The Natural Approach to Iron Deficiency

Low iron deficiency symptoms & remedies: What you need to know

Iron is our life force. It’s a major part of our blood, one of the four vital substances in Traditional Chinese Medicine. It’s what makes our muscles so red. Our babies are born with a coat of iron rich blood. Each iron atom is dark grey, almost black, the purest form of our feminine Yin, and it arrives with each bleeding cycle as a reminder that we’re regularly letting go of it, so we need to replenish it. However, iron deficiency is so common in women.

I’m a women's hormone naturopath and iron deficiency is prevalent in the women I see in my clinic. In this article, I’d love to share with you all that I’ve learned through my research, my experience as a naturopath but also my studies in Chinese Herbal Medicine on:

• The role of iron, particularly for women

• Why iron is such a key element in our diet in order to be strong and healthy throughout all of life phases

• What are the symptoms of iron deficiency?

• What studies say about iron supplementation?

• The best way to take iron

• How to maximize iron intake through the diet

• What Traditional Chinese Medicine says about iron and blood conditions

So let’s dive in!

Just how prevalent is iron deficiency?

Well put it this way, if you got together with a couple of friends the likelihood (going by current statistics) is that one of you is deficient in iron. I’ve just completed an audit on my clinic cases over the past couple of years, and at least 40% of my clients either had multiple symptoms of iron deficiency or were iron deficient on a blood test. Which is in line with estimates of global iron deficiency being over 30% of the population and particularly affecting women and children, my main clientele.

Well put it this way, if you got together with a couple of friends the likelihood (going by current statistics) is that one of you is deficient in iron.

The Scientific American published an article in 2021 called ‘The Global Iron-Deficiency Crisis’ where they shared lots of interesting aspects of iron-deficiency including the many health consequences of iron-deficiency for pregnant women and their babies.

Globally, iron deficiency affects around 2.4 billion people and if it becomes ‘iron-deficiency anaemia’ it affects 1.2 billion people. With a world population of 8 billion, you can see that’s over 25% of us. I’d say the real figures are a lot higher because it doesn’t include the people who don’t know they’re iron-deficient or haven’t had a blood test to prove it. 

Iron is life: why iron is essential for health & deficiency symptoms

We obtain various micronutrients crucial for maintaining a healthy hormone balance from the foods we consume, and one of these vital elements is iron. Iron plays a central role in the formation of haemoglobin proteins, which transport oxygen throughout our bodies via the bloodstream. This is why we experience fatigue, the most common symptom of iron-deficiency, when iron levels are insufficient.

Each haemoglobin molecule is composed of four iron atoms. Oxygen gets taken up in these molecules and that’s how it’s distributed to the rest of your body. Every cell in our body relies on oxygen to effectively metabolise glucose for energy and life force, and this oxygen is housed within the iron atoms found in each haemoglobin molecule.

Low iron levels will directly affect your oxygen status, limiting your energy and life-force. And it’s not just a matter of declining oxygen and energy supply to our muscles, it can also mean a compromised immune system, heightened nervous tension, feelings of dizziness, breathlessness, and potentially a lowered mood.

The main symptoms of iron deficiency typically reveal cardiovascular stress or impact and include:

• Fatigue

• Lethargy

• Poor concentration

• Dizziness or weakness

• Headaches

• Shortness of breath

• Cold hands and feet

• Pale skin

• Increased risk of infections

• Other symptoms that may be present include restless leg syndrome, dry mouth, hair loss and heart palpitations.

How much iron do we actually need:

• Age Group Recommended dietary intake (RDI)
  - 1 – 3 yrs: 9mg/daily
  - 4 – 8 yrs: 10mg/daily
  - 9-13 yrs: 8mg/daily
• Females
  - 14 - 18yrs: 15mg/daily
  - 19 – 50yrs: 18mg/daily
  - Pregnant: 27mg/daily
  - Lactating: 9mg/daily
  - 50yrs: + 8mg/daily
• Males
  - 14 - 18yrs: 11mg/daily
  - 19yrs+: 8mg/daily

For women, iron deficiency can lead to iron-deficiency anaemia, a more complex level of impact involving multiple systems and tissues in your body. At this stage, fertility and hormonal health can be compromised, leading to disrupted menstrual cycles, light or absent periods, and if pregnancy occurs it can increase the risk of preterm birth or low birth weight. There might also be increased risk of pre-eclampsia or bleeding in the mother during pregnancy.

