Organic matter is generally made up of Carbon, Hydrogen, Oxygen, and Nitrogen. However, inorganic matter such as Iron is incorporated in organic molecules in some instances. This can be observed in a special protein found in human blood called “haemoglobin”. This complex protein contains four iron atoms in the ferrous state (Fe2+). Without iron, the haemoglobin protein cannot carry out its most essential function which is to deliver oxygen throughout the body.
The Iron Mineral – What is it?
Historical records revealed that iron has medicinal properties which were recognized by the Egyptians, Hindus, Greeks, and Romans. Back then, physicians don’t understand why iron is beneficial for the human body. It would take several centuries before physicians would fully comprehend the importance of iron.
In 1932 compelling proof that inorganic iron played a major role in the synthesis of haemoglobin was uncovered and published. This scientific find led to more studies on fighting anaemia by improving iron intake The findings of such studies and their application to standard medical practice made detecting and treating iron deficiency easier. Despite such advancements in nutritional science, third-world countries are still plagued by iron deficiency that is brought about by infectious and inflammatory diseases, parasitic infections, and malnutrition.
1. The Function of Iron in the Body
As mentioned earlier, iron is an essential mineral for the human body because it is needed in the synthesis of haemoglobin, a protein that is responsible for the red blood cells (RBCs) ability to transport oxygen throughout the body.
Synthesis of haemoglobin occurs within the RBC as they mature. They give our blood its distinctive colour. Blood may vary in colour due to the differences in oxygen saturation. Blood that is saturated with oxygen is bright red in colour while blood that is not is dark. Every component of the haemoglobin protein is important. However, oxygen binds specifically to the ferrous iron (Fe2+) and nowhere else in the haemoglobin protein.
Iron’s role is not limited solely to the synthesis of haemoglobin. Iron is also needed in the maintenance of skin cells, hair, and nails.
Although the most abundant form of iron within the body is the ferrous iron found within the haemoglobin protein, iron has various forms besides that. Some examples of iron that isn’t bound to haemoglobin include flavin-iron enzymes, transferrin, and ferritin.
Iron within the body is recycled. When a red blood cell ruptures, a lengthy biological process breaks down the haemoglobin and collects the iron for later use. This iron can be delivered to various tissues because of transferrin. This molecule acts as a transporter of iron that is released into the blood plasma.
Intestinal enterocytes and reticuloendothelial macrophages are the cells that release iron into the blood plasma. Enterocytes being the cell that is responsible for the absorption of iron from dietary sources. These enterocytes are present in the small intestine, specifically the duodenum and upper jejunum area. Enterocytes can absorb iron allowing them to cross the intestinal lumen and into the bloodstream. They are also equipped with enzymes that enable them to extract iron that is present in dietary heme. Allowing the iron present in the dietary heme to pass through them as well.
Iron is usually absorbed in small amounts. Iron absorption may occur at a rate that is as low as 5% and as high as 35% depending on the amount of iron present in your body and the type of iron present in your diet.
2. Keeping Iron Balanced
The human body isn’t equipped with mechanisms that would allow the elimination of excess iron. For iron levels to remain balanced, regulation of this mineral occurs at the point of absorption. By adjusting the amount of iron absorption from dietary sources, a balance between iron uptake, transport, storage, and utilization is created.
3. Important Molecules in the Regulation of Iron
This hormone is regarded as the primary regulator of iron. They bind ferroportin, a special surface protein that facilitates the movement of iron into the blood plasma. An increase in hepcidin levels leads to increased blockage of ferroportin which ultimately leads to a decrease in iron plasma levels. Conversely, a decrease in hepcidin levels leads to a decrease in ferroportin binding which ultimately leads to an increase in iron plasma levels.
The amount of hepcidin present in the blood is affected by cytokines. Certain conditions can affect cytokines which could lead to the dysregulation of hepcidin and iron levels. Chronic inflammation is a condition wherein there would be a lot of inflammatory cytokines present in the blood plasma. This situation would lead to the overexpression of hepcidin which could lead to Anaemia of Chronic Disease.
There are also conditions where hepcidin levels themselves are abnormal. For example, some cases of hereditary hemochromatosis, a condition wherein there are abnormally high levels of plasma iron, stems from an abnormally low expression of hepcidin.
b). Ferritin and Hemosiderin
Ferritin along with hemosiderin is responsible for iron storage. Ferritin is an iron-binding protein and hemosiderin is responsible for storage. They are responsible for facilitating the storage of iron in insoluble form into the liver, spleen, and bone marrow. Measuring serum ferritin is the best way to estimate a patient’s iron stores.
