Iron deficiency anaemia is common condition in cycling women (especially those that experience heavy bleeding like in Endometriosis). To be clear, it is a symptom and not a disease – as it is always caused BY something that is out of balance in the body.
Do you have an iron deficiency?
Iron deficiency anaemia’s occurs when the body does not get enough iron - a key component of red blood cells. When you are experiencing iron deficiency, your red blood cells are unable to carry oxygen effectively causing you to feel tired, foggy and pale. Other common symptoms include: Respiratory changes (like shortness of breath), pale palm creases, pail nail beds, brittle hair, hair loss, poor mental and memory function, reduced thyroid function, hormone imbalances and having a hard time staying warm in cold weather.
Diagnosing an Iron deficiency
The most efficient way to find out if you are experiencing iron deficiency is to get a blood test thru your local GP. They will request an ‘iron panel which checks for:
- Iron – the amount of iron circulating in your blood.
- Transferrin/ Total Iron Binding Capacity (TIBC) – The main transport protein of Iron. This generally increases as your iron levels decrease and decreases when iron levels increase.
- Saturation – This shows how much transferrin is saturated with iron. It is a calculation made using the TIBC value when the circulating iron levels are unknown.
- Ferritin – the amount of iron stored in your body (which mainly happens in the liver and bone marrow).
Other blood markers that are also useful in diagnosing Iron deficiency anaemias come from the Full Blood Count (FBC):
- Haemoglobin- this is the iron-containing protein in red blood cells. The haemoglobin count will be low in iron deficiency anaemias.
- MCV – Mean Cell volume, which shows how big the red blood cells are. When there isn’t enough haemoglobin to go around, these cells become smaller and paler than normal.
SIDE NOTE – If your MCV comes back as high, it means the red blood cells are too big and you are experiencing macrocytosis. This is often due to a folate and B12 deficiency, but can also be caused by hypothyroidism, insulin resistant and Non-Alcoholic Fatty Liver Disease.
Iron deficiency causes
The cause of an iron deficiency isn’t as simplistic as it was 30 years ago. It is no longer a matter of just dietary intake. Major causes that need to addressed in treatment include:
- Poor dietary intake – this is usually the tip of the iceberg, and is common in vegans/vegetarians and those with low meat and animal product intake.
- Blood loss – resulting from a heavy period (menorrhagia) often caused by Endometriosis, polyps or fibroids; other hormonal imbalances and gastrointestinal bleeds (stomach ulcers, haemorrhoids).
- Absorption issues – caused by SIBO, Leaky Gut, Parasites, Coeliac disease, Chrones disease, Hypochlorhydria (low stomach acid), excess tannin intake (teas, coffee, dried fruit), Vitamin C deficiency.
- Utilisation issues – caused by a high dairy diets (iron competes with calcium), copper deficiency, Vitamin B deficiencies, high impact exercise and high levels of heavy metals such as mercury, lead and cadmium.
- Genetic factors – MTHFR and other folate polymorphisms, pernicious anaemia (where you are unable to absorb B12).
- Life stage – iron levels will naturally decline during pregnancy and breast feeding. Also the elderly often experience an iron deficiency due to reduced GI function.
Iron deficiency solutions
Logically, addressing all of the underlying causes above is the best path forward to resolving an iron deficiency. Other ways you can help yourself include:
- Eating plenty or Iron-rich foods. Diet is the start point. If you aren't getting enough iron in the foods you eat, it is unlikely you will retain adequate levels in your blood. The highest natural sources of Iron include: Organic beef and lamb (lean tenderloin); Mollusks such as clams, mussels, oysters; Organic liver (from meats); Beans and pulses such as lentils and white beans; nuts and seeds such as pumpkin seeds, cashews and almonds; wholegrains such as quinoa; tahini; molasses; dark leafy greens and dark chocolate. NB: The haem (blood) iron found in animal foods is 2-3x better absorbed than the non-haem iron found in plant sources.
- Get an adequate intake of protein. A protein deficient can sometimes contribute to anaemias. So getting enough protein in the day is essential, especially at breakfast (where getting 20g of protein in is the ideal for your energy throughout the day). Outside of dietary protein another fast way to supplement protein is via a good vegan protein powder (rice, pea, Inca iInchi) or via a high quality, flavourless marine collagen.
- Avoid tannins, especially near iron rich foods. Tannins are the bitter tasting, astringent substance that may inhibit iron absorption. They are found in high amounts in grapes, black tea, green tea, beer and fruit juices. If you have serious anaemia it is best to cut these drinks out altogether. For everyone else it is best just to avoid them when taking an iron supplement.
- Improve your gut Health. Work with a clinician to increase your stomach acid, and to correct any dysbiosis (bacterial imbalances), infections (parasitic, bacterial, fungal) or Small Intestinal Bacterial Overgrowth (SIBO).
- Address B12, folate, Vitamin C and zinc deficiencies. By taking nutritional supplements. These nutrients support your iron levels by increasing the amount of iron your body can absorb and the production of haemoglobin (an iron rich protein that carries the oxygen inside the red blood cells).
- Avoid certain medications, such as antacids (Quickeze, Mylanta) and proton pump inhibitors (Nexium, Losec). These medications reduce stomach acid and increase stomach pH which impairs the absorptions of iron, calcium, zinc, B12 and folate.
- Invest in cast-iron cookware. Cooking with cast iron cookware can increase your iron intake. This is especially true if you are cooking acidic foods at high temperatures.
- Try a transdermal iron cream. Transdermal iron is a cream for your skin that is infused with elemental iron. For some it is an easier more gentle form of iron supplementation (although I don't recommend it for those with inflammatory disease like with Endo). Transdermal iron creams need to be made by a compound pharmacist with a script from a practitioner.
A note about Iron Supplements
It is important to have your baseline iron levels checked first with your local GP before taking an iron supplement. This is imperative - if you take an iron supplement and your levels are already normal, you risk the chance of iron overload.
Iron supplements seem like the logical, short quick fix for an iron deficiency, but they leave many women feeling worse and totally unaware that that the supplement they bought over the counter is the cause.
You should avoid supplementing with iron with:
- Any inflammatory disease (including Endometriosis, Inflammatory bowel/Cardiovascular disease and joint issues.). Iron by nature is an ‘oxidant’ – that causes oxidative damage that may trigger other pathologies (via its inflammatory effect). This is why many people experience flare ups of pain and fatigue after taking iron supplements or having an iron infusion. These people are best to focus on dietary sources of iron and improving digestion, except in the case of pregnancy where a transdermal iron can be used.
- Over the counter Iron supplements, which are often made from ferrous sulfate that can irritate the gut (iron glycinate is a much better, more gentle form).
- With any sort of stomach irritation (gastritis), a stomach ulcer, diverticular disease, a haemolytic anaemia, SIBO or any Inflammatory Bowel Disease (IBD – such as Crohn’s or Ulcerative Colitis).
Once you have checked these things off your list and are safe to supplement with iron, it is best only to take Iron in the form of bisglycinate or Iron Amino Acid chelate (you will need to check the label). Always avoid ferrous or ferric salt forms (that are often sold in pharmacies) as they are harsher on the stomach and will likely cause constipation.
Has natural medicine ever helped you improve your iron levels?