Iron Deficiency: Fatigue, Hair Loss and More
Low iron and iron-deficiency anemia is much more common than most of us realize. Symptoms of fatigue, weakness, irritability, hair loss and insomnia are often not seen as being related to low iron levels, but they often are. Despite the fact that women need more than double the amount of iron than men, one out of every five women of childbearing age has iron-deficiency anemia.
Fatigue is a major concern for many of my patients. There are so many factors that could be playing a role in your fatigue. It’s vital to make sure that you’re ruling out all the major factor of your tiredness.
Hair loss is also a major issue I see in clinic. While the answer could lie in hormone imbalance, stress response or a dozen other issues, iron deficiency is an easy and important etiology to make sure you’re checking for.
Depression and anxiety can also be caused, in part, by low iron. Studies show that folks with depression tend to have significantly lower levels of ferritin, the iron we keep in storage for later use. When your body is carrying less oxygen, you’re more likely to spike your fight/flight/freeze response, which can lead to boatloads of anxiety.
What Does Iron Do?
Iron is important for the production of hemoglobin. This substance in red blood cells helps the cells to carry oxygen to all your body’s tissues. A decrease in iron results in less oxygen being transported around your body in your blood stream. Low oxygen in your tissues and muscles can lead to increased pain, inflammation and discomfort and can leave you feeling weak and tired.
Common Symptoms of Low Iron Levels Include:
- Fatigue (can get chronic or extreme, but in healthy young folks can feel like just a bit of the blahs)
- Weakness (again, can be intense when iron is very low… but can also just make you feel weaker than usual for you)
- Headaches, dizziness, lightheadedness
- Thinning hair (I see this in clinic super often!)
- Brittle nails
- Cold hands and feet
- Chest pains
- Pale skin
It’s important for all of us to get our iron checked regularly. It’s particularly important for those of us who get a menstrual period every month, and, thus, lose blood.
It’s possible to have Too much iron. Iron can build up in your blood, and too much iron intake can be harmful. Iron overdose is a real thing. Along with vitamins A, D and E, iron can build up in your body.
While iron toxicity is rare, it is not recommended that folks take an iron supplement without regular bloodwork to confirm levels. Food is a safer bet for most people, as it’s harder to overdose on iron through food.
Other Reasons for Having Too Much Iron
Ferritin, a storage form of iron, is what’s called an “acute phase reactant.” This means it goes up when there is an infection, either acute or chronic. Ferritin can stay elevated until the infection is managed. I most often see elevated ferritin levels when there are gut infections, imbalances in your gut microbiome, or viruses like Epstein-Barr Virus.
If you have hemochromatosis or another issue where your body holds on to excess iron, please check with your health care provider before increasing your iron intake. Yes, this applies to food too my loves. Better safe than sorry!
What Tests Should I Get?
In my clinic I check: Iron, Total Iron Binding Capacity (TIBC), ferritin and a complete blood count or CBC to get a full picture of iron levels and cellular health.
Common Causes of Low Iron
Some common causes of iron deficiency anemia include:
- Blood loss
- Your red blood cells have iron within them. When you lose blood, you loose some iron.
- Folks with heavy periods can become iron deficient because of that blood loss.
- Those with digestive issues are also at risk of iron loss
- ulcers, hernia, hemorrhoids, colon polyps can all come with blood loss.
- Aspirin or other over-the-counter medications and pain relievers can lead to a slow bleed in their guts from these drugs.
- The Gut is Where it’s At!
- As always, your digestion is vital for so many bodily functions.
- Iron from your food is absorbed in your small intestine.
- If you have celiac disease, Small Intestine Bacterial Overgrowth (SIBO) or other imbalances in your gut bacteria (dysbiosis) you may not be able to absorb iron and other nutrients well.
- Folks who have had small intestine surgery are also at risk of iron deficiency.
- Not taking enough iron in
- Seems obvious to say it, but if you’re not eating enough iron… you’re not getting enough iron to replace the iron your body uses up!
- In pregnancy your blood volume goes up. Iron stores are used up by your fetus. That iron needs to be replaced!
How Do I Increase My Iron Levels?
A simple solution is to eat more foods that contain iron. If that’s not doing the trick, follow up with a digestion specialist to see if your gut could be the issue.
Many lists of iron rich foods contain iron-fortified processed foods like cereals. I highly recommend that you focus on eating whole, unprocessed foods. Consider choosing a steak or some lentils over a processed breakfast cereal, which has little to no naturally-occurring nutrients left in it.
Heme iron from animal sources is better absorbed than the non-heme iron sources from plants.
Heme foods rich in iron:
- Oysters, mussels and clams
- Liver, beef or chicken
Non-heme Iron Sources
- pine nuts
- sunflower seeds
- cashews and white potatoes.
- Legumes (especially lentils).
- black strap molasses (1-2 Tbsp/day)
- Stinging Nettle Leaf tea steeped overnight to get the most iron out of it.
Consume vitamin C rich foods paired with non-heme iron-rich plant foods. For example, spinach and lemon juice; lentils and tomatoes; kale and sweet potato.
Iron Supplements Can be the WORST
Iron supplements get a bad rap – and often for good reason. The cheapo ones from the drug store, as well as the prescription ones, can cause yucky symptoms. Constipation, gas, bloating. No wonder people don’t take their iron!
I recommend getting iron from food when possible. When that’s not enough, I recommend herbs (like Nettles, above) and professional grade supplements. I lovvvve Strong Woman Syrup, it tastes glorious and it’s not constipating! I’ll put a link to my fave in pill form for you below.^
As always, fatigue can have so many sources. It’s important to get a proper work-up with a Functional Medicine provider if fatigue is a part of your life. In most cases, a cause like a gut imbalance, adrenal gland concerns, low iron, a virus or other infection, histamine issues or lifestyle issues like eating foods that don’t work for you can be the cause. Sometimes it’s something more insidious like cancer. Don’t panic – take action. Find a skilled holistic healthcare provider who can help you get sorted, and start making the changes you need to feel your best!
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^as always, discuss all supplements with your clinicians before starting them and make sure you’re not allergic to any of the ingredients!
Victoria Albina, NP, MPH is a licensed and board certified Family Nurse Practitioner, herbalist and life coach, with 20 years experience in health and wellness. She trained at the University of California, San Francisco, and holds a Masters in Public Health from Boston University and a bachelors from Oberlin College. She comes to this work having been a patient herself, and having healed from a lifetime of IBS, GERD, SIBO, fatigue, depression and anxiety.
She is passionate about her work, and loves supporting patients in a truly holistic way - body, mind, heart and spirit. A native of Mar del Plata, Argentina, she grew up in the great state of Rhode Island, and lives in NYC with her partner. A brown dog named Frankie Bacon has her heart, and she lives for steak and a good dark chocolate.
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