Iron deficiency – a worldwide problem

Iron - all you need to knowMeat, vegetables and wholemeal products. At least one of these food groups end on your plate daily and provide you with enough iron – or perhaps not! Chances are high that you, nevertheless, suffer from a deficiency and that, due to this, you are less effective and even shed hair. Iron deficiency is the most common deficiency disease, affecting almost 600 million people worldwide! Children between 0 and 5 years, women of childbearing age and pregnant women are at increased risk to suffer from iron deficiency.  Iron deficiency can cause chronic kidney diseases, heart defects, cancer and inflammatory bowel diseases. You don’t have to give special consideration to the myth that vegans and vegetarians suffer from iron deficiency. Also one or other meat lover may suffer from a lack. Whether you should eat more iron-rich products or should better take supplements, depends on the severity oft he deficiency. However, you can detect an iron deficiency by a simple blood test!

Below, we highlight some functions of iron and why your body depends on this so-called essential trace element. Iron plays a primary role for the transport of oxygen and for muscle growth. We guide you from the absorption from food in your bowel to the symptoms that can be caused by iron deficiency. Intestinal disorders and changed living conditions like e.g. pregnancy, can endanger your optimal iron level. You will learn why iron supplements can be both a curse and a blessing. The right diet with the optimum combination of foods you can optimize your iron levels and say ‚good-bye‘ to deficiency symptoms. Not only meat, but also fruits and vegetables provide your body with the positive qualities of iron. Only with the knowledge you can avoid the negative consequences of iron deficiency and protect your health. In addition, we explain the diagnosis of iron deficiency by means of a blood test and how an iron deficiency correlates with hair loss and overweight. The content is based on the current standard of knowledge.

What is iron?

Iron belongs to the group of essential trace elements. Essential trace elements cannot be made by the body and can only be found in the food we eat. The human body contains approx. 5 grams iron. 25 % of it are storage iron (i.a. ferritin), further 1-3 % are bound to transport proteins (transferrin) and the balance is the so-called functional iron (i.e. haemoglobin)[1].

The role of iron in the body

Every body cell needs iron! Iron helps to transport oxygen and is needed for blood formation. Without iron, less red haemoglobin is produced. Haemoglobin transports the inhaled oxygen from your lungs to the whole body – and thus enables your cells to do their work. Moreover, iron transports carbon dioxide to your lungs and oxygen to your muscle cells[1].

Iron not only plays an active role in oxygen transport, but also supports many other reactions as e.g. energy metabolism. The trace element strengthens skin, hair and nails. This means that lack of iron causes skin problems, hair loss and brittle nails. Apropos strengthening: Iron empowers your immune system! Also for the normal progressing of your pregnancy, iron is mandatory[2–4].

Iron metabolism

Just consider the following scenario: In summer, two groups want to go on a cruise with the MS Transferrin. The ship departs from the harbour called Mucosa (Bowel mucosa). However, due to its statics, the ship cannot carry much load. This is why the travel guides invented something quaint:

  • In order to carry as many passengers as possible and to fill their purses, the passengers may only carry a certain weight. What nonsense! The port access control only grants access to the divalent iron. The divalent iron is a quite slim person and is in compliance with the target weight.
  • The trivalent iron is, however, too heavily built. But it knows how to help itself! By means of a diet rich in vitamin C it manages to reach the weight of the divalent iron and to enter the port.
  • On arrival in Mucosa, chaos dominates. Various people are queueing to make it onto the cruise ship. The inspectors, the so-called ferroportins, decide, when new passengers may enter the ship. In the meantime, some people can establish themselves in the hotel ‚Ferritin‘ (stored iron), to bridge the waiting time.
  • Once the new MS Transferrin (transport protein) is docked at the marine, the ferroportins grant access to the passengers. The journey to the Red Sea begins!

Iron deficiency

Iron deficiency

Worldwide, iron deficiency is the most common deficiency disease. According to the National Consumption Study, 14 % of German men and 58 % of German women do not cover the Recommended Daily Allowance of iron. 

Symptoms can mostly be attributed clearly to iron deficiency. Old people, pregnant women, women in general, vegans, vegetarians and people suffering from gastrointestinal disorders may have a higher risk of suffering from iron deficiency[5, 6].

What is your daily iron requirement?

When you look at the requirement of both sexes according to the DGE (German Association for Nutrition), you can see that women have a higher requirement than men. Whereas men need 10 mg iron per day, women need 15 mg. Menopausal and post-menopausal women need less iron. The Recommended Daily Allowance is then limited to 10 mg iron. Children should take up 8 to 10 mg per day through food. Pregnant women have the highest requirement of 30 mg and breastfeeding women 20 mg per day[7].

