Iron deficiency; we’ve all heard of it, but what does it mean? And why does it seem to be more common in females? And, most importantly, what can we do about it?
As women, we have unique health needs, and iron is one of them. Our iron needs and levels vary and fluctuate a bit more than men based on our biology. We recently chatted with top women’s health experts about iron deficiency and why it’s more common in females.
In this article, we take a deep dive into the topic, giving you all of the information you need as well as your options for treating iron deficiency so that you can feel your best and live your fittest, healthiest life.
What is Iron Deficiency?
Iron deficiency or iron deficiency anemia is a condition in which your blood lacks adequate healthy red blood cells, which are the cells that carry oxygen to the body’s tissues. Just as the name implies, iron deficiency anemia is caused by insufficient iron.
Without enough iron in your body, your body is unable to produce the hemoglobin needed to carry oxygen. When this happens, you’re often left feeling tired and short of breath.
Why Is Iron Deficiency More Common In Females?
According to Kiera Lane, N.M.D., MSAc, L.Ac., Dipl. Ac., FABORM Physician, Acupuncturist, Wellness & Fertility Expert, Author, and Medical Director Arizona Natural Medicine Physicians, PLLC, “females tend to be low in iron for three reasons.
- Consistent blood loss from monthly periods
- Stress can cause a reduction of stomach acid which helps to improve absorption of plant sources of iron
- A poor diet or diet on the run can contain a lack of iron-rich foods.”
Kelly Johnson-Arbor, MD, FACEP, FUHM, FACMT, and Medical Toxicologist and Co-MedicalDirector at the National Capital Poison Center added that there are “increased metabolic demands during pregnancy that can contribute to anemia and iron deficiency. Additionally, women in some countries don't eat enough iron-rich foods, and that can also contribute to iron deficiency.”
Furthermore, Dr. Nita Landry, Board-Certified OB/GYN and the author of Dr. Nita’s Crash Course for Women, goes on to explain that other factors including “gastrointestinal tract abnormalities like celiac disease, inflammatory bowel disease, Crohn’s disease or bariatric procedures, body changes like growth spurts, pregnancy, and lactation, and blood loss” can all also contribute to the onset of iron deficiency anemia in women.
What are the signs of iron deficiency?
Iron deficiency in women can present many different symptoms. According to Dr. Nita, “people with anemia may notice symptoms such as fatigue, weakness, pale skin, shortness of breath, dizziness, thinning hair, brittle nails, cold hands and feet, chest pain, or an irregular heartbeat.”
Dr. Nita goes on to explain that, “if you have a constant or strong craving to chew ice, you may be iron deficient. Pagophagia is a form of pica focused on chewing ice specifically linked to iron deficiency. If a person increases their iron level with oral iron or iron infusions, they usually stop craving ice.”
If you are experiencing any of the signs and symptoms of iron deficiency anemia, it’s important to go see your doctor get a diagnosis before self-treating as overloading your body with iron can be dangerous for your liver and other organs.
How Much Iron Do Females Need?
So how much iron do we really need then?
“The recommended daily allowance or RDA for females is about 18 mg per day. However, this RDA is to avoid iron deficiency and may be too low for many women for optimal iron status. A better measure of iron needs is using blood work including a complete blood count, serum iron, and ferritin levels to determine iron needs. Ferritin is especially important in assessing iron needs. Ferritin tells you the iron stores of your tissue. If this is low you can have symptoms of anemia even if your other lab values are normal. Bloodwork is a great way to determine if you’re getting enough iron and if you need to have supplementation of iron beyond diet sources,” according to Dr. Lane.
There are, however, certain populations of women that have different iron level needs. For example, pregnant women have a higher recommended daily allowance and menopausal women have a lower recommended daily allowance.
Dr. Johnson-Arbor recommends “27 mg of iron daily during pregnancy” to help make sure the baby is getting adequate oxygen through your blood. She goes on to say that “during and after menopause, you may not need as much iron. ACOG recommends 8 mg of iron per day for women 51 and older.”
How to Get More Iron in Your Diet
Thankfully, the foods that we eat contain iron, so curing iron deficiency anemia in women is often accomplished by optimizing their nutrition to include the iron-rich foods their bodies need.
Dr. Nita explains that “With proper nutrition and a few tips to maximize absorption, you can meet your body’s need for iron. There are many great sources of iron. It’s important to understand that iron is present in two forms – heme and non-heme iron. Heme is only found in animal flesh such as seafood, poultry, and meat. Non-heme iron is found mainly in plant-based foods. Research shows our bodies absorb heme iron two to three times better than non-heme iron, which is why it may be challenging to reach adequate iron intake with a vegan diet.”
When it comes to heme iron vs non-heme iron, there are some important differences that are worth noting as you add these foods to your diet to improve your iron intake.
