Are You Iron Deficient? Here’s What You Need to Know
When it comes to nutrition, we tend to obsess over macros and let the micros take care of themselves. And why wouldn’t we? It’s impossible to know whether you’re getting enough of every key vitamin and mineral, attempting to track your intake would be painstaking. Unfortunately, the only time we tend to clock that we’re low on a particular element is when we get sick.
Iron deficiency can be particularly insidious, and not only because it can chip away at your gym power. The main symptoms – tiredness, lack of energy, shortness of breath – are applicable to such a multitude of illnesses that the only way to diagnose the condition is via a blood test at your doctor’s surgery. Since this demands a fair bit of life admin, sufferers tend to fly under the radar for a while.
‘Iron is an essential mineral we need for survival,’ says Matt Lawson, health expert at body composition analysis specialists Tanita. ‘Oxygen flows around our bloodstream in red blood cells, which have a lifespan of three months. Iron has an important job here, as it is the main contributor to haemoglobin in these cells that gives us oxygenated blood to keep us going. A lack of iron can lead to iron deficiency anaemia which is very common in the UK.’
Iron also keeps your brain, energy production and immune system functions ticking over, says dietician Dr Carrie Ruxton, from the Health and Food Supplements Information Service. About 70% of the body's iron is found in red blood cells – or haemoglobin – and muscle cells, or myoglobin.
Iron Deficiency Causes
Iron deficiency in men is rare, and tends to affect boys under five or men older than 65 – only around 15% of men don’t meet the daily requirement for iron from their diets according to the National Diet and Nutrition Survey, compared to a whopping 90% of women. This is mostly because men need far less iron – around 8.7mg per day as opposed to 14.8mg – since they don’t menstruate. The main causes of iron deficiency in men, Dr Ruxton explains, are increased requirements, whether down to physical growth, muscle building or increased blood volume, limited intake, or illness.
‘Iron deficiency in men can be a sign of bleeding in the stomach or intestines, which could be due to frequent use of non-steroidal anti-inflammatory drugs like ibuprofen or aspirin, stomach ulcers, swelling and inflammation in the intestines, haemorrhoids or piles, or – less commonly – cancer of the bowel or stomach,’ adds Mike Gibbs, founder of NHS-backed health app OurPath. Going veggie or vegan without reading up on nutrition can be another factor. ‘Another major cause of iron deficiency in men is inadequate intake of foods high in iron. The body absorbs two to three times more iron from animal food sources compared to plant foods.’
The iron you get through your diet is either in the form of ‘haem iron’, which is mainly derived from meat, poultry, and fish, or ‘non-haem iron’, which comes from cereals, pulses, legumes, fruit and vegetables, explains Orli Rhodes, senior dietitian at King Edward VII’s Hospital in London. ‘The bioavailability of iron from food varies significantly, and will also be determined by the type of diet we have,’ she adds. Vitamin C will help increase the absorption of iron, while physic acid – a component in many vegetables but primarily whole grains, beans, and nuts – may reduce the absorption.
Symptoms of Iron Deficiency
Iron deficiency anaemia occurs when you don’t have enough healthy red blood cells to carry enough oxygen to the body’s tissues, explains Gibbs, leaving you tired, lethargic, and short of breath. When your body is exhausted, your risk of infections and illness skyrockets, so if you can’t seem to shake the office cold no matter what the pharmacist throws at you, it could be a signal of iron deficiency.
Pale skin and heart palpitations can also be experienced by those with an iron deficiency, adds Dr Diana Gall from confidential online doctor service Doctor-4-U. Less commonly, you may experience a headache when suffering iron deficiency and food might taste unusual. ‘Men may also experience difficulty swallowing, tinnitus, a sore tongue, mouth ulcers and hair loss,’ she continues. ‘Constant tiredness and lacking energy, one of the most common symptoms, can have a real impact on your mental health and mood as well.’
Colleagues commenting that you look a little under the weather lately? A pale pallor and lightening of the gums and inner eyelids may also indicate that iron levels are below optimum levels, says Keri Filtness, lead nutritionist for Nature’s Best. Symptoms can also include reduced brain function and performance. “There are some indications that low iron may also be linked to a condition known as restless leg syndrome and also to cognitive and behavioural issues such as ADHD,” she adds.
The Three Stages of Iron Deficiency
In normal circumstances your body gets enough iron from the food you eat, and the excess is then stored, so it's available to make haemoglobin. When your body uses these iron stores faster than they can be refilled, or when you don't consume enough iron in the first place, iron deficiency anaemia can develop. As Dr Philip Veal, specialist digital clinician at Medichecks explains, this usually occurs in three stages:
First Stage
‘The first stage of iron deficiency is iron depletion. About 25% of the iron in your body is stored as ferritin, and stage one occurs when your iron stores are depleted and ferritin levels are low,’ says Veal.
