Correcting Your Iron Deficiency

By Joan Haynes, ND

Symptoms of Iron Deficiency

  • Fatigue
  • Poor attention, memory, and work productivity
  • Sore tongue
  • Poor condition of skin, nails, or hair including hair loss
  • Cracks or sores at the corners of mouth
  • Wounds heal slowly
  • Shortness of breath
  • Paleness
  • Restless leg syndrome

Reasons for an Iron Deficiency

  1. Blood loss – through heavy menstrual cycles, intestinal bleeding, etc.
  2. Low intake of iron rich foods (see attached list)
  3. Gastrointestinal problems:
    • Low hydrochloric acid and digestive enzymes
    • Celiac disease
    • Intestinal parasite infections
    • Intestinal bleeding (which the patient may not notice)
  4. Supplements and Medications that interfere with iron absorption
    • Calcium – in dairy foods and calcium supplements
    • Antacids such as Rolaids and Tums and acid-blocking medications such as Pepcid and Prilosec
  5. Health Issues
    • Chronic diseases such as hypothyroidism, cancer, and blood abnormalities.

Ways to Increase Iron Absorption

  1. Increase acid in the digestive tract
    • Vitamin C – 250-2000 mg can be taken at the same time as your iron
    • Vinegar – 1 ounce of apple cider vinegar with your iron or on your iron rich foods
    • Hydrochloric acid – if too low will inhibit mineral absorption. Read my article: Reflux: Could you have LOW Stomach Acid.  Caution: do not take hydrochloric acid unless you start very slowly and read the contraindications.
  2. Meat sources of iron are more easily absorbed than plant sources
  3. Combine plant and animal sources in the same meal to enhance the absorption of iron from plants
  4. Cast Iron cookware releases iron into food

Ways to Decrease Iron Absorption

– Try to not ingest the following with your iron supplement or iron rich meals, especially if you are having trouble getting your iron levels to rise.  Avoid them 1 hour before and 2 hours after iron ingestion.

  1. Oxalates – found in many foods, even iron rich foods like spinach and kale which prevent the iron from being released. But, if you cook those veggies it will help with availability.  Other high oxalate foods include beets, nuts, chocolate, tea, wheat bran, rhubarb, strawberries, oregano, basil and parsley.
  2. Phytates – this compound is found in whole grain, fiber supplements, walnuts, almonds, sesame, dried beans, lentils, peas and soy protein.
  3. Polyphenols – another plant compound found in coffee, tea, chocolate, walnuts, apples, blackberries, raspberries and blueberries.
  4. Calcium – cow’s milk products (cheese, yogurt, milk) and calcium supplements
  5. Antacids such as Rolaids and Tums and acid-blocking medications such as Pepcid and Prilosec

Testing for Iron Deficiency

  1. The most commonly ordered test is part of a Complete Blood Count which shows hemoglobin and hematocrit levels. However, these markers are unreliable and miss many people’s iron deficiency.
  2. It is much more useful to run a Serum Ferritin which will measure your iron stores and can reveal low iron levels much earlier than a CBC. We like levels above 90.

Taking an Iron Supplement

  1. There are different forms of supplemental iron, some of which are more easily absorbed. The commonly recommended form ferrous sulfate often cases gastrointestinal issues.  Amino-acid chelates are usually tolerated better such as iron bis-glycinate.
  2. Iron is best absorbed on an empty stomach. But if you experience stomach cramps, nausea or diarrhea, you can take with a small amount of food.
  3. If you need to take your iron with food, avoid taking it with the list above under Ways to Decrease Iron Absorption.
  4. For medications and supplements, wait at least 1 hour before and 2 hours after calcium, antacids, tetracycline, penicillin, ciprofloxacin, and drugs used for Parkinson disease and seizures. Check any other medication you are taking for iron contraindications.
  5. Black stools are normal when taking iron tablets.
  6. Liquid iron supplements can stain your teeth. Use a straw.
  7. If your iron is causing constipation, diarrhea, nausea which doesn’t go away by taking with food, contact the clinic and we can recommend another form of iron. There are forms of iron that are easier on the digestive tract.
  8. An iron deficiency may be a sign of other nutritional deficiencies as well. Be sure to take a multivitamin which includes a full spectrum of minerals too.
  9. Don’t give up – it takes time for iron stores to correct. Get tested regularly so you know your therapy is working.  If your ferritin levels are not increasing, make sure you follow up with your provider to investigate the reason.

Keep iron supplements out of the reach of children.

If your child swallows an iron pill, contact a poison control center right away.

Iron Rich Foods (from www.healthcastle.com)

The amount of iron you need depends on your age and iron status.  The recommended daily allowance varies from 0.27 mg/day for an infant to 27 mg/day for a pregnant woman.  An anemic person will need more until their condition is stabilized.

Animal Sources Containing Heme Iron which is more easily absorbed

  • Clams – 23.8 mg per 3 oz
  • Oysters – 7.8 mg per 3 oz
  • Liver per 3 oz
    • Chicken – 8 mg
    • Beef – 5.8 mg
  • Mussels – 5.7 mg per 3 oz
  • Sardines – 2.4 mg per 3 oz
  • Turkey – 1.6 mg per 3 oz
  • Beef per 3 oz
    • Extra lean ground – 2.5 mg
    • Prime rib – 2.1 mg
    • Short rib – 2 mg
    • Rib eye – 1.7 mg
    • Sirloin – 1.6 mg
  • Lamb chop – 2.1 mg per 3 oz
  • Egg – 1.2 mg per 2 large eggs

Plant Sources Containing Non-Heme Iron

  • Pumpkin seeds – 8.6 mg per 1/4 cup
  • Firm Tofu – 8 mg per 3/4 cup
  • Beans per 3/4 cup cooked
    • White beans – 5.8 mg
    • Red kidney beans – 3.9 mg
    • Soybeans: 3.4 mg
  • Lentils – 4.9 mg per 3/4 cup cooked
  • Some whole-grain breakfast cereals (per cup)
    • Total – 18 mg
    • Raisin Bran – 10.8 mg
    • Cheerios – 8.9 mg
    • Special K – 8.7 mg
    • All-Bran – 5.5 mg
  • Baked potato with skin – 2.7 mg
  • Chickpeas – 2.4 mg per 3/4 cup cooked
  • Blackstrap Molasses – 3.6 mg per Tbsp
  • Prune juice – 3.2 mg per cup
  • Dried fruits per 1/2 cup
    • Peaches – 1.6 mg
    • Raisins – 1.4 mg
    • Plums – 1.3 mg
    • Apricots – 1.2 mg
  • Nuts per 1/4 cup:
    • Cashew: 1.7 mg
    • Almonds: 1.4 mg
    • Pistachio: 1.2 mg
    • Walnuts: 0.9 mg
    • Pecan: 0.7 mg