Are you at risk of iron deficiency (ID) or iron deficiency anaemia (IDA)?
If you fall within any of these groups, you may be iron deficient
Women of reproductive age
- During each menstrual cycle you lose blood, which contains iron. If the amount of iron in your diet does not match what is lost, you could become iron deficient.1,2
- Iron deficiency is common during pregnancy as pregnant women have higher iron requirements for the growth of the placenta and a healthy baby.3
- Iron deficiency is common after giving birth due to blood loss at delivery.3,4
People living active lifestyles
- Iron is important for energy production and carrying oxygen to your muscles. If you have insufficient iron stores it will impact your well-being and athletic performance.5
- Long-term strenuous exercise places you at an increased risk of depleting your iron stores.5
Lack or iron in diet
- Your body gets the iron it needs from the food you eat. Iron-enriched foods include meat, eggs and leafy green vegetables and iron-fortified foods. If you follow a restricted vegetarian diet, you may have a greater risk of iron deficiency.1
Iron supplementation for Athletes
Are you living an active lifestyle?
Iron is utilised by the body for oxygen transport and energy production, it is therefore essential for athletic performance. 5 Insufficient iron stores may not only lead to a decline in health and well-being, but also athletic performance. 5
Athletes are commonly diagnosed with iron deficiency (ID). 5 This is due to strenuous exercise programs placing athletes at risk of depleting their iron stores, which can lead to iron deficiency anaemia (IDA). 5
The two main reasons for the loss of iron in athletes are: 5
- Foot strike haemolysis: the destruction of red blood cells in the feet due to the constant impact
- Sweating: exercise promotes the increase of sweating as a way of regulating body temperature, however, it is also a mechanism by which the body may lose iron
Other factors contributing to iron losses in athletes are gastrointestinal bleeding and haematuria (blood in the urine). 5
Therefore, a sufficient intake of iron is essential for athletes in order to replace the iron that is lost during exercise. Iron supplementation has been linked to improved performance due to oxygen being better transported through the body. 5
IRON SUPPLEMENTATION FOR BARIATRIC SURGERY
The term bariatric surgery covers many different operations that encourage weight loss and which are typically performed on people who are obese.
Weight loss is achieved by modifying your stomach and/or intestines to restrict the type and amount of food that you can eat and, sometimes, the types of nutrients that can be absorbed from your food. 1-3
Fifty per cent of people who have had bariatric surgery are iron deficient within one year of the surgery, 2 and 20-62 % of patients are iron deficient 4 to 12 years after surgery.2 It is possible to develop iron deficiency (ID) following bariatric surgery for the following reasons: 3
- Eating fewer iron-rich foods, such as red meat, as they may now be difficult to tolerate
- Reduced absorption of iron from food due to less stomach acid (needed to break down food and release iron) produced following surgery
- Reduced absorption of iron from diet as food no longer passes through the part of the intestines where iron is absorbed
- Blood loss at the site of surgery
Following bariatric surgery it is important to treat any ID that develops. If you have had surgery it is likely that you will have regular follow-up appointments to monitor your weight loss and any side effects. If you feel you are suffering from symptoms of ID, talk to your doctor at your next appointment.
Iron supplementation for cancer treatments
Cancer and cancer therapies can lead to the development of anaemia, iron deficiency (ID) or both.12
About 40 % of cancer patients are found to have anaemia when they are first diagnosed with cancer and over 60 % of cancer patients become anaemic at least once during the first six months after the diagnosis. 12 One possible cause of this anaemia is ID and around 30-45 % of people across all types of cancers are iron deficient.12
There are many reasons why you may be iron deficient if you have cancer. Some of these reasons are dependent on the type of cancer you have.12 These include:
- Gastrointestinal or colorectal cancer: you might be losing blood, and therefore iron1
- Some gynaecological cancers12,13
- Chronic inflammation can occur with all types of cancers: an inflammatory state within the body disrupts the iron transport systems, and the body’s iron stores cannot be delivered to the bone marrow where they are needed for red blood cell production, leading to decreased red blood cell production and anaemia13
Cancer therapies can also lead to the development of anaemia. Chemotherapy can suppress the production of red blood cells in your bone marrow, and this effect can get worse with multiple rounds of chemotherapy.13 To help with your anaemia during chemotherapy you may be given erythropoiesis-stimulating agents (ESAs) which work by signalling the production of red blood cells.2,14 For ESAs, to work best, your doctor may need to prescribe extra iron to ensure that you have enough iron to make haemoglobin for the new red blood cells.12-14
Iron supplementation for chronic heart failure
If you have been told you have chronic heart failure (CHF) it means that your heart is not working well enough to pump the blood to your organs and tissues around your body.15
Your heart may have been damaged or weakened by several conditions such as coronary artery disease, high blood pressure, heart valve defects or other factors such as alcohol misuse or viral infection.16
About 50 % of heart failure patients have some form of iron deficiency (ID), with or without anaemia.17,18 If you are suffering from CHF, there are a few reasons why you may also be suffering from ID:18
- You may be absorbing less iron from your food into your bloodstream because of changes to the gut wall19
- You may not have enough iron in your diet
- Drug interactions may reduce the amount of iron you absorb19
- Medications may also cause internal bleeding which means that more iron is lost from your body than normal18
Iron supplement for chronic kidney disease
Chronic kidney disease (CKD) occurs when you have kidney damage or reduced kidney function for more than three months.21
It can be caused by many factors, such as high blood pressure and diabetes.21 Your doctor may tell you that you have a particular stage of CKD between stage 1 and stage 5, where 5 is the most serious.21
If you have been diagnosed with CKD, your chance of having anaemia increases. Iron deficiency (ID) may be playing a role in this anaemia. The stage of your CKD influences your likelihood of becoming anaemic. As your stage increases, it becomes more likely you will also suffer from anaemia.22
If you do become anaemic with your CKD, ID may be the cause. ID in CKD may occur due to:
Blood loss (and therefore iron loss) from:
- Frequent blood tests23
Lower iron intake, caused by:
- Eating less iron-rich food22
- Reduced absorption of iron into bloodstream14,22
- Treatment with an erythropoiesis-stimulating agent (ESA)14
Fatigue is a well known symptom of anaemia and CKD.24 If you are experiencing fatigue it is important to talk to your doctor. Fatigue, and other signs and symptoms, that are caused by ID can be treated, and your doctor can recommend the most suitable treatments for you.
