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Man working out outside after supplementing with iron

Do you find you are lacking the energy you need each day? Do you follow a plant-based diet? Have you recently donated blood? Do you have gastrointestinal issues? You may have an iron deficiency. Iron deficiency is so prevalent that the World Health Organization (WHO) has identified it as the most widespread nutritional deficiency in the world, affecting 25% of the world’s population.

The WHO says iron deficiency affects 2 billion people around the world. The lack of iron is more common in developing countries compared to the United States, as well as among vegetarians, vegans, young children, and women in their reproductive years. Surprisingly, WHO states that 20% of maternal deaths were due to anemia from iron deficiency.

Iron is an essential mineral responsible for transporting oxygen through the body by a protein called hemoglobin. Iron also plays a role in the nervous system, as iron levels impact dopamine, norepinephrine, and serotonin levels. If our blood iron levels drop, we may feel fatigued or have low energy, weakening our immune system. A deficiency may be caused by iron deficiency anemia or anemia associated with chronic disease.

Two Types of Iron

So why is iron deficiency common even in first-world countries? The most common reason is low iron intake in a normal diet. For example, fruits and vegetables are top sources of iron. However, a CDC study in 2019 found that less than 15 percent of Americans ate the recommended amount of fruits and vegetables. A daily multivitamin with iron can help support healthy eating habits to ensure iron absorption. There are two forms of iron in the diet: heme and non-heme. Heme iron is derived from hemoglobin; therefore, it is found in animal foods that originally contained hemoglobin. Good sources of heme iron are animal foods such as meat, fish, and poultry. The body better absorbs heme iron.

Non-heme iron can be found in enriched rice, fortified cereals, beans, seeds, and dark leafy greens. Although our diets contain more non-heme iron, this iron is not as readily absorbed by our bodies. People who follow a diet completely free of animal products (including eggs and dairy) are more likely to be iron-deficient. Still, lacto-vegetarians are also at risk for iron deficiency as dairy and eggs are non-heme.

What Can You Do To Increase Iron Levels?

  • Vitamin C combined with iron can increase iron absorption. Include fruits and vegetables high in vitamin C in the same meal as iron-rich foods. For example, have a piece of citrus fruit or a glass of orange juice with a breakfast containing an iron-fortified cereal. While the Cooper Clinic follows a food-first philosophy, the source of vitamin C does not impact how well the iron is absorbed. In addition to the vitamin C in Cooper Complete® multivitamins, we offer a 1000 mg Natural Vitamin C and a 250 mg vitamin C gummy.
  • Limit consumption of foods and beverages that inhibit iron absorption. Drinking coffee on a low-iron diet can reduce iron absorption by 24-73% during a meal. To maximize iron absorption from a meal or supplement, do not drink coffee with your meal or when taking iron supplements.
  • Cooking in cast iron cookware may provide additional iron to your diet. Researchers have found that cooking in an iron skillet increases the iron content of many foods. Soups, stews, and other dishes with high moisture content and foods with high acidities, such as apples, tomatoes, and spaghetti sauce, absorb the most iron. For example, one study published in the Journal of the American Dietetic Association found that the iron in 100 grams of spaghetti sauce increased from 0.6 mg to 5.7 mg after being cooked in a cast-iron pan. You can read more here about specifics for your cast iron.
  • About five percent of women and two percent of men have persistent and severe iron deficiency anemia. A gradual deficiency will develop if we consume less than our body needs or if absorption and storage are compromised. Iron supplements can help restore proper iron levels for people with a deficiency.
  • Healthy adults absorb about 10-15% of their daily iron intake. Current levels of iron stores have the most significant effect on our absorption; iron absorption increases when our levels are low. When the concentration is high, the absorption decreases.
  • Supplementation can help. Choose a multivitamin with iron. In the Cooper Complete® line of nutritional supplements, Cooper Complete With Iron and Basic One With Iron are multivitamin and mineral supplements that contain 18 mg of iron.
  • Standalone Time Release Iron provides 54 mg of iron per serving for those who need higher levels of iron. In the prolonged-release tablet, the iron release begins within approximately 30 minutes of taking and continues over six to eight hours. The amount of iron our body absorbs decreases with increasing doses, so when taking supplements, it is recommended to take the daily dose in two doses.

Do Athletes Need More Iron?

Iron tops the nutrients needed for aerobic performance in athletes because it is an essential component of hemoglobin. Hemoglobin carries oxygen from the lungs to the rest of the body, including the muscles. A low level of iron in the body equates to low hemoglobin, which equates to low oxygen in the muscles. This may lead to lower performance.

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Any athletic activity that requires intensive aerobic exercise can cause iron deficiency. Also, running on hard surfaces can lower hemoglobin levels. This is because blood causes swelling in the feet during running, and constantly running on hard surfaces damages the red blood cells on the foot strike.

Increasing aerobic capacity increases the body’s iron requirements. The body’s natural response to exercise is to make more red blood cells. While this increase improves oxygen delivery, it needs more iron. In addition, more hemoglobin is needed, which is another reason athletes need more iron.

Dietary supplementation with an iron-containing multivitamin improves iron without adjusting food intake. Food should not be replaced with multivitamins but can be added to the diet to increase the iron level gradually. This may be useful for balancing nutritional levels without adding additional calories.

How Does Being a Blood Donor affect Iron Levels?

Blood donors are allowed to give blood every 56 days or every eight weeks, but of great concern is that about 25-35% of regular blood donors will eventually develop iron deficiency. Low iron levels can cause the following symptoms:

  • Fatigue and weakness
  • Chest pain, shortness of breath, and fast heartbeat
  • Headache, dizziness, or lightheadedness
  • Cold hands and feet
  • Little or no appetite

The National Heart, Lung, and Blood Institute (NHLBI) found that two-thirds of blood donors did not recover lost iron after 24 weeks without supplementation. However, those taking 38mg of iron each day returned to pre-donation levels faster than those not taking supplements (11 weeks versus more than 24 weeks). Information from the American Red Cross can be found here for regular donors on how to recover from donations faster.

Healthy Iron Levels

In general, iron is an essential nutrient for the functioning of the body. However, excessive iron intake can lead to toxicity and cause serious medical problems, including nausea, vomiting, diarrhea, and stomach pain. In addition, long-term toxicity can lead to congestive heart failure (CHF), coronary artery disease (CAD), and liver cirrhosis. Therefore, staying within the following levels is recommended until you have a blood test to determine if you are iron deficient.

Iron Recommended Daily Allowance (RDA)

Age Men Women
19-50 years 8 mg 18 mg
51 years and older 8 mg 8 mg

A doctor will use a blood test to measure hemoglobin levels to determine iron levels.

Hemoglobin Blood Levels

Gender Men Women
Cooper Clinic Recommendation 14-18 g/dL 12-16 g/dL

A doctor will use a blood test to measure hemoglobin levels to determine iron levels. Knowing these levels is very important for everyone. Don’t take iron supplements as a ‘just in case’ as it’s essential to have your blood tested and schedule regular follow-ups with a physician for complete blood testing to evaluate levels when taking iron supplements.

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