population is iron deficient? Did you know that iron deficiency is the most common nutrient deficiency in the world, exacting incalculable tolls which we shall later discuss? Iron deficiency is the most common cause of anemia worldwide. Granted, the problem is four times greater in developing countries than in the U.S. Still, at least 10% of the U.S. population is deficient and since they are rarely males, that means 20% of the women and children are clearly deficient. Iron deficiency is the most common nutrient deficiency in American children.
Check out the following list of those at risk for low iron levels, and you will see at least half of the population is at risk. Only males are relatively safe, unless quite elderly and malnourished, or with specific risk factors.
High risk groups for increased likelihood of iron deficiency are :
- Babies given cows milk instead of breast milk or iron fortified formula. Cow and goats milk are very low sources of iron and the iron is poorly absorbed. Breast milk is a good source of bioavailable iron, assuming the mother has adequate iron stores.
- Embryos in formation. Low maternal iron may result in intrauterine growth retardation, low birth weight, increased infant mortality, and increased maternal complications and mortality.
- Children 1-4 years old are at risk because of rapid growth unless iron fortified food or supplements are given.
Iron deficiency early in childhood can have long-term effects on mental development that may be irreversible. Iron deficiency is not easy to detect without a blood test. Most babies, particularly those who are premature or have low birth weight, need an iron supplement. Give as an iron fortified formula or as a separate liquid supplement to breastfed babies.
- Teenagers are at risk because of rapid growth rates, and poor eating habits.
- Menstruating women, especially those who have heavy periods. Menstrual bleeding is one of the most common causes of low iron. Such women require twice as much iron as do men. Thirty five-fifty percent of young otherwise healthy women have some degree of iron deficiency. More so in pregnancy.
- Women using an IUD (because they generally have heavier periods)
- Pregnant, postpartum and breastfeeding women
- Women with more than one child
- People who repeatedly crash diet
- Vegetarians, (since animal products contain the most usable forms of iron.)
- Athletes in training, as they may have exercise induced iron loss, especially with endurance sports and body building
- People with kidney failure
- People with worm infestation, or chronic parasites
- Low income earners
- The elderly have both decreased intake and absorption
- Regular blood donors. Each 500ml of donated blood costs 200-250mg of iron.
- People with conditions that predispose them to bleeding, such as gum disease or stomach ulcers, polyps or cancers of the bowel
- Those with gastrointestinal disorders such as low or absent stomach acid, celiac disease, ulcerative colitis, Crohns Disease, partial removal of the intestines
- People taking aspirin as a regular medication
- Those with low thyroid functioning
All of those at high risk should take some form of daily iron supplement, and focus on eating iron rich foods, as listed later. The iron can be part of a multivitamin mineral supplement. Women who are not menstruating and men should not supplement iron unless they have a known problem or are at high risk for deficiency .
WHAT ARE THE SYMPTOMS OF IRON DEFICIENCY
With all the possible consequences from iron deficiency, you can see the extraordinary impact of low iron and why this is such an important topic. An iron deficient person would not have all of these symptoms, but some constellation of them. With 5 or more, consider iron problems.
- Listlessness, weakness, decreased work productivity
- Impaired learning and cognitive function
- ADD and ADHD type behavioral disturbances
- Developmental delay in infants and young children
- Poor memory
- Decreased attention span and increased distractibility
- Impaired reactivity and coordination
- Appetite loss
- Cravings for non foods such as ice, dirt or clay
- Difficulty swallowing (because low iron may cause a thin membrane to grow across the esophagus)
- Joint soreness
- Night time leg cramps
- Sores on skin, or itching
- Poor wound healing
- Can cause excessive menstrual bleeding
- Hair loss (LOW IRON IS A FREQUENTLY OVERLOOKED CAUSE OF HAIR LOSS)
- Sore or burning tongue
- Soreness in corners of the mouth
- Brittle, flat, or spoon shaped nails
- Longitudinal ridges on nails
- Heart palpitations on exertion
- Shortness of breath
- Cold extremities, with decreased resistance to cold and poor regulation of body temperature
- Tendency to recurrent infections
- Chronic bladder infections
- Anemia (hypo chromic, microcytic) paleness, weakness, drowsiness, fatigue
- Numbness & tingling
- Night sweats
- Fragile bones
- Growth impairment in children
- Eye soreness
- Vague gastrointestinal symptoms: belching, gas, nausea
- Vitiligo (light blotches on the skin)
- Swelling in the ankles
- Bluish tint to the whites of the eyes
- Visual disturbances
- Papilledema (swelling inside the eye)
- Enhanced heavy metal absorption and risk for toxicity. Those with low iron will have an increased GI absorption of metals which is not specific for iron, so will absorb more lead, cobalt, cadmium, mercury. High blood levels of lead are more common in children with low iron.
