Iron Deficiency and Anaemia – when things go from bad to worse

We discuss the difference between Iron Deficiency and Anaemia and how the former leads to the latter. A common presentation in the clinic is patients whose blood tests show they are low in Iron and borderline Iron deficiency, but not necessarily Anemia. Rather than letting things go from bad to worse our experienced Naturopaths and Nutritionists can guide you on dietary changes, correct dosing, the best type of iron supplements and the duration of time required to correct iron status.

When Iron Deficiency become Anaemia

Iron Deficiency Anaemia (IDA) develops due to the lack of sufficient iron to form normal red blood cells. It is typically caused by inadequate intake of iron, chronic blood loss, or a combination of both. (1) Unless the iron deficiency is reversed, the hemoglobin and hematocrit levels (part of red blood cells) decrease to sufficiently low levels to be classified as anaemia. (2) 

Preventing Anaemia from developing

Early intervention is a key aspect of why Naturopaths interpret your blood test results a little differently. The Naturopathic principle ‘Prevention is Best Cure’ allows us to provide fresh insight into whether your iron levels are lower than ideal for preventing progression towards Anaemia.

Patients seeking advice about heavy menstrual periods, thyroid problems, pregnancy health, digestive complaints, fatigue and infertility may need to get their iron levels tested and interpreted with attention to detail to ensure that any underlying issues related to iron are not causing or worsening their health concerns. Preventing Anaemia from developing is always a top priority.

Getting enough Iron in the Diet

The human diet contains two forms of iron: heme iron and non-heme iron. Heme iron is well absorbed and only derived from meat. Non-heme dietary iron, which is found in cereals, beans, and some vegetables is generally less well absorbed. Plant phytates (found in grains) and tannins (in black and green tea) are known to decrease the absorption of non-heme iron (1). For this reason, Vegetarian and Vegan diets can be challenging to ensure the iron is replete, especially in females with heavy menstrual periods. However, a Vegan diet is usually sufficient to prevent Anaemia even though the individual’s iron stores may be low. (2) A diet review is useful in a Naturopathic consultation to establish risk factors for iron deficiency and other nutrient deficiencies.

Finding the cause of low Iron levels is very important.

Meat eaters are not immune from developing iron deficiency if there is a significant issue contributing to blood loss, including blood donation or nosebleeds. Loss of iron stores can also occur after chronic physical exertion when significant iron is lost in sweat and may contribute to the deficient state. (2)  Gastrointestinal disorders are always suspected in an iron-deficient or anaemic patient and investigations such as a colonoscopy or endoscopy may be required to find the cause of the problem.

Diseases associated with gastrointestinal bleeding, including colon cancer, gastric cancer, peptic (stomach) ulcer, polyps in the colon, and Inflammatory Bowel Disease (IBD) can greatly increase the risk of developing anaemia. Other digestive disorders such as gastritis, Helicobacter pylori and Coeliac disease(3) are considered non-bleeding gastrointestinal causes of anaemia. Getting tested for the Coeliac disease is something your Naturopath will consider and discuss with you when if you present with iron deficiency and closely assessing signs and symptoms of other serious digestive health issues.

Anaemia itself can occur for other reasons, and Anaemia of Chronic Disease (ACD) is the second most prevalent cause of Anaemia, after IDA. ACD can occur for numerous different reasons including infections, cancer, auto-immune disease and chronic kidney disease. (4) Other markers in the blood help determine the cause and type of anaemia in these types of cases and require referral to specialists.

When Iron Deficiency becomes Anaemia

In the absence of major haemorrhage or other serious pathology, IDA generally develops slowly over the course of months or years. It makes sense then that resolution of IDA may be equally slow. This may depend on the adequacy of gastrointestinal function(2). Treating the gut is a big part of addressing the issue by improving iron absorption, alongside diet changes and appropriate supplementation.

While a slow and steady approach may be acceptable to treat iron deficiency, anaemia can be of real consequence. When a person is anaemic, their heart must work harder to ensure that muscles and organs get the oxygen they need. (5)

IDA during pregnancy can cause reduced foetal brain maturation, paediatric cognitive defects, and maternal depression. (2) A Naturopath will prioritise correcting iron levels in preconception care and throughout pregnancy and lactation to ensure the health of both mother and baby. In some instances, an Iron infusion may be recommended to replenish iron stores rapidly.

The Do’s and Don’ts of Iron

Do:

• Get a yearly blood test at a minimum. A GP will include a full blood count (to look at the red and white blood cells) and iron studies. The third test to request to include is CRP (C-reactive protein) and is a marker of inflammation which may affect the levels of iron in storage as ferritin.
• Get advice about your test results from your GP and seek further advice if you have a history of iron deficiency or would like your test results to be viewed more holistically.
• Recognise the iron-rich foods in your diet and ensure you are eating them regularly
• Get a high-quality iron supplement ideally prescribed from a professional rather than an over the counter product.
• Get follow up testing every 3-6 months when required.
• Take deficiency seriously and work with a professional to find out the root cause of the problem.

Don’t:

• Self prescribes iron supplements – if you don’t need it, it may cause you more harm than good.
• Assume you are low in iron, even if you have been low in the past
• Take iron while you have a cold or flu since it can promote inflammation.

We are here to help you ‘iron out’ any confusion regarding iron deficiency and anaemia. While IDA is a common problem, no two people are the same and so getting advice tailored to your needs is vital to ensure your health is well managed. We have a wonderful recipe to help with low iron.

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