How can you prevent iron deficiency? Find out everything about this essential mineral

Today we are dealing with the topic of iron. In addition to general facts and the functions that iron fulfills in the body, you will learn why an adequate supply of iron is necessary for your health.

What will you learn in this guide?

1. General facts

The essential trace element iron is one of the transition metals. It is of central importance both for our body and for our planet . Iron is the main component of the earth's core and is the fourth most common element in the earth's crust.

Iron is an indispensable part of modern life. It is the main component of steel , which can be found in machines and buildings, as well as in various everyday objects. Even in ancient times, people had recognized that iron also plays an important role for the body . The healer and seer Melampus treated his patients with a drink made of wine and the rust of an old iron knife. The method of hammering pure iron nails into an apple and eating it the next day is also known in Polish folk medicine [1].

However, most doctors advise against such methods because it is not possible to determine an exact dosage. An overdose of iron can have a negative impact on health (more on this later). Thanks to modern science, we now know that the human body contains around 4.5 grams of iron [2], which performs various functions there.

2. Function of iron

In your body, iron contributes, among other things, to the normal formation of red blood cells and the red blood pigment hemoglobin they contain. Here it even represents the central atom. The red blood cells (erythrocytes) have the task of ensuring that all of our body cells are supplied with vital oxygen and of transporting away the metabolic waste product carbon dioxide .

This happens through the lungs, where oxygen is absorbed and carbon dioxide is exhaled. The iron contained in the lungs enables the oxygen to be bound and thus transported . Your red blood cells are constantly being built up and broken down again. On average, their lifespan is 100 to 140 days . Therefore, around 1.2 liters of blood are produced each month [3].

The body produces around 2 million red blood cells per second. It is therefore not surprising that the production of hemoglobin requires over 70% of our iron [4]. Iron is also present in the inorganic core of the storage protein ferritin. While hemoglobin has only 4 iron atoms, ferritin contains up to 4000 iron atoms per protein unit [5].

Iron is also present in many enzymes in the body , where it performs a wide range of tasks . It contributes to normal energy metabolism and to the normal functioning of the immune system . It is also essential for well-functioning cell division and our cognitive functions.

3. Causes of iron deficiency

There can be different causes for iron deficiency. These three reasons are the most common:

1. An increased need for iron that cannot be met. This occurs during the growth period in children and adolescents, during pregnancy, during menstruation or after increased blood loss, e.g. after a blood donation.
2. Insufficient iron intake , which can quickly occur with a low-meat or meat-free diet. If care is not taken to integrate suitable alternative iron sources into the diet, a deficiency can quickly arise.
3. Reduced iron absorption , which can occur, for example, in cases of reduced gastric acid production or chronic intestinal diseases, can also be a factor in deficiency [6].
   

4. Who can be affected by iron deficiency?

Insufficient iron supply or even a severe deficiency is not only an enormous problem in developing countries. People in industrialized countries can also be affected. More than 500 million people in the world suffer from iron deficiency. In Germany and other industrialized countries, the figure is around 8% [7],[8]. While many people in developing countries can only afford very little meat, people in industrialized countries often consciously try to reduce meat consumption.

Health, environmental and ethical concerns are particularly important for many people. Even though there are other foods that contain a similar amount of iron or even more than meat, they cannot be replaced one-to-one (more on this in section 5).

20-30% of women between 20 and 35 years of age in industrialized countries suffer from iron deficiency. In developing countries, the figure is as high as 50% of all people [9].

There are two main reasons why women are particularly affected by iron deficiency.

On the one hand, due to their menstrual cycle, they have an average 50% higher iron requirement than men. According to the DA-CH reference values ​​recommended by the German Society for Nutrition [10], 10 mg of iron per day is enough for men to cover their daily requirement. Women, on the other hand, need 15 mg . In addition, women consume less meat, which is the food with the best iron absorption, on average.

5. Iron-rich foods and iron absorption

If you only consider the amount of iron in food , 15 mg of iron intake per day seems easy to achieve. Unfortunately, people often forget that bioavailability is crucial.

In fact, the body of a normal person needs on average only 1 milligram of iron per day to maintain its balance [11]. However, on average only 5% to 10% of the iron contained in food is absorbed by the body. This value varies greatly, depending on the food and the combination of different foods within a meal.

To understand this connection, we must first distinguish between trivalent iron (FE3+), which is found in plant foods, and divalent iron (FE2+) , which is present in meat mainly as heme iron.

The divalent iron in heme iron is bound to the proteins hemoglobin and myoglobin . This form even has its own receptor and is absorbed at a rate of about 23%. There is no receptor for trivalent iron, so it must first be converted to divalent iron so that it can be absorbed. Therefore, only about 3-8% of trivalent iron is absorbed [12].

Only bivalent iron reaches the intestinal cells. From there it is released into the blood via the transport protein ferroportin. In the blood, Fe2+ is oxidized to Fe3+ for further transport. The trivalent iron is then bound to the transport protein transferrin and taken to where it is needed.

