Opinion: Iron deficiency - are you getting enough?


This week marks 2018 World Iron Awareness Week.



Dr Claire Badenhorst from the School of Sport,
Exercise and Nutrition.

By Dr Claire Badenhorst

We all know of someone who has been diagnosed with iron deficiency or iron deficiency anaemia. It’s probably the most common nutrient deficiency in the world, with close to a third of the global population being affected. Closer to home, figures from nutritional surveys suggest one in every 14 Kiwi women is iron deficient.

More often than not, the people that we know with iron deficiency will be our female friends, colleagues or family members. Usually after months of feeling tired and run down, they finally go and see a doctor, they have a blood test and the doctor puts them on a course of iron supplements.

The typical symptoms for iron deficiency include fatigue, weakness, shortness of breath and pale skin. In most cases, iron deficiency is only diagnosed once it has progressed to the final clinical end point, where iron levels have dropped so substantially that the individual now suffers from anaemia and presents with low levels of iron and haemoglobin; a molecule that has a role of carrying oxygen around your body.

Having iron deficiency anaemia with low haemoglobin is like living at high altitude where every activity seems hard and more taxing than usual, as your body is deprived of oxygen. While the majority of iron within our bodies is found within oxygen transport proteins, what most people are not aware of is that iron actually forms a crucial component of many enzymes within the body. An enzyme is a substance that speeds up the rate that a chemical reaction can occur within the body.

If you were beating eggs to make a cake you could either use a hand-held whisk or an electric mixer. Most people would choose to use the electric mixer because it will help you get to the end result quicker. Within your body, your enzymes are the electric mixers. Now imagine the mixer loses a vital component – it probably won’t work as well. In a similar manner, if your iron stores start to decrease in your body, then you are affecting a vital component of many of your body’s enzymes and as a result, the quality of the work they are doing will likely be reduced.

The effect of declining iron stores will not only make you feel tired but will also reduce your body’s immune function, so you may become sick more frequently. It will also reduce your cognitive activity. Have you ever experienced that brain fog that no matter how many coffees you drink you cannot seem to shake the feeling? It’s like that, all the time. You have a reduced ability to function at an optimal level for your normal everyday living.

Iron has many roles in the body however, so it’s not just about transporting oxygen. Your thyroid glands can be impaired by iron deficiency. People with iron deficiency anaemia have five times the risk for hypothyroidism (an under-active thyroid), while those suffering from iron deficiency without anaemia have twice the risk.

The role of the thyroid gland is to regulate your body’s metabolism, therefore if the function of the thyroid gland decreases then it is likely that your metabolism will slow down. People with sub-optimal functioning thyroid glands may have symptoms of fatigue, weakness, weight gain, coarse skin, hair loss, cold intolerance and digestive issues, though symptoms may vary from individual to individual.

Psychological health may also deteriorate since individuals who suffer from hypothyroidism often present with increased feelings of anxiety and depression. While iron deficiency is not a primary cause of hypothyroidism, it can certainly act to progress its clinical presentation.

Iron deficiency can also be a serious threat to bone health and can be considered an emerging risk factor to osteoporosis. In fact, there is research that has demonstrated that simply inducing iron deficiency can decrease markers of bone formation and increase markers of bone breakdown and as a result decrease bone mineral density.

The potential interactions that iron has with so many of our body’s systems is still one that requires a vast amount of research. The level of iron depletion that will affect these various systems, enzymes and normal functioning is yet to be defined, but I am of the belief that we should not be the ambulance at the bottom of the cliff - treating at the final stage of iron deficiency when haemoglobin is finally reduced. We should all be more proactive about getting and keeping our iron levels stable, to prevent other areas of physical and psychological health deteriorating.

If you’re hoping to improve your iron stores through natural food sources your best options will be to ingest animal foods that contain heme iron such as beef, chicken, pork and fish (particularly clams, oysters and mussels). Your red meat and organ meats such as liver are particularly great options to choose from. You should be aiming for two to three servings per week of heme iron. You can also choose to get iron from plant sources (non-heme), though this is less readily absorbed within your body. These sources include dark green leafy vegetables like spinach and kale, as well as broccoli, soybeans, lentils and tofu. You can increase your absorption of non-heme iron by either ingesting it with heme iron product, or by eating it with foods that contain prebiotics or vitamin C or A.

Dr Claire Badenhorst is a lecturer in exercise and sport science, from the School of Sport, Exercise and Nutrition at Massey University.

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