Are You Deficient In Iron?
By Kara Carper, MA, CNS, LN
November 30, 2022
The human body is pretty incredible. While we go about the responsibilities of our day, the systems of the body carry out a number of different tasks: the lungs breathe about 22,000 breaths a day, the kidneys process around 50 gallons of blood, and the 650 muscles create movement with our extremities while also creating movement internally with our organs (think of that heart muscle pumping blood!). We typically don’t even notice these tasks happening as most of them are subtle, involuntary, and a small part of a bigger collaboration between multiple actions and reactions that happen inside of us.
As a nutrition company, we know how important the food we eat is to assist our body in its daily functions. When we get all the vitamins, minerals, phytonutrients, and macronutrients (think protein, fats, carbs) from our food, our body can do what it does best. When we experience adverse symptoms, we can look to see where we have deficiencies and how we can support our body through food and supplements. Today, let’s take a closer look at IRON.
Iron’s Role In The Body
Iron is an essential mineral that helps make up hemoglobin. In order to talk about iron, we need to talk about oxygen, so hang on tight for this short biology lesson. Every healthy cell in the body is fueled by oxygen and the body has about 37.2 trillion cells! The cells receive this oxygen from the red blood cells.
Hemoglobin is the protein in the red blood cells that carries the oxygen we inhale from our lungs into the bloodstream and is then carried by the blood to all the other areas of the body. You can think of hemoglobin as being the seatbelt for oxygen as it takes its ride in the red blood cells to various tissues throughout the body on the roadway of blood vessels. The mineral iron functions as part of the seatbelt mechanism to assist the hemoglobin in bringing the oxygen to our tissues.
Even with this vital role, iron is not produced by the body (like omega-3 fatty acids), so we need to get iron through nutrition. The good news is that the body can store iron. About 70% of our body’s iron is found in the hemoglobin of the red blood cells as well as in myoglobin, which is a protein in the muscle cells that stores, transports, and releases oxygen into the muscles. While hemoglobin hangs out in the blood stream, myoglobin is like an oxygen tank in the muscle cells that can temporarily provide oxygen when blood oxygen is low during intense muscle activity. This is one reason why an iron deficiency can cause symptoms like fatigue, low energy, muscle weakness, and shortness of breath. There isn’t enough iron to help the oxygen get to the muscles and so we feel tired!
Signs You Might Be Deficient In Iron
So, how do you know if you are deficient in iron? In addition to storing iron in the hemoglobin, about 25% is stored in the liver and can be used if the iron in our hemoglobin is low. If we don’t get enough iron through our food or if we are having trouble absorbing iron from various reasons we’ll get to below, the body’s iron stores get lower over time, which can be determined through a blood test. Ferritin is a measure of this “stored iron” and is helpful data for what’s going on in your body.
Work with your medical professional to get both your hemoglobin and ferritin levels checked. If your hemoglobin is under 12 mg/dl, you’ll probably be showing signs of anemia*. For ferritin, standard ranges are between 12-300 for men and 12-150 for women. Those are pretty wide ranges, so if you are near the lower end of that spectrum, you’re more likely to be experiencing symptoms of iron deficiency. The range where the average person feels good is 40-80, with the sweet spot being 70.
How do you know if you should get a blood test? Here are some symptoms you could be feeling if you’re experiencing iron deficiency:
- Cold hands and feet
- Headache, dizziness or lightheadedness
- Swollen or sore tongue
- Chest pain, fast heartbeat, or shortness of breath
- Low immune function
- Brittle hair and nails
- Hair loss
- Wanting to eat ice (Pica)
- Restless legs
- Cracks on the sides of the mouth
- Lack of focus
*Often the diagnosis of “anemia” can come with iron deficiency. The definition of anemia is diminished red blood cell quantity, size, or function. The most common causes of chronic anemia are vitamin B12 deficiency and iron deficiency. Both of these conditions can be related to diet or medical illnesses, with iron deficiency anemia being much more common than vitamin B12 deficiency anemia, so getting to the root cause with blood draws is an important step to your healing.
Low Hemoglobin vs Low Ferritin: Why You Need To Check Both
The most common scenario nutritionists and dietitians come across is someone feels "slightly tired" and their doctor checks for hemoglobin which is in the normal range. They carry on with their lives feeling more and more fatigued and not realizing their ferritin is in the tank. If someone is iron deficient, their body will use stored iron first and a hemoglobin test could show up in the normal range, but ferritin (iron storage) has been depleted and is low. This can happen in early stages of iron deficiency. If the source of the iron deficiency is not corrected, eventually hemoglobin will be low as well and this happens in the later stages of iron deficiency.