Second Stage
‘In the second stage, which is called iron-deficient erythropoiesis, there is a visible change in your red blood cells, for example your red blood cells might shrink,’ Veal explains.
Third Stage
‘The third and final stage is iron deficiency anaemia. This happens when changes in the red blood cells lead to a haemoglobin reduction. Haemoglobin is the protein that carries iron and oxygen around your body. Low haemoglobin, or anaemia, is the most serious stage of iron deficiency,’ says Veal.
Dangers of Iron Deficiency
Perhaps unsurprisingly, the longer you’re deficient for, the graver the consequences. Left untreated the symptoms of iron deficiency can become very serious, particularly extreme fatigue and shortness of breath, warns Dr Gall. ‘Extreme cases of severe low iron can also lead to heart problems such as a rapid or irregular heartbeat,’ she says. ‘This is brought about by the heart working harder to compensate for the lack of oxygen being carried in the blood.’ Not exactly ideal.
Long term, untreated iron deficiency anaemia ‘can become severe and weaken your immune system, making you become prone to infections and disease,’ adds Lawson. ‘As well as damaging vital organs like the brain, heart and lungs, the circulatory system can struggle as a result of the heart not being able to pump enough oxygenated blood around the body to support tissue functions.’ In essence, you could end up really unwell.
How to Boost Your Iron Levels Naturally
Your body can’t produce its own iron, so you need to look elsewhere. Start with a good diet, then add supplements as necessary, advises Dr Ruxton. Iron-rich foods include red meat, offal and oysters, with chicken, turkey, pork, fish and eggs also relatively high in mineral. For veggies or vegans, fill up on nuts, seeds, lentils, beans and other legumes, tofu, tempeh, quinoa, amaranth grain, and green, leafy vegetables – but remember the variety of iron in plants is absorbed at a far lower rate than animal sources.
To boost non-haem absorption, eat foods high in vitamin C such as citrus fruits, strawberries, tomatoes, and leafy greens with your iron-rich foods, Gibbs suggests. ‘Avoid drinking tea and coffee at the same time as iron-rich foods,’ he adds. ‘The tannins in these can prevent iron absorption. And avoid foods fortified with calcium or calcium supplements with meals, as calcium also prevents iron absorption.’
If you do opt to go down the supplementation route, you need to be careful you're not overdoing it. ‘If you take iron supplements, make sure you're not taking too much, as consuming too much iron can be harmful,’ says Veal. ‘Taking 17mg or less a day of iron supplements is unlikely to cause any harm, but [only] continue taking a higher dose if you've been advised to by a doctor.’
Are There Any Links Between Iron Deficiency and Weight Gain?
Iron deficiency can lead to a host of difficulties, complications and health issues, but can it lead to weight gain? According to Veal, yes it can.
‘Low iron levels can sometimes lead to weight gain,’ says Veal. ‘When iron levels are low, red blood cells can struggle to carry normal amounts of oxygen around your body. This leads to you feeling exhausted and reduce your exercise levels, which can lead to weight gain. Iron deficiency can also trigger hypothyroidism - an underactive thyroid - and weight gain is a common symptom of this.’
What Issues Can Excess Iron Cause?
While a lack of iron can give rise to a host of health complications, too much iron, or iron overload, is no walk in the park either.
The most common iron overload disorder is a hereditary condition called hemochromatosis, which can cause unpleasant symptoms and damage parts of the body, like the liver, joints, pancreas and heart, if left untreated.
‘Excess iron levels can be harmful to your health and can lead to a number of symptoms, including weakness, fatigue, joint pain, abdominal discomfort, erectile dysfunction, and even cardiac problems,’ says Veal. ‘If your iron levels are high over a long period, this can lead to serious long-term complications, like liver disease, diabetes, arthritis and even heart failure.’
When to See a Doctor
If you’re suffering symptoms of iron deficiency, or indeed iron overload, don’t attempt to self-diagnose, as tempting as it might be. Go to your doctor who can do a blood test and confirm the diagnosis, recommends Dr Gall. ‘It’s important to identify whether or not there may be an underlying cause of iron deficiency, so a proper diagnosis and examination is essential,’ she explains.
Things like rectal bleeding or blood in the faeces should be reported as soon as possible, warns Dr Ruxton, as it could be a sign of polyps or bowel cancer – especially in older men.
‘If you still have low iron levels despite having an iron-rich diet,’ says Veal, ‘you should discuss this with a doctor. You should also consult a doctor for any symptoms like an upset or bleeding bowel, feeling lightheaded or suffering with a shortness of breath. Several causes of iron deficiency anaemia are entirely unrelated to your diet, so this should always be explored and confirmed by a doctor.’
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