It's thought that around 1/5 maternal deaths are caused by iron shortages.

It's thought that around 1/5 maternal deaths are caused by iron shortages. I like to make sure my fertility clients, especially if they’re vegan or vegetarian, have their iron needs met prior to conceiving. 

Best ways to supplement iron:

If you are deficient in iron there are (so) many ways you can replenish iron. You will likely need to use supplementation though, as you may not get enough through food alone in a deficiency state.

1. Nutritional iron: There are three ways you get iron into your cells. The first is what you take in through the diet. Consume the recommended amount of iron in your diet daily. This will be ongoing and long term.
2. Supplemented iron: Take an iron supplement (tablet, liquid, capsule, iron-rich herbal extract). Take 2-3 months to restore levels.
3. Intravenous iron (via a vein) for a quick fix: Iron is delivered into a vein here and usually can restore haemoglobin levels within a couple of weeks.

Choosing what form of iron is right for you depends on your age, sex, deficiency level, and other factors like gut health. Your preferred practitioner (GP, naturopath, nutritionist) can prescribe a range of oral iron supplements to suit your needs.

Most iron supplements come in a salt form like ferrous fumarate which might be cheap, but isn’t absorbed as well and can cause nausea, diarrhoea or black stools. Iron chelate is a better choice that’s more absorbable and less likely to irritate, or iron bisglycinate. I also give iron rich herbs and foods to support any supplements.

After ingestion, iron is absorbed in the intestines, but not in totality. You might for example eat your 5-20mg iron daily (or take it in a supplement), but only 1-2mg will ultimately be absorbed into the intestine according to a 2022 study on Iron-Deficiency Anaemia.

Also, poor gut assimilation of nutrients may mean that you won’t be able to absorb oral supplements well, or you might be trying for a baby and need to get your iron levels up swiftly to avoid pregnancy complications. Intravenous iron may be preferred here. Research says you’ll be able to quickly correct iron status with intravenous iron, and it bypasses the gut too, but you’ll still need to look at your diet and lifestyle to maintain levels. The IV won’t fix the root cause, it’s more of a top up.

Note, there are side effects associated with IV iron such as headache, muscle pain and shortness of breath. Well (Kumar et al 2022).

Another way we get iron is from ‘iron recycling’, a process that our bodies perform internally by releasing the iron stored in red blood cells that are wrapping up their 120 day lifespan.

How to get the most out of an iron supplement

• Take your iron supplement with your largest meal of the day before eating.

• You’ll get the most absorption if you take it on an empty stomach providing it doesn’t upset your stomach. I give my clients an extra gentle iron supplement and we rarely have issues like this. So you have options if your current supplement isn’t going down well.
• Take a high quality vitamin C powder or supplement. This can help with iron absorption.
• Avoid taking any of these at the same time as your iron supplement: milk, antacids, raw vegetables, chocolate, coffee. They interfere with iron absorption.

Nourishing your blood is the pathway to better iron

• Legumes: Aduki bean, Black Soybean, Kidney bean
• Date, Chinese Red Date
• Spinach, Kale, Kelp and Leafy Greens, Watercress, Seaweed, Silverbeet, Red Chilli, Green Chilli, Sundried Tomato
• Meat: Bone Marrow, Liver, Beef, Chicken Liver (very high in iron), Red meat
• Chicken egg
• Red Miso
• Red wine, Cocoa power
• Fruits: Cherry, Longan berry, Figs, Dark Grapes
• Herbal teas: Nettle leaf, Dandelion leaf, tea
• Culinary herbs for cooking: Parsley, Coriander leaf, Basil leaf

Herbal teas can be consumed, added to smoothies or even incorporated into meals. However it’s important to consult a healthcare professional before adding herbal supplements into your routine, especially if you have underlying health conditions or are taking other medications. A naturopath or herbalist like myself can guide you to what is safe and efficacious.

In conclusion