Iron deficiency is a condition in which the level of iron in the body decreases, leading to insufficient amounts for normal hemoglobin synthesis. Although iron deficiency itself is not anemia, it can cause various unpleasant symptoms such as weakness, fatigue, and cognitive decline. If iron deficiency progresses, it can lead to the development of iron deficiency anemia, which poses a serious health risk. Iron deficiency anemia can develop not only due to a lack of iron but also as a result of other factors that interfere with the body’s ability to absorb or utilize iron.
Definitions of Iron Deficiency and Iron Deficiency Anemia
First, let’s introduce some terms:
- Erythrocytes: Red blood cells that carry oxygen from the lungs to all body tissues and transport carbon dioxide back to the lungs.
- Hemoglobin: A protein in erythrocytes that binds oxygen and carries it throughout the body.
- Ferritin: A protein that stores iron in the body. Ferritin is stored in the cells of the body, primarily in the liver, spleen, bone marrow, and muscles.
Now, it’s necessary to explain a few concept, as confusion often arises here:
- Iron deficiency: A condition in which the body’s iron stores are insufficient. This can be caused by increased needs (such as during exercise, periods of growth in children, or during pregnancy), inadequate dietary iron intake, blood loss (for example, due to heavy menstruation), or impaired iron absorption in the intestines.
- Anemia: A condition characterized by low levels of hemoglobin in the blood. There are several causes of anemia; iron deficiency anemia is just one type. Other causes of anemia include vitamin deficiencies (such as vitamin B12 or folate), chronic diseases (such as kidney disease or cancer), hereditary conditions (such as sickle cell anemia), infections, autoimmune diseases, blood production disorders (such as aplastic anemia), and hemolysis (destruction of red blood cells).
- Iron deficiency anemia (IDA): Anemia caused by insufficient iron stores in the body. In IDA, the following laboratory signs are often observed: reduced erythrocyte size, decreased hemoglobin content in erythrocytes, and low ferritin levels. In cases of sudden blood loss or in the early stages of iron deficiency, anemia with normal-sized erythrocytes may be observed.
Why is Iron So Important?
Iron plays a key role in the body, and its deficiency can significantly affect overall health.
- Role in Oxygen Transport: Iron is essential for the production of hemoglobin. Without adequate iron, the body’s cells do not receive enough oxygen, leading to fatigue, decreased physical endurance, and even heart attacks in severe cases of anemia.
- Impact on Energy, Brain, and Immunity: Iron is involved in energy production and supports normal brain function, influencing cognitive abilities, concentration, and mood. It is also necessary for maintaining the immune system, helping the body fight infections.
- Effect on Thermoregulation: People with anemia often feel cold even in warm weather. This is because a lack of iron reduces energy production in cells, which can disrupt the body’s thermoregulation.
How is Diagnosis Made?
When it comes to diagnosis, things are constantly changing. Without going into details (pregnancy, adolescence, etc.), let’s look at how the diagnosis is made for an adult in the province of Ontario, but this is not yet done in the province of British Columbia:
- If a person’s ferritin level is <30 µg/L (some recent studies suggest this value should be even higher, at 50 µg/L), iron deficiency can be indicated. In this case, it is recommended to first raise iron levels with oral supplements, and if there is no improvement, intravenous iron infusions should be considered.
- If hemoglobin levels are below acceptable values, which depend on age, gender, and other factors, this is already classified as anemia, and the diagnosis is made regardless of ferritin levels. This occurs due to the possibility of falsely elevated ferritin levels in the presence of inflammatory processes in the body.
I do not wish to delve into the ranges of values and other parameters used in diagnosis, as this is quite a complex topic even for specialists. It is important to understand the main disagreement lies in when to begin treatment, rather than what constitutes anemia.
Statistics on Iron Deficiency and Iron Deficiency Anemia in Canada
Here are the prevalence data for iron deficiency anemia among various population groups:
- Overall Population: According to Statistics Canada, the prevalence of iron deficiency anemia in the general population is approximately 3-5%.
- Women: About 10-15% of women of reproductive age (15 to 49 years) may suffer from iron deficiency anemia.
