Iron deficiency and iron deficiency anaemia
Iron is one of the essential trace elements and therefore cannot be produced by the body itself. It plays a central role in the energy balance and numerous metabolic processes.
Find out here about the causes and symptoms of a deficiency and why anaemia should be compensated for through therapy or diet.
Why does the body need iron?
About 30% of the world's population is affected by iron deficiency anaemia. This anaemia means that the body cannot produce enough of the blood pigment "haemoglobin", which is found in the red blood cells (erythrocytes) and whose job it is to bind oxygen and pass it on to the cells. The consequences are shortness of breath during exercise, poor performance, palpitations and fatigue.
The trace element iron is very important for the immune system as it is involved in many processes, particularly in the functioning of T cells, macrophages and general cell division.
The mitochondria convert fats and carbohydrates into ATP (adenosine triphosphate, energy for the cell). The body requires enzymes for these chemical reactions of the energy metabolism, which in turn are iron-dependent.
The formation of hormones is iron-dependent in many cases. For example, the thyroid hormone, which plays a role in metabolism and weight reduction, or dopamine, which is important for ADHD.
Iron plays a major role in connective tissue, as it is involved in the production of type 1 and 3 collagen fibres. These play a major role in skin, hair, mucous membranes, fingernails and toenails, as well as in the highly stressed tendons of athletes.
The body needs myoglobin and iron as its binding site to transport oxygen to the muscle cells. In this case, an iron deficiency leads to rapid muscle fatigue. The central nervous system relies on iron to prevent symptoms such as weakness, dizziness, exhaustion, dementia and depression.
What is the difference between iron deficiency and iron deficiency anaemia?
In the case of iron deficiency, the body first depletes its iron reserves. Only when these have been used up does iron deficiency anaemia develop. In this case, the haemoglobin content (red blood pigment) or the proportion of red blood cells (erythrocytes) is too low, which reduces the capacity of the blood to transport oxygen and carbon dioxide. Signs of anaemia are often tiredness and difficulty concentrating. The cause of anaemia is either insufficient replication (e.g. due to a lack of micronutrients) or excessive consumption of blood cells (e.g. due to bleeding in the gastrointestinal tract or very heavy menstruation).
What symptoms occur with an iron deficiency?
As long as the body can draw on iron reserves, the red blood pigment haemoglobin is still within the normal range. The symptoms of iron deficiency only become apparent once the reserves are depleted and the iron in the blood has to be used. Complaints such as headaches, sensitivity to cold, increased nervousness and loss of performance can then be the result. Dizziness, pallor, dry skin, increased susceptibility to infections, brittle nails, pain when swallowing and a burning tongue (Plummer-Vinson syndrome) can also occur. Iron deficiency can be a cause of the so-called burn-out syndrome with severe fatigue, mental exhaustion and depression. Symptoms such as ADHD [3], depression, forgetfulness and memory impairment have also been linked to iron deficiency [4].
How is iron deficiency diagnosed?
In order to obtain a clear diagnosis of the iron balance, the following values are read from the blood count:
- Erythrocytes (number of red blood cells)
- Haemoglobin value / Hb- red blood cells)
- Reticulocytes (not yet fully mature precursor of red blood cells)
- Transferrin / transferrin saturation (transport protein for iron)
- Soluble transferrin receptor / sTfR (receptors for the uptake of iron into the red blood cells)
- Ferritin- value / storage iron (water-soluble protein, that stores iron and protects cells from the damaging effects of free iron) [2]
How does iron deficiency develop and what diseases cause it?
Low dietary iron intake:
An iron deficiency anaemia can occur as a result of an unbalanced, meat-free diet or unbalanced diets. It often affects infants, small children, vegetarians, alcoholics and people with eating disorders in particular.
Impaired iron absorption:
Chronic inflammatory gastrointestinal diseases such as Crohn's disease. Gastritis or infection with the bacterium Helicobacter pylori can be a reason for impaired absorption of the trace element. Long-term use of medication against excessive stomach acid production (antacids) and caffeine from black tea or coffee can also hinder absorption. Simultaneous intake of calcium, also through the diet, can hinder the effectiveness of iron. Phosphoric acid from soft drinks containing caffeine can even prevent this!
Chronic blood loss:
Bleeding in the gastrointestinal tract is the most common cause [1] of iron deficiency anaemia. It can be caused by diseases such as gastritis (inflammation of the stomach lining), ulcers, haemorrhoids or cancer in the gastrointestinal tract. Bleeding from the urinary tract or genital organs (menstruation) is often the cause of iron deficiency anaemia in young women, especially if they are prone to heavy bleeding. Growths in the uterus (fibroids) and endometriosis also result in a higher iron requirement.
People affected by kidney disease lose around 2.5 litres of blood per year through dialysis and therefore have an increased iron requirement. They are therefore often dependent on treatment with oral iron supplements or an iron-rich diet.