According to Dr. Johnson-Arbor, “the best dietary sources of iron are lean meats and seafood. This is because these iron sources contain heme iron, which is able to absorb and distribute throughout the bloodstream better than other forms of iron (nonheme iron). Many other types of foods, including nuts, beans, bread, cereal, and vegetables, contain nonheme iron. Nonheme iron is still absorbed and used by the body, but people may need to consume more of it than they think to achieve adequate body stores of iron.”
Iron-Rich Foods to Add to Your Diet
Dr. Nita recommends the following iron-rich foods:
“Shellfish, lean beef, liver, turkey, fish, tofu, dark leafy greens like spinach, kale, and collard greens, broccoli, pumpkin seeds, quinoa, beans, dried apricots, raisins, and bonus – dark chocolate!”
She also recommends the following iron-packed burrito bowl recipe to really ramp up your iron intake with just one simple meal. To make:
- Combine a cup of cooked quinoa (2.8 mg of non-heme iron)
- Half a cup of black beans (1.8 mg of non-heme iron)
- Half a cup of spinach (3 mg of non-heme iron)
- Half an avocado (0.6 mg of non-heme iron)
- Top with the protein of your choice – 3 ounces of steak (2.1 mg of iron), chicken (1.1 mg of iron), or tofu (4.5 mg of non-heme iron)
A couple of iron tips and tricks from Dr. Nita:
"Pairing plant-based iron sources with Vitamin C helps your body absorb more. It’s a tip we often gave on “The Doctors” – squeeze some lemon or lime on your spinach!"
“One surprising way that you could be sabotaging your iron absorption is by drinking coffee or tea with an iron-rich meal. Studies have shown that coffee or tea can reduce iron absorption by 39 to 90%. But I have good news for coffee lovers – if you wait at least an hour between your meal and your coffee or tea, there’s no issue with your iron absorption.”
Should Women Take an Iron Supplement or a Multivitamin With Iron?
If you’re not confident that you can sufficiently add enough iron-rich foods to your diet, you might be able to benefit from adding an iron supplement to your diet or to selecting a women’s multivitamin with iron to enrich and optimize your iron levels.
Speaking with Dr. Johnson-Arbor about whether or not adding an iron supplement or iron-containing multivitamin to your diet is a good idea, she states “If you eat meat regularly, you may not need iron supplementation at all, but if you don't get enough iron from dietary sources then a multivitamin with iron may be beneficial. If you are found to have an iron deficiency that persists despite the use of iron-containing multivitamins or if your iron deficiency is severe, your doctor may recommend iron supplementation. Iron supplements typically contain much higher amounts of iron than iron-containing multivitamins and may benefit people who have chronic low iron levels from intestinal disease (malabsorption syndrome), pregnancy, or chronic diseases.”
She goes on to say that “since vitamin C enhances absorption of iron in the human body, it's beneficial to take iron with vitamin C (some iron supplements contain vitamin C for this reason). Also, there is some evidence that suggests that taking iron supplements every other day is as effective and associated with fewer side effects than taking iron on a daily basis.”
Dr. Nita warns that it’s always best to consult with your doctor before taking iron supplements or multivitamins containing iron to reduce the risk of over-supplementation.
“I strongly recommend a CBC (complete blood count), an iron test, and a consultation with your doctor before starting an iron supplement. These tests will determine if you have iron-deficiency anemia. Iron supplements can be tough on the stomach, causing abdominal pain, diarrhea, vomiting, or constipation. High doses of iron can cause stomach ulcers. If your doctor determines you’re iron deficient and supplementation is needed, you can take an oral iron supplement or IV iron. A fiber supplement, stool softener, or eating whole grains can help ease constipation commonly associated with iron supplements.”
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What Happens When You Get Too Much Iron?
Overdosing iron supplements can be fatal. “An acute overdose of iron can cause life-threatening symptoms including organ failure, seizures, and death (this is why it's so important to keep all vitamins and supplements away from young children),'' says Dr. Johnson-Arbor.
“If someone overdoses on iron (such as a toddler getting into a parent's multivitamin or iron supplement), they should contact poison control for expert advice. There are two ways to contact poison control in the United States: online at www.poison.org or by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day”, adds Dr. Johnson-Arbor.
Wrapping Up On Iron Deficiency in Females
Iron deficiency anemia is one of the most common nutrient deficiencies worldwide, across all populations and both genders, however, women tend to have a higher rate of iron deficiency due to a variety of factors.
With some knowledge of dietary iron sources and a little intentionality, many women can improve their iron levels through diet alone. However, some women need a little extra, which is where adding a women’s multivitamin with iron or an iron supplement, in some cases, can really be the difference maker.
If you’re experiencing symptoms of iron deficiency anemia, be sure to see your doctor ASAP for a diagnosis and recommended course of treatment.