The USA issue a similar recommendation. However, they recommend to multiply the Recommended Daily Allowance by factor 1.8[8].

 

Recommended Daily Allowance

 Iron in mg/day

m

w

children (1 to 10 years)

8

10

children (10 to 19 years)

12

15

adults (from 19 years to 50 years)

10

15

adults (51 years +)

10

10

pregnant women

 

30

breastfeeding women

20

Source: Eisen, https://www.dge.de/wissenschaft/referenzwerte/eisen/

Good to know: Due to menstruation, woman have a higher requirement than men. Women lose 25 mg iron per menstruation. For your information: The human body contains two to four grams iron. In compensation, women must take up more iron through food[5].

Iron deficiency – Symptoms

What are symptoms of iron deficiency?

It is iron’s main task to ensure oxygen supply to all body cells. If the cells are not adequately provided with oxygen, they cannot carry out their function due to lack of energy. Likewise, the brain doesn’t function properly which causes concentration problems and tiredness. Further deficiency symptoms are[1, 5]:

  • hair loss, brittle nails, cracks on the side of the mouth
  • feeling of faintness, lack of energy, headaches
  • anemia

Iron deficiency – Causes

There are several causes for iron deficiency. Finding out the reason is crucial for an efficient therapy and should therefore be clarified before the start of therapy.

What causes iron deficiency?

How an iron deficiency was caused can be diagnosed easily: The iron supply doesn’t cover your requirement. An imbalance arises which results in empty iron stores. There may be different reasons for it[9]:

  • blood loss
  • increased requirement
  • reduced uptake

Another possible cause might be undetected inner bleeding as in case of an intestinal tumor.  A stool test discloses hidden blood in stool[9]. If your requirement remains uncovered over a longer period, this causes another form of deficiency: iron deficiency anemia. In this case, the stores in your bone marrow are exhausted[9].

Good to know: Iron deficiency anemia
With almost 80 percent, iron is the chief culprit for iron deficiency anemia,

In case of anemia, not enough blood pigment haemoglobin can be produced. Haemoglobin transports oxygen. Iron is the central element for the production of haemoglobin. Thus, iron deficiency leads to lack of haemoglobin, which is combined with lack of oxygen[10].

Blood loss

Beside the apparent blood loss through heavy menstruation, the term „blood loss“ covers frequent blood donations and dialysis as well as possible inner bleeding. The latter may be caused by a tumor (intestinal tumor) but also by other gastro-intestinal disorders. The last two reasons can only be ruled out by a doctor by means of specific diagnostics[11].

Increased requirement

During pregnancy, growth phase and competitive sports, the body needs more iron. Under these circumstances, your body needs more iron which must be taken up through food[11].

Reduced uptake

When you’re on calorie restriction, on a strictly vegetarian or vegan diet, suffer from anorexia or intestine-parasites, you take up less iron. Chronic inflammatory bowel diseases and celiac disease are just two of many intestinal disorders which can impair iron absorption[11].

In short: The causes of iron deficiency are blood loss, an increased requirement and a reduced absorption of the trace element. The body’s requirement cannot be covered and this leads to an imbalance. For an optimal therapy, the cause must be explored as a first step towards filling up the iron stores. 

Iron deficiency and risk groups

Basically, the iron supply in Germany is good. Nevertheless, iron deficiency is one of the most common deficiencies worldwide. The following risk groups suffer particularly frequently from iron deficiency[9, 13, 14]:

Women, pregnant women and breastfeeding women

·       heavy menstruation

·       growth of unborn child

·       gets lost via the breast milk

·      increased demand during pregnancy and breastfeeding period

Seniors

·       lack of appetite

·       nutrient-poor diet

·       biting irregularities

Newborn babies and children

·       quick development of brain

·       growth

Alcohol abuse

·      alcohol impairs the iron stores

Vegetarians and vegans

·       trivalent iron (in plant foods) has a lower bioavailability

People with intestinal disorders

·       impaired intestinal iron absorption

Competitive athletes

·       increased requirement

·       often diet very poor in iron and very rich in carbohydrates

If you belong to one of the above-mentioned risk groups or have diagnosed a deficiency by means of an iron deficiency test, you should test your ferritin-level regularly to be able to take countermeasures in a timely manner in case of a deficiency. We strongly advise against self-therapy without laboratory examination due to the risk of iron overload.

Iron and pregnancy

Pregnant women have an increased daily iron requirement. Whereas women normally need 15 mg iron per day, pregnant women need twice as much: 30 mg per day.  The reasons are: growth of womb, child and placenta. For a proper functioning of this trio, adequate blood circulation and oxygen supply are important – wherefore more iron is needed.

