How to know if you have an iron deficiency and what to do about it

Iron is an essential nutrient for many of the activities our bodies perform every day, yet more than one-third of adult women of reproductive age in the United States are iron deficient.

Menstrual bleeding and pregnancy are the main causes of deficiency. Symptoms are often nonspecific and vague, such as fatigue, brain fog, dizziness, sleep disturbances, and reduced ability to exercise. If left untreated for a long time, iron deficiency can deplete healthy red blood cells in the body, causing anemia. During pregnancy, iron deficiency and anemia can have adverse effects on mother and fetus.

If you have heavy periods, are vegetarian or are planning to become pregnant, consider asking your doctor to test your ferritin levels, which measures the amount of iron produced, said Dr. Malcolm Munro, professor of obstetrics and gynecology at stored in your body. David Geffen School of Medicine at the University of California, Los Angeles. During annual checkups, most doctors will only check hemoglobin levels, he said, but that’s a sign of anemia, not iron deficiency. He adds that testing your ferritin level is usually covered by insurance. This isn’t some fancy test.

According to the World Health Organization, for non-pregnant women, ferritin levels should be at least 15 micrograms/liter and hemoglobin levels should be at least 12 grams/dL. But a growing number of researchers say the threshold should be higher: for ferritin, between 30 and 50 micrograms per liter; and for hemoglobin it is 13 grams per deciliter.

If you determine that your iron levels are low, we take this approach, we say we have to stop the leak and refill the tank,” said Dr. Munro. Here’s what it might look like.

Dr. Angela Weyand, a pediatric hematologist at the University of Michigan Medical School, said many women don’t know whether their menstrual bleeding is considered heavy.

“I see a lot of teenagers who have very heavy menstrual bleeding and end up becoming severely anemic and having to be hospitalized,” she said. Often, these patients do not even realize that their bleeding is abnormal.

Soaking a pad or tampon every two hours, bleeding that lasts longer than seven days, or needing double coverage (like a tampon and tampon) are all signs that your period is too heavy .

If you have heavy bleeding and are iron deficient, talk to your gynecologist first to rule out factors that could be causing excessive bleeding, like endometriosis or uterine fibroids, suggests Dr. Munro. . From there, you can consider methods to reduce bleeding, such as birth control pills or hormonal intrauterine devices.

Taking naproxen (sold as Aleve) or ibuprofen may also help reduce blood loss if taken two days before your period begins and throughout it. Tranexamic acid, a prescription medication, is another option.

There are many types of supplements that provide different amounts of iron, but higher doses are not necessarily better; Dr. Munro says it’s best to take no more than 100 milligrams per day. Exceeding that amount can worsen side effects, such as constipation or nausea, and the iron will not be absorbed well. For example, the most common iron tablets contain 325 milligrams of ferrous sulfate, which provides 65 milligrams of iron, and one of these is enough.

Studies show that taking iron supplements every day is just as effective and has fewer side effects than taking the medication more frequently.

Avoid taking calcium supplements, milk, coffee, tea or high-fiber foods at the same time as iron supplements, as these can interfere with your body’s ability to absorb iron.

Dr. Munro says continuous supplementation will improve ferritin counts in about three months. Once your ferritin count is up and you’re not losing a lot of blood during your period, he adds, you can simply rely on your diet for iron supplements.

According to federal recommendations, men of all ages and women over 50 should consume at least 8 milligrams of iron per day, while women 19 to 50 should aim for 18 milligrams. Requirements increase to 27 milligrams during pregnancy.

There are two types of iron found in foods: heme and non-heme. Heme iron is found in any source of animal origin, including meat, poultry, and fish; Non-heme iron is found in plant-based foods such as lentils and beans, some vegetables, grains and nuts, says Elaine McCarthy, a nutrition researcher at University College Cork in Ireland. Both types of iron can be valuable sources, but your body absorbs heme iron more effectively, says Dr. McCarthy.

That said, plant-based foods can still be excellent sources of iron. A cup of cooked lentils contains more than the 6.6 milligrams of iron in a serving of beef, but you’ll want to use a few tricks to help your body absorb it, says Diane DellaValle, associate professor of nutritional sciences at Kings. absorb it. University in Wilkes-Barre, Pa. Creating a personal plan with a registered dietitian is worth doing, but here are some of her tips for getting more iron:

  • Combines plant-based iron with absorption enhancers: Adding a bit of meat or a good source of vitamin C to the same meal will improve your ability to absorb non-heme iron, says Dr. DellaValle. For example, you can add tomatoes or bell peppers to lentils or serve them with strawberries or oranges.

  • Avoid taking absorption blockers: Dr. DellaValle says some compounds found in tea and coffee can interfere with the absorption of non-heme iron from foods and supplements, so avoid drinking those drinks at the same time as iron sources. of plant origin.

  • Look for nutritious foods: Other good sources of iron include certain iron-fortified foods, like breads and pastas that contain enriched flour, says Dr. DellaValle. Iron-rich rice also contains more iron, but you will lose some iron if you rinse the rice before cooking. And many breakfast cereals are fortified with iron; just keep in mind that the iron will leach into the milk in your bowl of cereal, so you’ll need to drink milk to get the full dose.

  • Cooking with special utensils: One of Dr. DellaValles’ favorite tips is cooking with Lucky Ironfish. Put it in your cooking pot along with a few drops of lemon juice or vinegar, and the product will release six to eight milligrams of iron into whatever you’re preparing, whether it’s rice, oatmeal or soup. Cooking with a cast iron pan can also add iron to your meals. Dr. DellaValle often recommends Lucky Iron Fish to the college athletes she works with, and she gives it as a holiday gift.

Alice Callahan is a health and science reporter for the Well Desk, focusing on nutrition and sleep.

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