4. Iron Losses
The body losses iron when there is loss of blood. Menstruation, wounds, and pregnancy can all lead to blood loss which leads to iron losses. The body may also lose some minute amounts of blood when the body exfoliates cells from epithelial surfaces. In some instances, the simultaneous loss of blood and iron brought about by menstruation, wounds, or pregnancy can be so heavy that the affected individual suffers from the symptoms of iron deficiency. Women are more likely to be deficient in iron because of this fact. It is also due to this fact that physicians would recommend iron supplements to women.
5. Dietary Forms of Iron
Dietary iron comes in two forms: heme and nonheme. Iron obtained from dietary heme comes from meat products like beef, poultry, and fish. Nonheme iron can be obtained from fruits and vegetables. Heme iron is relatively more bioavailable than nonheme iron. In other words, the iron present in dietary heme is relatively easy to absorb compared to iron present from nonheme sources.
Despite nonheme iron being less bioavailable, dietary sources of nonheme iron offer high concentrations of this type of dietary iron. On top of that, certain foods don’t interfere with the absorption of nonheme iron. In essence, nonheme iron offers more iron for our body but is not easily absorbed. This is why those who follow a strict plant-based diet are advised to consume double the amount of foods that contain nonheme iron.
Certain molecules and minerals ingested from food may inhibit iron absorption. Phytic acid, polyphenols, calcium, peptides, and partially digested proteins are some of these molecules and minerals that have this property. Fortunately, ascorbic acid can improve iron absorption.
How Much Iron Do I Need?
Daily iron requirement is dependent on a person’s age and gender. In females, pregnancy and breastfeeding may alter their iron requirement.
- From birth to 6 months, a person would require 0.27 mg of iron. This has to do with their mass which is a factor for a person’s daily iron requirement.
- At the age of 1 to 3 the baby would have gained a considerable amount of mass which is why their daily iron requirement is increased to 7 mg.
- Children, ages 9 to 13 years old, adult men, 19 to 50 year-olds, and adults beyond the age of 50 must obtain at least 8 mg of iron from their diet every day.
- Breastfeeding women have a slightly higher daily iron requirement of 9 mg.
- Children 4 to 8 years and breastfeeding teens have a daily iron requirement of 10 mg
- For fast the fast-developing bodies of Infants, 7 to 12 months old, and teen boys, 14 to 18 years old, their daily iron requirement is even higher at 11 mg.
- Teen girls, ages 14 to 18 years old, may need more iron due to menstruation. Thus, their daily iron requirement is increased to 15 mg to compensate for that.
- Adult women, ages 19 to 50 years old, would have their menstruation and they also have a bigger body mass than teen girls. Thus, their daily iron requirement is 18 mg.
- Pregnancy significantly increases the daily iron requirement of females. Be it, pregnant teens or pregnant adult women, their daily iron requirement is 27 mg.
Determining Your Iron Status
When in doubt, there are methods for determining how much iron is present in your body. These tests are also beneficial for differentiating Iron Deficiency Anaemia from other types of anaemia. Simple tests such as haemoglobin and hematocrit are used to screen for iron deficiency. Since these are screening tests, they are not specific. Meaning other conditions may exhibit the same abnormal haemoglobin and hematocrit levels present in Iron Deficiency Anaemia.
Despite this, they are useful tests because they help physicians decide whether they should entertain the possibility of Iron Deficiency Anaemia or investigate other possible conditions. If a patient’s haemoglobin and hematocrit levels are abnormal and the doctor suspects Iron Deficiency Anaemia, the doctor could request serum ferritin which is a clinical laboratory test that is specific for Iron Deficiency Anaemia.
Without showing any symptoms of iron deficiency, health experts suggest that a person must have their haemoglobin and hematocrit tested at least once a year. For those who just finished their treatment for iron deficiency, a three-month waiting period is required before their serum ferritin levels are determined. If they get tested too early, their results might show that they have normal iron levels when in reality they are not.