Why iron is important during pregnancy

During pregnancy, 30 to 40 % more blood must be produced to supply the growing unborn child with enough oxygen and other nutrients and to develop properly. Insufficient iron intake during pregnancy leads to iron deficiency anemia. Studies prove that more than 30 % of European pregnant women suffer from iron deficiency. Anemia increases the risk of disease and death for mother and child during pregnancy. Miscarriages and premature births may occur. Moreover, the child grows slower and this can lead to developmental disturbances. The mother shows increasing signs of fatigue, weakness, paleness, circulatory problems and shortness of breath[15]. Pregnant and breastfeeding women should thus pay special attention to their iron uptake when it comes to nutrition. Children who were strengthened by iron during pregnancy are born with healthy birth rates[13, 16]. Especially in the third trimester of pregnancy, mother and child need high iron amounts. The third trimester is the period between the sixth month of pregnancy an delivery. During this phase, the body produces higher amounts of blood as the unborn child needs more and more nutrients for growth. Thus, the number of pregnant women suffering from iron deficiency increases especially in the third trimester.

Scientific findings

A study conducted in 2015 examined the course of iron deficiency anemia during pregnancy. At the beginning of the study, 5 % of pregnant women had an iron deficiency anemia. During the course of the pregnancy, the number rose. After the first 3 months, already 6.9 %, after 6 months 14.3 % and after delivery even 28.4 % of mothers suffer from iron deficiency anemia[17].

Apart from the increased blood requirement for the unborn child (foetus), further factors lead to a decline of the iron levels of pregnant women. One example are gastrointestinal disorders like nausea, vomitting and diarrhoea. These lead to reduced absorption of iron via the intestine[15]. Pregnant women should give priority to covering their requirement through food, compared to iron supplements. Iron supplements could lead to iron overload and cause unpleasant side-effects. Please keep in mind: The use of iron supplements requires medical supervision! Resort to iron-rich foods – fortify not only yourself, but also your child[13, 16].

Iron during pregnancy and vegetarian/vegan lifestyle

Pregnant women, who are on a strict vegan or vegetarian diet, should pay special attention to foods rich in iron. Animal iron is normally absorbed better than plant iron. In order to avoid a deficiency, regular blood tests should take place. In addition, pregnant women should be aware of appropriate and iron-rich foods. The right combination of different foods improves the iron absorption! For more information, see chapter „Iron deficiency – Therapy“.

In short: During pregnancy, you should check your iron levels regularly. Do not use iron supplements on spec and without prior medical diagnostics. High dosage supplementation can lead to iron deposition in the organs and this can e.g. damage your liver.

Iron deficiency in seniors

Older people often suffer from iron deficiency. This results from chronic diseases which impair absorption of iron by the intestine. Added to that is the fact that lack of appetite often leads to reduced food intake.

Iron deficiency in children

In their growth period, children have an increased iron requirement as the blood volume and the number of cells requiring oxygen increases. This often leads to a negative iron balance.

Iron deficiency in competitive athletes

Both amateur and competitive athletes have a higher iron requirement due to increased sweat production. Especially endurance athletes suffer from iron deficiency. Studies have shown that iron replacement therapy not only replenishes the body’s stores but also increases oxygen supply – which in turn increases performance and overall blood volume[18]. Without enough oxygen, lactate in the muscles raises which leads to rapid power loss and tensioning of muscles. After training, the positive effect of iron persists: for muscle growth and muscle recovery, more minerals and vitamins are needed. Blood is supplying them to the muscles. Without sufficient blood formation, which is controlled by iron, this process is only possible to a limited extent. Further symptoms or consequences are:

Fatigue, physical weakness and shortness of breath – all the things that impede sports performance!

In short: Athletes, especially endurance athletes, need iron. It is vital for maintaining performance and avoiding muscle cramps. Iron is particularly important for muscle growth and muscle recovery.

Iron deficiency only in vegetarians and vegans? The truth about the myth

It is a popular misconception that vegans automatically suffer from iron deficiency. Iron can not only be found in animal foods. Plant foods, such as wholemeal products or dried fruit, also have a high iron content. Some even have a higher content than beef. The problem of pure vegetable diet is the poor bioavailability for the human organism. In addition, cereals, fruit, vegetables and legumes contain compounds that inhibit iron absorption.

Good to know: The bioavailability of a nutrient.
The bioavailability describes how quick and to what extent a nutrient can become effective
[1].

Combine plant iron with...

Did you know that the body absorbs 2 to 3 times more iron if the iron stores are empty? Therefore, vegetarians and vegans are not affected as often by iron deficiency as often believed[5].

