Why You Should Take Iron Deficiency Seriously
This is our second piece in a two-part series on iron deficiency. Read part one
to learn about the notable signs of low iron levels.
Quick recap: Iron is a vital mineral needed to form haemoglobin, the part of red blood cells that carries oxygen throughout the body. A lack of it means a lack of oxygen, which can result in headaches, low energy and mood swings.
It's easy to brush off some of these symptoms. Tiredness, brain fog? All in a day's work, we think. But there's also hair loss, shortness of breath, a weakened immune system. Left untreated, low iron levels could lead to other serious complications.
“Traditionally we have been most worried about iron deficiency when it leads to severe anaemia, as this may lead to increased risk of cardiac failure,” says Dr Dheeraj Khiatani MBBS (UK) BSc (Hons) (UK), medical director of The Iron Suites Medical Centre.
“Iron deficiency ahead of anaemia has hence been considered rather innocuous by the medical community, however more recent data is starting to change our minds.”
Iron deficiency without anaemia increases risk of all-cause mortality
Dr Dheeraj tells us that in 2020, two studies highlighted that patients with iron deficiency without anaemia had increased risk of all-cause mortality. “This increased risk of death over a 10-year period was 30% in patients with low iron levels but increased significantly to 90% in patients with absolute iron deficiency."
It can cause complications during and after pregnancy
"Studies suggest that mothers with iron deficiency and anaemia have a three-times increased risk of low birth weight babies, two-times increased risk for pre-term birth and are nearly seven times more likely to give birth to an iron deficient baby," says Dr Dheeraj.
Iron is essential in first six months of life for neurological development. Additionally, the mothers are more likely to suffer from fatigue and depression; have increased risks for postpartum haemorrhage, require a blood transfusion, or both.
There are other dangers
“We have had several patients that have come to us after having motorcycle accidents due to feeling dizzy, another common symptom of iron deficiency, or even fainting whilst riding,” says Dr Dheeraj.
“In several cases they were admitted to the hospital and told they were anaemic but then discharged without treatment of the underlying problem, that is iron deficiency.”
He says that this also highlights another common issue and danger associated with more severe iron deficiency that has resulted in anaemia – namely the transfusion of red blood cells. Although transfusions help correct anaemia in the short term, they are "contrary to popular belief, not without risk and really should be a last resort and not utilised in haemodynamically stable patients."
“Finally, iron deficiency is not a naturally occurring state and it may be a warning sign of another problem, such as cancer,” he adds. “Therefore determining the cause of the iron deficiency, and treating it, is as important as correcting the iron deficiency.”
A quick questionnaire
If you tick more than two of the points below, the chances of suffering from iron deficiency are over 50%.
Passing of large blood clots
Need for double sanitary protection (both towels and tampons)
Need for frequent changes of tampons and towels (every two hours or less, or 12 items per cycle)
Flooding through to clothes or bedding
Pregnancy. During pregnancy the extra volume (and red cell mass) of the mother combined with the iron for the foetus means that an average 55kg women will require about 1000mg of iron per pregnancy. Remember the average woman only has 3000mg of iron in her body!
Surgery, especially major surgery such as hip replacement, cardio-thoracic, knee reconstruction etc.
Poor nutritional intake. Iron from non-haem (or vegetarian) diets is quite poorly absorbed. Many products also inhibit absorption of iron from vegetable sources .
GI issues. If our gut isn't working well, then iron absorption is impaired. Anti-reflux drugs can also alter the pH levels of our gut, which also reduces the ability to absorb iron.
Chronic diseases. Most chronic diseases lead to what is known as inflammation. This inflammation unfortunately also reduces the ability of the body to absorb iron from dietary sources.
Endurance running. When running long distances, especially in hot and humid countries like Singapore, we have increased sweat as well as continued footstrike which can lead to haematuria (blood in urine). Again, with increased loss of blood, there is increased iron loss.
You've ticked the boxes and noticed the signs, now what?
Seek out your doctor and get tested. Don't try to treat it on your own as too much iron can also cause its own set of health problems.
“If you are aware or have been told that you are, or were, anaemic, have two or more children (especially if small age gap between them) and, or, have any of symptoms, it would be worth checking your levels.”
The best way to find out if you are iron deficient is to have a full iron studies test via blood pathology, or a full blood count (FBC). “Unfortunately, many clinicians still only look at your haemoglobin, so you may need to be proactive and ask your doctor to measure your iron profile, and specifically ask for serum ferritin,” says Dr Dheeraj.
A quick note: Ferritin is not the same thing as iron. It is a protein that stores iron, releasing it when your body needs it. "Levels under 30ng/mL confirm absolute iron deficiency whilst levels under 100ng/mL are suggestive of low iron stores."
Treating iron deficiency
Switch up your diet. In mild cases, eating foods rich in heme and non-heme iron like lean red meat, lentils, beans and tofu can raise iron levels. Pair these foods with Vitamin C-rich food sources to help enhance iron absorption, and avoid consuming with teas and coffees which contain compounds that can interfere with iron intake.
Iron supplements. If iron deficiency can't be rectified through diet alone, your doctor may recommend oral iron. Whilst oral iron can restore iron levels, you need to be aware of the unpleasant side effects of taking it, including nausea, constipation and diarrhoea.
Intravenous (IV) iron infusion. In some instances, your doctor may recommend IV iron (administered via injection), which immediately increases levels of iron and haemoglobin in your body. It's also an option for people who can't take oral iron for specific reasons, absorb it adequately through the gut or need to increase levels quickly – the procedure can be done in under an hour.
Dr Dheeraj Khiatani is a GP who graduated from Kings College London School of Medicine (UK). In addition to his MBBS degree, he holds a Bachelor of Science in Psychology. Dr Dheeraj spent his junior doctor years gaining experience in various specialities such as Otolaryngology (ENT), Anaesthesia and Emergency Medicine (A&E), both in hospitals in London under the NHS and in government hospitals in Singapore.
His clinical interests are in the field of Nutritional, Lifestyle and Aesthetic medicine. He believes in integrative and holistic management of his patients and has a special interest in the role of iron to improve physical and mental well-being and overall energy levels of patients.
The Iron Suites Medical Centre (TISMC) is a clinic dedicated to educating, diagnosing and managing iron deficiency with a focus on intravenous iron infusions. Learn more about them here.