How to Recognize and Address Iron Deficiency Anemia

November 11, 2019

"Without iron we can't form hemoglobin, and without hemoglobin, the red blood cells can't carry oxygen around the body."

On today's show, Dr. Keller Wortham, MD, is talking about the importance of red blood cells, and more specifically a condition called Anemia, which can occur when we don't have enough of them. Today's focus is on one of the most common forms of this condition — Iron Deficiency Anemia. Dr. Keller will review why iron is so important, what causes Iron Deficiency Anemia, how to treat it, and some health concerns that are associated with it. Don't miss this important topic!

Video Highlights

  • 00:03: Iron Deficiency Anemia
  • 02:15: Iron Deficiency
  • 03:51: The Most Surprising Symptom
  • 04:44: Diagnosing Iron Deficiency Anemia
  • 05:41: Causes of Iron Deficiency Anemia
  • 08:34: Iron in Our Diets
  • 11:45: Iron Supplementation
  • 13:10: Iron Infusions
  • 13:45: Wrap-Up

Iron Deficiency Anemia

Red blood cells are so important to us. These little cells only live for about three months, but during their very brief lifetime they are critical to getting oxygen around our bodies. Anemia is basically a low red blood cell count, but anemia is a non-specific term. That means that there are a lot of things that can lead to anemia —  blood loss, nutritional deficiencies, cancers, infections, and iron deficiency. 

Iron deficiency anemia is caused by a lack of iron. So why is iron so important to red blood cells? Well, red blood cells need a certain molecule to carry oxygen around the body, called hemoglobin. Hemoglobin is basically a bunch of heme groups with iron in the middle. Since iron is critical to forming this molecule — so without iron we can't form hemoglobin, and without hemoglobin, the red blood cells can't carry oxygen around the body.

Iron Deficiency

Our bodies don’t make iron, so we have to get it from our diets. Since red blood cells live only about three months, when they break down, they lose that iron and that means that as we're making new red blood cells, we need a constant supply of iron. Thankfully, a lot of iron from our old red blood cells can be reused and reabsorbed, but we also need to supplement that with new iron from our diet, as iron breaks down and we lose some.

If you don’t have enough iron (and therefore don’t have enough hemoglobin), you might start to experience symptoms of anemia. You're not making enough red blood cells and now your blood cell counts are low and then you start to get symptoms like:

  • Fatigue, caused by not having oxygen that travels around your body in concentrations high enough to keep your system going
  • Headaches
  • You might get cold really easily  
  • Increased heart rate because you're trying to move blood faster, because there's not enough oxygen in the blood.  
  • You might get dizzy and lightheaded  
  • Your skin might become pale, because there's not the same redness to it.  

So, these are all things that can happen with low red blood cell counts, due to iron deficiency.

The Most Surprising Symptom  

Interestingly, one of the symptoms specific to iron deficiency anemia is something called PICA, which is the desire to eat inorganic things like dirt. This happens because there is an instinct in our body that tells it you need iron, and you’re not getting it. Dirt is a very rich source of iron, so your body might actually start to crave it. In developing countries especially, where foods are not iron-enriched, people will start to eat dirt when their body senses an iron deficiency. So, if you're experiencing symptoms like lightheadedness, shortness of breath, fast heart rate, pallor, or maybe even a desire to eat dirt, then you should go to your doctor to be evaluated for iron deficiency anemia.

Diagnosing Iron Deficiency Anemia

There's a pretty easy way for your doctor to diagnose whether you have iron deficiency anemia. They do a simple blood test, looking at the hemoglobin and hematocrit, which show how rich the oxygen-carrying molecule in your body is. If those red blood cell counts look low, the levels of hemoglobin look low, and especially if the red blood cells are a smaller size, then there’s a pretty good chance there's an iron deficiency anemia. The doctor can then do iron studies, which measure whether you enough iron in your blood, and enough proteins that carry iron throughout the body, so they can make the diagnosis.

Causes of Iron Deficiency Anemia

If you are diagnosed with iron deficiency anemia, the next step is to determine the cause.  WHY you are iron-deficient is an important question, because there are certain things that can lead to iron deficiency anemia, some of which are more serious than others. 

Blood Loss

This can be from an injury, surgery, or it can be more hidden or insidious bleeding. If you’re a woman and you have really heavy menstrual periods, for example, you're losing a lot of blood and you’re losing the iron in the blood, so your body can't resorb it and reuse it as it makes new red blood cells. Or you could have a hidden bleed in your GI tract, stomach, or colon, and you might not even know it, but you could be losing blood slowly and days and days, which can deplete your iron stores and leave you with not enough to make red blood cells.  

That gets even riskier if you regularly take things like aspirin which thin the blood — you can lose blood even faster and not even know it. If you are over the age of 50 and you have iron deficiency anemia, your doctor should screen you for a GI bleed, anywhere along the GI tract, specifically screening for colon cancer.