Iron supplementation for coeliac disease
Coeliac disease and iron deficiency (ID) often occur together.25
Having coeliac disease increases your chances of also being iron deficient,25 and it’s even possible that your doctor found you to be iron deficient before they diagnosed you with coeliac disease.26
Coeliac disease is a condition where your immune system attacks your intestines when you eat gluten, which is found in wheat, barley and rye. This causes the lining of your small intestine to become inflamed and sometimes damaged.26,27
If you have inflamed or damaged intestines because of coeliac disease, it is likely that nutrients such as iron, folic acid and vitamin B12 are not absorbed well from your food into your bloodstream.25 In the case of iron, this can lead to ID and iron deficiency anaemia (IDA).25 As well as the reduced uptake of iron from your diet, coeliac disease can cause internal bleeding in your gastrointestinal tract.25 This loss of blood means that more iron is lost from your body than normal, which could also lead to ID.
You are also at greater risk of ID if you have coeliac disease and you are:28
- Pregnant, as pregnancy increases the iron demands on your body
- Premenopausal women, as your “period” increases the amount of iron lost from your body
- An athlete
Once you are following a gluten free diet it is likely that your iron levels will improve but you may also need to be treated with extra iron to replenish the iron levels in your body.25
Talk to your doctor if you are concerned about your health or you are experiencing any of the signs and symptoms of ID. Fatigue is a well-known symptom of coeliac disease,27 as well as restless-legs syndrome 29 and hair loss.27 It is important that you discuss all your signs and symptoms with your doctor at your next appointment.
Iron supplementation for inflammatory bowel syndrome disease
Inflammatory bowel disease (IBD) is the name for a group of chronic conditions where sections of your gastrointestinal tract becomes inflamed.
The two most common forms of IBD are Crohn’s disease and ulcerative colitis.30 If you have IBD, your risk of also having iron deficiency (ID) and iron deficiency anaemia (IDA) increases.31 In patients with IBD, 36-76 % experience IDA.32
Anaemia is a frequently occurring problem in patients with IBD, and IDA is the most common cause. 30 Other causes of anaemia in IBD patients include:30
- Anaemia of chronic disease (inflammation)30
- Anaemia due to decreased absorption of Vitamin B12 and folate in inflamed regions of the gastrointestinal tract30
- Drug-induced anaemia30
Anaemia affects the majority of patients with IBD, with the average IBD patient being anaemic one out of every five months. 33 It is important that anaemia, whether due to ID or any of the other reasons mentioned, is treated. ID can lead to a reduced work capacity, and if symptoms are severe, can cause an extended hospital stay. If you think you may have signs and symptoms of ID, it is important that you talk to your doctor
Iron supplement for rheumatoid arthritis
Rheumatoid arthritis (RA) is a chronic inflammatory condition, that causes pain and swelling in your joints.34 Anaemia is common in RA, with 30-70 % of RA patients being anaemic.35
There are several types of anaemia that can occur in patients with RA:
- Anaemia of chronic disease (ACD): where your body stores a good amount of iron but the release of iron from your stores is reduced, reducing iron available for red blood cell production36
- Iron deficiency anaemia (IDA): where the amount of iron stored in your body is too low for your body’s needs, meaning that you cannot make the normal number of healthy red blood cells, due to reduced iron availability for uptake into red blood cells36,37
ACD and IDA oftentimes occur together in patients with RA.35 ID can also occur without anaemia, and you may still experience signs and symptoms of ID).35
Iron supplement for restless legs syndrome
Restless legs syndrome (RLS) is a condition, which can lead to you feeling unpleasant creeping, tingling or burning in your legs and an urge to move your legs when you are resting.38
RLS is associated with ID and IDA.38,39 In people who have increased risk of ID, such as pregnant women,38 patients with chronic kidney disease (CKD),38 patients undergoing haemodialysis,40 and people with coeliac disease41 are also more likely to have RLS.
