The most common nutrient deficiency worldwide!

Can you guess it? IRON! 

Iron is important right from day one in-utero, in infants, and throughout our lives. Iron is used to create hemoglobin in our blood which brings oxygen everywhere it needs to go - so it can impact all of the systems in our body.  It’s important for everyone, but in pregnancy and menstruating years, deficiency is even more common. With menstruation - we’re losing blood each month, and as such, losing iron.  Pregnancy also takes a LOT out of the body in terms of iron reserves as the blood volume increases dramatically and babies needs are high.  The vast majority of my menstruating patients, and especially those who have had pregnancies, are iron deficient.  

How does it make me feel?

Iron deficiency doesn’t just cause fatigue and shortness of breath, it can also cause headaches, weakness, restless legs, palpitations, and is associated with significantly higher incidence of anxiety disorders, depression, and insomnia.  Observational studies show that people who are iron deficient postpartum were 1.66 x more likely to experience symptoms of postpartum depression than those who were iron-replete.  Low iron also makes it harder to clot, which can cause more blood loss during menstruation and perpetuate this cycle! We need to be screening this!

But my doctor told me my iron was good…

While your hemoglobin might tell us something about your iron, your ferritin is the more important number to watch.  A ferritin <35 would be considered iron deficient even if you’re not yet anemic (so even if your hemoglobin is good).  For someone with an inflammatory condition (which can include PCOS, endometriosis, or Hashimotos’), or if you had bloodwork while fighting a cold, the ferritin is NOT the best marker as inflammation/infection will cause it to rise and look normal where it may not actually be normal.  In that case an iron panel, specifically transferrin saturation is most important.  I’ve seen many people with a ferritin of 15 that were never told it’s a problem, so always get a copy of your own bloodwork and look for yourself!  Even if the ferritin is a little bit higher than 35, if you’re experiencing heavier menstrual bleeding (losing >80mL in a cycle), you may still be at risk of iron deficiency.

So can I just eat more iron-rich foods?

Not if you’re actually deficient, no.  If you’re trying to prevent deficiency - absolutely, but if you’re deficient you generally need close to 100mg elemental iron daily or every other day to get it up.  To compare that to dietary sources, ½ cup of cooked spinach has 3.2mg of iron.  

Can I just take iron?

Too much iron can cause harm, so don’t just take it without testing! We also want to make sure that the supplement is working for you.  It’s VERY important to re-test after a few months of supplementation to ensure that it’s working, and to keep an eye on the ferritin at least annually if you’re menstruating.  

If you’re feeling tired, anxious and depressed - get that iron tested! It may not be the ONLY reason for those symptoms but if it’s low, treating it will definitely help!