Vitamin C and various fruit acids help to significantly increase the conversion of Fe2+ to Fe3+ . The trick of combining vitamin C with iron is a good way to improve iron supply. Unfortunately, there are also many inhibitors that impair iron absorption - these are known as antinutrients. These are various substances, of which phytic acid is the best known. In plants such as grains, pulses and oilseeds, they store phosphate and other minerals such as iron. In the digestive tract, phytic acid binds to these nutrients and prevents them from being absorbed by the body.

Since vegans and vegetarians tend to consume a lot of plant-based foods rather than iron from meat, these people are more at risk for iron deficiency. Methods such as sprouting and fermenting can reduce the phytic acid content. However, very few people take the time to prepare their food in this way.

Other antinutrients such as tannins , which are found in tea, coffee and wine, certain fibers such as hemicellulose and lignin or medications such as gastric acid binders can also impair iron absorption [13]. Divalent animal heme iron is so effective because it is not affected by antinutrients due to its protein structure.

But it is not just diet that is important. Certain diseases also have an influence on iron absorption and iron requirements . In addition, the saturation of iron stores determines how much is actually absorbed, since the conversion of trivalent to divalent iron is controlled by the body depending on the amount in the stores. Depending on the bioavailability of the food and the status of the iron stores, absorption can even be between 1% and 50% [14].

6. Symptoms and consequences of iron deficiency

There are three different stages of iron deficiency that you can be in [15].

In the first stage , the body is forced to use the iron it has stored to ensure that the body is adequately supplied with iron due to insufficient iron absorption. The longer this condition lasts, the faster the iron stores become depleted. When the supply is exhausted, the ferritin level in the blood serum begins to fall . This iron deficiency does not yet constitute anemia (anemia) because the body is still able to produce enough red blood cells.

In the second stage, the iron reserves are so depleted that the bone marrow produces fewer and fewer red blood cells . The amount of iron in the body is so low that the cells can no longer be adequately supplied . The hemoglobin level is only just within the normal range.

In the third stage, there is a dangerous iron deficiency. The deficiency is so severe that the body can no longer produce enough red blood cells . The hemoglobin level is now below normal. This becomes noticeable in the form of iron deficiency anemia symptoms. The body's cells can no longer be supplied with enough oxygen . At this point, at the latest, various symptoms appear.

A decrease in performance , which is accompanied by concentration problems , severe tiredness and dizziness , very similar to a vitamin B12 deficiency, are typical of this. Shortness of breath and strong heart palpitations (especially during physical exertion) are also serious signs that are often noticeable. If pale skin, hair loss, chapped lips and brittle nails occur, the deficiency is already so advanced that it can be seen from the outside. The function of our immune system is also impaired by an iron deficiency [16],[17].

Liposomal iron

7. The problem with incorrect supplementation

When it comes to iron, it is crucial to find the right amount . It has already been made clear that too little iron is harmful. But the same applies to too much iron . The reason for this is the mechanism of iron absorption. Under natural conditions, this is able to protect our organism from an excess of iron .

The saturation of the iron stores determines how much iron is absorbed. In addition to the conversion of trivalent to divalent iron, the iron transporter ferroportin is crucial for how much iron actually gets from the intestinal cells into the blood. The peptide hormone hepcidin , which is produced in the liver depending on the body's iron status, regulates ferroportin. It is essentially the door opener for the iron in our bloodstream. If there is a deficiency, more doors than usual are open so that as much iron as possible gets into the blood [19].

If extremely high amounts of iron are taken in at once in such a situation, far too much iron will enter the blood. Because iron supplements with extremely high doses do not occur naturally, your body does not expect such a high dose. The transferrin responsible for iron absorption is not able to bind all of the iron.

This excess iron can cause cell damage throughout the body , as free iron ions promote the formation of hydroxyl radicals. This means that exactly what antioxidation is supposed to prevent is brought about: damage to the body by free radicals [19]. The liver, pancreas and heart are particularly affected. Excess iron can also accumulate in the liver and overload the organ. It can therefore be very dangerous to start with a high dose if you are in a state of deficiency.

Even with an above-average iron-rich diet, it is difficult to absorb the dose that can be achieved with dietary supplements in one go. Very high doses of supplements without medical supervision are strongly discouraged!

8. Have iron levels determined correctly

If a deficiency is suspected, a well-informed doctor will determine both the hemoglobin level , which shows the iron content in the blood, and the serum ferritin level , which provides information about the amount of iron in the stores [20]. This is the only way to correctly assess how advanced the deficiency has become.

It is an advantage if you use a preparation that has a high bioavailability . This prevents unused iron from remaining in the intestines and causing problems such as diarrhea. Liposomal supplements have a particularly high bioavailability because the iron is encapsulated in small liposomes and is protected when it enters the bloodstream. There it can develop its full potential instead of remaining in the intestines and causing problems.

[1] https://www.spiegel.de/politik/aepfel-gegen-eisenlack-a-19476845-0002-0001-0000-000040350001?context=issue