Iron supplement for special diets (vegetarian and vegan)
A well-balanced vegetarian or vegan diet should be sufficient to keep your iron levels up. 42 However, if you eat a restricted vegetarian diet (e.g. macrobiotic diet), you may have a greater risk of being iron deficient.42
Iron from plant sources is not as easily absorbed as iron from animal sources and its uptake can also be reduced by other food and drinks, such as tea, coffee and dairy products.43 If you are a vegetarian or vegan, you rely on iron from plant-based sources. It is important that you:43
- Eat a variety of iron-rich foods
- Eat foods that increase the absorption of iron
- Avoid foods that inhibit iron absorption around the time you are eating iron-rich meals
- Mayo Clinic. Iron deficiency anemia. [Online] 2016 Nov 11 [cited 2018 Feb 19]. Available from: URL: https://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034.
- Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci 2014;19(2):164-174.
- Breymann C. Iron deficiency anemia in pregnancy. Expert Rev Obstet Gynecol 2013;8(6):587-596.
- Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Ann Hematol 2011;90:1247–
- Peeling P, Dawson B, Goodman C, Landers G, Trinder D. Athletic induced iron deficiency: new insights into the role of imflammation, cytokines and hormones. Eur J Appl Physiol 2008;103:381-391.
- Geisser P. Safety and efficacy of iron (III)-hydroxide polymaltose complex: A review of over 25 years experience. Arzneimittel-Forschung 2007;57(6a):439-452.
- Borbolla JR, Cicero RE, Dibildox M, Sotres D, Gutiérrez R. Iron hydroxide polymaltose complex vs iron sulphate in the treatment of iron deficiency anaemia in infants. Revista Mexicana de Pediatria 2000;57(2):63-67.
- Yasa B, Agaoglu L, Unuvar E. Efficacy, Tolerability, and Acceptability of Iron Hydroxide Polymaltose Complex versus Ferrous Sulfate: A Randomized Trial in Pediatric Patients with Iron Deficiency Anemia. Int J Pediatr 2011;2011:1-6.
- Buchwald H, Oien DM. Metabolic/bariatric surgery worldwide 2011. Obes Surg 2013;23(4):427-436.
- Jáuregui-Lobera I. Iron deficiency and bariatric surgery. Nutrients 2013;5(5):1595-1608.
- Love AL, Billet HH. Obesity, bariatric surgery, and iron deficiency: true, true, true and related. Am J Hematol 2008;83(5):403-409.
- Aapro M, Österborg A, Gascón P, Ludwig H, Beguin Y. Prevalence and management of cancer-related anaemia, iron deficiency and the specific role of i.v. iron. Ann Oncol 2012;23(8):1954-1962.
- Janis M. Supportive Oncology Iron Deficiency Anemia in Cancer Patients. Oncol Hematol Rev 2012;8(2):74-80.
- Wittwer I. Iron deficiency anaemia in chronic kidney disease. J Ren Care 2013;39(3):182-188.
- Cleveland Clinic. Heart failure: Understanding Heart Failure. [online] [cited 28 Febr 2020] Available from: URL: https://my.clevelandclinic.org/health/diseases/17069-heart-failure-understanding-heart-failure
- Cowie MR, Mosterdft A, Wood DA, Deckers JW, Sutton GC, Grobbeef DE. The epidemiology of heart failure. Eur Heart J 1997;18:208-225.
- Ebner N, von Haehling S. Iron deficiency in heart failure: a practical guide. Nutrients 2013;5(9):3730-3739.
- Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J 2013;165(4):575-582.
- Mcdonagh T, Macdougall IC. Iron therapy for the treatment of iron deficiency in chronic heart failure: intravenous or oral? Eur J Heart Fail 2015;17(3):248-262.
- Jankowska E a, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010;31(15):1872-1880.
- Levey AS, Coresh J. Chronic kidney disease. The lancet 2012;379(9811):165-180.
- Mehdi U, Toto RD. Anemia, diabetes, and chronic disease. Diabet Care 2009;32(7):1320-1326.
- Fishbane, Pollack S, Feldman HI, Joffe MM. Iron indices in chronic kidney disease in the National Health and Nutritional Examination Survey 1988-2004. Clin J Am Soc Nephrol 2009;4(1):57-61.
- Macdonald JH, Fearn L, Jibani M, Marcora SM. Exertional fatigue in patients with CKD. Am J Kidney Dis 2012;60(6):930-939.
- Halfdanarson TR, Litzow MR, Murray JA. Hematologic manifestations of celiac disease. Blood 2007;109(2):412-421.