Iron deficiency and inflammatory bowel diseases

More than 25% of patients with an inflammatory bowel disease suffer from iron deficiency. One might say that anemia is a possible complication of bowel diseases. This iron deficiency is caused by chronic blood loss due to intestinal bleeding or insufficient absorption of iron via the intestinal mucosa. For treatment of the deficiency, doctors often prescribe iron supplements[5].

Iron deficiency – Therapy

Already with the right diet you can treat iron deficiency. Comply with the following advice to optimize your iron levels long-term.

Some people completely rely on the intake of iron supplements in the form of tablets or capsules to treat their iron deficiency resp. for prevention. Even if this type of iron intake appears as playful, side effects may occur: 20 percent suffer from stomach pain, nausea and constipation after taking iron supplements. Injections may be an alternative. If you suffer from an illness which impairs iron absorption, injections might be a solution for raising your iron blood levels. Same applies in case of severe blood loss. If your  iron deficiency is diet-related, you can whip your iron levels into shape by eating the right foods!

Please keep in mind: Prior to therapy start, the reason for your iron deficiency  should be clarified to choose the appropriate therapy option!

Which foods contain iron?

Iron can mainly be found in animal food, legumes and wholemeal products. Vegetables like chanterelles, spinach and red beet contain iron. Who likes it sweet can resort to dried apricots.

The most iron-rich foods are[5].

  • salted herring
  • amaranth
  • lentils
  • peas
  • soybeans

The following table provides an overview of the foods with the highest iron content:

Food

Iron content in mg per 100 g

Salted herring

20.0

Pork liver

18.0

Amaranth

9.0

Quinoa

8.0

Lentils

8.0

Egg yolk

7.2

Beef liver

6.9

Millet

6.9

Soybean

6.6

Chanterelles

6.5

White beans

6.2

Oat flakes

5.4

Peas

5.0

For those with a sweet tooth: 25 grams dark chocolate enrich your body not only with happy hormones but also provide 3 mg iron[20]!

Which fruits and drinks contain iron?

Iron can also be found in the motley world of fruits. Iron-rich fruits are kaki fruit, coconut and mulberry. Pharmacies and drug stores often offer iron-rich beverages. The contain up to 80 mg iron per 100 ml. One glass seems to be enough to cover your daily requirement. Iron-enriched drinks are that highly dosed in order that your body can take up enough iron. However, please keep the following in mind[20]:

  • Does it contain vitamin C to help iron absorption?
  • Does it contain nutrients that impair iron absorption (please see the list of contents that impair iron absorption)?
  • Does the beverage contain a lot of sugar to suppress the iron taste resp. bloody/rusty taste?

Instead of spending a lot of money for iron-enriched beverages, you can easily create them yourself! If you like to prepare a fruit-smoothie, just add a handful of spinach or kale and a shot of lemon juice. Further cheap alternatives for iron-enriched drinks are tomato and prune juice[20].

How to efficiently replenish your iron stores

If you want to replenish your iron stores, you should, above all, pay attention to the quality of the iron. It is not important, how much iron you supply to your body, but how much it can absorb. Depending on the iron source, the intestine absorbs almost 20 percent of animal iron. For plant foods, the absorption rate is only five percent[5].

The valence of iron describes how easily the small intestine can absorb the trace element. Your body can easier absorb divalent iron, the so-called hem-iron, compared to trivalent, non-hem, iron. This is why hem-iron is considered as high-quality iron. Hem-iron is mainly be found in animal foods. The following foods are brimming with hem-iron[5].

  • Blood sausage
  • Beef liver
  • Liver sausage
  • Beef
  • Pork

If you don’t like meat or if you are on a vegetarian or vegan diet, you can fill your stomach with iron-rich plant foods. Please consider that your small intestine needs an acid for the absorption of plant iron (non-hem iron).

The following plant foods contain abundant iron[5].

  • Oat flakes
  • Wholemeal products
  • Legumes
  • Pistachios
  • Sesame

Why does your body absorb animal iron easier than plant iron?

Animal iron (hem-iron) has a different chemical composition than the plant one (non-hem iron). Via the mucosa of the small intestine, hem-iron gets into the blood. The body has to first transform non-hem iron into hem-iron. During this process, a big part of the iron gets lost, which is why only 5 % are finally absorbed by the boy. In comparison: 20 % of animal iron can be absorbed.

The combination of both – animal and plant iron – in the form of a mixed diet, guarantees absorption of 15%. This is why nutritional scientists state that iron in meat is more valuable than that of vegetables and cereals[5].

