This post is dedicated to my beautiful cousin and countless other women around the world who suffer from serious medical issues due to basic micronutrient deficiencies. These common issues while hidden, can easily be corrected in early stages with key education and good medical care.
Hello! With this part 1 ‘Low Iron Levels in Women’, I’m starting a new series called ‘Take Charge of Your Health’. I will be highlighting key nutrition deficiencies in women beyond what our healthcare system tells us vs. what it does not, how these deficiencies may impact our wellbeing and the best strategies to overcome it. These nutrient deficiencies often go un-noticed and untreated by the most well-meaning doctors and health practitioners. If left untreated, they can lead to low energy, hormonal imbalance (especially thyroid and estrogen), low immunity, weight gain, and other serious issues. Often, the solution is so simple and in many cases, life saving.
The most common deficiency in the world
According to WHO, iron deficiency is the most common micronutrient deficiency in the world. So, how do you identify low iron levels? Are supplements enough? What other information do you need in order to make sure that most amount of iron is absorbed by your body as efficiently as possible?
Turns out that the iron is more elusive than a snow leopard. Despite supplementation, it can take years to raise levels to normal. Here, I have summed up my journey in low-iron, my research and the strategies I’m using to successfully raise my iron levels fast. This is not medical advice. I only hope that this will inspire you to take charge of your own health and track your micronutrient levels for a vibrant life.
My iron story as a woman in her 40’s
In the recent months, I’ve been feeling tired (even in the morning after a full night of sleep), low-energy and occasionally a little dizzy. I also felt that I’m not getting enough oxygen while breathing (slightly jarring), but I chalked that to something in my head. All my symptoms came on slow and I did not connect them together, just like many of us do in these cases.
I eat a well-balanced diet including lots of greens, fruits and other vegetables (some meat 1-2 times a month). I workout 4-5 times a week including HIIT, strength training, and yoga. So… what the plague?
Stay curious to be healthy
Out of curiosity and with my usual need to get to the root of any problem (in this case ‘not feeling my optimal self’), I decided to control of my health. I called my doctor so we can get my annual bloodwork done including all vitamin levels. The bloodwork came back normal and my Hemoglobin levels were as good as can be. Then, I noticed that my Iron and Ferritin results were missing from the report. So, I called the doctor’s office again and specifically requested another Iron specific blood test. At first, the nurse tried to tell me that since my Hemoglobin was good, I don’t need this additional test. But then, she was nice enough to indulge my curiosity.
So, we did another blood test. And, lo, and behold! While most of my iron panel was normal, my Ferritin (stored iron) levels were quite low (15ng/ML). These levels are bordering on anemia.
My actual iron panel report as of May 30, 2020
Most labs would say that 16-232 ng/ML is in the normal range for women, but this is a VERY wide range. Through my research, I’ve learned from experts such as Dr. Libby Weaver that optimum Ferritin levels in adult women should be around 90-100 ng/ML. You will feel so much better!
Fascinating, isn’t it?
Why you need iron?
Iron is an important component of hemoglobin, the substance in red blood cells that carries oxygen from your lungs to transport it throughout your body. Hemoglobin represents about two-thirds of the body’s iron. If you don’t have enough iron, your body can’t make enough healthy oxygen-carrying red blood cells. Iron is also one of the key ingredients that we need for optimum thyroid function. Others nutrients include vitamin B, selenium, zinc and iodine. Lack of one of these nutrients can lead to hypothyroidism (among other things) that can lead to fatigue, low immunity, constipation and inexplicable weight gain among many other issues. Frankly, who can afford low immunity during 2020, the year of the plague?
But first, take control of your own health
I started obsessing over biochemistry, epigenetic and nutrition science in the recent years especially because I started to realize that if I want to age healthily, I will have have to take control of my own body. And, this included educating myself in this realm as much as possible.
Prior to that, I would have just trusted my doctor, as one would. I wouldn’t have known what blood tests to ask for and how to read the results. Nor, would I have known the optimum levels despite the large range (16-232 ng/ML). The way I’m going to feel at the low end of the range is very different than towards higher end. It is devastating for me to think just how many women around the world suffer from basic nutrient deficiencies. These deficiencies, if go untreated, can do irreparable damage to energy, hormones, fertility, brain, organs and other important functions of the body.
In fact, most women don’t even know that they’re nutrient deficient. They suffer in silence, try to ignore their symptoms, and that’s heartbreaking.
In my view, medical practice is falling behind in terms of keeping up with the latest scientific studies in order to truly service the population. This is especially true in terms of disease prevention and quality of life maintenance. We as a society have resorted to getting sicker and sicker as we age. Our systems are designed to only treat us once we are sick, and do not proactively help us to become and stay healthy.
Through this experience, the biggest lesson I have learned is to take charge of my own health. Going forward, I plan to get a complete blood test at least 1-2 times a year just to stay at the top of my game. My goal is to test all the nutrients, cholesterol, blood count, complete metabolic panel, and thyroid among other factors to establish my base levels regarding what makes me feel my best.
Being determined to get back to normal ASAP, I did what I enjoy best. Digging into the latest geeky scientific research on the subject. You can easily research on iron rich foods, but today I’m sharing some important information that took a lot of digging. And, that I did not find in one easy guide. I hope to save you precious time sifting through dry scientific studies and summarize my findings for you.