- Children: Studies indicate that around 5-10% of children aged 1 to 4 years may have iron deficiency anemia.
- Elderly People: Some studies show that about 10-15% of elderly individuals (over 65 years) may have iron deficiency anemia, especially if they have chronic illnesses.
- Vegetarians and Vegans: Individuals following vegetarian or vegan diets are also at high risk for iron deficiency anemia, particularly if their diet is not rich in iron-containing foods.
These data underscore the importance of monitoring iron levels and the risk of anemia in different population groups. The necessity of conducting preventive tests in at-risk groups is now recognized in many countries and provinces of Canada (with British Columbia currently excluded).
Causes of Iron Deficiency and Iron Deficiency Anemia
The causes of iron deficiency anemia are diverse, and some may pose serious health risks. It is essential not only to identify the iron problem and increase its levels but also to determine the cause of this condition to prevent more severe health issues.
Inadequate Dietary Iron Intake
- Vegetarian or vegan diet.
- Low intake of iron-rich foods.
Increased Iron Loss
- Heavy menstruation (estimates suggest that at least 10% of women of reproductive age suffer from iron deficiency).
- Regular blood donation.
- Surgeries involving significant blood loss.
- Hematuria (macro or microscopic) – blood loss in urine.
- Intravascular hemolysis – destruction of red blood cells.
- Intense physical exertion in athletes.
- Chronic kidney failure, which reduces the production of erythropoietin, the hormone that stimulates red blood cell formation.
- Chronic infections and inflammatory processes (e.g., malaria, parasitic infections, Babesia, Bartonella).
Gastrointestinal Bleeding
- Colorectal cancer.
- Stomach or small intestine cancer.
- Hemorrhoids.
- Peptic ulcers.
- Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis).
- Angiodysplasia.
- Esophagitis.
Impaired Iron Absorption
- Celiac disease.
- Crohn’s disease or ulcerative colitis.
- Chronic gastritis (including H. pylori infection and autoimmune gastritis/pernicious anemia).
- Stomach lymphoma.
- Surgeries on the stomach and intestines (gastrectomy, small bowel bypass, bariatric surgery).
- Mold toxicity (mycotoxicosis).
- Minor thalassemia (alpha form).
Nutrient Deficiencies Necessary for Iron Metabolism
- Vitamin B12 deficiency.
- Copper deficiency.
- Folate deficiency.
- Vitamin C deficiency (reduces iron absorption).
Iron Deficiency and Depression
It seems quite logical that iron deficiency anemia can affect brain function—insufficient oxygen supply to the brain will certainly impact its performance. However, it turns out that even just iron deficiency can lead to a range of mental health issues, even when there is no issue with oxygen supply to tissues.
Iron plays a crucial role in the synthesis of neurotransmitters such as serotonin, dopamine, and norepinephrine, as it is necessary for the enzymes involved in these processes. Neurotransmitters are chemicals that transmit signals between nerve cells in the brain, affecting mood, emotions, and behavior. The neurotransmitter imbalance in this case will result from the disruption of biochemical intracellular processes.
- Serotonin affects mood, sleep, and appetite. Low serotonin levels may be linked to depression. Serotonin is produced from tryptophan with the involvement of the enzyme tryptophan hydroxylase, which depends on iron. Iron deficiency slows down this process, reducing serotonin synthesis.
- Dopamine is involved in motivation, cognition, and pleasure. A deficiency in dopamine can lead to mood and concentration issues. Dopamine is synthesized from tyrosine with the help of the enzyme tyrosine hydroxylase, which is also iron-dependent. Iron deficiency disrupts dopamine synthesis.
- Norepinephrine helps regulate the body’s response to stress and influences energy levels and alertness. Norepinephrine is formed from dopamine through the enzyme dopamine β-hydroxylase, which also depends on iron.
Thus, iron deficiency anemia disrupts the synthesis of neurotransmitters, potentially leading to depression, decreased concentration and energy, as well as sleep and mood disturbances. Treating anemia can help address these conditions. Anemia should always be checked and treated if there are signs of neurotransmitter deficiency.