Iron Deficiency Anaemia is one of many conditions that feature low iron levels. This condition shares the same symptoms as iron deficiency or any other condition that results in abnormally low iron levels. The low iron levels would lead to a decrease in the red blood cells’ ability to carry oxygen which ultimately leads to most of the following symptoms:
- Lethargy or being tired all the time and not having enough energy to carry out daily tasks
- Difficulty concentrating – a result of being tired all the time
- Shortness of breath
- Heart palpitations
- The decrease in red blood cells could result in difficulty regulating your body temperature or often feeling cold and pale skin
- Hearing ringing, hissing, or buzzing noises inside your head
- Increased frequency of illness
- A sore tongue or difficulty swallowing
- Changes in the way food tastes
- Hair loss
- Pica or cravings for non-food items, such as ice or dirt
- Painful open sores in the corners of the mouth
- Spoon-shaped nails
- Restless leg syndrome or the uncontrollable urge to move your legs
Iron Deficiency Anaemia
Symptoms of iron deficiency anaemia are the same as with any condition that causes low iron levels. Iron deficiency anaemia is also diagnosed the same way as with any other condition that causes low iron levels. Due to the similarity between iron deficiency and iron deficiency anaemia, physicians have developed a means of differentiating the two through staging. At each stage, the physician takes note of a patient’s red blood cell (RBC) count, haemoglobin level, and hematocrit level.
- The first stage is the “mild iron deficiency stage” when serum ferritin levels drop to 10 to 30 mcg/L. However, the RBC count is normal, the haemoglobin level is normal, greater than 12 g/dL, and the hematocrit is also normal, above 36% for women and 41% for men.
- If nothing is done to address the deficiency in iron, the patient’s condition could worsen and progress to “mild functional iron deficiency anaemia stage”. At this point the iron stores are completely depleted, serum ferritin levels would drop to less than 10 mcg/L. Despite this drastic decrease in the patient’s iron stores, the red blood cell count, hematocrit, and haemoglobin are still normal. But not for long.
- The final stage is full-blown Iron Deficiency Anaemia. The depletion of stored iron, serum ferritin levels less than 10 mcg/L, would begin to reflect in the patient’s clinical laboratory tests. The RBC count would be abnormally low. Haemoglobin would drop below 12 g/dL. Hematocrit would follow suit and drop below 36% for women and 41% for men.
1. Differentiating Iron Deficiency Anaemia from Other Types of Anaemia
The first thing that comes to a person’s mind when they hear anaemia is Iron Deficiency Anaemia. However, that isn’t always the case. Other types of anaemia do not stem from a lack of iron. Treating these types of anaemia with iron supplementation wouldn’t be beneficial for the affected patients.
a). Anaemia of Chronic Disease
This type of anaemia has to do with the release of cytokines as a response to inflammation. The cytokines would then promote hepcidin expression. The increase in hepcidin would lead to a decrease in iron levels as these molecules can block the iron from entering the plasma.
Anaemia of Chronic Disease is confusingly similar to Iron Deficiency Anaemia when it comes to their presentation in the laboratory results. Both conditions would present with low RBC count, low haemoglobin, and low iron. This is why on top of the usual tests for Iron Deficiency Anaemia, an individual who has anaemia but does not respond to iron supplementation would have to undergo the ferritin blood test.
Those who have Anaemia of Chronic Disease would have high ferritin levels. This means there is enough iron in storage but is not readily available in the blood plasma. The elevated ferritin levels also allude to the fact that the body is trying to keep iron away from any pathogen that enters our body. Anaemia of Chronic Disease has a different treatment course. Iron supplementation for patients with Anaemia of Chronic Disease is highly discouraged.
b). Vitamin B-12 Deficiency Anaemia or Pernicious Anaemia
Another type of anaemia that may present with symptoms similar to Iron Deficiency Anaemia is Pernicious Anaemia. In this type of anaemia, autoimmune antibodies would interfere with a person’s ability to absorb Vitamin B-12 which leads to anaemia.
Vitamin B-12 Deficiency Anaemia is a type of anaemia that is very similar to pernicious anaemia because both of them have the same primary issue which is the lack of vitamin B-12 within the body. Vitamin B-12 Deficiency Anaemia can come about by several means. It may appear due to an infection with the fish tapeworm or Diphyllobothrium latum, or it could also manifest due to insufficient intake of Vitamin B-12.
Like all types of anaemia, the patient would present with a low RBC count, low haemoglobin levels, and low hematocrit levels. To differentiate Vitamin B-12 Deficiency Anaemia or Pernicious Anaemia from Iron Deficiency anaemia, a reticulocyte count must be conducted. This type of anaemia would exhibit high amounts of reticulocyte, the immature form of RBC. This is because a person who has Vitamin B-12 deficiency would have RBCs that mature at a slower rate. Iron supplementation may not work for individuals with this type of anaemia.
2. Treating Iron Deficiency
Individuals who are presenting symptoms of iron deficiency are advised to take 2 to 5 mg of iron per kilogram of their body weight every single day until the symptoms would dissipate and their ferritin levels would go back to normal. Individuals who are otherwise healthy, are advised to follow the recommended daily intake of iron that is appropriate for their age and sex.