Diet

The second thing that can contribute to iron deficiency anemia is just not getting enough iron in your diet. Keep reading to find out where to get iron in your diet; if you're not consuming enough iron through your food, you're not resupplying your body’s constant need of iron and that can lead to a deficiency.

Inability to Absorb Iron

A third issue is the inability to absorb iron.  So, you're getting it in your diet, but your body's not doing a good job assimilating it. That can happen in people with certain kind of GI diseases, like celiac disease or other inflammatory diseases, which reduce the absorption of iron from your gut so that even if you’re consuming it in your diet, it’s getting in there.

Pregnancy

This is a fourth, very common reason that women specifically can get iron deficiency.  When you are bringing new life into the world, and it is in your body, it's going to require a lot of iron just to make its new red blood cells. So, women who are pregnant can get iron deficiency anemia just because they're supplying iron to a whole new living being inside them.  

Iron in Our Diets

Let’s talk about where to get iron in our diets. One of the main sources is animal meats.  Animals, just like humans, have red blood cells and iron in their tissue, so red meat especially, as well as other meats like chicken and fish, all have rich stores of iron.  

You can also get it from leafy greens like kale, broccoli, and spinach, which are all very rich sources of iron, as well as from dried fruits.  So, if you're a vegetarian and leafy greens, fruits, and beans should be your go-to sources.  

Just a note, iron absorbs much more easily into our bodies when it comes from meat products.  So if you are a vegetarian, especially if you’re a woman who is going to lose blood every month during her menstrual cycle, you really need to make sure you're getting enough plant-based iron. You’ll want to increase the amount of leafy greens, fruits, and other iron-rich foods that you eat.  

One additional thing everybody can do to help with the absorption of iron is add vitamin C.  Vitamin C is great for helping to get iron out of the gut into the body. Most people know by now that oranges are very rich in vitamin C, but so are strawberries, melons, tangerines, and broccoli. Do yourself a favor and add vitamin C to your diet to help your body absorb any iron you eat. We always come back to healthy eating, because it does so much for your body in so many ways, so make sure that you're eating a healthy diet in order to get the iron you need, as well as the vitamin C to help it get it into your bloodstream.

Caveat for Breastfeeding Women

Children, particularly infants, really need iron as their bodies are developing. So if you have an infant, remember that breastmilk is very rich in iron. If you 're breastfeeding your baby, he or she is probably getting as much iron as they need. If you're using a formula, make sure you're using an iron fortified formula. Once you start weaning a child off of breastmilk and formula, you can then choose iron fortified cereals that will help get them enough iron into their diet and replace what they're not getting from breastmilk or formula. Cow's milk that you buy at the store typically doesn't have iron in it. So, if you’re feeding your baby cow’s milk for whatever reason, just know that it's fine for other things but they're not getting iron from it.  

Iron Supplementation

If you have had a severe amount of iron loss due to a bleed or due to heavy periods, or if you were eating a poor diet for a long time and now you’re iron-deficient, you may need to take an iron supplement. You can find these in pill form and in liquid form, and they are great at boosting your iron levels, especially for vegetarians, or people who choose not to eat a lot of red meat. 

 

If you're going to take an iron supplement, be warned that they can cause constipation, so make sure you’re also getting fiber in your diet. There are also some things that you can do to help get the iron out of the supplement and into your bloodstream:  

  • Take it on an empty stomach, as stomach acid helps it.
  • Don't take it with antacids, or an acid blocker, because you're going to neutralize those acids and the iron won't be absorbed as well.
  • Take vitamin C with it, either by eating fruit or taking a vitamin C product.
  • Use a liquid iron, which might be more absorbable for your GI tract.  

Iron Infusions

If you’re taking all these steps and you still have a deficiency, you can get an IV infusion.  Most of the time people who need this have serious GI tract issues, like inflammatory bowel disease or celiac disease, Crohn's, ulcerative colitis, or something that causes them to lose a lot of blood in the GI tract. People with these issues often don't absorb iron very well.  So that is the last step if you're really having a problem getting enough iron into your bloodstream.

Wrap-Up

So that's our introduction to iron deficiency anemia. Again, anemia is a lack of enough red blood cells in the body. We need hemoglobin for our red blood cells to really be able to carry oxygen, and hemoglobin needs iron. That’s why it’s important to make sure you're getting enough iron in your diet from leafy greens and meat products, as well as fortified cereals.  Make sure you're adding vitamin C to your diet from fruits and vegetables that are rich in this vitamin. If you do have iron deficiency anemia confirmed by a blood test, talk to your doctor about what the root cause might be, and make sure they're screening you for things like GI bleeds and other issues that might be depleting your red blood cells. 

Of course, there are other causes for anemia, which we’ll address in future articles and videos. We hope you’ve found this helpful!

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