If you have fatigue that doesn't go away even with proper rest, you may have anemia. Iron deficiency anemia is the most common type of anemia and makes up 50% of all cases. Iron is essential to blood production, and deficiencies can result in symptoms such as an inability to work or fatigue. The causes of this form of anemia vary from person to person and can depend on age and gender. Most patients may be asymptomatic until it is identified through a blood test.
However, untreated iron deficiency can lead to more serious medical issues, stressing the importance of testing and treatment. This article will explain the varying underlying causes of iron deficiency anemia and provide integrative approaches to treat this condition. With proper testing and diagnoses, iron deficiency anemia can be managed effectively.
What is Iron Deficiency Anemia?
Anemia is a blood condition that affects your red blood cells. The condition is characterized by a hemoglobin level that is below the mean levels set by age and gender. In iron deficiency anemia, iron levels, which are needed to produce hemoglobin in your blood, are low. There are three stages of iron deficiency anemia. In the first stage, the iron stores start to decrease, but it doesn't impact your red blood cell production yet. During the second stage, your iron levels are low, so your bone marrow makes red blood cells that are deficient in hemoglobin. Iron deficiency anemia occurs in the third stage, in which the hemoglobin levels drop below the normal range, and symptoms may occur.
What Are The Signs & Symptoms of Iron Deficiency Anemia?
Symptoms of iron deficiency anemia can develop over time and be dependent upon the stage that the condition is in. The main symptoms are tiredness and shortness of breath due to a reduction in oxygen, as hemoglobin levels are low and are needed to carry oxygen through your body. Other common symptoms include:
- Feeling of weakness
- Paleness in your skin
- Increased heart rate
- Chest pain
- Unusual food cravings for ice, dirt, or paper
- Bruising easily
- Restless leg syndrome
- Brittle or spooning nails
- Corner cracks in the lips
- Cold to the touch
- Sore tongue
The Possible Causes of Iron Deficiency Anemia
The causes of iron deficiency anemia in adults can vary due to age, gender, and socioeconomic status. The following are the top underlying causes of this blood disorder:
Insufficient Dietary Intake
Not eating enough iron-rich foods is a major reason for iron deficiency anemia. Iron mainly comes from your diet, like red meat, poultry, seafood, legumes, fortified cereals, and leafy greens. Not having these foods enough can happen because of food choices. Some diets, like vegan or vegetarian diet, may lack sufficient amounts of iron and may need to supplement. Other nutritional causes include limited access to nutritious food or when your body needs more iron, for example, during pregnancy.
The most common cause of iron-deficiency anemia is blood loss. This cause occurs most often in the older population. Blood loss can occur because of bleeding in the gastrointestinal (GI) tract. Conditions like ulcers, polyps, and colon cancer are other common reasons for blood loss from GI tract bleeding, which can also happen from prolonged use of medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. Additionally, bleeding in the urinary tract, blood loss from injuries or surgeries, heavy menstrual periods, and frequent blood donation can all lead to iron-deficiency anemia.
Gastrointestinal (GI) Issues
GI conditions such as celiac, gastritis, H. pylori infection, and inflammatory bowel disease (IBD) are all associated with contributing to low iron levels. These inflammatory conditions can impact how your body absorbs nutrients such as iron. Individuals who had gastric bypass surgery may also be at risk for iron deficiency anemia, as this surgery can prevent iron absorption.
Athletes or people who do endurance training can lose iron levels, as it has been shown to break down red blood cells. This breakdown is especially true for marathon runners or cyclers, which increases their risk of iron deficiency anemia.
Functional Medicine Labs to Test for Root Cause of Iron Deficiency Anemia
In order to help diagnose and manage iron deficiency anemia, your doctor will order lab tests. Here are the top functional medicine labs to test for the root causes of iron deficiency anemia:
CBC (Complete Blood Count)
The CBC blood test is the top go-to test for iron deficiency anemia as it measures hemoglobin levels, iron levels, and ferritin levels. The results of this test can diagnose this condition. Iron and ferritin levels less than 10 will indicate iron-deficiency anemia. Other markers that indicate iron deficiency anemia include low levels of hemoglobin, hematocrit, MCV (mean corpuscular volume), MCHC (mean corpuscular hemoglobin concentration), and MCH (mean corpuscular hemoglobin).
The anemia panel is specific for iron deficiency anemia and should be regularly tested for those who have a history of this condition. This panel assesses serum iron levels, ferritin, TIBC (total iron binding capacity), UIBC (unsaturated iron binding capacity), transferrin, and transferrin saturation. Low levels of transferrin and transferrin saturation will indicate iron deficiency. In comparison, low levels of serum iron will indicate a progression of anemia, as this marker shows the body's use of iron stores. TIBC and UIBC have an indirect relationship with transferrin and transferrin saturation. Therefore, these levels will be elevated iron deficiency anemia.
The Gut Zoomer analyzes the gut's overall health and the microbiome's balance. This functional lab test will also provide information on any pathogens that are associated with chronic conditions such as H. pylori. The comprehensive microbiome analysis will also provide practitioners with valuable insights into gastrointestinal conditions such as celiac and IBD that are linked to creating iron absorption issues.