That’s why getting both a hemoglobin AND a ferritin test are very important. If iron deficiency is suspected, a transferrin lab test should also be requested (transferrin is a protein that carries iron throughout the body and is another lab test that can determine iron deficiency).
Why You Might Be Low In Iron
Because the body gets iron through food and is mostly stored in the blood, you might be low in iron if:
- You have digestive issues (especially gluten sensitivity) that makes it challenging to absorb iron
- You aren’t getting sufficient amounts through food (especially if you are a vegan or vegetarian or have trouble getting enough animal protein into your meals)
- You have heavy bleeding (like regular menstrual cycles, GI bleeding, injury, or postpartum/birth)
- You’re going through a stage of life where the body changes (like pregnancy, cancer diagnosis, or growth spurts in children and adolescents)
- You are a female, endurance athlete (younger female endurance athletes are at an even higher risk due to blood loss from both a growth spurt and/or menstruation). Experts estimate that up to one-quarter of female athletes are iron deficient and this is true from clinical experience as a nutritionist. The majority of clients I worked with who were anemic were female runners and is super common.
To get to the root cause of what’s causing your deficiency, working with a dietitian, nutritionist, or your medical professional can help pinpoint what’s going on and how to support your iron needs.
Food Sources For Iron
As a food-first company, we focus on how to get essential nutrients from food when we can. The body can absorb iron from animal food much more (up to 20%) than from plant food (between 1%-7%), but if you’re following the Weight & Wellness Way of eating animal proteins, healthy fats, and whole food carbohydrates, you’ll get a mix of both! Here are some foods rich in iron to include into your meal planning:
- Meats: beef, pork, lamb, liver, organ meats
- Poultry: chicken, duck, turkey, liver, eggs
- Fish: shellfish (including clams, mussels, and oysters), sardines, anchovies
- Leafy greens: spinach, kale, turnip greens, collards, Swiss chard, cabbage
- Legumes and seeds: lima beans, green peas, pinto beans, black eyed peas, pumpkin seeds
To help your body absorb the iron in plant-sources, like your leafy greens, make sure to include vitamin C. This vitamin helps enhance the bioavailability of iron for the body, meaning it helps the body break it down to be more easily absorbed. Here are some vitamin C food sources you can include:
- Citrus: oranges, kiwi, lemon, grapefruit
- Bell peppers
- Cruciferous veggies: broccoli, brussels sprouts, cabbage, cauliflower
Squeeze a lemon over your kale salad or with your cast-iron cooked protein. Make a steak fajita with bell peppers and tomatoes. Chop up some leafy greens to hide along with some ground liver in your beef meatballs. Top your spinach salad with chicken, strawberries, and pumpkin seeds. Make our Egg Roll In A Bowl for your pork and cabbage. The options for eating your iron and vitamin C are endless and delicious!
Iron Supplementation & Who Should Take It
If your iron stores are low and your hemoglobin levels are near an anemia diagnosis, you might need to take an iron supplement to return your stores to an optimal level. If you do decide to supplement, you’ll want to look for a high-quality iron that’s easily absorbed by the body. Lower grade iron supplements made up of ferrous sulfate can cause digestive upset, including constipation and indigestion. Instead, look for a chelated form made of iron glycinate, iron bis-glycinate, or iron malate. NutriKey Iron is a great option, especially when paired with the Complete C-1000.
It's important to note that while we want enough iron stores in our body for energy and to provide oxygen to our tissues for vibrant health, we also don’t want TOO MUCH iron. If you aren’t deficient in iron, you don’t need to supplement, especially if you aren’t regularly menstruating. Often pregnant and post-partum women can get iron in a high quality pre-natal supplement, so check with a medical professional if you’d need extra supplementation on top of what you’re already taking.
Iron Wrap Up
In summary, because the body doesn’t produce iron on its own, we need to get sufficient amounts from our nutrition. Include lots of leafy greens, meats, poultry, and fish with citrus fruits, bell peppers, tomatoes, and cruciferous veggies to get that synergistic combo of iron and vitamin C. Get your hemoglobin and ferritin labs tested to see where your levels fall, especially if you’re experiencing symptoms of deficiency, have heavy menstrual periods, are pregnant, are a female endurance athlete, or are vegan/vegetarian. Work with your nutritionist, dietitian, or medical professional to supplement and problem-solve so your tissues can get the oxygen they need to function and your body can do what it does best.
For more information on mineral deficiencies, check out these resources:
- Listen: Signs of a Mineral Deficiency
- Read: Signs You May Be Deficient In Minerals
- Read: Multivitamins: What to Look For and What to Avoid
- Take: The Magic Of Minerals
Nestor, James (2020). Breath: The New Science of a Lost Art, Riverhead Books of Penguin Random House, LLC.