Useful information for optimal absorption

Vegetables don’t supply iron? Error! By means of a little chemistry and acid, you as a vegetable lover or passionate porridge-eater can absorb large iron quantities and can counter the prejudice. This scientific trick helps you get the best from plant foods. The magic word is vitamin C! Vitamin C, also called ascorbic acid, is an acid which transforms non-hem iron into hem-iron. By means of this step in iron metabolism, the valence of iron in plant foods can be raised. Drink e.g. a glass of orange juice with your brown bread or your porridge. The vitamin C ensures a better absorption of iron. Thus, the myth that vegans and vegetarians are always suffering from iron deficiency is unreasonable. With an appropriate diet also plant foods supply enough iron.

In order to completely cover your daily iron requirement, we have compiled some inspirations for iron-rich meals. They are particularly suitable for the risk groups:

Meals with high iron content[21]

Breakfast: (with orange juice)

-  Sourdough bread with rosehip jam

-  Oat flakes with cinnamon, apricots, nuts

-  Green Smoothie with kale or spinach and lemon

Main meal:

-  Bean stew with potatoes and peppers

- Liver with peas

-  Curry with red lentils / chickpea curry with or without meat

-  Kale with beef goulash

Side dish:

-  Hummus or houmous

-  Salad with black lentils, carrots, tomatoes, parsley, sunflower seeds

Evening:

-  Millet salad with sheep cheese, vegetables and herbs

-  Salad plate with turkey strips, almond slivers and soy germs

Snack:

-  Pistachios, pumpkin seeds, 1 glass grape juice

Getränke:

-  Orange juice with red beet juice (ratio 1:1)


Why does your body not absorb 100 % of iron?

Apart from physical conditions and the valence of iron, there are other factors that might deteriorate iron absorption like different food components. These anti-nutrients include[1, 5, 22]:

  • Milk products: calcium salts
  • Wholemeal products: lignin and phytates
  • Spinach, red beet, rhubarb and cocoa: oxalic acid
  • Cola: phosphate
  • Tea, coffee: polyphenols

You’re probably wondering why the list includes wholemeal products and spinach though these foods are a good iron source. Next to the high iron content, they also contain substances inhibiting iron absorption. You can counter this contradiction by soaking wholemeal products in water or by washing spinach well and cooking it so that the anti-nourishing factors are removed[1].

Good to know

Even aspirin inhibits iron absorption – due to the ingredient salicylate.

Tips for improving iron absorption

The following tips and information help you to fully support the iron absorption:

  • Do not drink tea, coffee and milk immediately after eating and in moderation.
  • Instead of normal milk, use plant alternatives. These contain less calcium which inhibits iron absorption.
  • Soaking vegetables and legumes in water for several hours removes the inhibiting substances.
  • Boiling vegetables reduces the contents of oxalic acid.
  • Acidified foods such as sourdough bread and sauerkraut contain less anti-nourishing factors.

In short: The right diet will help you treat a slight iron deficiency. Animal foods contain high-quality iron which is absorbed directly through the intestine. Plant iron, however, can only be absorbed in small quantities. You can increase the absorption rate by adding vitamin C. Some foods contain substances that inhibit iron absorption. To inactivate those, you have to use special preparation methods for your food.

5 tips to improve iron absorption

Iron supplements – Dosage

Apart from the natural therapy of iron deficiency through iron-containing foods you can, alternatively, use synthetic iron supplements. Especially vegans and vegetarians often resort to iron supplements. Some use them even if they don’t need them.

Iron therapy

Iron supplementation

The absorption of iron up to replenished stores can be done in three different ways:

  • By iron supplements,
  • by iron-rich foods or
  • by injections or infusions administered by a doctor.

Taking iron supplements

Do not just easily use iron supplements as excessive use can be harm your health. You should always check the actual supply situation before taking iron supplements. This can be done by a doctor or you can do a test conveniently at home by using a so-called diagnostic self-test. If there is a deficiency, you can use iron supplements from suitable suppliers. There is a large selection of iron supplements, ranging from iron powder, capsules, droplets to tablets. Which preparation works best for you, depends on the severity of the deficiency and on the tolerability. Both OTC- and prescription drugs are suitable for replenishing your stores. These contain different iron quantities and forms.

How to choose the right supplement

Foods contain different iron compounds: iron oxide, iron sulphate and ferrous gluconate are only some of them. You are right to wonder which is the best compound.  Particularly recommendable is ferrous bisglycinate. Apart from the good tolerability, it is absorbed well as it is divalent. In contrast to other compounds, as e.g. iron sulphate, ferrous bisglycinate doesn’t bind to other insoluble substances that inhibit absorption. Moreover, bisglycinate has no unwanted side-effects and thus even high quantities are tolerated well. Make sure to take the supplements before eating or between meals so that the food ingredients don’t impair iron absorption[23].

If ferritin-levels are very low (< 15 ng/nl) or intestinal absorption problems inhibit iron absorption, the use of OTC supplements is no longer sufficient for counterbalancing a deficiency. In this case, you should consult your doctor and control your ferritin-levels regularly. In this case, normally, another supplementation form is used.

