Stop Iron Supplementation!
I see too many people unnecessarily taking iron supplements and so I wanted to write this blog to clarify a few things that we are otherwise not taught! People are typically familiar with the implications of low iron but they aren’t aware of the consequences of too much iron or WHY their iron might be low.
As always, I’m wanting to get to the heart of an issue (why iron is low) and not just treat the symptom (supplement with iron).
Our body’s are a lot more complex than it sometimes seems from the outside (surprise surprise) and the same is true with iron metabolism. There is a complex system that controls our body’s absorption, utilisation and recycling of iron. There are also other organisms (bacteria/yeasts/parasites) that can compete for our iron within the gut which can warp the whole picture and worsen gut issues when you supplement with iron (feed the microbes) without actually addressing the root of the issue (an overgrowth of iron loving bacteria/yeasts/parasites).
Iron is found within the protein haemoglobin which carries oxygen around our body. As iron levels drop, haemoglobin levels will eventually also drop and therefore we get less oxygenation of our cells and many of the resulting symptoms.
We need about 25mg per day of iron however most of this is recycled (all going to plan..) and so our daily requirement is more like 2-5mg. Because absorption of iron is typically low we still need a good 20-30 mg of iron per day in our diet as there will only be a small percentage of that which is actually absorbed (again, all going to plan).
Symptoms of iron deficiency:
Fatigue
Shortness of breath - occuring more quickly that it usually would e.g. while climbing some stairs in your house
Poor memory and mental clarity
Brittle hair and nails
Restless leg syndrome
Heavy menstrual cycle
Weakness
Dizziness and lightheadedness
Cold hands and feet
When I work with someone who has low iron levels I want to firstly test their full iron panel, not just ferritin, to have a clear understanding of what is going on. I then want to consider why their level might be low.
The reason I don’t go straight in with an iron supplement every time is because iron is a heavy metal and can very easily oxidise. Think about iron in your backyard - it rusts very easily! This is an example of oxidation. This oxidation process can also occur internally and is a big driver of inflammation and ageing. If you have had an iron infusion you may have experienced nausea/vomiting, dizziness, headaches or generally feeling pretty unwell after it to do with this big flux of iron of which part of it would have undoubtedly oxidised → particularly if you don’t have the right nutrients to utilise it.
The following factors are what I would want to investigate in regards to low iron levels:
Poor intake - common with a vegetarian/vegan diet
Poor digestion
High blood loss due to heavy menstruation
Pregnancy/birth
Infections - bacteria / yeasts / parasites
Low levels of vitamin A and copper which are necessary for the recycling of iron
Poor absorption: Inflamed intestinal lining / brush border
Long-term use of antacids or proton pump inhibitors (PPI)
And this is how I would tackle them:
Poor Intake
There are two types of iron - haem and non-haem iron. Haem iron is found in animal sources as it is derived from haemoglobin (meat, poultry and seafood) and is the more bioavailable form of iron - best for absorption. Non-haem iron is found in plant sources of iron and is not well absorbed.
In most cases vegetarians/vegans suffer here and it’s investigating whether they are happy to include any animal protein in their diet to increase their intake or whether they do in fact need to supplement.
Also making sure that the iron that is consumed is not consumed alongside tannins (tea and coffee) which prevent absorption. Whereas, vitamin C will increase the absorption of iron.
2. Poor digestion
We need to actually break proteins down well so that your digestive enzymes can extract the nutrients - iron - from the food. If this is not happening, even if you have a high iron intake you won’t be digesting and absorbing the iron from it.
Some tools I would like to use are:
Apple cider vinegar to increase the acidity of the stomach which is essential for protein digestion.
Supplementing with digestive enzymes
Managing stress levels to ensure the digestive system is ‘turned on’. This won’t happen well in a stressed state
Chewing your food well
3. High blood loss due to heavy menstruation
Addressing why the individual is bleeding so much. This can be to do with low progesterone levels, high estrogen levels, dairy intake, gluten intake, vaginal infection and perimenopause. It can also be aggravated by low iron levels so exploring why this has happened in the first place.
4. Pregnancy/birth
Typically here the body has a higher need for iron but it will also increase absorption of iron over this period. I always recommend a pregnancy multi which will contain some iron in an easy to absorb form - iron bisglycinate. In many cases I will also recommend supplementation or consumption of organ meat which contains high levels of iron and also the accompanying nutrients copper and vitamin A which are important for the utilisation/recycling or iron.
A post-partum multi is beneficial here and depending on the birth additional iron might be needed for a short-period of time.
5. Infections - bacteria / yeasts / parasites
This can occur with both low ferritin levels and high ferritin levels. One of the body’s mechanisms when we have an infection (cold/flu) is to store excess iron away so that the infection doesn’t have easy access to our iron for its own survival and replication - quite clever!
In the case of an overgrowth of bacteria/yeasts/parasites in the gut, they are able to absorb the iron we are eating or supplementing with before we can absorb it. Not only does this affect our iron intake but it also fuels the growth of these unfriendly microbes and contributes to the many symptoms they may be driving - bloating, constipation, loose bowels, IBS, gas etc. So, if iron supplementation aggravates your gut, think carefully before taking more!
In this instance I would often do a stool test to see more clearly what’s going on here and then address the infection through the use of natural antimicrobials and probiotics. Once the infection has gone iron levels typically go up naturally without the need for supplementation.
6. Low levels of vitamin A and copper which are necessary for the recycling of iron
It can be hard to test for these levels but observing the diet we can see if you include many copper or vitamin A rich foods in your diet:
Vitamin A:
Liver
Fish
Eggs
Full fat dairy
Green, orange and yellow vegetables
Copper:
Liver and kidneys
Oysters
Bee pollen
Chlorophyll
Potatoes
Whole grains
7. Poor absorption: Inflamed intestinal lining / brush border
In many cases people simply aren’t absorbing the iron they are consuming due to an inflamed / damaged gut lining. This is often the case in chronic health conditions such as:
Coeliac disease, undiagnosed coeliac disease or non-coeliac gluten sensitivity
Crohn’s disease
Ulcerative colitis
But it can also occur in cases where there are other undiagnosed food intolerances or there is overuse of certain medications such as non-steroid anti-inflammatories (ibuprofen/nurofen) which damage the gut lining and can contribute to leaky gut.
Addressing these conditions by nourishing the gut lining with certain nutrients and herbs and eliminating exposure to other inflammatory culprits - sugar, alcohol, medications, in some cases dairy, soy etc. We can also address other driving factors such as stress and bacterial infections which can drive these conditions.
8. Long-term use of antacids or proton pump inhibitors (PPI)
Here we would address the upper digestive system so that there is no reliance on these medications. The use of apple cider vinegar, digestive enzymes and proper chewing can really help here.
Finally, if you are going to supplement you want to make sure it’s in a form that is easily absorbed and kind on the gut. Most of you will have experienced constipation or black stools from taking iron supplements - this shouldn’t happen! And it never does when you take a good quality one.
Iron bisglycinate is the form you want at 20-24 mg per day. Best to be taken with food, away from coffee/tea which can inhibit absorption and taken with vitamin C to increase absorption. Most good quality supplements will have vitamin C in them as well.
Any questions, sing out in the comments below!
