Why watching iron levels is more important for women than for men

Posted on 5 February 2019

Your body needs iron to function healthily. Women, in particular, are prone to iron deficiency, and the problem affects as many as one in two South African women. Dr Mike du Toit, a haematologist at Mediclinic Constantiaberg, explains why maintaining healthy iron levels is so important for women.

What is iron and why does the body need it?

Iron is a micronutrient needed for the synthesis of the haemoglobin (heme) protein in the body. Haemoglobin carries oxygen in your blood from your lungs to other places in your body. Cells then use this oxygen to generate the energy needed for cellular processes. Iron is vital not only for the growth and development of red blood cells but for the energy requirements and healthy functioning of every cell in the body.

Dr du Toit explains that your body needs just enough iron – no more, no less. “Excessive amounts of iron are extremely toxic, so the body stores only what is required. The natural source for your system to obtain iron is through nutrition, and the maximum amount the gastrointestinal tract allows us to absorb is about 15%. Once that iron is in the body, your system guards it jealously – it’s essential for healthy cellular function, so the body does not want to lose it.”

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Who is particularly vulnerable to iron deficiency?

The only way we lose iron is by blood loss. This means that women in their reproductive years are particularly vulnerable to low iron stores. During monthly menstruation, they lose blood, and with it, red blood cells containing iron.

“The body also requires more iron during a child’s growth years,” Dr du Toit explains. “Adolescent girls are particularly vulnerable to low iron stores when they’re starting their periods. Not only are they growing so the demand for iron is high, but they’re also menstruating. So it’s a double whammy.”

Non-meat-eaters are another large risk group. There are two types of iron – heme iron (iron from animal sources) and non-heme iron (iron from plant-based sources). Heme iron is better absorbed by the body than non-heme iron. Foods containing non-heme iron form an important part of a nutritious, well-balanced diet, but the iron contained in these foods won’t be absorbed as completely as the iron in meat. You only absorb between two and 10 per cent of the non-heme iron you consume.

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This is not to say you cannot meet your body’s iron requirements as a vegetarian or a vegan. You just need to be more careful about what you eat, ensuring you’re eating foods that are iron-rich, and avoiding simultaneously consuming foods that may inhibit iron absorption (such as coffee and tea). Vegans are therefore more likely to need iron supplements.

What are the symptoms of low iron?

If your iron levels are low, your cells receive less oxygen, leaving them less able to generate energy. Symptoms of iron deficiency include:

• low energy levels
• fatigue
• light-headedness
• poor concentration

What is the difference between low iron stores and anaemia?

Anaemia is a low level of haemoglobin in the blood. There is a whole range of conditions that can result in anaemia, from a nutritional deficiency of iron or vitamin B12 to bleeding, genetic issues, chronic disease, plus chronic viral and other infections. This means that not everyone who is anaemic has an iron deficiency – iron deficiency is one possible cause of anaemia.

In the case of iron deficiency, you only start becoming anaemic once that iron deficiency is severe. Your body will struggle to produce more haemoglobin as your iron reservoirs become depleted, the level of red blood cells becomes lower than normal, and the result is full-blown iron deficiency anaemia.

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Are pregnant women more prone to iron deficiency?

Dr du Toit explains pregnant women are more prone to iron deficiency because they are sharing their iron stores with the developing embryo. “While in the womb, the baby will take whatever iron it can from its mother. This makes it important for pregnant women to have good iron stores during pregnancy so that she is physically able to meet the demands of her newborn baby.”

Female endurance athletes, particularly long-distance road runners, are also prone to iron deficiency. This is because, in addition to the usual causes of low iron for women, repetitive long-distance running may cause the body to retain iron as a protective response to stress. In addition, the constant trauma relating to the jarring impact of running for long distances on a hard surface may cause the breakdown of red blood cells, depleting iron stores.

How to choose the best iron supplement

There are many iron supplements available, and with many formulations, it can be confusing deciding which is most suitable. “When choosing your supplement, read the label carefully and opt for the one with the most iron. Be aware that iron supplements can lead to constipation, so counter that by taking in enough liquids and fibre in your daily diet,” says Dr du Toit. There is also some evidence to suggest that taking iron supplements every second day may be better than a daily intake.

It is important to note that iron supplementation is not a quick fix – you can’t expect to take iron supplements for a week and be cured. If you are diagnosed with an iron deficiency, you need to stay on supplementation for at least three months before being retested. Your doctor will then re-evaluate whether you need to decrease the dose or stop taking the medication and simply make some dietary changes. Severe iron deficiency may be better treated with an iron infusion.

Best dietary sources of iron

• all red meats
• liver
• pork
• chicken
• turkey
• eggs
• sardines
• tuna
• salmon
• mackerel
• haddock

Best vegetarian sources of iron

• beans and lentils
• tofu
• chickpeas
• sweet potatoes
• cashews
• dark green leafy vegetables
• peas
• kale
• pumpkin
• squash
• fortified cereals
• whole grains
• wheat germ
• pumpkin seeds
• dried apricots
• prunes
• raisins
• dates
• strawberries
• figs
• watermelon
• sesame seeds
• pecans
• walnuts
• tomato paste
• molasses
• quinoa
• cooked soybeans
• spirulina

Iron enhancers

Vitamin C increases iron absorption, so all foods rich in vitamin C (citrus fruits, strawberries, peppers, tomatoes, etc.).

Iron inhibitors

The most common robbers of iron are tannins (tea), so reduce your intake and don’t drink tea an hour or so before/after an iron-rich meal. As calcium is also an iron inhibitor, avoid high-calcium foods during/before/after eating iron-rich foods.