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Some people take iron because they feel tired and "run down"
all the time, and they believe that they have anemia and thus, need to
take iron. In the vampire community, I have seen people automatically
dish out the advice "Oh, you're a vampire? You need iron!"
Both of these assumptions are - as long as the person is otherwise in
good health - very often, WRONG!
In reality there are somewhere around a dozen different types of anemias,
only ONE of which is caused by iron deficiency, and close to twenty other
ailments that have similar symptoms. Anemia essentially means that there
is a problem with the body's production of red blood cells, or RBC's -
problems in RBC production can happen for many MANY reasons. Taking iron
supplements - when there is no iron deficiency to begin with - will NOT
fix the problem. Sometimes it will make the existing problem worse - or
create additional problems if the body cannot get rid of the excess iron
in a timely manner.
This article will explain more about iron deficiency and the blood test
items that need to be checked to verify the presence of an actual iron
deficiency. This article makes the assumption that the reader is in their
late teens or adulthood, and is in reasonably good health.
GLOSSARY
CBC
Complete Blood Count (sometimes done "with differential",
sometimes without.) This is one part of routine bloodwork run by most
doctors. The "differential" part refers to the examination
of a blood smear on a slide by a lab tech. (This is sometimes called
a "peripheral smear".)
CMP
Complete/Comprehensive Metabolic Panel. This the other part of routine
bloodwork run by most doctors. There is a less 'complete' version, I
believe termed as just "metabolic panel" - the CMP tracks
14 or so different items, the smaller MP tracks just 7 or 8 items.
HCT (part of the CBC)
Hematocrit - This is the red blood cell count, which is low in various
types of anemia and in cases of blood loss (either externally obvious
or internally not-so-obvious.)
HGB (part of the CBC)
Hemoglobin. This carries oxygen in the blood. Red blood cells made improperly
carry less oxygen.
MCV, MCH or MCHC (part of the CBC)
These three items all reflect the sheer volume of red blood cells in
a sample, as well as how much hemoglobin is in them.
Microcytes
Smaller than normal red blood cells; growth is stunted for various reasons,
including iron deficiency. This is seen on a differential smear, but
can be hinted at with other bloodwork items as well.
RDW (part of the CBC)
Red cell Distribution Width - this reflects the variation in size of
red blood cells. Some variation is routinely expected, but in cases
of anemia, the size variance will be greater than normal.
Reticulocytes
Indicates quality of bone marrow production vs. state of health. Reticulocytes
are too high in anemia with normal bone marrow production ability or
too low if there's an impairment of the bone marrow production ability
in addition to the anemia.
WHAT IS IRON DEFICIENCY?
Iron deficiency simply is an indicator that the body has low iron stores.
This can be due to blood loss, poor diet, or an inability to absorb
enough iron from foods.
Always remember that iron deficiency is a SYMPTOM of a disease process,
not the actual disease itself. Many doctors (especially those who see
a lot of low-income patients, or have a very crowded practice) see a
low HCT on bloodwork and assume the patient is iron deficient, when
this is not always the case. The actual cause of the iron deficiency
has to be found and treated - and differentiated from other diseases
with similar symptoms, otherwise the problem will keep getting worse.
Iron deficiency usually develops over time if the body doesn't have
enough iron to build healthy red blood cells. Without enough dietary
iron (or without proper absorption in the stomach or GI tract) the body
starts using the iron it has stored. When that runs out, the body cannot
produce as many red blood cells (hence the lowered HCT) and the red
blood cells that are made will have less hemoglobin than normal (hence
a lowered HGB.) The bone marrow - if working properly - will attempt
to produce more red cells in order to compensate (shown by a higher
reticulocyte count)
HOW IS IT DIAGNOSED?
Symptoms of iron deficiency show that body tissues are not getting
as much oxygen as they should. These symptoms do overlap with many other
health conditions, but acute AND chronic (yes, even cancer!) which is
why it's absolutely critical to be certain what the actual cause is.
Some of these symptoms include:
- Chest pain
- Chronic fatigue
- Depression
- Dizziness
- Headaches
- Shortness of breath
- Sleepiness
- Twitching muscles
- Weakness
Iron deficiency can be suggested (but so can other reasons for lack
of blood cell production) by the following items on a routine CBC:
- low HCT
- low HGB (hemoglobin)
- Microcytes
- high RDW
- Low MCV, MCH or MCHC
- Differential smear may also show poikilocytosis (variation in shape)
and anisocytosis (variation in size)
Iron deficiency needs to be verified with the following items - these
are DIFFERENT bloodwork items, not included on a CBC or a CMP:
- Serum Iron
- TIBC (total iron-binding capacity)
- UIBC (unsaturated iron-binding capacity)
- Serum ferritin
- Reticulocyte count
- Transferrin saturation
WHAT CAUSES IRON DEFICIENCY?
- Chronic Internal bleeding (bleeding ulcers, bloody diarrhea, etc.)
- Chronic illness (cancer, Crohn's disease, Celiac Syndrome, etc.)
- Copper deficiency (rare)
- External hemorrhage (rectal bleeding due to hemorrhoids, accident/trauma,
etc.)
- Medications that reduce stomach acid (ulcer medications, etc.)
WHO SHOULD TAKE IRON SUPPLEMENTS?
Anyone who demonstrates an iron deficiency on specific bloodwork, as
talked about above.
Possibly children (because they're growing) or menstruating women of
reproductive age (because they shed blood due to their monthly cycles)
IF they don't have a lot of meat in their diet OR they have a malabsorption
problem.
For men, iron supplementation is not only generally unnecessary, but
not recommended (it can lead to side effects and overload symptoms)
for men with a meat-heavy diet. Iron tends to accumulate in the liver
first (which can cause jaundice - yellowing of skin and eyes) and contributes
to certain types of cancers.
Dietary Sources
Meat, fish, eggs, spinach and other dark leafy greens, dried fruits,
dried beans, nuts, vitamin C taken with iron (helps absorption), regularly
cooking in cast iron pots and pans (especially cooking acidic foods
like tomatoes), liver, bone marrow, stinging nettle tea.
One person also suggested a bit of iron (plain iron, not coated with
anything else) stuck in a lemon, and then make lemonade with it the
next tday, will also add iron to the diet. (Most iron nails in the hardware
store are coated with something that's probably not safe for digestion...
you may need to visit a metal shop to get plain iron.)
Things That Impair Absorption
Aspirin (Acetacylic Acid) and aspirin derivatives, antacids, cholesterol
busters, drugs for urinary stones, too little acid production (if the
patient is taking any anti-ulcer medications), calcium, phosphates,
diary products (because milk has calcium), egg whites, phytates/phosphorus
in beans, tannins in tea/coffee. Separate these from iron supplementation
by 8-9 hours.
IRON OVERLOAD / TOXICITY SYMPTOMS
Initial overload side effects are due to the corrosive nature of iron
in large doses on tissues in the stomach and GI tract, and include:
- Abdominal pain
- Diarrhea
- Nausea
- Vomiting
Interestingly, these are also listed as common side effects on every
over-the-counter iron supplement, along with the additional effects
of black tarry fecal matter and occasional constipation.
If overloading of iron continues, it may progress to cellular and organ
toxicity, and also include (in addition to above):
- Fatigue, weakness
- Impaired blood production (too much iron crowds out other necessary
ingredients)
- Joint pain
- Lack of energy
- Loss of sex drive
- Organ damage starting first with: Liver, kidneys, heart, and/or
endocrine system.
~SphynxCatVP, 2010
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