Important Things to Know About Iron Deficiency

By Dr. Linda J. Dobberstein, DC, Board Certified in Clinical Nutrition

September 26, 2022

Important Things to Know About Iron Deficiency
Iron deficiency is the most common mineral deficiency in the world, affecting up to 2 billion people. Children, premenopausal women, the elderly, individuals who consume a plant-based diet and populations of low and middle-income countries are more likely to experience insufficient iron intake.

An estimated 15-35% of female athletes and 5-11% male athletes are iron deficient. Up to 50 percent of pregnant women around the globe experience anemia due to inadequate intake of iron, vitamin B12, and/or folate. Are you someone who has depleted iron stores? A lack of iron may affect you more than you realize!

Iron is Essential for Function

Iron is an essential mineral that is required for oxygen delivery to cells. It is stored in red blood cells, bone marrow, spleen, liver, and muscles. About 70 percent of iron is found within the hemoglobin of red blood cells.

Iron is critical for your survival and optimal function. Sufficient iron stores is a requirement for mitochondrial function, enzyme and cell signaling activities, transport and building proteins, organ function, immune system function, neurotransmitter activation, and tissue repair that affects your entire body. Adequate iron stores are especially important for cardiac and kidney function changes that occur with age and decline.

Insufficient iron stores, or iron deficiency, stresses normal physiology and makes it harder to manage existing health concerns. Iron deficiency contributes to a decline in your health and decline in physical and mental stamina. It affects your capacity to exercise, mentally focus, concentrate, and contributes to irritability, a depressed mood, anxious feelings, memory changes, and much more.

Brain Function for All Ages

Starting during pregnancy, optimal iron levels are essential for brain and nerve health. Severe iron deficiency during pregnancy can lead to neurological deficits that may chronically affect the child. Infants and young children need iron, otherwise their growth and development suffers. Iron adequacy affects learning and cognitive skills, socio-emotional skills, coordination, balance, and movement.

Iron is necessary for dopamine production, which helps concentration and focus. Iron status for all ages also greatly affects the function of other neurotransmitters such as serotonin, glutamate, GABA, and epinephrine, their receptors and gene signals. Iron is also essential for the function of the hippocampus, the memory center of the brain.

Iron is required to produce the myelin sheath, the fatty insulation layer around nerves. This affects the speed at which nerve signals travel to and from the brain. Iron is also needed for hearing and reaction times related to sight and sound.

Jumpy Legs, Nerve Irritability

A lack of iron contributes to restless legs or making your legs feel jumpy as you drift off to sleep. Low iron is linked with six-and-a-half-time increased risk of fibromyalgia, which is related with changes in pain processing mechanisms in the brain and in small nerve fibers.

Bones and Posture

Iron aids in the activation of vitamin D and collagen production. It is needed to strengthen and support bone formation. Adequate iron levels support your posture.

Adrenals and Thyroid

Iron is required for the adrenal glands to secrete cortisol. Without adequate iron, you may experience ongoing fatigue levels, limited exercise tolerance, feel winded more easily, and feel cold.

Iron is also needed by your thyroid gland for normal function. Iron deficiency increases the risk of autoimmune thyroid concerns. If you have symptoms of thyroid and/or adrenal dysfunction, but are not responding to care, check your iron status and serum ferritin levels.

Obesity, Inflammation, and Other Health Concerns That Contribute to Iron Deficiency

Several issues contribute to iron deficiency because of poor absorption and interference with its metabolism. Menstrual blood loss, GI bleeding, Celiac disease, intestinal infections, GI cancers, hernias, bariatric surgery, diverticulosis, gastritis, fatty liver, chronic hepatitis, H pylori infection, bowel obstructions, TPN therapy, and inflammatory bowel disease can lead to iron deficiency.

Being overweight or obese is linked with higher prevalence of iron deficiency. Iron absorption is decreased by 30% or more because of hormonal and biochemical changes related to adipose tissue inflammation.

Elevated C-reactive protein and IL-6, which are markers of inflammation, are linked with diminished iron absorption in the digestive tract.

Medications that Lead to Iron Deficiency

Medications that interfere with iron absorption include acid-blocking PPI medications such as Prilosec, Prevacid, Protonix, Nexium, etc. and antacids that contain calcium carbonate (TUMS), magnesium hydroxide, and aluminum hydroxide. NSAIDs and salicylates/aspirin used for pain management and blood thinning, certain antibiotics (aminoglycosides), cholesterol lower medications (bile acid sequestrants), and ulcer medications (histamine H2 antagonists) interfere with iron absorption. Check with your provider or pharmacist for more information.

