Iron Supplements: When do you need them? What are the risks? Why does iron deficiency occur and what does it cause?

Iron supplements

Symptoms of Iron Deficiency

Severe fatigue

Poor performance

Poor cognition (thinking)



Passing out (syncope)

Shortness of breath

Chest pain

Heart Attack of Stroke (severe cases)

Iron supplements are widely prescribed around the world mostly in an attempt to treat anemia, or low blood count, even though most doctors know that the only kind of anemia that iron supplements help is iron deficiency anemia. There are many other kinds of anemia, of course that iron doesn't help, but sometimes we do it anyway, because we're not sure if iron deficiency may be playing a role or not, and because it's cheap, and because there is not much risk to taking it.

However, if we follow our usual rule that we shouldn't really take a lot of supplements if we don't need them, then we should really only take an iron supplement if we know that we're iron deficient (as measured by a blood test), or if there is a significant risk of developing iron deficiency - as in the case of pregnant women, menstruating women, infants, patients with severe kidney disease or those with chronic disorders of the gastrointestinal tract.

Iron Deficiency

How does one become iron deficient?

  • Poor nutrition - poorly balanced diet lacking in many of the food sources indicated below.

  • Chronic blood loss - often caused by menstruation in pre-menopausal women or by some internal gastrointestinal bleeding that we're often not aware of 'til we develop symptoms of anemia. Chronic loss of blood on a regular basis from almost any source can cause or contribute to iron deficiency. Iron can also be lost during kidney dialysis.

  • Malabsorption - meaning that the iron we take in is going right back out without being absorbed into the blood stream where it can be used by the tissues. This is usually caused by a decrease in gastric acid that occurs gradually as we get older. The iron that we ingest needs a certain amount of stomach acid to be absorbed. If the acid is not there, the iron doesn't get absorbed and we can become deficient. One way to avoid this malabsorption is to take iron supplements with vitamin C (ascorbic acid). This will aid in the absorption of iron.
  • Other potential causes of malabsorption include prior gastric bypass surgery, Celiac disease, and any inflammatory condition involving the small intestine where most of the iron is absorbed.

    One other group of people that can develop iron deficiency or at least borderline low iron levels are athletes who engage in intensive exercise routines like jogging, cycling or swimming, especially female athletes, long distance runners and cyclists or vegetarian athletes. Make sure you get adequate nutritional sources of iron if you're in one of those categories and get checked by a doctor if you develop any of the symptoms mentioned below.

    It's important to remember that each and every one of the vitamins and minerals work together for a common goal - your well-being! Your body works in harmony when it has everything it needs. If you're deficient in one vitamin or mineral, you're likely to experience toxicity or deficiency symptoms of other vitamins and minerals.

    What happens in Iron Deficiency?

    The greatest use of iron in the body is related to the production of red blood cells - the oxygen-carrying round concave little cells in our blood without which we cannot survive. Each red cell contains molecules of hemoglobin which is what the oxygen binds to when it's being carried around in our blood into the capillaries where it is then transmitted into the tissues to be used by other cells. Our bodies make hemoglobin from iron. Thus, if we are iron deficient, we won't have enough hemoglobin to make red blood cells and we then become anemic.

    Further more, we need vitamin B6, vitamin B12, and folic acid along with other nutrients to create your red blood cells! The end result is anemia.

    What happens if we're anemic?

    The symptoms of anemia include the following:
  • Severe fatigue

  • Poor performance

  • Poor cognition (thinking)

  • Dizziness

  • Lightheadedness

  • Passing out (syncope)

  • Shortness of breath

  • Chest pain

  • Also, in severe cases, it can lead to stroke or heart attack.

    Sources of Iron

    The main food sources of iron include almost any kind of meat or fish product, oatmeal, beans, lentils, soybeans, tofu, raisins, bread (white or wheat), grits, spinach, black-eyed peas and molasses. Vegetarians need to be especially careful to take in plenty of the not-meat items mentioned since the amount of iron those items contain is 2/3 less than the amount they would get in the same amount of meat.

    Iron Toxicity

    An acute iron overdose can be lethal, so we should always be cautious not to leave medicines or supplements within the reach of children.

    Long term use of an iron supplement when it is not needed can also cause significant liver disease, called hemachromatosis. This is usually a genetic disorder resulting in excessive absorption of iron from the diet. The same effect however can occur in those who take excessive iron supplements over a long time (years) when there is no reason to do so. Hemachromatosis is a severe potentially fatal liver disease and can also lead to heart failure and diabetes. If you don't fall into one of the groups mentioned above as being at high risk for iron deficiency, or if you haven't been diagnosed with iron deficiency by your doctor, then you probably shouldn't be taking it.

    One other side effect of taking iron supplements worth mentioning is that they are sometimes very constipating and can also cause nausea in many people.

    Additionally, iron supplements cause the stool to turn black, which can be confusing to someone who knows that blood in the gastrointestinal track also turns the stool black. So if you're taking an iron supplement and your stool becomes black, you won't know if it's just the iron or if you're bleeding internally till you stop the iron or have your stool tested by your doctor. Pepto Bismol and Kaopectate, incidentally, have the same effect of turning the stool black.

    Once again, iron is an essential mineral for us and iron deficiency can be a severe illness, but so can iron toxicity and overload. If you think you have symptoms of iron deficiency, don't just start taking iron supplements. See your doctor so you can be sure you're doing the right thing.

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