What is iron deficiency?

Iron is a mineral found in every cell of the body. It is vital for good health and for our mental and physical wellbeing. Lack of iron is the most common single nutrient deficiency worldwide, with women and preschool children being at particular risk. However, correcting an iron deficiency is usually straightforward.

Why do I need iron?

Iron is one of 20 minerals found in food. It is stored in your liver, spleen and bone marrow. If your body lacks iron, it cannot make enough haemoglobin, which is the substance in your red blood cells that carries oxygen to the body and brain.

Iron boosts your immune system, helps fight infections, and is vital for normal child growth and intellectual development. If you do not have enough, you may lack energy and get sick often. Iron is needed for optimum brain function in adults and children.

Who is at risk?

You may develop iron deficiency if you do not eat iron-rich foods for a long period of time. People need more iron at certain times, such as in adolescence, pregnancy or when exercising a lot. Iron deficiency can be due to lengthy illness or losing blood from heavy periods or stomach ulcers – bleeding from some cancers is a rare but important cause.

Your doctor can check you have no serious cause for deficiency. Drugs (eg, aspirin and some anti-inflammatories) can also cause bleeding in the gut.

Girls and women

Women need more iron because of blood loss during their periods. They also need more than double the usual intake of iron during pregnancy. Women (or men) who follow restrictive or fad diets can become iron deficient.

Infants and young children

Iron deficiency is extremely common in preschool children in New Zealand, with up to a quarter of those under three years of age suffering from iron-deficiency anaemia. This can have a permanent impact on brain development, making such children less able to learn.

Iron-deficient youngsters may also not gain enough weight, have problems with feeding and digestion, get tired easily and be more prone to infections and illness. Children between six and 24 months are at greatest risk.

Teenagers and athletes

Teenagers need extra nutrients to fuel growth spurts, but they are also more likely to have a poor diet. Iron is lost through excessive sweating and some athletes (particularly those for whom weight is an issue) may have unbalanced diets.

Vegetarians and vegans

Iron in plant foods is not as easily absorbed as that in meat, so vegetarians and vegans may get too little iron. You should tell your doctor if you have a non-meat diet so he or she can test you for iron deficiency and, if necessary, refer you to a dietitian for advice.

Recommended daily dietary intake of iron

 

infants 7–12 months 9mg
children 1–11 years 6–8mg
teenagers 12–18 years 10–13mg
women 19–54 years 12–16mg
54+ years 5–7mg
men 19+ years 7mg

 

What are the symptoms?

There may be no symptoms, or you may lack energy or your skin and the inside of your mouth may be pale. If you go on to develop iron-deficiency anaemia, you’ll feel even more tired because not enough oxygen is getting to your cells.

You may be unable to do very physical tasks, be unable to concentrate and find learning difficult, have headaches, be irritable or be more prone to infections. Older people may get heart pain or angina, as the heart has to work harder to supply enough oxygen to the body.

How is it diagnosed?

You may have some of the symptoms already mentioned, or you may only find out if you have a routine blood test that reveals low iron levels or anaemia. More tests may be needed to check for any medical condition causing your iron deficiency.

If there are causes for your iron deficiency other than inadequate intake of iron then these causes need to be treated. However, iron deficiency can most often be corrected by iron supplements and/or changes to your diet. Your blood count may have to be checked regularly to make sure the problem has not returned.

Where do I get iron from?

Iron-rich foods in your diet

  • Meat and fish: beef, lamb (especially kidneys and liver), veal, pork, poultry, mussels, oysters, sardines and tuna
  • Fruits: dried fruits such as prunes, figs, raisins, currants, peaches and prune and blackberry juice
  • Vegetables: greens (spinach, silverbeet, lettuce), beans and peas, pumpkin and sweet potatoes
  • Grains: oatmeal, iron-fortified breakfast cereals and wholegrain breads.

The iron in meat, fish and chicken is called haem iron and is more abundant and more easily absorbed than the iron in vegetables, which is called non-haem iron. It is best to get iron from a variety of sources – protein in meat also helps your gut absorb non-haem iron.

Iron contained in 100g of different foods

 

haem iron
lamb kidneys 12mg
lean beef steak 4.3mg
chicken breast 1.9mg
non-haem iron
tofu 5.4mg
baked beans 1.9mg
spinach 1.3mg

 

Your body absorbs only a small amount of iron at any one time, so it is important to eat a lot of iron-rich foods every day. To get the most out of those foods remember:

  • eating foods rich in vitamin C (citrus fruits, leafy green vegetables) will help iron absorption
  • drinking milk around meal times or when taking iron tablets can interfere with iron absorption
  • drinking tea with meals also hinders iron uptake.

Iron supplements

Iron supplements are usually tablets, but if you need a lot of additional iron your doctor may give you an injection. Iron tablets turn your bowel motions black and can cause indigestion, constipation, diarrhoea or nausea. If so, your doctor may change them. Vitamin C also helps you absorb the iron in iron tablets.

A small number of people are at risk of storing too much iron, so iron supplementation should be reviewed periodically by your doctor.

Infants and young children

Breast milk contains enough iron for babies until six months of age. Meat, where possible, or iron-fortified cereals should be introduced by six to eight months. Bottle-fed or weaned babies should have iron-fortified formula until 12 months of age.

Cow’s milk should not be given in the first year of life: it is not a good source of iron and can cause stomach upsets with some bleeding in the gut and further iron loss. Tea should not be given to preschoolers as it prevents iron absorption.

Make sure your child’s diet is well balanced and contains a wide variety of the iron-rich foods mentioned above. Refer to Plunket guidelines on when to introduce different foods. A liquid iron supplement may be necessary if your child has iron deficiency.

What happens if it is not treated?

You can feel more and more unwell, particularly if an underlying cause of iron deficiency, such as stomach bleeding, is not treated. If infants go untreated it can result in developmental and learning difficulties.

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