Iron Deficiency Anemia
By Dr Emily Wiggins & Dr Kelcie Rosendhal
What Is It and Why Does It Happen?
Iron deficiency anemia is a common type of anemia caused by insufficient amounts of iron in the body. Iron is necessary for the production of hemoglobin, a protein molecule in the red blood cells that carries oxygen from the lungs to tissues, and growth and developmental processes as well as the production of some hormones.
Iron deficiency anemia can be detected on a routine blood test called a complete blood count (CBC). Further investigation into the extent of the iron deficiency can be done with an iron panel. Sometimes additional tests are necessary, especially if your doctor suspects that you're bleeding internally.
Common Causes of Iron Deficiency Anemia Include:
Blood loss (including monthly menstruation)
Pregnancy
A lack of iron in the diet or a decreased ability to absorb iron.
You can usually correct iron deficiency anemia with iron supplementation or by incorporating more iron rich foods into your diet. We will explore more about each of these below.
Blood Loss as a Common Cause for Iron Deficiency Anemia
Blood loss is the most common cause of iron deficiency anemia. Blood contains iron within red blood cells and thus blood loss results in iron loss.
Women with heavy periods are at risk for iron deficiency anemia due to amount of bleeding that occurs during menstruation.
Slow, chronic blood loss within the body, such as from a peptic ulcer, a hiatal hernia, a colonic polyp or colorectal cancer, can also cause iron deficiency anemia.
If iron deficiency anemia is caused by blood loss, it is imperative to work with your trusted healthcare provider to determine the source of the bleed so it can be addressed appropriately.
Difficulty Absorbing Iron can Lead to Iron Deficiency Anemia
An inability to absorb iron can also lead to iron deficiency anemia. Iron ingested from food is absorbed into your bloodstream in your small intestine.
Compromised function of the small intestine, such as in celiac disease, decreases your intestine's ability to absorb nutrients from digested food and can lead to iron deficiency anemia. Your ability to absorb iron, and other nutrients, can also be compromised if part of your small intestine has been removed surgically.
Pregnancy as a Cause of Iron Deficiency Anemia
Pregnancy is another culprit of iron deficiency anemia. Pregnant individuals need more iron than non-pregnant individuals because blood volume increases during pregnancy. More blood means more red blood cells and increased hemoglobin production. The developing fetus also uses its mother’s iron to create hemoglobin.
Many pregnant women need to supplement with iron to keep up with this increased demand.
Lack of Iron in Diet as a Cause of Iron Deficiency Anemia
Iron deficiency anemia can also be caused by a lack of iron in the diet. Our bodies regularly get iron from the foods we eat. If we consume too little iron, our bodies can become iron deficient over time.
Dietary iron is found in two forms, heme and non-heme iron. Heme iron contains a hemoglobin and thus is more easily absorbed by the body. It is estimated that the body absorbs approximately 15-35% of heme iron.
Sources of heme iron include: red meat, fish and poultry. It is important to maintain a healthy balance of heme and non-heme iron.
Non-heme iron accounts for the majority of iron found in plants. Food sources of non-heme iron include leafy greens, whole grains, nuts, seeds and legumes. Non-heme iron is the type of iron added to iron-fortified and iron-enriched foods.
We do not absorb non-heme iron as well as heme iron, but most of the iron we consume in our diets is non-heme iron. Fortunately, there a few easy ways to enhance iron absorption from non-heme sources.
Iron absorption, especially from non-heme food sources, can be enhanced by eating foods high in vitamin C with your meal. Vitamin C, also known as ascorbic acid, helps to change non-heme iron into a more absorbable form for the body.
Foods high in ascorbic acid include citrus fruits, bell peppers, dark leafy greens and strawberries.
Another way to enhance iron absorption is to include foods high in Vitamin A and beta-carotene in your meal. Vitamin A and beta-carotene containing foods include sweet potatoes, carrots, spinach, oranges, red peppers and kale.
Iron absorption can also be enhanced by avoiding foods that contain phytates and polyphenols. Phytates are considered “anti-nutrients” as they bind minerals in the digestive tract and make them less available for use by our bodies. Phytates are found in grains, legumes, nuts and seeds. The concentration of phytates in foods can be decreased by soaking beans and legumes before consumption. Phytates are also broken down with heat and fermentation. It is important to note that phytates also have potential health benefits and pose the most challenge for iron absorption in individuals following a vegetarian or vegan diet.
You Can Reverse Iron Deficiency Anemia
We need iron to efficiently transfer oxygen from the lungs to all other cells in the body. Iron is also involved in growth and developmental processes and the production of some hormones. Iron deficiency anemia occurs when there is isn’t enough iron in the body. Common causes of iron deficiency anemia include blood loss, pregnancy, decreased absorption and a lack of iron in the body.
Luckily, iron deficiency anemia can often be reversed through supplementation or by incorporating more iron rich foods into the diet. However, iron deficiency anemia can be a sign or something more serious going on, such as an ulcer or colon cancer, and it is important to work with your trusted healthcare provider to determine the cause of the deficiency!
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References:
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Goddard AF, James MW, McIntyre AS, et al. Guidelines for the management of iron deficiency anemia. Gut 2011;60:1309-1316.
Short, Matthew, W and Domagalski, Jason E. Iron Deficiency Anemia: Evaluation and Management. Am Fam Physician. 2013;87(2):98-104
Hallberg L, Brune M, Rossander L. The role of vitamin C in iron absorption. Int J Vitam Nutr Res Suppl. 1989;30:103-8. PMID: 2507689.