As for me, these days, I’m taking iron supplements along with the key strategies I have listed below and slowly getting back to my normal. I’m also paying specific attention to an iron-rich diet but that alone is not enough.
So what does one need to know and do?
How much iron do you need?
According to the National Institutes of Health (The average daily iron intake from foods and supplements is 13.7–15.1 mg/day in children aged 2–11 years, 16.3 mg/day in children and teens aged 12–19 years, and 19.3–20.5 mg/day in men and 17.0–18.9 mg/day in women older than 19. The median dietary iron intake in pregnant women is 14.7 mg/day.
Heme iron (mostly found in meat) is easiest for your body to absorb and is 14–18% bioavailable in mixed diets. In comparison, nonheme iron, the iron source in vegetarian diets, has a bioavailability of 5–12% (source). Bioavailability refers to the amount our bodies actually absorb and use.
To meet the RDI (Reference Daily Intake) guidelines for iron, a women older than 19 will need to eat at least 1.375 lbs of beef a day (before we even consider the bioavailability factor).
Needless to say, most people may not get enough iron from their diets. Women, in particular, lose a good amount every month during menstruation especially if their periods are heavier (more than 3 tablespoon of blood in a given cycle may be considered heavy).
What to do before taking iron supplements
First and foremost, it is very important get your comprehensive blood tests done (and regularly) before you start any supplementation. High iron levels (not as common as low levels) can also be harmful. These days, in the US, you can go through your doctor or order your own directly through labs such as Quest Diagnostics etc. It’s quite inexpensive and a life saver, in my opinion.
As of writing this post, iron tests on Quest Diagnostic’s website costs around US $59 and full women’s profile is around US $199. For me, it was covered under my medical insurance as my doctor ordered it.
How to take iron supplements and tips to improve bioavailability
Now, this I find to be the most strategic part of my iron replenishment plan. Iron levels can take a very long time to get back to normal. In fact, I know many cases of my close friends and relatives where it took more than 2 years to get even close to normal. Despite the diet and the supplements, your body may only absorb less than 10% of what is available.
So, how do you ensure that you are doing everything possible to increase your iron levels? Below is a culmination of my research findings and the strategies that I’m using to raise my iron levels:
What to do:
- Take the supplements every other day. Studies show that iron absorption is greater (40-50%) with every other day dose than daily, especially in iron deficient women.
- Take iron supplements at night, ideally 2-4 hours after dinner. Do not take any other vitamins or supplements with it with the exception of vitamin C.
- Take vitamin C supplements or vitamin C-rich foods with iron as it may raise iron absorption by your body (bioavailability) four-fold. Link to a related study here.
- Add vitamin A-rich foods to your diet e.g. carrots, sweet potatoes and cantaloupes. Vitamin A has also recently been shown to increase iron absorption.
- Work with the doctor. Depending on the root cause of your deficiency, your doctor may recommend birth control to stop your periods and prevent blood loss until your levels are back to normal.
- Treat the root case. Micronutrient deficiencies can arise from many different factors including diets, genetics, biochemical, lifestyle and stress. To properly fix these problems, you must treat the real underlying issues or at least know what is causing them.
- Reduce stress and focus on walks, yoga and other gentle exercises during this time. Stress in particular is shown to reduce serum iron levels. Here is a blog post I wrote on some Simple Ways to Reduce Stress.
- Cook in cast iron. When you use acidic foods such as tomatoes, the iron from the pot leeches in the food making the food iron rich. In fact, this strategy is often used in developing countries as a treatment solution.
- For relief from side effects, try different types of Iron supplements. Not all supplements are the same. Iron is hard on the digestive tract. Constipation is the most common side effect, but iron supplements can also cause nausea, indigestion, gas and bloating. One option is to switch to a liquid supplement and you can experiment with different doses and lower your intake until your system can handle it. I’m experimenting with Floradix® (a liquid supplement combined with vitamin B, C and digestive herbs) and Thorne Bisglycinate 25mg. So far, I do not have much side effects (usually I have a sensitive system).
- Get tested for celiac disease. Many people are allergic to gluten and they might not know. Celiac disease can prevent your body from absorbing certain nutrients from your food. If you have any symptoms (which you may or may not be aware of), best thing to do is try removing gluten, as it might help raise your iron levels if you have undiagnosed celiac disease.
What not to do:
- Do not eat dairy with food or iron supplements. Space dairy from your iron-rich diet and supplements (at least 2 hours before or after iron rich meal or supplements). The calcium in dairy competes and wins in absorption over iron as it has larger structure.
- Do not drink tea (even herbal) with your food or iron supplements. Time your tea and coffee (including most herbal teas) 2-3 hours before or after eating iron rich foods. Surprisingly, it is not the caffeine, rather the tannins (polyphenolic biomolecules found in most plants) in most teas that can inhibit iron absorption especially if you’re already low.
- Do not do strenuous exercise during this time. You may risk further depleting your iron levels and creating complications by exercising vigorously. Be kind to your body during this time. The body is built to heal itself given the right conditions and nutrients.
Have you had your iron levels tested recently? Have you been diagnosed with low iron levels? What are you doing to raise your iron? How is it working? I’d love to hear from you, so leave me a comment below or join our community of women who want to take charge of their health by clicking here.