Iron

Background: There are about 37 trillion cells in the human body Each one requires oxygen to function. Iron is essential for us because it enables our red blood cells to pick up and carry oxygen to all parts of the body. Without iron, we would cease to exist. It is as also instrumental in the maintenance of hormonal balance and in neurological development.

Our body does not make iron. We get it from the foods we eat. And there are many processes that regulate the iron levels in our bodies. Iron is primarily absorbed from the small intestine and enters the bloodstream where it is picked up by a protein (transferrin) and taken to the bone marrow. Once in the bone marrow, the iron attaches to heme which is found in developing young red blood cells. Both the iron and the heme make up hemoglobin on the red blood cell. The new red blood cells enter the bloodstream as reticulocytes, and when they mature, they become erythrocytes. This process takes up to about five days . These new red blood cells go to the lungs, pick up oxygen, and take it to the rest of the body. All cells in the body require oxygen to function.

Red blood cells function for about 120 days, at which point they send chemical and physical signals to the macrophages in the liver and the spleen which to seek them out and destroy them leaving some iron behind to be stored in the liver, heart, pancreas and, to a lesser degree, muscle tissue. 

Overall, we store about 25% of our iron in our bodies. The liver and the iron stores, in general, play a role in regulating the amount of iron absorption that initially takes place in the gastrointestinal tract.

How do the bones know when to make new red blood cells? When oxygen in the blood decreases, the kidneys sense this and send out a chemical signal (erythropoietin), which alerts the bones to start producing more red blood cells (the kidneys also directly regulate some iron absorption).

In looking at the many processes involved in iron metabolism, it is clear that there are many places where things can go wrong, in turn, causing many physical problems. Nutritional deficiencies (low iron foods), absorption problems in the intestine, transport problems, blood loss, problems with bones that affect the production of red blood cells, storage problems, issues with the maturation of red blood cells as well as kidney dysfunction, genetics, and others.

What Does Iron Do for the Body?

Iron helps every organ of the body because it helps deliver oxygen to all the cells that make up your body.

Respiratory: Iron optimizes adequate respiratory function by helping red blood cells transport oxygen to the cells of the lungs. (It can also sometimes help stop a cough that is caused by medication - ace inhibitors [i.e. Lisinopril])

Cardiovascular:  Iron bound to the hemoglobin molecule carries oxygen to the heart, which contributes to cardiovascular function

Gastrointestinal: Sufficient iron levels contribute to optimal gastrointestinal functioning

Musculoskeletal: Adequate levels of oxygen (carried on the iron of the hemoglobin molecule) may help decrease generalized pain due to anemia. Iron lends to muscle and nerve development and function

Neurologic: Iron may improve thought processes and attention span of young anemic girls (6-18 years old), restless leg syndrome, fatigue related to anemia

Skin: Iron helps decrease skin damage and helps enhance wound healing

Mental Health: May help in childhood ADHD (discuss with healthcare provider)

Glucose: Adequate levels of iron (carrying oxygen) may help maintain optimal glucose control

Immunity: Sufficient amounts of iron help support immunity

Cancer: Adequate levels of iron may help prevent gastrointestinal cancers.

Symptoms of Iron Deficiency

• Fatigue

• Weakness

• Shortness of breath

• Pale skin

• Sometimes chest pain

• Tachycardia (heart racing),

• Headaches

• Dizziness

• Fatigue

• Weakness

• Cold extremities

• Tongue soreness

• Very smooth tongue

• Brittle nails

• Sometimes, muscle and joint pain

• PICA (eating unusual non-food substances esp ice)

• Decreased appetite

• Sores in the outer corners of the mouth

• Tinnitus (ringing in the ears)

Some physical risks of having chronic iron deficiency/low iron: Reduced bone mass, osteoporosis, and fracture risk, heart problems (because the works harder when less oxygen), risk of blood clots, pallor, dizziness, weakness, shortness of breath, sore mouth (and mouth sores), fatigue, Pica (an urge to eat unusual things like dirt or ice) and others.

 

Causes of Low Iron Levels/Iron Deficiency

• Diet: A diet deficient in iron can cause iron deficiency anemia. A poor iron intake can contribute to this, especially in vegetarians and vegans. Certain foods also deplete your body of iron, like soda, peanuts, chocolate, and coffee, and drinks and foods that contain tannins, like tea, grapes, and corn. Some dairy products like cow's milk also decrease the absorption of iron. Intake of calcium supplements, in general, at the same time as taking iron supplements may interfere with iron absorption by your body. foods that contain phytates, like whole grain wheat products and brown rice

• Pregnancy in iron deficiency anemia (low intake relative to greater intake by the fe

• Certain medications can also bind with iron and cause less absorption (i.e. antibiotics, a few     blood pressure medications, thyroid hormones, Levodopa and others – READ LABELS).

• Intestinal damage caused by conditions such as Crohn’s, celiac, gastric bypass, and inflammatory bowel disease causes less iron absorption.

• Acute blood loss: When the body loses iron faster than it can replace it, it is considered an iron deficiency anemia. For example, gastrointestinal bleeding like ulcers (loss of red blood cells and iron), polyps, colorectal cancers, menstruation, injuries with blood loss and others.

• Kidney disease: A diseased kidney not only produces fewer red blood cells but causes a decrease in iron absorption in the GI tract (duodenum) and produces a hormone that restricts the release of iron from iron stores.

