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Why are My Iron Levels Low All the Time?

Low iron can make you feel tired and fatigued all the timeDo you suffer from any of these?

  • Tiredness or fatigue
  • Feeling weak
  • Getting tired easily during or after physical activity
  • Pale skin
  • Get injured easily
  • Brittle nails
  • Low immune system
  • Irritability
  • Body aches
  • Chest pains, a fast heartbeat, or shortness of breath
  • Headaches
  • Fainting, dizziness or light-headedness
  • Cold hands and feet
  • Hair and skin problems
  • A sore tongue
  • Unusual cravings, such as ice, dirt or starch
  • Poor appetite (especially in infants and children)

If so, you may be deficient in iron.

How Your Body Uses Iron

Its main use is to transport oxygen in your body, but it supports many other body and mental functions as well.

  • Iron is essential for red blood cells to carry oxygen
    One of the most important functions of iron is in the creation of haemoglobin, a protein in red blood cells, which transports oxygen from the lungs to the rest of the body. Without enough iron your body can’t get enough oxygen, leading to you feeling tired or exhausted.
  • Iron helps convert food to energy
    ATP (Adenosine Triphosphate) is the body’s primary energy source, and our cells require iron to convert the energy from nutrients into ATP. (This process is known as cellular respiration.)  Low iron means less ATP, which is another reason why low iron levels can make you feel tired and fatigued all the time.
  • Iron helps maintain a normal immune system
    Iron is necessary to produce and mature your immune cells (especially lymphocytes), which protect us from bacteria and viruses.
  • Iron contributes to normal brain function
    Iron plays an important role in maintaining normal cognitive function, including memory, concentration, alertness, learning, intelligence, language, and problem solving. Maintaining a good level of iron in our bodies helps us to ensure our brain is performing correctly and at its best.

What Causes Low Iron

Some of the common causes of iron deficiency include

  • Lack of iron in the diet – there are two types of dietary iron, haem iron (found in animal tissue) and non-haem iron. The body absorbs haem iron much more easily than non-haem iron. Dietary intake of iron could be inadequate for a variety of reasons, including a poorly balanced vegetarian diet or fad dieting.
  • Low ability to absorb iron – healthy adults absorb only about 10% -15% of dietary iron, but some people’s bodies will absorb even less. Iron is absorbed through your stomach and small intestine, so if these are not functioning well it can cause problems. Often surgery to these areas (including a gastric bypass or gastric band) will also affect how much iron you can absorb.
    The iron in plant-based foods is much harder to absorb than the iron in animal foods. So if you’re a vegetarian or vegan, it’s important to understand how to prepare iron-rich foods to make sure you absorb as much iron as possible.
  • Exercise – people who train a lot are prone to iron deficiency, because regular exercise increases the body’s need for iron in a number of ways. For example, iron is used to make new red blood cells, and hard training increases the rate of red cells being produced. Iron is also lost through sweating.
  • Inflammation – this is often overlooked as a cause of low iron, and one we commonly see in our clinic.
  • Blood loss – iron deficiency easily occurs in situations of chronic blood loss. Common causes include heavy menstrual periods, regular blood donation, regular nosebleeds, chronic disorders that involve bleeding (such as ulcers, hiatus hernia, bowel polyps or bowel cancer), and certain medications, particularly aspirin or other anti-inflammatory drugs.
  • Increased need – an adolescent growth spurt, pregnancy and breastfeeding are situations when the body requires more iron. If this increased need isn’t met, a deficiency can quickly occur.
    Babies need breast milk or iron-fortified formula for the first year. Those who have cow’s milk instead are more likely to develop an iron deficiency.

Why does inflammation matter?

In 2000, scientists discovered a compound called hepcidin, and deemed it the “Master Regulator” of iron metabolism.1 Essentially, hepcidin controls whether iron can get into and out of cells. This affects a few key processes related to iron metabolism:

  • Iron absorption from the digestive tract
  • Iron recycling from damaged cells
  • Release of iron from storage

Typically, hepcidin levels are increased when there is a high level of circulating iron. This reduces absorption of iron from the diet, reduces the amount of recycled iron released into the system, and converts more iron into the storage form, ferritin. All of this helps to protect the body from iron overload.

Inflammation can also cause hepcidin production to increase.2 The increase in response to inflammation helps our bodies defend against invading bacteria, viruses, or other pathogens. Foreign invaders need iron to survive and thrive, just as we do. Therefore, the body responds by increasing hepcidin levels, causing much of the available iron to be converted to ferritin and put into storage. The lack of iron in the blood suppresses the ability of these invaders to grow and multiply.