Should I Take Iron Supplements?
If you are an individual with a high risk of developing anaemia then it is advised that you take iron supplements. High-risk individuals are those:
- Who are pregnant because of the increased iron demand
- Infants and Young children because their bodies are developing fast
- Females experiencing heavy periods because the loss of blood would lead to iron loses
- Frequent blood donors because they lose iron when they give their blood
- People with cancer
- People who can’t absorb dietary iron well due to conditions such as celiac disease, ulcerative colitis, or Crohn’s disease. This includes those who have undergone gastric surgery
- People with heart failure
- Those taking iron-depleting medications, such as those used to reduce stomach acid
- People regularly partaking in heavy exercise
- Those following a vegetarian or vegan diet – although sources of nonheme iron contain high levels of said dietary iron, they have low bioavailability and must be consumed in such a way that doubles the dosage of the iron present
- People with blood disorders, such as thalassemia or sickle cell anaemia
- People with alcoholism
Iron is such an essential mineral to our body. However, too much of a good thing is always bad. Taking too much iron may lead to the following symptoms:
- Feeling sick
- Being sick
- Stomach pain
If the amount of iron taken in is excessive, it could lead to a serious condition called Hemochromatosis wherein the excess iron would build up in the following organs or tissues:
- Pituitary gland
Natural Ways of Increasing Iron
The best way to increase your iron storage would be to obtain iron from food. 3 Ounces of Oysters contains as much as 8 milligrams of dietary iron. One cup of white beans has the same amount of dietary iron. If you consume these two together, you’ll be meeting 88% of the Daily Value for Iron. Add in some 3 ounces of 45% Cacao Dark chocolate then you’ll be exceeding your daily value for iron by 27%.
If you are on a strict plant-based diet then no need to fret. Iron is abundant in several vegetables. However, keep in mind that the dietary iron present in plant-based foods, the non-heme iron, has less bioavailability. Double the amount of plant-based foods for good measure. For example, if it says that one cup of White Beans has 8 milligrams of dietary iron, double it to 2 cups.
Iron supplements are food supplements that contain high amounts of dietary iron. There are several iron supplements for anaemia that are available in the market. They come in two forms: iron tablets or iron supplements liquid. Their active ingredients may vary from brand to brand. These are the usual active ingredients in iron supplements for anaemia:
- Heme iron polypeptide
- Ferrous sulfate
- Elemental Iron
- Ferrous fumarate
- Ferrous bisglycinate
- Polysaccharide iron complex
- Ferrochel iron bisglycinate
- Ferronyl iron
Among the 8 active ingredients ferrous fumarate is considered the best iron supplements uk.
Taking in Iron Supplements
People react to iron supplements differently. In some people, taking iron before meals can cause gastric discomfort, nausea, and diarrhoea. However, the best way to take iron is on an empty stomach. So to deal with this issue, those who have a negative reaction to iron supplements when taken on an empty stomach are advised to take small amounts of food to avoid gastric distress while maintaining efficient iron absorption.
Certain minerals may interfere with iron absorption, calcium is one of them. Thus, you must not partake of any food or pharmaceuticals that contain calcium; some common examples are milk, calcium supplements, and antacids.
As mentioned earlier, drinking too much calcium could lead to hemochromatosis. Besides drinking too much iron, you should be wary of what you partake along with the iron. A 2004 study mentioned that taking in ferrous salts along with vitamin C can lead to oxidative stress within the gastrointestinal tract. Taking in iron and vitamin C together may lead to ulceration, inflammatory disorders, and the worsening of existing gastric conditions. It is better to space the intake of iron supplement and vitamin C supplements.
Iron is an essential mineral whose primary function is to serve as an attachment site for oxygen within the haemoglobin protein. A deficiency in iron brought about by insufficient intake, blood loss, or ineffective absorption can lead to various symptoms. The most common and obvious symptoms that would manifest are those symptoms related to the decrease in the RBC’s ability to carry oxygen. As iron gets depleted, haemoglobin, as well as RBC production, slows down. This leads to fewer attachment sites for oxygen which ultimately leads to less oxygen delivery to the person’s cells. Less oxygen delivery to cells would manifest as symptoms like nausea, headaches, and more. Fortunately, Iron Deficiency is well studied and easy to treat. Prevention of Iron Deficiency is as simple as consuming more iron-containing foods. However, certain individuals are at a higher risk of developing iron deficiency; these individuals are advised to take iron supplements.