What to Know About Iron Deficiency: Signs, Symptoms, and Treatments
August 24, 2020What to Know About Iron Deficiency
Whole Blood
To best understand what iron deficiency anemia is and how it affects us, it is important to start out by learning some basics about blood.
There are 4 different parts that make up “whole blood”:
Plasma (55%) – This gives blood its liquid consistency. Plasma helps carry nutrients, proteins, electrolytes and fats.
Red blood cells or “RBCs” (45%) –RBCs carry a special protein called hemoglobin inside of them. Hemoglobin helps your red blood cells carry oxygen from your lungs out to the rest of your body. A pretty important job! If you cut this hemoglobin molecule in half, inside it you will find our topic of discussion…IRON! Iron is a mineral that is an essential part of the hemoglobin molecule and is responsible for giving blood its bright red color.
Platelets (Less than 1%) – Help blood clot to seal a wound and prevent blood loss
White blood cells or “WBCs” (Less than 1%) – WBCs are part of the body’s immune system, and considering they only make up <1% of whole blood, they are absolutely vital for our health and fighting illness.
What is Iron Deficiency Anemia?
Iron deficiency anemia is an extremely common type of anemia in the United States. It affects up to 25% of the population and is the most prevalent cause of anemia worldwide.
Iron deficiency anemia is characterized by a decrease in red blood cell mass which subsequently leads to an insufficient amount of iron in the blood. Without enough iron, our bodies cannot make hemoglobin, and therefore cannot carry enough oxygen to our tissues. Feeling tired, weak, and short of breath are just some of the symptoms you can experience when there is not enough oxygen in your blood.
To have anemia, or to be “anemic”, is not a diagnosis but rather an indication of an underlying disease process. With a little detective work and a simple blood test, you and your doctor can uncover the cause behind your low iron levels and be on the path to the best treatment options available.
How Is Iron Deficiency Anemia Diagnosed?
A simple blood test along with your medical history and physical exam can be used to diagnose an iron deficiency anemia. Depending on your symptoms, you may also require an endoscopy and/or colonoscopy to asses for blood loss.
What Are The Signs & Symptoms of Iron Deficiency?
Signs of iron deficiency:
- Spooning and/or soft, brittle nails
- Pale skin
- Dry, cracked lips, especially at the corners of your lips
- Swollen, puffy tongue
Symptoms of iron deficiency:
- Becoming easily fatigued
- Feeling weak
- Shortness of breath
- Heart racing or irregular heartbeat
- Frequent headaches
- Ringing in your ear (Tinnitus)
- Having cravings for non-food items such as ice, clay, laundry detergent (PICA)
- Feeling colder than usual, especially in your hands and feet
Why Am I Iron Deficient?
These are just some of the questions your provider will ask you if they suspect, or have confirmed, you have iron deficiency anemia.
“Have you had bariatric surgery?”
Patients that have had bariatric surgery are at a much greater risk for developing a nutritional deficiency. Iron is absorbed in your duodenum, which is the first section of your small intestine.
During some bariatric surgeries such as the gastric bypass, and the duodenal switch, food will bypass this part of the small intestine, causing a deficiency in iron to develop. In addition to not being as well absorbed, patients are eating very small portions of food after bariatric surgery and may not be receiving 100% of their recommended daily amount of iron from food alone. Because of this, many bariatric surgeons will place their patients on a post-operative iron supplement, as well as promoting a healthy, low-carbohydrate diet rich in high-iron foods.
“How is your diet?”
Iron deficiency can develop if you are not getting enough iron in your diet. According to the RDA, men need 8mg of iron a day, women aged 18-50 require 18mg and if you are pregnant, this amount increases to 27mg of recommended iron daily.
“Do you have any pre-existing conditions?”
Conditions such as Crohn’s disease, Ulcerative Colitis and Celiac disease make it difficult for your body to properly absorb iron.
“Have you had a blood loss recently?”
For young females, having a heavy menstruation can be a common cause of iron deficiency. Because of this, many oral contraceptive pills are supplemented with iron to help during this time. Other things that can lead to an iron deficiency due to blood loss are peptic ulcer disease, colon cancer, recent blood donations and trauma.
“What medications are you taking?”
Proton pump inhibitors (a common class of medications prescribed after weight-loss surgery to treat acid reflux), over the counter acid-reducers and calcium supplements can all interfere with the absorption of iron.
How Do I Treat Iron Deficiency?
Diet
Iron can be found naturally in animal products that contained hemoglobin (think: Red meat, poultry and seafood), however there are a ton of plant based, or “non-heme” sources we can get iron from as well. According to the American Academy of Nutrition, the body absorbs three times more iron from animal sources than from plants.
In the United States, many wheat and flour based products such as breakfast cereals and enriched breads are fortified with iron and can provide up to 100% of your required daily amount. Although high in iron, these are not recommended for those trying to achieve weight-loss due to the high carbohydrate and sugar content.
Some examples of healthy iron-rich sources include:
- Oysters – 8mg per 3oz
- Beef liver- 5mg per 3oz
- White beans and Lentils- can range 3-8mg per 1 cup
- Cooked spinach- 3mg per ½ cup
- Tofu – 3mg per ½ cup
- Sardines- 2mg per 3oz
- Tomatoes – 2mg per ½ cup
- Tuna, canned in water- 1mg per 3 oz
Dietary Supplements
For better absorption, take your iron pill with Vitamin C (ascorbic acid) and avoid taking it with any dairy or calcium supplements as this will decrease the absorption of iron.
For mild to moderate cases of iron deficiency anemia, an over-the-counter oral iron supplement taken once to several times a day will suffice. It will take months for your blood iron stores to be replenished so a repeat blood test will be necessary.
Contact your doctor if you are currently on any other medications, such as antibiotics or antacids as these may interfere.
Do note however, many patients report gastrointestinal issues such as constipation, black colored stools, nausea, bloating, abdominal cramps and even diarrhea while taking oral iron supplements.
Intravenous iron or a blood transfusion is recommended for patients with more severe cases of anemia who require immediate correction of their iron deficiency or are unable to tolerate oral iron supplements.
How Do I Know If I’m Still Deficient?
If you have had bariatric surgery, your surgeon will likely be monitoring your blood work every 6 months to 1 year for nutritional deficiencies. It is recommended that you follow-up with your primary care physician for a physical exam and blood work at least annually.
If you suffer from severe iron deficiency anemia, you may be referred to a doctor who specializes in blood disorders, called a hematologist. Depending on the severity, you may be required to follow up with your hematologist every few months.
 | ABOUT THE AUTHOR Jennifer K. Puciloski PA-C, RD, CDN is both Registered Dietitian and board certified Physician Assistant in the state of New York. She worked as a critical care dietitian prior to becoming a PA. Jennifer is currently working as a Plastic and bariatric surgery PA at New York Bariatric Group where she is able to combine her passion for both nutrition and medicine. |