Good to know: The valence of iron supplements is important when using supplements. Trivalent iron supplements are optimally metabolized when taken with a meal. Divalent iron should best be taken one hour before eating.

Iron supplementation via injections or infusions

In case of a marked lack or bowel function disturbances, iron should be supplemented via injections or infusions. These have to be prescribed and administered by a doctor.

What is the best time of day to take an iron supplement?

Your body can best absorb iron when taken in the morning on an empty stomach. Best, a good half hour before breakfast with a glass of orange juice or fruit juice or another vitamin C-containing beverage. For at least two hours before and after the ingestion, you should not drink tea or coffee. If you cannot tolerate it on an empty stomach, you can take it two hours after eating[21].

How much iron per day do I need and for how long should I take it?

If you want to replenish your stores, you should pay attention to the quality of the iron supplement. It is not important how much iron you take, but how much of it your body can absorb  [5]. Basically, your body can absorb max. 5 mg iron per day – depending on whether it is taken up from food resp. iron tablets. The exact quantity as well as the duration of use depends on the deficiency. Both are determined by means of the measured ferritin level. Please consider that the iron deposits can be built up only slowly. Iron supplements have to be taken for at least 1.5 to 2 months. A short-term intake is not sufficient!

It takes 40 to 50 days to replenish you iron deposits!

The calculation of your ferritin supplementation in case of a deficiency:

If your measured ferritin value is 18 ng/ml (= tight to empty deposits), 82.0 ng/ml iron are missing to reach the target value of 100 ng/ml. For increasing your blood levels, 819.7 mg* iron in the form of iron supplements have to be taken. This can be done as per the following scheme:

1st week: 80 mg daily
2nd week: 100 mg daily
from the 3rd week onwards, for 35 days, 200 mg have to be taken.

Or

Total 819.7 mg iron in the form of infusions or injections, administered by your doctor.

Iron supplements - Side effects?

Anyone, who has ever taken iron supplements, is aware of the side effects: stomach pain and constipation. If you suffer from stomach pain, take the supplements with a meal or before going to bed. Don’t be surprised when your stool gets darker. The colour is caused by the iron and doesn’t have any negative consequences. In case of constipation, soaked dried fruit, linseed and yoghurt in the morning are helpful.

Iron overload

Disturbances in iron metabolism can also mean too much iron is stored in your body due to a genetic defect. This is called haemochromatosis[24].

Good to know:

Normally, your body stores up to six grams iron. In case of a haemochromatosis, it can be up to 80 grams[25]!

This causes symptoms and diseases that affect the whole body[24]:

  • bronze skin colour
  • liver diseases
  • cardiac arrhythmia
  • diabetes
  • impotence

Bloodletting helps to avoid the consequenes. The doctor takes once or twice a week 500 ml blood to empty the iron deposits. This form of therapy must be performed life-long[24].

Iron deficiency - Test

Iron deficiency should not be underestimated. Especially under certain circumstances such as diseases and during pregnancy, you must ensure optimal iron supply. During pregnancy, iron is vital for both mother and unborn baby.

Good to know: Not only iron deficiency provides cause for a ferritin test. Iron overload can also have health consequences!

How to test for iron deficiency

cerascreen Ferritin Blood Test

You can find out about your iron level by a simple blood test. For the cerascreen® Ferritin Blood Test only a few blood drops from your fingertip are needed. Then you simply send the sample to our laboratory which measures the ferritin level. Ferritin is the name of the stored iron in the body and meaningful parameter for your iron supply.

How do doctors diagnose iron deficiency?

When you suspect iron deficiency, the first step is a detailed anamnesis by your doctor about symptoms, their frequency and duration. If your doctor suspects an iron deficiency, he/she will analyse your blood for haemoglobin and haematocrit levels as well as total number of red blood cells. These parameters provide information about a possible anemia. Your doctor will also check your ferritin and transferrin (= iron-transport protein) levels to diagnose an iron deficiency.

The test result

The following table explains the measured values with regard to deficiency, optimal iron supply or even overload. The values are based on the gold standard of current studies.

Ferritin-concentration

evaluation

< 15 ng / ml

Iron deposits are exhausted

15-30 ng / ml

Tight to exhausted iron deposits

31-99 ng / ml

Nearly exhausted iron deposits

100-310 ng / ml

Optimal iron supply

311-799 ng / ml

Iron deposits are nealy overloaded

ab 800 ng / ml

Iron deposits are overloaded


Iron deficiency and hair loss

When the brush fills up

Hair loss can occur in people at different ages – in children during puberty, in women during menopause or in men in their mid-twenties. Everybody can be affected. Particularly well known is hair loss in men. The hairline recedes further and further and the problem becomes bigger and bigger. But also women suffer more and more often from hair loss. This can be caused by hormone fluctuations, but also by mineral deficiency. Hair is thinning and volume decreases. What to do as a man? Cut hair off? Courage to a bald head?


