How to: spot an iron deficiency

 
 iron deficiency….It could be affecting you?

iron deficiency….It could be affecting you?

 

Feeling tired? Not sleeping well? Nails weak? Looking a bit sickly pale? Iron deficiency is a pretty common diagnosis in women of child-bearing age.

Even if you’re haven’t gone 100% plant based (vegan) just yet, iron deficiency can still rear it’s ugly head ESPECIALLY if you don’t focus on getting enough iron rich food each and every day.

Is this you?

It was me!

That’s right, a few years ago as a result of reducing a whole lot of meat in my diet, I too developed an iron deficiency. I recall still eating milk and cheese but was very very obsessed with saying no to meat at all meals. I didn’t go plant based gradually and eventually I found myself at the doctors complaining of fatigue, poor motivation and pale skin. As a dietitian, I thought there is no way I could have iron deficiency (I wan completely in denial).

So to prevent you from developing this condition in the first place let take a look at:

  • Why do we need iron?

  • How much iron do we need to eat each day?

  • How to understand your blood test

  • What is the difference between iron deficiency and iron deficiency anaemia?

  • What are the symptoms of an iron deficiency?

    and finally, practical food tips to prevent iron deficiency!


Why do we need iron?

Put simply, iron plays huge role in the body across a range of different processes. For example iron:

  • is the key nutrient in haemoglobin (the molecule that binds to oxygen circulates our blood)

  • is found in myoglobin

  • is essential in the process of energy production

  • is essential for our immune system and in the formation of thyroid hormones

How much iron do we need to eat each day?

In order to maintain a healthy iron status, women between the ages of 19-50 years old require a huge 18mg/day. This is more than double what males require at 8mg/day. There is a bit of confusion out there with regards to how much iron vegans require. It is recommended that vegan and vegetarian eaters need to consume an additional 1.8x times compared to a meat eater because these diets are higher in iron inhibitors (components in plants that prevent or reduce iron from being absorbed) such as phytates and oxalates and non-haem iron. This would mean women would require 32.5mg/day and if you’re pregnant and plant based you’d need an even bigger 48.6mg/day (of which is almost impossible to achieve without iron supplementation).

However is this true? Do we need more iron?

These recommendations are extremely old and based on one single study (published over 20 years ago in 1991). Since then, the EPIC-Oxford study compared the lifestyle and nutrient characteristics of meat-eaters and plant based diets. They reported that plant based diets have one of the highest intake of iron compared to meat eaters. Additionally, the American Dietetic Association position statement on Vegetarian Diets states that vegan and vegetarians have lower iron stores compared to meat-eaters but this was still found to be within the healthy reference range. So in summary, there may be no strong evidence to suggest plant based women need an extra 180% iron each day but it is important to consume iron containing plant based foods each and everyday. Remembering too that we’re all individual and heavy period, being an athlete and being pregnany may mean you do in fact need much much more iron than you’re having so always consult an Accredited Practising Dietitian and/or your GP for further advice.

How to interpret your blood test?

Note that your doctor will typically provide you a copy of your blood test results (example below) after briefly explain whether or not you have iron deficiency. Make sure you bring a copy to your initial consultation where we will have more time to discuss what it all means.

 Real life example of iron studies on a blood test

Real life example of iron studies on a blood test

Until then, this is what you should know:

  • Iron deficiency isn’t as simple as just looking at the ‘iron’

  • It is best to review the trend over time

  • Don’t self-diagnose and instead ask for clarity

  • Don’t let your doctor assume an iron deficiency is due to a vegan or vegetarian diet (Inflammatory Bowel Disease and Coeliac’s disease can also cause iron deficiency)

Each parameter on the test includes:

  • Iron = (aka serum iron) levels which is the amount of iron circulating your body. It is not accurate to just consider this one parameter and is often only reviewed in isolation in cases where iron poisoning is suspected.

  • Trans Sat = (aka transferrin saturation) represents the percentage (%) of bound iron. Note ‘transferrin’ is a molecule that binds to iron and transports it around the body.

  • TIBC = (aka total iron binding capacity) represents how much iron is present in your blood and available to bind to the molecule transferrin.

  • Ferritin = (serum ferritin) is the amount of iron stored in the body. Often ferritin is increased during inflammation including conditions such as inflammatory bowel disease, chronic kidney disease, cancers and rheumatoid arthritis. CRP = C-reactive protein can indicate a level of inflammation.

For a more details descriptions visit Royal College of Pathologists Australia and Lab Tests Online

What is difference between iron deficiency and iron deficiency anaemia?

Yes, there is a difference! Iron deficiency refers to low levels of iron circulating the blood whereas an anaemic individual that has iron deficiency anaemia doesn’t have enough healthy red blood cells in the blood to carry oxygen to all the tissues and organs.

If we consider iron deficiency on a spectrum from mild to moderate then to severe (iron deficiency anaemia) then it would look something like this (serum ferritin ug/L):

iron deficiency on a spectrum.png

What are the symptoms of an iron deficiency?

 
 Icons artists from www.thenounproject.com (clockwise); Eat by Guilherme Furtado; Wind by Martin; Dizziness by priyanka; Fatigue by Lorie Shaull; Sudden Paleness by Jane Terekhov; Fingernail by Omer Viner; No Sleeping by Muhammad Riza

Icons artists from www.thenounproject.com (clockwise); Eat by Guilherme Furtado; Wind by Martin; Dizziness by priyanka; Fatigue by Lorie Shaull; Sudden Paleness by Jane Terekhov; Fingernail by Omer Viner; No Sleeping by Muhammad Riza


 

As mentioned above, iron deficiency often develops on a spectrum. This means that at some point if the iron deficiency is not addressed, iron deficiency anemia will develop. Some or all of the symptoms below often manifest as the severity of the iron deficiency increases.

Other symptoms not represented here include:

  • sensitive to the cold

  • reduced immunity

  • heart palpitations.

Practical tips to prevent iron deficiency anaemia?

 
 
 Fill your basket with colour especially orange and dark green vegetables

Fill your basket with colour especially orange and dark green vegetables

 Use this  iron fish  in cooking including to make iron infused water. Genius!

Use this iron fish in cooking including to make iron infused water. Genius!

 

The first thing you want to do is follow your doctors advice regarding iron supplementation. However, in the long term it is best to not have to rely on supplementation forever (and instead just use it as a back up) especially if you want to continue a plant based way of eating. Here are my top tips:

  • Get familiar with what plant based foods contain iron

    • wholegrains

    • lentils

    • beans

    • dark green vegetables

    • tofu

    • cashews

    • almonds

    • dried figs

    • dark chocolate

    • molasses

  • Stock the pantry and fridge with these foods

  • Grab a Lucky Iron Fish & use it in cooking

  • Each day, try to have 2 meals that are packed with plant proteins

    • lentils

    • red kidney beans

    • cannellini beans

    • tofu

    • tempeh

  • Avoid calcium fortified milks, calcium supplements or caffeine containing tea or coffee when eating iron containing foods

  • Combine iron containing grains with beta-carotene veggies (sweet potato, carrot, pumpkin, spinach)

  • Combine legumes and plant based proteins with vitamin C containing foods (strawberries, lemon, lime, oranges, kiwi fruit)

  • Don’t try to address it yourself, get support and a personalised strategies of how to get your iron up with an initial nutrition consultation