Low Iron Stores are Still a Symptom

Low iron stores are the most common nutrient deficiency I treat in clinic. It’s particularly prevelant in women of reproductive age, and children. I’ll discuss children in a future post and while there will be some crossover, for the women the potential causes include:

1. Low dietary intake such as in pescatarians, vegetarian and vegans;
2. Poor nutrient uptake and absorption, which can have a microbial origin;
3. Hormonal imbalances which cause heavy monthly blood loss, such as:
   a. Estrogen dominance, best diagnosed via salivary or urine testing.
   b. Fibroids or polyps, which should be investigated via pelvic ultrasound.
   c. Endometriosis, where the gold standard for diagnosis is via laparoscopy (keyhole surgery).
4. Genetic conditions such as coeliac disease;
5. Genetic SNPs including the G277S allele.

Low iron stores are also extremely common in pregnancy, where a degree of physiological anemia is essential however iron deficiency and iron deficiency anaemia (IDA) must be avoided.

Low iron stores are a symptom and as always, must be treated via the root cause rather than a band-aid solution. I do believe iron supplementation can be extremely useful, however it should be treated as a short term intervention while further investigation takes place.

Let’s take a closer look at supplementation, including dosage, nutrient combinations and interactions.

If you do take an iron supplement, whether that be during pregnancy or while you address the root cause of your deficiency, please consider:

1. An alternate day dosage regimen, which has been shown to increase absorption by 34%. This is largely due to lowered hepcidin production – hepcidin is a key regulator of the entry of iron into the circulation and when levels are high, serum iron levels falls due to iron trapping. More here;
2. Avoiding doses higher than 40mg, which have been shown to negatively impact the microbiome including via inflammation and/or the potential to feed harmful pathogens. Yes, this means that Maltofer and Ferrograd are out.
3. Nutrient combinations to improve tolerability and decrease toxicity, such as supplements which include:
   a. Lactoferrin – an iron binding glycoprotein that improves the hemoglobin response to supplementation by transporting iron to the natural site of absorption in the small intestine and lowering inflammatory markers including IL-6.
   b. Vitamin A – ideal for those who have reached iron deficiency anaemia (IDA) and not responded to previous interventions. Vitamin A testing should take place first.
   c. Prebiotics – a prebiotic such as galacto-oligosaccharide (GOS) helps to minimise the negative impacts of iron supplementation on the microbiome.

In addition:

• Avoid consuming your supplement with caffeine or dairy as these can impair absorption.
• Avoid taking supplements containing zinc within the hour, as zinc and iron interact competitively during intestinal absorption. Note: this may include your prenatal.
• Consume alongside vitamin C rich foods and/or natural sources including Kakudu plum or camu camu to aid absorption.

In part 2 I will discuss testing. Many of you have long standing iron issues that stem from your menstrual cycle, which has never been addressed as part of, or the root cause.

Learn more in Understanding Low Iron here. 

References

Stoffel NU, Cercamondi CI, Brittenham G, et al. Iron absorption from oral iron supplements given on consecutive versus alternate days and as single morning doses versus twice-daily split dosing in iron-depleted women: two open-label, randomised controlled trials. Lancet Haematol. 2017;4(11):e524-e533. doi:10.1016/S2352-3026(17)30182-5