The Iron Paradox

Iron is an essential mineral required by your body for basic good health. Yet, iron deficiency continues to be the most common deficiencies throughout the entire United States. In fact, the CDC estimated that 1 out of every 10 women is deficient in the mineral.¹ How much do you know about iron and iron deficiencies? Let’s get to the bottom of it.

Iron Deficiency: Defined

An iron deficiency can lead to various health problems throughout the body, these include:

• Exhaustion
• Brain fog
• Shortness of breath

Yet, unlike many other essential nutrients, iron is toxic and dangerous in large amounts. This is what we refer to as the iron paradox. It is also why it is so crucial to keep a consistent eye on your iron levels. This way, you can always keep your amounts dialed in, and not have to worry about overdoing your body’s supply.

Today, let’s take a look at the signs and symptoms of iron deficiency and iron overload. From there, we can explore and discover how to get your iron levels within a healthy range.

Why Iron Is Important For Health

Iron is essential for building blood and transferring oxygen from the lungs to your cells. In fact, around 70% of all the iron in your body is found in your red blood cells. For this reason, your body really needs to receive adequate quantities regularly.

Too Little Iron

Low-iron levels prevent your body from producing enough red blood cells. As a result, low levels can cause iron deficiency anemia.² Iron-deficiency anemia often leads to fatigue and exhaustion, but you might also experience:

• Cold hands and feet
• Anxiety
• A headache or dizziness
• Rapid heartbeat
• Mental confusion or brain fog
• Hair loss
• Brittle nails
• Difficulty swallowing
• Shortness of breath
• Restless leg syndrome

Too Much Iron

However, too much iron is no better than too little. In large quantities, iron can be toxic and create a condition called iron overload. The symptoms of iron overload can lead to severe health problems, including:

• Diabetes
• Darkening of the skin
• Arthritis
• Adrenal function problems
• Hypothyroidism
• Hemochromatosis

Too much iron can also cause fatigue, as well as weakness, joint pain, and stomach pain.

There are even rare cases of long-term exposure to excess levels of iron being linked to poisoning of the major organs and certain cancers, cirrhosis of the liver, and incidences of heart attacks.

Ensuring Healthy Iron Levels

How much iron you need each day depends on three key factors:

• Your age
• Your gender
• Your overall health

Due to blood loss during menstruation, women need more iron: roughly 18 mg per day, while men and women over the age of 50 frequently need just 8 mg per day.

However, the standard American diet contains around just 7 mg of iron per 1000 kcal, which is why deficiency is so common.³ Malabsorption is also rife; since most individuals only absorb 1 – 2 mg of the 7 mg.⁴

Action Steps: Iron Deficiency

Because of the iron paradox and malabsorption, effectively regulating your iron level often requires working closely with your doctor, who will check your iron levels with a series of simple blood tests, including:

• CBC (complete blood count)
• Iron panel (serum iron, transferrin saturation, and total iron-binding capacity)
• Ferritin (storage form of iron)

If your test results show us that your iron levels are optimal, that’s fantastic! If your iron levels are low, or even high, it is essential we take action.

Dietary Iron Therapy

There are two types of dietary iron:

1. Those containing heme, and
2. Those containing non-heme iron

Heme iron comes from animal protein and is easier for the body to absorb than non-heme iron. But certain elements can help increase absorption. Ascorbic acid (a type of Vitamin C), for example, is one nutrient that can help increase the absorption of iron.

This means that adding 500 mg of Vitamin C to your daily intake of dietary iron would be very helpful if your iron levels are low.

There are also certain substances found in food that inhibit iron uptake, like the phytates in grains and the tannins in tea.

To make sure you’re getting enough heme iron and non-heme iron, you may find your IH doctor recommends you add specific foods into your diet.

For heme dietary iron, they may recommend:

• Beef
• Chicken liver
• Turkey
• Seafood (crab, oyster, clam, shrimp)
• Chicken

For non-heme dietary iron, they might advise you to eat more:

• Fortified cereals
• Lentils and beans
• Spinach
• Chard
• Tofu
• Nuts and seeds
• Blackstrap molasses

Oral Iron Therapy

Oral iron therapy is another way to increase your iron levels. There are many forms used for iron supplements, but it’s important to know that they were not made equal.

What’s more, iron supplements can fall into two categories:

• Ferrous iron
• Ferric iron

Absorption differs a lot between the two, because each one contains a different amount of elemental iron ready to be taken into the body.

The most commonly used types of ferrous salt supplements are ferrous fumarate, ferrous sulfate and ferrous gluconate. There is more elemental iron and bioavailability in ferrous iron than ferric iron.⁵

However, one of the biggest drawbacks of the high dose iron supplementation is digestive upset. It can cause:

• Nausea
• Constipation
• Abdominal discomfort

However, studies have shown that ferrous bisglycinate chelate is well tolerated and highly absorbed with none to fewer gastric side effects.⁶

This is the form we are happy to recommend to our IH patients.

IV Iron Therapy

If dietary or oral supplementation is not effective for patients, we often recommend intravenous iron therapy. Many of our patients assume this is a new type of therapy, as many have never heard of it before or even been offered it by previous medical practitioners they have visited. But its history actually goes way back to the early 20th century.

There are a number of different types of iron that can be administered via IV infusion, including:

• Iron dextran (INFeD)
• Iron sucrose (Venofer)
• Sodium ferric gluconate (Ferrlecit)
• Ferumoxytol (Feraheme)

We have studied all of these supplement types, so we’re very familiar with them. Extra care always needs to be taken when administering any substance straight into the bloodstream, of course, and we take this very seriously.

Iron dextran intravenously has unfortunately been associated with anaphylactic reactions,⁷ which is why selecting the right IV iron preparation is so important.

Some of the safest and gentlest IV iron preparations include iron sucrose and sodium ferric gluconate.  Studies have shown that sodium ferric gluconate and iron sucrose are more bioavailable and lower incidence of reactions.⁸ By far, iron sucrose has the advantage with the most favorable studies with adverse effects rarely seen.⁹

For this reason, we use iron sucrose (venofer) at IH, and we’ve found it to be very well tolerated by patients.

Ferumoxytol has a higher infusion dose with fewer infusions, which means fewer injections. Some patients prefer this approach. It is also rapidly infused over a shorter period.

However, caution should be taken in regards to adverse reactions with Ferumoxytol, so we use it in very specific cases.

The benefits of using IV iron therapy include:

• Quicker and more effective uptake of the mineral
• Faster reversal of deficiency
• Speedier relief of deficiency symptoms
• Highly reduced or no digestive upset, even with larger doses
• More predictable outcomes
• There are no pills to take (or forget to take!)

If you’d like to know more, ask your IH doctor for recommendations on an iron therapy appropriate for your specific needs.