Nutrients May Affect Iron Absorption

Chronic high dose intake of some nutrients may also interfere with iron absorption or affect its metabolism. These include calcium, fiber, green tea and other tannin rich supplements or teas, manganese, milk thistle, phosphorus, soy protein, high-dose turmeric, and zinc. The greatest interference occurs when these nutrients are taken in high doses at the same time as dietary or supplemental iron. Supplemental iron with low bioavailability like ferrous sulfate is at greatest risk for this nutrient-nutrient competition.

Iron and Red Blood Cell Production

Every day about 200 billion red blood cells are produced in your body. This process known as erythropoiesis, requires about 20 mg of iron obtained through your diet and iron stores in your body.

Iron Deficiency - First Stages of Depletion

Iron deficiency refers to depletion of iron stores within your body. This is the first stage of iron depletion.

Serum ferritin measures iron stores. Low iron stores are the only reason for a low serum ferritin.

Iron deficiency slows down erythropoiesis, i.e. the production of red blood cells. Over time, it causes iron deficiency anemia, with lower red blood cell counts and hemoglobin levels. Iron deficiency anemia is a deeper stage of iron depletion. Iron deficiency and iron deficiency anemia should always be investigated as to why it has occurred.

Serum Ferritin

Ferritin levels, or other ferritin-related markers are considered superior and more accurate than a hemoglobin or red blood cell count to evaluate iron deficiency as defined by Lancet, the American Journal of Clinical Nutrition, and other notable medical journals.

After extensive review of global literature, the American Journal of Clinical Nutrition recommended a minimum serum ferritin level of 100 μg/L to maintain optimal iron status in most situations. Ferritin levels below 12 μg/L indicate absent iron stores or functional iron deficiency.

Individuals with heart, kidney, inflammatory diseases, or other significant health concerns may need more iron intake pending their provider’s recommendations. Get your serum ferritin measured with your annual physical or more often if you have a history of iron deficiency, etc.

Elevated Ferritin

Iron excess or increased ferritin levels are also a cause for concern. High ferritin levels may occur because of acute illness, overactive thyroid, chronic alcoholism, poorly controlled diabetes, and other medical concerns. Chronic inflammation affects iron transport and metabolism which also makes it harder to absorb dietary iron. Some individuals have a hereditary condition that causes them to retain iron. Your health care professional will need to investigate further.

RDA for Iron

The Recommended Dietary Allowance (RDA) for iron is:

Birth to 6 months: 0.27 mg (breastfed only)
7-12 months: 11 mg
1-3 years: 7 mg
4-8 years: 10 mg
9-13 years: 8 mg
14-18 years: 11-15 mg
19-50 years: 8-18 mg
51 + years: 8 mg

Women who are breast feeding and have menstrual cycles need more iron. Individuals on a plant-based diet also need nearly twice the amount of dietary iron as non-heme iron is more difficult to absorb than animal or heme-iron rich foods. If you are iron deficient or have iron deficiency anemia, you need more than the RDA recommendations.


The best sources of heme-iron include animal and seafood proteins like beef liver and oysters. Other red meats, poultry, seafood, eggs, beans and legumes, spinach, tomatoes, potatoes, nuts, grains, and dark chocolate provide 1-3 mg of iron per serving.

Iron Quality Makes a Difference

Ferrous sulfate is commonly added to foods, and is widely available over the counter. This iron form is associated with poor absorption, stomach upset, and constipation. Other forms of iron like iron bisglycinate have superior absorption, without stomach upset. A randomized, controlled study in pregnant women demonstrated that 25 mg of iron bisglycinate was better absorbed and tolerated than 50 mg of ferrous sulfate.

We offer this gentle form of iron in our products: Blood Booster, Daily Prenatal Multiple Vitamin, and the children’s multiple vitamin Super Mini Multi.

Insufficient iron intake and low iron stores are common concerns for all ages. If you are feeling run down, cold, slow, forgetful, depressed or anxious, and your thyroid feels like it’s not working, get your serum ferritin levels measured. If your provider measures only the RBC and hemoglobin for your iron status, then the early stage of iron deficiency is completely missed. Serum ferritin is the best and most efficient way to check your iron status. Do you know your status?

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