However, iron deficiency anaemia can also be caused by chronic bleeding gums or nosebleeds or blood loss through blood donations.
What are the consequences of an untreated iron deficiency?
A severe iron deficiency can lead to anaemia in humans, which increases the risk of cardiovascular disease and can cause heart muscle weakness. Other symptoms can include restless legs syndrome or chronic fatigue syndrome, as well as an increased susceptibility to infections. It is therefore essential to treat the deficiency once a diagnosis has been made.
Which foods can compensate for an iron deficiency?
Symptoms can often be compensated for with a healthy diet. Care should be taken to eat a diet with a high iron content. Vegetarians and vegans in particular should find out which plant-based foods contain a high level of plant-based iron in order to avoid possible anaemia. Particular attention should be paid to any symptoms of iron deficiency anaemia during pregnancy. This is caused by an increased iron requirement due to the embryo being supplied with iron via the blood.
Haemic iron, i.e. bivalent iron (Fe), is mainly found in red meat and sausage products. This animal protein has a high bioavailability for the human body. Eggs should not be ignored here either, as they are among the very good sources of iron.
As plant-based iron comes in a compound, it sometimes also contains components that can inhibit iron utilisation. These include phytates and oxalic acid, for example. These can bind to the iron and inhibit its availability to our organism. However, plant-based foods also offer a wide range of other nutrients that have a beneficial effect on the nutrient balance.
Good plant-based sources of iron include beetroot, Brussels sprouts, fennel, kale, spinach, Swiss chard, wholemeal cereal products, pulses such as lentils or chickpeas, oat flakes, sesame seeds, pumpkin seeds and soya. Also millet, amaranth, quinoa, cocoa and especially berries such as redcurrants, elderberries, blackberries, blueberries and mulberries. Cooked and ripe bananas are also good sources of iron. Nuts also have a good content of the trace element, especially pistachios, cashews and hazelnuts.
As vitamin C improves the body's absorption of iron, it is advisable to take this vitamin with both animal and vegetable iron to avoid anaemia despite a balanced diet.
What inhibits iron absorption?
In order to be able to optimally utilise iron, it is advisable to maintain a regular interval between the intake of iron-containing foods and the following:
Calcium-containing foods, such as milk and dairy products, as well as food supplements with calcium
Caffeinated foods, such as coffee, black and green tea
Phosphoric acid, such as in special soft drinks.
What promotes iron absorption?
A simultaneous intake of vitamin C and foods containing vitamin C (e.g. a glass of orange juice) can increase iron utilisation, especially as it is required for the formation of erythrocytes.
- Vitamin A supports the transport of iron in the body
- Vitamin B2 (riboflavin) improves haemoglobin levels
- Vitamin B12 is required for the production of erythrocytes
- Folic acid is needed to build erythrocytes. is needed to build erythrocytes
- Copper supports iron absorption from the intestine
- Zinc promotes more effective compensation of iron deficiency
Why are women particularly often affected by a pronounced iron deficiency?
Women lose a particularly large amount of iron during menstruation, as the monthly blood loss attacks the body's own reserves. The red blood cells bind oxygen and contain a large proportion of all the iron.
What are the consequences of an iron deficiency during pregnancy?
During pregnancy, there is an increased need for iron as the embryo needs to be supplied with it. A deficiency increases the risk of premature births and miscarriages, as well as the risk of growth retardation and malformations, particularly in relation to the embryo's brain development.
Immediately after giving birth, women often suffer from postpartum depression due to the large blood loss of childbirth and the associated higher iron requirement. Why are women more likely to have an iron deficiency during the menopause? The early stages of the menopause in particular are associated with heavy bleeding and frequent intermenstrual bleeding, which exacerbates the cause of anaemia during this phase. Women in this phase often experience tissue changes in the uterus, such as polyps and fibroids. They are often the cause of heavy menstrual bleeding and thus provoke a higher iron deficiency during the menopause.
How is an iron deficiency linked to depression?
An iron deficiency can put a strain on the psyche. The trace element is responsible for the formation of myelin, which insulates the nerve cells and gives them a framework. A sufficient supply of iron is also necessary for the formation of neurotransmitters such as dopamine and serotonin. A deficiency therefore has a direct influence on a person's ability to think and memory.
How quickly do iron supplements work?
Depending on how high the deficit is, it can take between 2 weeks and 6 months for the iron stores to be replenished. A noticeable improvement usually occurs after just a few days of treatment.
Sources
[1] https://www.onkopedia.com/de/onkopedia/guidelines/eisenmangel-und-eisenmangelanaemie
[2] https://www. kbv.de/media/sp/KBV_LaborDiagnostik_Eisenmangel.pdf
[3] https://cordis.europa.eu/article/id/150898-brain-iron-levels-in-adhd-patients/de
[4] https://www.internisten-im-netz.de/krankheiten/eisenmangel/krankheitsbild.html
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