Iron-deficiency Anemia

Symptoms of Iron-deficiency Anemia
Risk Factors for Iron-deficiency
Treatment for Iron-deficiency Anemia

Iron deficiency is the most common nutrient deficiency in the U.S. It is more common during pregnancy, among women with heavy menstrual periods, and in those consistently eating a diet low in iron. Iron-deficiency anemia can usually be corrected with iron supplementation.

There are three levels of iron deficiency, listed below from least to most severe.

Stage 1—Iron Depletion: occurs when stored iron decreases, but is mild enough that it does not result in symptoms, and common lab values (hemoglobin, hematocrit) will remain normal.

Stage 2—Iron Deficiency: occurs when levels become substantially reduced and the production of hemoglobin decreases.

Stage 3—Iron Deficiency Anemia: the final stage, which occurs when iron stores are decreased to the extent that normal red blood cell production can no longer be supported. Anemia can be further categorized as mild, moderate, or severe.

When iron deficiency has progressed to anemia, blood tests will show low red blood cell count, hemoglobin, and hematocrit levels.


Symptoms of Iron Deficiency Anemia

Red blood cells carry oxygen to the body's tissues, providing energy. If you are iron deficient, you don't have enough healthy red blood cells and, as a result, you may feel extremely tired and weak. Other symptoms can include pale skin, rapid heart rate, headache, dizziness, and irritability. Symptoms of severe iron deficiency can include brittle or spoon-shaped nails, sores in the corner of the mouth, a sore tongue, and loss of taste buds.


Risk Factors for Iron-deficiency

Pregnancy

Iron requirements increase substantially during pregnancy due to increased iron use by the developing baby. The RDA (Recommended Daily Allowance) for iron for pregnant women is 27 mg. Severe iron deficiency anemia has been linked to low birth weight and premature birth.

Intense Endurance Exercise

Studies show that iron loss is greater in athletes involved in intense endurance training. It is estimated that those participating in regular intense exercise may need up to 30% more iron than sedentary individuals.

Increased Blood Loss

Red blood cells contain iron, so if you lose blood, you lose iron. Because of menstruation, women need more iron before menopause than they do after. Heavy use of aspirin or other over-the-counter anti-inflammatory drugs (i.e. ibuprofen) can lead to gastric (stomach) bleeding and loss of iron. Some medical conditions such as an ulcer, a bladder or kidney tumor, a colon polyp or cancer, or uterine fibroids can result in iron deficiency anemia over time. Contact your doctor if you see blood in your urine or stools.

Vegan Diet

The form of iron in plants is not as well absorbed as the form in animal sources. Vegetarian (vegan) women who are not taking a multivitamin with iron may need to get more iron in their diet than the RDA, which is set at 18 mg for premenopausal women. For vegans, it is recommended that the RDA be adjusted to 33 mg for premenopausal women and 14 mg for postmenopausal women. Vitamin C increases the absorption of iron, so eating foods rich in vitamin C at the same time as a plant source of iron is beneficial. For example, top a spinach salad with sweet red peppers or strawberries.


Treatment for Iron-deficiency Anemia

Iron supplements are recommended for the treatment of iron deficiency. Iron supplements at doses needed for repletion (over 45 mg/day) can cause gastrointestinal (GI) side effects such as stomach upset, nausea, vomiting, diarrhea, or constipation in around 10% of women. Iron supplements should be taken with food to help reduce the risk of GI upset.

In addition to supplementation, women with iron deficiency should increase the amount of iron in their diet. Foods rich in iron include beef, dark meat chicken, oysters, shrimp, raisin bran, kidney beans, prunes, and spinach.

The iron in plant foods such as vegetables, beans, and grains is called nonheme iron. It is not absorbed nearly as well as iron from meat, which is called heme iron. Phytic acid, found in legumes (soybeans, black beans, lentils, and split peas) and rice, decreases the absorption of nonheme iron even further. As a result, much of the iron in these foods is not absorbed.

Vitamin C increases the absorption of iron from plant foods. The iron from spinach or beans, for example, is much better absorbed when eaten along with vitamin C-rich foods such as oranges/orange juice, grapefruit, strawberries, red bell peppers, broccoli, and tomatoes.