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Less known reasons why your iron level can be low

Iron deficiency anemia is very common, especially among women. The WHO has recognized it as the most common nutritional deficiency in the world, with 30% of the population being affected with this condition.

Low iron level impacts the amount of oxygen which can be carried by the hemoglobin to the cells leading to fatigue and tiredness. Iron is a cofactor for some of the enzymes in the body -among others for an antioxidant enzyme - catalase and another enzyme which participates in collagen synthesis, it also plays a role in thyroid function.

When iron level is too high it is toxic to our bodies and increases oxidative stress so keeping a balanced level of iron in the body- not too high, not too low - is very important.

There are few parameters on the blood test which are important to look while identifying iron deficiency anemia:

The optimal levels are the following:

hemoglobin males: 125 - 170 g/L, females 115-150 g/L

iron in the serum: 50 - 10 mcg/dL (8.96 - 17,92 mcmol/L)

ferritin - males 33-236 ng/ml

females before menopause 10-122 ng/ml

females after menopause 10-263 ng/ml

according to Aviva Romm the optimized should be slightly above 70 µg/L

* The values above were taken from a book "Blood chemistry and CBC analysis by D. Weatherby and S. Ferguson

The main root causes of iron deficiency anemia are:

  1. Dietary inadequacies - it can happen with people on rather plant based diet if it is not well balanced as the iron from meat sources is much more available to absorb. Also people eating not very much in general can be impacted by it.

  2. Malabsorption - iron is absorbed mainly in duodenum and proximal jejunum, low pH in duodenum helps convert an insoluble ferric form (Fe3+) to absorbable ferrous (Fe2+) ion. Therefore the gastric acid level in the stomach plays a crucial role in iron absorption. I highly recommend to read my blog post about stomach acid and how to optimize its level.

  3. Increased iron loss - it can be due to internal bleeding, injury with blood loss or heavy periods for women

  4. Increase iron requirement - during pregnancy

However, there are few others less know reasons why your iron level can be low:

  1. Additional factors from the food which inhibit absorption:

  • High level of phytates in the diet - this is a compound found in plant-based diets that demonstrate a dose-dependent effect on iron absorption. (they prevent only non-heme iron absorption)

  • Polyphenols which are found in black and herbal tea, coffee, wine, legumes, cereals, fruit, and vegetables which inhibit iron absorption. (they prevent only non-heme iron absorption)

  • Calcium inhibits both heme and non-heme iron at the point of initial uptake into enterocytes.

  • Animal proteins such as casein, whey, egg whites, and proteins from plants (soy protein) have been shown to inhibit iron absorption in humans.

  • Oxalic acid binds to and inhibits iron absorption - found in spinach, chard, beans, and nuts

It is highly recommended to take any iron supplement (if needed) apart from above mentioned food.

As mentioned above there are two types of iron: heme and non-heme form. Heme one comes from animal sources and is much more absorbable comparing to non-heme iron coming from plants - vitamin C enhances non-heme iron absorption.

2. Imbalanced gut microbiome - most bacteria depend on iron to survive. And while only 10% of iron is absorbed in the small intestine, another 90% can be available in the large intestines for gut bacteria. Pathogenic bacteria possess more efficient pathways to acquire free iron than beneficial ones. They compete between each other for the iron but also, they compete with the host. The body has its tools to prevent the iron use by the bacteria by increasing the storage in body tissues (making it unavailable) or transferrin. This can result in low iron level on the blood test despite iron overload in the tissues.

3. There are some crucial nutrients which are required for iron homeostasis: copper and vitamin A. Up to 24 mg of iron is recycled in the body on daily basis and one of the main factors for the iron recycling system to work is copper. When copper levels are low, the body may absorb less iron which can cause iron deficiency anemia. And copper needs vitamin A in retinol form to work properly.

Sometimes supplementing with iron does not bring the expected results so it is worth looking what is the real cause of iron deficiency for you. We can do such analysis together reviewing your current health or running some additional blood tests.

You are welcome to contact me to run an introductory call to discuss the possibilities of nutritional therapy for you.

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