Ferritin levels are usually a good measure of your overall iron status, but in the presence of inflammation, they may act as an immune response marker instead of an indicator of your iron stores.

However, inflammation in the body can come from other sources apart from invaders. These include strenuous exercise, a niggling injury, contraceptive pills, digestive problems, allergies or food intolerances, inflammatory bowel disease, excess weight, autoimmune diseases, poor diet, stress, and lack of sleep.

Understanding Your Blood Test

Your blood test will often include your levels of

  • Haemoglobin – which the red blood cells use to transport oxygen from your lungs to the cells of your body
  • Serum iron – measures the level of iron in the liquid part of your blood.
  • Transferrin – transferrin is a protein in your blood that transports iron, and your body produces transferrin according to your iron needs. When its iron stores are low, the transferrin levels should increase, and your levels should be low when there is too much iron. (Usually about one third of your transferrin is being used to transport iron.)
  • Total Iron Binding Capacity (TIBC)– this is a good indirect measurement of transferrin. (A pathology lab will normally measure either the transferrin levels or the TIBC.)
  • Transferrin saturation: this is the percentage of transferrin that is filled with iron.
  • Ferritin – ferritin is the main protein your body uses to store iron, so this is a measure of the amount of iron stored in your body

The balance of these readings is often helpful in determining what is causing your low iron.

In many types of iron deficiency the transferrin and TIBC may be high. Remember that the TIBC and transferrin are not measuring the amount of iron in the blood but the ability of the blood to carry iron. When the body lacks iron, it increases the amount of transferrin to gather as much of it as it can.

(Women using the contraceptive pill will often have high transferrin levels as well.)

On the other hand, those with chronic inflammation usually have low transferrin (or TIBC).

Here is a summary of the typical test results for the common types of iron deficiency.

Iron deficiency caused by Serum iron Transferrin or TIBC Transferrin
saturation
Ferritin
Low intake, low absorption, blood loss Low High Low Low
Chronic inflammation Low Low Low Normal / high

This chart is only a very general guide. For example, after strenuous exercise, your demand for oxygen will have increased, so your levels of transferrin will be higher short term. But if you over-exercise over a long period, the chronic inflammation may cause your transferrin levels to become low. And over time, if your body is not absorbing iron as fast as it is losing it, your ferritin levels will also become low.

So interpreting blood tests correctly requires careful evaluation, and a knowledge of the person’s diet and lifestyle.

Improving your iron levels

Obviously, the most important thing is to identify and address what is causing the problem. Having said that, some of the more common considerations are

  • Diet– an increase in foods that contain plenty of iron in an easily absorbed form is often important.
  • Absorption – it is very common to find that the person’s digestive system is not absorbing iron easily, so improving digestion is necessary most of the time.
    The tannins in tea and coffee bind to the iron and interfere with absorption, so cut back on the amount of these you drink, especially around mealtimes.
  • Address any inflammation or infection – low grade inflammation can occur almost anywhere in the body for a variety of reasons, however the digestive system is a very common source.

Taking iron supplements

Don’t take these if you don’t need to.

  • Unnecessary iron supplementation can interfere with your body’s absorption of other minerals, including zinc and copper.
  • Some prescribed iron supplements can cause constipation, nausea, vomiting and diarrhoea, especially if they are taken on an empty stomach. Some can even cause internal bleeding (making the iron levels worse instead of better!).
  • About one in 300 people have haemochromatosis, which is an inherited disorder that causes the body to absorb more iron than normal. Excess iron damages their body’s tissues and increases their risk of cancers and heart disease. People with this condition need to limit how much iron they consume.

The best iron supplements are easily absorbed by the body, and contain extra vitamin C to increase the absorption rate. They contain a bio-available form of iron, and are very unlikely to cause any of the side effects associated with some of the others.

If your iron levels seem to be low all the time, just check with your doctor first to make sure there isn’t anything serious happening. Then we can check what is going on in your body and recommend the correct diet, supplements or treatment for you, to help you get your energy and spark back again. We even offer a free Comprehensive Assessment, to perform a detailed check of how your body is working and the best way to sort it out. (Terms and conditions- the Assessment is a free service, with no obligations whatsoever.) So if you would like to enjoy better energy and better health, please give us a call.

References:

  1. [1] Park, Christina H., et al. “Hepcidin, a urinary antimicrobial peptide synthesized in the liver.” Journal of biological chemistry 276.11 (2001): 7806-7810.
  2.  [2] Ganz, Tomas, and Elizabeta Nemeth. “Iron sequestration and anemia of inflammation.” Seminars in hematology. Vol. 46. No. 4. WB Saunders, 2009.