WHAT ARE THE FUNCTIONS OF IRON IN THE BODY?
Seventy five to ninety percent of the iron in your body is in hemoglobin which carries oxygen to all parts of your body to keep you from being anemic. There is the mistaken belief (even among those who should know better) that if you do not have anemia you have enough iron. Unfortunate and gross misinformation is given to the general public. In truth, the development of anemia is the last stage of iron deficiency occurring after many functions are already impaired.
a major player in multiple bodily processes and is needed for the function of about 100 enzymes and coenzymes in your body. For more details about these, you can see http://www.expasy.org/enzyme/. If you go there, click search by cofactor and then click on the 3 listings of iron and the one of heme. These enzymes allow necessary biochemical reactions and transformations to take place. Some of the more studied of these enzymes are cytochrome C, cytochrome C oxidase, catalase, aconitase, and aromatic amino acid hydroxylases. The iron related enzymes are quite sensitive to depletion with even minor iron deficiency.
Hydroxylases are needed for the conversion of the amino acids tyrosine, phenylalanine and tryptophan to form critical brain neurotransmitters which are responsible for essential brain functions. This is why depression, learning and memory problems, and other brain malfunctions may be early signs of iron deficiency. The enzymes can malfunction with minor iron deficiency and before any manifestation of anemia. This is why there are so many symptoms associated with iron deficiency which may not necessarily be related to anemia.
Catalase breaks down and removes hydrogen peroxide from your body by turning it in to harmless water and oxygen. Hydrogen peroxide is a toxic waste product of metabolism which can accumulate and cause symptoms if not removed regularly.
The cytochrome enzymes are located in the inner membrane of the mitochondria, the energy generating part of each cell in your body. These enzymes participate in the process of changing your food to energy. Too little or too much iron in the mitochondria will cause malfunction of energy production.
Iron is also required for the synthesis of collagen and elastin which are the main supportive structures holding your body together.
Iron starvation arrests cell proliferation, presumably because the metal is required by ribonucleotide reductase and other enzymes involved in cell division. It is also required for DNA synthesis which allows cells to multiply and regenerate.
Iron is needed for the synthesis of the amino acid carnitine, which plays a role in fatty acid metabolism.
Iron plays a critical role in the major detoxification pathways of the liver.
HOW CAN YOU EAT MORE IRON?
Foods with high iron
- Animal liver, kidney and heart
- Oysters, clams, caviar
- Iron-fortified bread and cereal, wheat germ and bran, rice bran
- Lean red meat
- Nuts/seeds (pistachio, pinon nuts, black walnuts, sesame, sunflower, pumpkin)
- Egg yolks
- Dried beans and legumes
- Blackstrap molasses, sorghum syrup, brewers yeast
- Dried fruit (apricots)
- Dark leafy green vegetables (chives, parsley)
- Nettle tea
- Foods cooked in an iron skillet
Does this sound like what most of you eat.
Foods with medium iron
- Seafood ( herring, mackerel, sardines, tuna, swordfish, scallops, shrimp. Abalone)
- Meat/Organs (chicken, duck, goose, eggs, pork, veal, beef tongue, heart)
- Nuts/seeds (almonds, brazils, cashews, chestnuts, peanuts, coconut, pecans, walnuts)
- Grains (barley, brown rice, rye, wheat, buckwheat)
- Fruits (gooseberries, dates, figs, raisins, prunes, olives)
- Vegetables (beets, radishes, beet greens, brussel sprouts, chard, endive, kale, spinach, watercress, artichokes, lima beans, green beans, broccoli, cauliflower, peas, lentils, red kidney beans, garbanzos)
- Dairy (cheddar cheese)
- Misc ( maple sugar, brown sugar, bakers yeast, mushrooms)
And I include all of these gory details for two reasons; to see how much iron we may not be eating, and to guide those who are know iron deficients to eat more carefully and consciously.