Iron deficiency expresses itself in hair loss. Already in the 1960s, the context between hair loss and micronutrients was mentioned. Iron tops the list of nutrients. Iron is vital for blood formation. Hair needs a lot of blood. If your body’s blood volume is not optimal, first the “irrelevant” organs and parts of the body – your hair – are no longer supplied with blood. This leads to hair loss[2].

Scientific findings

According to a study from 2002, increasing iron levels (ferritin-level = stored iron in the body) from 33 to 89 mg/ml over 6 months reduced hair loss by 39 %. First reductions were already visible at an iron level of 70 mg/ml. It was therefore assumed that hair loss can be reduced when the iron level reaches at least this value[26].

In summary, it can be said that the supply of micronutrients plays an important role for hair growth. According to several studies, especially iron seems to be relevant for hair health. In case of increased hair loss, it thus makes sense to check your iron levels and to balance a possible deficiency. This should reward you with healthy hair and vigorous hair growth.

Iron and overweight

In the 1960s, scientists discovered a correlation between overweight and iron levels. Several studies from 2000 and 2011 show that iron deficiency and overweight often appear jointly[27]. Another study from 2015 also shows that seriously overweight people have lower iron levels than people with normal weight[28]

Summary

  • Iron is a vital trace element which the body cannot make itself. It must be taken in through food.
  • Iron is necessary for production of the red blood pigment haemoglobin. Long-term deficiency causes anemia – iron deficiency anemia.
  • Worldwide, 600 million people are affected by iron deficiency and it is, thus, the most common deficiency disease.
  • Risk groups are: women, pregnant women, breastfeeding women, seniors, babies and children, alcohol addicts, vegetarians, vegans, people suffering from gastrointestinal illnesses and competitive athletes.
  • The central role of iron is the supply of cells with oxygen. In case of a deficiency, too little oxygen reaches the body cells which impairs energy metabolism. Headaches, concentration problems, tiredness, hair loss are only some of the symptoms of iron deficiency.
  • Women have a higher demand than men due to the monthly menstruation. This is why they often suffer from a deficiency.
  • Pregnant and breastfeeding women have a two to three times higher requirement of iron.
  • Both animal and plant foods contain iron. However, the human body can better absorb the iron-structure of animal iron.
  • For a better bioavailability of plant iron, you should take it up together with vitamin C.
  • Iron supplements can be use to replenish empty iron deposits.

