Obviously, there are many reasons for fatigue, but I wanted to discuss Iron its roles in the body and why supplementing might not be the first answer…

Lets pump some Iron! (Fe)

Iron:

Iron (Fe) as an essential mineral for use in the body, as humans do not make our own iron (Tish, 2013) – we must consume it from food products, most well know and abundant being red meat. It also can be found in vegetables and fruit; however, the chemical make-up and actions tend to be different between these two food types, as well as how they absorbed. Red meat contains ‘heme’ iron which is utilized to make hemoglobin and ‘non-heme’ is derived from plant and fortified sources.

Iron in the body:

The iron mineral is required for essential mechanisms in the body. It is needed for ATP synthesis and used in enzyme reactions to make new DNA and also plays a role in immune system enzymatic reactions (Tis, 2013). Iron is an oxygen lover and attracts it wherever it goes: brain, muscle or blood. It is an essential chemical of myoglobin, as it helps attract oxygen in the muscle cells. Iron gives the red pigment of the blood and of course allows for oxygen carrying in the red blood cells (Iron deficiency, 2017) known as hemoglobin – which is where most of the iron in our body resides.

Absorption:

• Non heme iron is not as-well absorbed as Heme sources

• The breakdown of iron from dietary sources requires enzymes and Low stomach pH

• Absorption also requires Vitamin C

• Some anti-nutrients inhibit the absorption (caffeine or oxalates)

• Some good nutrients compete for binding sites(calcium and zinc)

 

The ‘heme’ compound found in iron is biologically important. Non-heme and heme iron are absorbed non-competitively, however non-heme iron is not as well absorbed and heme iron. West & Oates (2008) point out that heme’s solubility increases in the presents of protein, but the actual mechanism and catabolism of iron are not well understood. Vitamin C or ascorbic acid foods have been known to increase the bio availability of iron for absorption (Hallberg, Brune & Rossander-Hulthen, 1987).

I found this diagram helpful to understand the absorption pathways (Firgure 1 West & Oats, 2008)

 

Low Iron levels

Might look like:

• Fatigue

• Weakness

• Pale skin

• Shortness of breath

• Cold hands and feet

• Brittle nails

• Sore tongue or gums

• Heart palpitations

• Restless leg syndrome

 

Why does it happen?

• Blood loss – most obvious and overt

• Pregnancy – during pregnancy iron stores are used for their increased blood volume and for the blood required for the fetus.

• Lack of intake

• Low stomach acid

• Calcium, soy, caffeine and tannin intake at the same time

• Can be caused by intake of medications like (proton pump inhibitors or NSAIDS) or anything that may cause imbalance in stomach acid pH or enzyme function.

• Serious illness – stomach ulcers, inflammatory bowel disease or cancer.

• Copper deficiency can cause a similar symptoms as iron deficiency (Ha et al., 2016)

 

Iron or heme is release from proteins ingested (hemoglobin and myoglobin) via the low stomach acid and the proteolytic enzymes (Hooda, Sha & Zhang, 2014) in the small intestine and stomach.

Calcium as well as soy-based foods, caffeine, tannin (found in black tea) can all compete for absorption of iron (Ford-Martin, 2018).  Too little iron in our body can obviously cause a myriad of issues due to the lack of oxygen carrying, and result in corresponding symptoms: shortness of breath, fatigue, pale skin, weak nails, concentration problems, etc (For-Martin, 2018). Iron deficiency has also been associated with restless leg syndrome (Zhu et al., 2020; Restless legs syndrome, 2019). Copper deficiency can mirror iron deficiency or even cause some symptoms as copper is necessary for iron metabolism (Ha et al., 2016).

One case study demonstrated that prolonged use of proton pump inhibitors can result in iron deficiency anemia (Imai, Higuchi, Morimoto, Koyamada & Okada, 2018). This might be related to the fact that proton pump inhibitor drugs can increase hydrochloric acid pH, which prevents the absorption of iron, calcium, vitamin B12 and magnesium (Ito & Jensen, 2010; Heidelbaugh, 2013; Kines & Krupczak, 2016).

 

Too much Iron is not great either!

 

If too much iron is absorbed, then it cannot be utilized and builds up in the body and blood stream which can create imbalances in the body. It is noted that increased level of hemoproteins has been correlated with increase oxygen consumption and the progression of certain cancers (Hooda et al., 2014).

What can we do?