Symptoms of Iron Deficiency and Iron Deficiency Anemia
The symptoms of iron deficiency and iron deficiency anemia are often listed together, as iron deficiency usually accompanies anemia. However, it is important to understand the difference between these conditions.
Symptoms of Iron Deficiency (low ferritin, normal hemoglobin)
- Fatigue: General weakness and quick fatigue.
- Reduced Performance: Difficulty concentrating, paying attention, remembering, and decreased efficiency in studying or working.
- Neurotransmitter Disruption: Low iron levels can affect the synthesis of dopamine and serotonin, leading to mood changes, depression, and anxiety.
- Dizziness: May occur with sudden rises or physical activity.
- Cold Sensation: Especially in the hands and feet.
- Decreased Immunity: Increased susceptibility to infections.
- Changes in Skin and Hair: Dullness, brittleness of hair and nails.
- Thermoregulation Issues: Increased sweating or feeling hot.
Symptoms of Anemia (low ferritin and hemoglobin)
When hemoglobin levels drop, more pronounced symptoms related to oxygen deficiency in tissues are observed:
- Shortness of Breath: Especially during physical exertion.
- Paleness of Skin: Particularly noticeable on the face and mucous membranes.
- Increased Heart Rate: The heart tries to compensate for the lack of oxygen, especially during physical activity.
- Headaches: May occur due to insufficient oxygen in the brain.
- Weakness and Fainting: Especially when standing up quickly or changing body position.
- Chest Pain: May occur due to heart strain from lack of oxygen.
The symptoms of iron deficiency and anemia are nonspecific, making diagnosis challenging. Preventive testing allows for early detection of problems when treatment will be more effective.
How to Address Iron Deficiency?
Iron deficiency can be addressed in various ways. It is essential to note that not all sources of iron are absorbed equally, and certain conditions are necessary for its absorption. Let’s explore the main methods to increase iron levels in the body:
- Foods Rich in Heme Iron: Red meat, poultry, liver, and fish contain heme iron, which is absorbed much more efficiently than non-heme iron.
- Plant Sources (Non-Heme Iron): Legumes (lentils, beans), nuts, and seeds are good sources of iron; however, they are absorbed significantly less effectively.
- Importance of Vitamin C: Vitamin C enhances the absorption of non-heme iron. It is recommended to combine iron-rich foods with sources of vitamin C, such as citrus fruits and bell peppers. Remember that vitamin C breaks down at temperatures above 60 degrees Celsius.
- Iron Supplements: When taking iron supplements, several recommendations should be considered: take them on an empty stomach and avoid dairy products, coffee, and tea during consumption, as they impair iron absorption.
- Cooking with Cast Iron Pans: This method can also help add iron to the diet, but it should not be solely relied upon.
Issues with Iron Absorption and Side Effects of Iron Supplementation
Side Effects of Iron Supplementation:
- Constipation: One of the most common side effects associated with iron supplements.
- Dark Stools: A typical reaction to iron intake; however, remember that blood in stools can also cause dark coloration.
Other Issues with Iron Absorption:
- Medications:
- Antacids: They may reduce the effectiveness of iron by neutralizing stomach acidity, which is necessary for its absorption.
- Antibiotics: Some antibiotics can negatively affect iron absorption.
- PPIs (Proton Pump Inhibitors): Long-term use of these medications can lead to iron deficiency and impair absorption.
- Nutrients:
- Phytates and Tannins (found in whole grains, legumes, and tea) reduce iron absorption.
- Calcium (from dairy products and supplements) blocks iron absorption.
- Caffeine in coffee and tea also decreases iron absorption.
- Excess zinc can interfere with copper absorption.
Conclusion
Iron deficiency and iron deficiency anemia represent significant issues that require a careful diagnostic approach and appropriate treatment. Understanding the differences between these conditions, their causes, and symptoms is crucial for timely diagnosis and prevention of potential complications. Given that many population groups are at risk, regular testing for iron and ferritin levels can help identify problems early. Treatment includes dietary adjustments, oral iron supplements, or, in some cases, iron infusions. It is also essential to identify and address the underlying causes of the deficiency to prevent recurrence of the issue.