Should you supplement with iron? It depends! What are your levels and do you have signs of iron deficiency? Having appropriate iron is extremely important to numerous body processes, including delivering sufficient oxygen to your tissues via the red blood cells (iron binds the oxygen) and enzyme support in detoxification, hormone processing and antioxidant status.
So, while having sufficient iron is extremely important, it’s also not a mineral that’s “the more the merrier.” You should only supplement with iron if your levels are low. Let’s discuss how that can happen and what it might look like…
Who is at risk for having low iron?
- Those not getting enough in. This might be due to:
- Lack of iron in the diet (which is often the case with vegan and vegetarian diets). While there are plant foods that contain non-heme iron, it is much less well-absorbed than the heme iron we find in animal foods – and heme iron is the more usable form that we need.
- Inability to absorb iron well due to GI issues with absorption, such as inflammation or dysbiosis (an imbalanced microbiome). This includes having diseases/issues like celiac disease, inflammatory bowel disease, irritable bowel syndrome, even functional issues like low HCL (stomach acid)
- Taking medications that interfere with absorption – ex proton pump inhibitors that decrease stomach acid – also lower ability to absorb iron.
- Eating a diet high in phytates (especially grains, nuts & beans), tannins (think coffee & tea) or dairy – which all bind and prevent absorption of iron
- Also at risk for low iron are those who are consistently losing blood or who had a major bleed, such as:
- Menstruating women
- Recent hemorrhage/significant bleed (think surgery, childbirth, etc)
- Those with any kind of chronic bleeding, such as from the GI tract with ulcerative colitis or crohn’s disease.
What are the signs of low iron?
Common signs of low, insufficient iron (including anemia) include the following:
- Fatigue or low energy
- Hair loss
- Heavy periods
- Light periods
- Pale skin where it should be deep pink (palms, inner eyelids)
- Anxiety
- Dizziness or lightheadedness
- Cold hands and feet
- Restless leg syndrome (especially in kids)
If you have any of the signs above, it’s highly worthwhile to measure the level of iron in your blood.
What are the most important tests for iron status?
- Complete blood count (CBC)
- Iron panel: Serum iron, total iron binding capacity, transferrin and iron saturation
- Ferritin (stored iron)
So who may want to consider iron supplementation?
- Those with labs that show microcytic anemia on a CBC – aka low RBC count, HGB, HCT and “small” size of RBCs aka MCV.
- Those with iron panel results that show low iron levels, low iron saturation and/or high binding capacity.
- People who are bleeding regularly (ex. via menstruation) AND who have a low ferritin level (i.e. stored iron). As a naturopathic doctor and expert in functional medicine, I consider a ferritin level below 50 ng/ml to be low. Contrary to what the “normal” lab range will tell you, a ferritin of 12 or 20 ng/ml is very rarely sufficient. Symptoms like fatigue, hair loss, continued heavy bleeding, and more can all be from sub-optimal iron levels or low-normal ferritin levels.
- *Note: if your ferritin level is HIGH, this is likely due to acute inflammation, but either way should be looked into and addressed with your doctor – that’s not typically a time to add more iron to the fire, so to speak.⠀
Iron supplementation can be a bit tricky to navigate, because you want to stay on top of your levels and not over (or under) supplement. You may also find certain types of supplementation work better for you than others. Work with your naturopathic doctor or functional medicine doctor to stay on top of this and whether or not it makes sense for you to add more iron via diet and/or supplementation.
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