The average American diet contains about 10-15 mg of iron daily, of which only 10% is absorbed, so about 1-1.5 mg daily. This about equals the daily amount of iron which is lost from the body through shed intestinal cells, sweat, and blood loss ( which may be minor, but chronic). Chronic loss of even small amounts of blood may significantly increase iron requirements. The average daily menstrual loss is 0.6-0.7mg. In Fe depletion, dietary absorption increases but rarely to > 6 mg of Fe unless supplemental Fe is added.
WHAT IMPROVES IRON ABSORPTION?
The two types of dietary iron are:
- Haem iron which is found in animal foods such as beef, chicken and fish. Organ products such as liver and kidney are particularly rich in haem iron. The body absorbs around 15-20% per cent of the iron from animal sources. Liver may be as high as 35%. There are no side effects or gastrointestinal problems caused by the absorption of this form of iron. The amino acid in animal proteins which particularly increases iron absorption is cysteine
- Non-haem iron is found in plant foods such as beans and lentils. The body only absorbs between two and eight per cent of the iron from plant sources. Good vegetarian sources of non-haem iron include iron-fortified breakfast cereals, flours and grains. Red meat also contains some non-haem iron.
Defective iron absorption is caused by diets low in iron. high in cereal/grain content, and low in animal protein. Some amino acids in animal protein facilitate the absorption of iron.
Other factors that boost iron absorption
- Vitamin C (found in fruits and vegetables) increases iron absorption.
- Adequate stomach acid boosts iron absorption. Absorption takes place in the stomach and small intestines.
- Copper and folic acid are major enhancers of iron absorption and utilization
- Other synergists for iron are Vitamin B12, Selenium, Chlorophyll, and Molybdenum
- Meat boosts iron absorption from plant sources.
- In most cases, cooking increases the amount of available non-haem iron in vegetables. For example, the body absorbs six per cent of the iron from raw broccoli, compared to 30 per cent from cooked broccoli.
- Theoretically, those low in iron will absorb more dietary iron than those with adequate or high levels, so absorption rates adjusts depending upon the baseline levels. This assumes there are no gastrointestinal problems contributing to the low absorption of iron.
Dietary and other factors that reduce iron and iron absorption
Certain foods and drinks reduce your body's ability to absorb iron, including:
- Soy proteins can reduce absorption from plant sources.
- Tannins from tea, coffee and wine reduce iron absorption by binding to the iron and carrying it out of the body.
- The stored phosphorus in bran, called phytate or phytic acid, reduces iron absorption.
- High fiber diets can reduce the absorption of iron and other minerals, because food is moved very quickly through the digestive system. A common cause of low iron is a high cereal/grain, low animal protein diet.
- Low Vitamin A can lead to iron deficiency because Vitamin A helps to release stored iron.
- Calcium, phosphorus, Manganese, Chromium, Magnesium, Zinc, Nickel, and Cadmium reduce the absorption of plant-sourced iron. Zinc is a major antagonist of iron.
- Antacid use
- Egg Yolk inhibits iron absorption
Iron deficiency is more likely on a dairy rich diet.
Cow's milk products are very low in iron, thus, if they become a major part of one's diet, iron deficiency is more likely. In addition, clinical studies have shown that infants consuming cow's milk lose small amounts of blood from their digestive tracts. For this reason, the American Academy of Pediatrics recommends that infants below one year of age not be given whole cow's milk. "We now think that iron deficiency at that age can lead to brain damage" - Dr. Lewis Barnes, University of Wisconsin Pediatrician. If you consumed only dairy products, you would have to drink 50 cups of milk to reach your RDA's for iron.
WHAT IS THE USUAL REQUIRED MAINTAINANCE DAILY IRON INTAKE?