Tired of being tired – should you check your iron levels?
Fatigue is an unavoidable part of life and one of the main issues raised during doctors’ visits. Feeling run-down could be the result of normal life stressors, a recent illness or even a period of grief. However, if the tiredness persists after some rest and recuperation, it might be cause for concern.
In this article I look at the role that iron plays in maintaining healthy energy levels and general well-being, especially in women.
What is iron deficiency anemia?
Anemia occurs when your body does not have enough healthy red blood cells to transport oxygen through your body. This means that you have low levels of ferritin (iron) or hemoglobin, the protein which gives red blood cells its colour and carries oxygen from the lungs to the organs where it is needed.
Low levels of oxygen can cause fatigue, shortness of breath, restless legs and muscle weakness.
While anemia could have many origins, it is most often caused by iron deficiency.
How much iron is enough?
According to Dr Annadie Krygsman, physiologist at Stellenbosch University, iron deficiency frequently goes undiagnosed. “Unfortunately, clinicians tend to assess patients only with the complete blood count, which does not accurately reflect iron stores and the absence or presence of iron deficiency anemia. Iron status can be promptly and accurately measured by testing serum ferritin and transferrin saturation (TS), which indicate the body’s iron stores and iron availability respectively. Ferritin of <30 ng/mL and TS of <20% are indicative of iron deficiency. Failure to order these tests is an educational gap that must be addressed for iron deficiency anemia to be diagnosed and treated effectively,” she explains.
What causes iron deficiency?
The main cause of iron-deficient anemia is loss of blood, typically due to abnormal uterine bleeding. People can also lose blood through injury, surgery, or internal (mostly gastrointestinal) bleeding. Frequent blood donation or blood tests are also contributing factors.
In the developing world, a diet that does not provide enough iron can contribute to anemia, but several medical conditions could also prevent the effective absorption of this mineral despite eating the right foods, such as celiac disease or gastritis.
How do I know if I am iron deficient?
The most common symptoms related to low iron levels include the following:
Fatigue
Restless legs
Hair loss
Reduced cognitive abilities
Muscle weakness
Shortness of breath
Pale skin colour
Headache
Chest pain
Dizziness
Another symptom that can be linked to iron deficiency, but is often missed, is depression.
“Anemia may cause a higher risk of depression, likely due to low oxygen levels and a resultant lack of physical activity. Iron, specifically ferritin, also plays an important role in how the body makes the neurotransmitters serotonin, dopamine and norepinephrine, all of which determine a person’s mental health status.”
This depression is of physiological, not psychological, origin.
Let your physician know you are experiencing one or more of these symptoms.
How is iron deficiency anemia treated?
The good news is that iron-deficient anemia can be treated effectively.
“After performing the necessary blood tests, your doctor will determine which type of treatment is appropriate,” Krygsman explains. “In severe cases, or where the patient has abnormal iron absorption or severe intestinal reactions to oral iron supplement, intravenous iron therapy might be required. First line management of mild to moderate iron deficiency anemia remains oral supplementation of 40-80 mg elemental iron per day.”
Sources:
https://www.mayoclinic.org/diseases-conditions/anemia/symptoms-causes
https://www.medicalnewstoday.com/articles/anemia-and-depression#mental-health
Moisifis-Tesch C.M. and Shulman L.P. (2022) Iron deficiency in women’s health: New insights into diagnosis and treatment. Adv. Ther. 39:2438-2451.
https://www.michiganmedicine.org/health-lab/could-low-iron-make-mental-health-symptoms-worse
Hidese S., Saito K., Asano S. and Kunugi H. (2018) Association between iron-deficiency anemia and depression: A web-based Japanese investigation. Psychiatry Clin Neurosci. 72(7):513-521.