Source references

    1. Elmadfa, I.: Ernährungslehre. Verlag Eugen Ulmer Stuttgart (2015)
    2. Park, S.Y., Na, S.Y., Kim, J.H., Cho, S., Lee, J.H.: Iron Plays a Certain Role in Patterned Hair Loss. J. Korean Med. Sci. 28, 934–938 (2013). doi:10.3346/jkms.2013.28.6.934
    3. Wright, J.A., Richards, T., Srai, S.K.S.: The role of iron in the skin and cutaneous wound healing. Pharmacol. 5, (2014). doi:10.3389/fphar.2014.00156
    4. Cherayil, B.J.: Iron and immunity: immunological consequences of iron deficiency and overload. Immunol. Ther. Exp. (Warsz.). 58, 407–415 (2010). doi:10.1007/s00005-010-0095-9
    5. Eisen: Qualität nicht Quantität ist die Frage | Verbraucherzentrale.de, https://www.verbraucherzentrale.de/wissen/lebensmittel/nahrungsergaenzungsmittel/eisen-qualitaet-nicht-quantitaet-ist-die-frage-8026
    6. Dupont, C.: [Prevalence of iron deficiency]. Arch. Pediatr. Organe Off. Soc. Francaise Pediatr. 24, 5S45-45S48 (2017). doi:10.1016/S0929-693X(17)24009-3
    7. Eisen, https://www.dge.de/wissenschaft/referenzwerte/eisen/
    8. Office of Dietary Supplements - Iron, https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
    9. Wie kommt es zum Eisenmangel? - Landesärztekammer Baden-Württemberg, http://www.aerztekammer-bw.de/20buerger/30patientenratgeber/a_f/eisenmangel.html
    10. Was ist eine Eisenmangelanämie und wie kommt sie zustande? | Die Techniker, https://www.tk.de/techniker/service/gesundheit-und-medizin/behandlungen-und-medizin/bluterkrankungen/was-ist-eine-eisenmangelanaemie-und-wie-kommt-sie-zustande-2022006
    11. Eisenmangel und Eisenmangelanämie — Onkopedia, https://www.onkopedia.com/de/onkopedia/guidelines/eisenmangel-und-eisenmangelanaemie/@@view/html/index.html
    12. Kasper, H.: Ernährungsmedizin und Diätetik. Urban & Fischer Verlag/Elsevier GmbH (2014)
    13. Schwangerschaft: Eisen verhindert Mangelgeburten, https://www.aerzteblatt.de/nachrichten/54900/Schwangerschaft-Eisen-verhindert-Mangelgeburten
    14. Eisenaufnahme bei Kleinkindern in Europa teilweise zu gering, https://www.ernaehrungs-umschau.de/news/12-02-2015-eisenaufnahme-bei-kleinkindern-in-europa-teilweise-zu-gering/
    15. Cantor, A.G., Bougatsos, C., Dana, T., Blazina, I., McDonagh, M.: Routine iron supplementation and screening for iron deficiency anemia in pregnancy: a systematic review for the U.S. Preventive Services Task Force. Intern. Med. 162, 566–576 (2015). doi:10.7326/M14-2932
    16. Richtig essen in der Schwangerschaft - BZfE, https://www.bzfe.de/inhalt/pressemeldung-6590.html
    17. Mei, Z., Cogswell, M.E., Looker, A.C., Pfeiffer, C.M., Cusick, S.E., Lacher, D.A., Grummer-Strawn, L.M.: Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. J. Clin. Nutr. 93, 1312–1320 (2011). doi:10.3945/ajcn.110.007195
    18. Burden, R.J., Pollock, N., Whyte, G.P., Richards, T., Moore, B., Busbridge, M., Srai, S.K., Otto, J., Pedlar, C.R.: Effect of Intravenous Iron on Aerobic Capacity and Iron Metabolism in Elite Athletes. Sci. Sports Exerc. 47, 1399–1407 (2015). doi:10.1249/MSS.0000000000000568
    19. Kaitha, S., Bashir, M., Ali, T.: Iron deficiency anemia in inflammatory bowel disease. World J. Gastrointest. Pathophysiol. 6, 62–72 (2015). doi:10.4291/wjgp.v6.i3.62
    20. Der kleine Souci, Fachmann, Kraut. Lebensmitteltabelle für die Praxis. Wissenschaftliche Verlagsgesellschaft mbH Stuttgart, Stuttgart (2004)
    21. Eisen im Blut wichtig für Ihre Leistungsfähigkeit, https://www.uniklinik-freiburg.de/fileadmin/mediapool/09_zentren/izg/pdf/Spende/140908_Eisen-Flyer_6Seiten.pdf
    22. Kein Tee oder Kaffee zu Eisenpräparaten, https://www.aerztezeitung.de/panorama/ernaehrung/article/502349/kein-tee-kaffee-eisenpraeparaten.html
    23. Duque, X., Martinez, H., Vilchis-Gil, J., Mendoza, E., Flores-Hernández, S., Morán, S., Navarro, F., Roque-Evangelista, V., Serrano, A., Mera, R.M.: Effect of supplementation with ferrous sulfate or iron bis-glycinate chelate on ferritin concentration in Mexican schoolchildren: a randomized controlled trial. J. 13, (2014). doi:10.1186/1475-2891-13-71
    24. Pschyrembel Online | Hämochromatose, https://www.pschyrembel.de/H%C3%A4mochromatose/K09AD/doc/
    25. Definition- Universitätsklinikum Ulm, https://web.archive.org/web/20090527193626/http://www.uniklinik-ulm.de/struktur/kliniken/innere-medizin/klinik-fuer-innere-medizin-i/home/klinische-schwerpunkte/ambulanzen/haemochromatose-ambulanz/definition.html
    26. Daniells, S., Hardy, G.: Hair loss in long-term or home parenteral nutrition: are micronutrient deficiencies to blame?: Curr. Clin. Nutr. Metab. Care. 13, 690–697 (2010). doi:10.1097/MCO.0b013e32833ece02
    27. Choma, S.S.R., Alberts, M., Modjadji, S.E.P.: Conflicting effects of BMI and waist circumference on iron status. J. Trace Elem. Med. Biol. Organ Soc. Miner. Trace Elem. GMS. 32, 73–78 (2015). doi:10.1016/j.jtemb.2015.06.003
    28. Nazif, H.K., El-Shaheed, A.A., El - Shamy, K.A.I., Mohsen, M.A., Fadl, N.N., Moustafa, R.S.I.: Study of Serum Hepcidin as a Potential Mediator of the Disrupted Iron Metabolism in Obese Adolescents. J. Health Sci. 9, 172–178 (2015)