• Correct the root cause of an iron deficiency – as supplement may not be absorbed!

• Ensure you have adequate/low enough stomach acid – ask me how!

• Eat vitamin C or ascorbic acid rich foods with your iron sources or supplement

• Avoid consuming calcium rich foods, soy, caffeine or black tea (phytates or tannins) while you eat your iron sources.

• Eat sources of iron regularly

Iron rich sources:

• Organ meat

• Meat and poultry

• Seafood

• Beans

• Dark green leafy vegetables like spinach – wilt your spinach for best iron absorption as it removes the oxalates from binding to the iron.

• Peas

• Iron fortified breads and cereals – keep it organic and integral

 

*Remember supplementing before you know the root cause could leave you with unnecessary symptoms/side effects AND wasted money and resources.

Questions!?

 

Kaley

MN BN CNC

 

References:

 

Ford-Martin, P. (2018). Iron. In J. L. Longe (Ed.), Gale virtual reference library: The Gale encyclopedia of nursing and allied health (4th ed.). Gale. Credo Reference: https://search.credoreference.com/content/entry/galegnaah/iron/0?institutionId=129

 

Ha, J. H., Doguer, C., Wang, X., Flores, S. R., & Collins, J. F. (2016). High-Iron Consumption Impairs Growth and Causes Copper-Deficiency Anemia in Weanling Sprague-Dawley Rats. PloS one, 11(8), e0161033. https://doi.org/10.1371/journal.pone.0161033

 

Hallberg, L., Brune, M., & ROSSANDER‐HULTHÉN, L. E. N. A. (1987). Is there a physiological role of vitamin C in iron absorption?. Annals of the New York Academy of Sciences, 498(1), 324-332. Retrieved from https://nyaspubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1749-6632.1987.tb23771.x

 

Heidelbaugh, J. J. (2013). Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Therapeutic advances in drug safety, 4(3), 125-133. Retrieved from https://journals.sagepub.com/doi/full/10.1177/2042098613482484

 

Hooda, J., Shah, A., & Zhang, L. (2014). Heme, an essential nutrient from dietary proteins, critically impacts diverse physiological and pathological processes. Nutrients, 6(3), 1080–1102. https://doi.org/10.3390/nu6031080

 

Imai, R., Higuchi, T., Morimoto, M., Koyamada, R., & Okada, S. (2018). Iron deficiency anemia due to the long-term use of a proton pump inhibitor. Internal Medicine, 57(6), 899-901. Retrieved from; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5891535/

 

Iron deficiency. (2017). In Harvard Medical School (Ed.), Health reference series: Harvard Medical School health topics A-Z. Harvard Health Publications. Credo Reference: https://search.credoreference.com/content/entry/hhphealth/iron_deficiency/0?institutionId=129

 

Ito, T., & Jensen, R. T. (2010). Association of long-term proton pump inhibitor therapy with bone fractures and effects on absorption of calcium, vitamin B12, iron, and magnesium. Current gastroenterology reports, 12(6), 448–457. https://doi.org/10.1007/s11894-010-0141-0

 

Kines, K., & Krupczak, T. (2016). Nutritional Interventions for Gastroesophageal Reflux, Irritable Bowel Syndrome, and Hypochlorhydria: A Case Report. Integrative medicine (Encinitas, Calif.), 15(4), 49–53. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991651/

 

Restless legs syndrome. (2019). In Harvard Medical School (Ed.), Harvard Medical School special health reports. Harvard Health Publications. Credo Reference: https://search.credoreference.com/content/entry/hhpharvard/restless_legs_syndrome/0?institutionId=129

 

Tish, D. A. (2013). Iron. In K. Key (Ed.), The Gale encyclopedia of diets: a guide to health and nutrition (2nd ed.). Gale. Credo Reference: https://search.credoreference.com/content/entry/galediets/iron/0?institutionId=129

 

West, A. R., & Oates, P. S. (2008). Mechanisms of heme iron absorption: current questions and controversies. World journal of gastroenterology: WJG, 14(26), 4101. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725368/

 

Zhu, X. Y., Wang, H. M., Wu, T. T., Liu, T., Chen, Y. J., Li, X., … & Wu, Y. C. (2020). SNCA-Rep1 polymorphism correlates with susceptibility and iron deficiency in restless legs syndrome. Parkinsonism & Related Disorders, 81, 12-17. Retrieved form https://www.sciencedirect.com/science/article/abs/pii/S135380202030729X