• Rare genetic diseases

There are several other types of anemia that are not iron deficiency anemias: These are usually caused by red blood cell alterations. For example, aplastic anemia is marrow dysfunction that can cause a disruption in bone marrow production of red blood cells. This can be caused by radiation, chemical toxins, chemotherapy, severe osteoporosis, bone marrow cancers, and various viral infections (i.e., hepatitis, Epstein Barr, and HIV). Sickle cell anemia is another genetic type of anemia that causes an abnormal “sickle” shape of the red blood cells - an alteration in the hemoglobin - make it difficult for the red blood cells to carry oxygen very efficiently. Pernicious anemia is caused by insufficient vitamin B12 which, in turn, causes fewer mature red blood cells. 

Symptoms of Elevated Iron Levels

• Joint pain.

• Abdominal pain.

• Weight loss

• Fatigue.

• Weakness.

• Mood changes

• Brain fog

• Diabetes.

• Loss of sex drive/impotence

• Change in skin color: Bronze, gray

• May increase the intensity of urinary tract infections/bladder problems

Risks of chronically high levels of iron

• Heart problems

• Liver disease

• Thyroid problems/hypothyroidism

• Pancreatic disease/diabetes

• Age-related macular degeneration, possibly cataracts

• May increase the risk of stroke

• Lung disease

• Risks of blood clots

Causes of High Iron Levels

Because we store iron instead of excreting it through our urine, we can develop excessive iron stores. Excessive oral or injectable iron intake can cause iron levels to rise above normal levels. Hemochromatosis - storage of abnormally high levels of iron (genetic), thalassemia - abnormal hemoglobin (genetic), chronic liver disease, hepatitis cirrhosis from excessive alcohol intake, blood transfusions, frequent use of kidney dialysis, and others, can all cause higher than normal iron levels.

Side Effects From Iron Supplement Ingestion: Mainly gastrointestinal problems: Nausea, diarrhea, constipation, heartburn, stained teeth

Cautions and Contraindications: Those with certain non-iron deficiency anemias like sickle cell and thalassemia cannot use iron efficiently, so taking supplemental iron can cause an excessive iron stores in the body. Older people tend to accumulate iron more than others, which can increase their risk for heart disease, diabetes, certain types of cancers, and dementia. Others who must exercise caution with iron administration include: Those with undiagnosed blood in their urine; people who have had multiple blood transfusions. 

People on certain medications that may interact with iron should stagger their doses (wait two or more hours between taking the iron and taking the other medication (iron binds with certain medications so you cannot absorb the full dosage). Examples of these include:

• Antibiotics: Tetracyclines (the “cyclines”) like doxycycline and like quinolones (Common: Cipro, Levaquin)

• Certain blood pressure medications  - ace inhibitors (common: Lisinopril)

• Bisphosphonates: Oral medications used to treat osteoporosis called bisphosphinates (common: Fosamax, Actonel, Boniva)

• H2 receptor blockers: Anti-ulcer medications (common: cimetidine/Tagamet, ranitidine/Zantac, famotidine/Pepcid)

• Cholesterol-lowering medications (common: Cholestyramine and Colestipol)

• Thyroid hormones: Hypothyroid medication (common: Synthroid, levothyroxine) 

• Calcium (binds)

FORMS: Tablets, liquids, capsules, gummies (vitamin C helps absorption), IV (intravenous), IM (intramuscularly)

DOSAGE: As directed

Iron regulates so many things in our bodies that too little or too much can cause many problems. So, it is vital to maintain normal levels in the body.

The following doses are recommended doses by the NIH:

              14–18 years: 11 mg daily (males)  15 mg daily (females)

              19–50 years:  8 mg daily (males)   18 mg (females)

               51+ years: 8 mg daily (males and females)

Note: The above are recommendations for non-pregnant, non-lactating females

Note:  An increase in iron intake may be necessary for optimal health and function due to excessive bleeding (lost red blood cells). It is estimated that 20% of women under 50 years are low in iron - menstruating women should have iron in their multivitamins unless advised otherwise by their healthcare provider.

Under normal circumstances, the ideal way to get iron is through your diet. Sources of Iron include the following: Meat, fish, shellfish, eggs, tofu, beans, broccoli, kale, spinach (green leafy vegetables), cereal, brown rice, garbanzo beans, fortified cereal and other foods. Cooking with a cast iron skillet can also increase iron intake.

Recommended Brands:

Life Extension Iron Protein Plus 300mg (This link is to a trusted affiliate brand** of calcium (with added protein to reduce constipating effects). This product has been third-party tested by ConsumerLab and evaluated for quality, declared ingredients, freshness, purity/contamination (including heavy metals and others), cost, and disintegration.

Notes:

• Vitamin C helps with iron absorption

• While iron can be helpful, you do not want to go out and take massive amounts of iron to try to achieve its benefits. Ideally, you can do a lab test (CBC and ferritin) and discuss findings with a healthcare provider.

• According to the information provided above, the recommended daily allowance for vegetarians is 1.8 times higher than for people who eat meat.

• People with bowel diseases or bowel surgeries should speak to their primary care provider regarding iron supplementation. Often, the preferred method of administration is intravenous or intramuscularly because the gut does not absorb oral preparations properly.

• While this site is not for pregnant women, it is common for the latter to develop iron deficiency anemia. They should follow up with their ob-gyn.