Insufficient iron in your body causes anemia. Iron is needed to make hemoglobin, which carries oxygen in red blood cells. Hemoglobin also is necessary for energy and proper function of the immune system.
What causes lack of iron? This topic was addressed in a helpful article by Sara Berg, MS who interviewed two blood specialists, Drs. Richard Eisenstaedt and Amar Kelkar.
The interview was published in JAMA News Wire in January 2024. Their answers form the basis of this blog post.
Anemia is the lack of an adequate number of red blood cells. Symptoms may include fatigue, dizziness, brittle nails, pale skin and eyes, headaches, feeling cold, shortness of breath or exercise intolerance.
One uncommon symptom is pica, which involves chewing lots of ice and/or eating starch or other unusual foods.
We lose iron every day from the normal shedding of intestinal cells (about 1 milligram per day).
Menstruating women lose an average of 30 milligrams each month (more or less depending on how heavy their menses are).
Typically, we eat food with iron that provides us with about 20 milligrams per day, but we only absorb about 10% of that.
So, the average menstruating woman takes in just enough iron in her diet to compensate for the loss of iron from menstrual bleeding and shedding of intestinal cells.
It should be no surprise that the most common cause of anemia in menstruating women is inadequate intake of iron.
In men and non-menstruating women, the most common cause of iron deficiency anemia is disease in the intestinal tract. Colon cancer would be an example.
Thus, iron deficiency anemia in these individuals should include an evaluation of their GI tract by a colonoscopy and other tests.
Iron deficiency is easily identified by a blood test, a ferritin level. It indicates the total amount of iron the body has stored. If it is low, the person has iron deficiency.
The underlying cause must be treated. In addition, additional iron needs to be provided. Taking iron pills twice a day between meals is often prescribed.
Do not take iron with antacids or food, including milk or black tea, because they can reduce the absorption of the iron.
On the other hand, iron should be given with vitamin C from supplements or orange juice. It enhances the absorption of iron.
Iron is also present in many foods. Good examples include meat, seafood, beans, legumes, dark leafy greens like spinach, raisins, apricots, and some cereals, breads and pastas (read the labels).
Do not take more iron than recommended by your doctor because too much iron can cause liver or heart damage in susceptible people.
Some people experience vague abdominal symptoms such as cramps or constipation when taking iron. Temporarily reducing the dose until your intestines acclimate to the dose may resolve the problem.
Always communicate with your doctor if you have any problems taking recommended iron.
Sometimes iron deficiency is discovered when someone tries to donate blood and is told their red blood cell count is too low. They should see their doctor who can order appropriate tests to find the cause.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