The micronutrient panel is a great functional lab to assess for nutrient levels such as iron. It also measures vitamin C levels that can help with iron absorption. The results of this test can guide targeted supplement protocols to address any nutrient deficiencies.
Conventional Treatment For Iron Deficiency Anemia
Conventional treatments for iron deficiency involve iron supplementation and IV infusions. Iron supplements will be utilized most often by doctors. However, if the anemia is from a condition that prevents absorption, they may prescribe IV infusions of iron to replete iron storage. This condition is usually reversible after treatment.
Functional Medicine Treatment for Iron Deficiency Anemia
The functional medicine approach for iron deficiency anemia is to address the underlying causes while supporting the whole body and optimizing overall health. The following are functional and integrative approaches to addressing iron-deficiency anemia:
Nutrition Considerations For Iron Deficiency Anemia
Maintaining sufficient iron levels requires a diet rich in iron. Iron consists of two forms, heme iron and non-heme iron, with varying absorption rates. Heme iron, found predominantly in animal-based foods like red meat, poultry, and seafood, is more easily absorbed by the body and contributes significantly to total dietary iron intake. In contrast, non-heme iron is found in plants, including legumes, kale, and spinach. It's also beneficial to enhance iron absorption by incorporating vitamin C-rich foods such as citrus, strawberries, bell peppers, broccoli, and tomatoes.
It's important to understand that there are also certain foods that can hinder iron absorption. For those with iron deficiency anemia, it is advisable to limit the intake of iron inhibitors like tea, coffee, calcium-rich foods, and high-phytate foods such as whole grains and legumes. These substances can interfere with iron absorption and should be consumed separately from iron-rich meals.
Using Supplements To Support The Treatment of Iron Deficiency Anemia
There are a few ways that iron supplements should be taken to increase absorption. They should be taken at least two hours away from antacids, dairy, or calcium-rich foods. Iron supplementation should also be taken without food, as food can decrease absorption by 40%. With that stated, here is the best form of iron supplement to take along with cofactors to help with absorption:
There are many forms of iron for supplements. They include ferrous, gluconate, and fumarate. However, the most commonly used form of iron used by functional medicine practitioners is iron bis-glycinate as it people may have less constipation and it is tolerated better. The dosing recommendation is 60 mg every other day, away from meals for at least three months.
Vitamin C has been associated with increasing the absorption rate of iron by up to 7.1% when taken with it. The effective dose of vitamin C was 1,000 mg taken every other day at the same time as iron supplementation for at least three months.
Hydrochloric acid has been shown to improve digestion and absorption of iron-rich foods and supplemental iron in GI issues that have a reduction in stomach acid. Therefore, supplementing with Betaine HCl may be beneficial. The recommended dose is 500-1000 mg with meals.
Complementary and Integrative Medicine
Other complementary and integrative therapies have been associated with increasing iron absorption, such as acupuncture and yoga. Evidence suggests that acupuncture-based weight loss can increase the absorption rates and therapeutic effects for iron deficiency anemia patients. It was shown to improve the intestinal iron absorption rates.
Yoga is another integrative approach that has been shown to increase the absorption of iron levels. This therapy also increased levels of zinc, copper, and magnesium. The study revealed that there was a significant improvement in these nutrients after twelve weeks of yoga compared to control groups.
The most common form of anemia is iron deficiency anemia. Symptoms can range from non-existent to chronic fatigue, chills, restless syndrome, and chest pain, depending on the stage of the condition. Fortunately, with testing, proper diagnosis, and treatment, this condition can usually be reversed. Clinicians often prescribe iron supplementation to treat this form of anemia.
There are also other integrative approaches to consider, such as nutritional plans incorporating iron-rich foods and acupuncture to increase absorption rates. IV infusion can also be utilized for people who have absorption issues. It's also important to note that GI issues such as Celiac can cause the development of iron deficiency anemia. Therefore, it is vital to assess the root cause of this condition so it can be accurately addressed. Functional medicine labs are excellent tools to help you investigate these root causes.
Lab Tests in This Article
Clinic, C. (2022). Iron-Deficiency Anemia: Symptoms, Treatments & Causes - Cleveland Clinic. Retrieved September 6, 2023, from Cleveland Clinic website: https://my.clevelandclinic.org/health/diseases/22824-iron-deficiency-anemia
Iron-Deficiency Anemia. (2022, March 24). Retrieved September 6, 2023, from NHLBI, NIH website: https://www.nhlbi.nih.gov/health/anemia/iron-deficiency-anemia
Cloyd, J.(2023, February 2). Retrieved September 6, 2023, from Rupa Health website: https://www.rupahealth.com/post/top-lab-test-to-run-on-your-iron-deficiency-anemia-patients
Cloyd, J.(2023, July 26). Retrieved September 6, 2023, from Rupa Health website: https://www.rupahealth.com/post/a-functional-medicine-iron-deficiency-anemia-protocol-comprehensive-testing-therapeutic-diet-and-supplements
Warner MJ, Kamran MT. Iron Deficiency Anemia. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448065/
What Is Iron Deficiency Anemia? (2021, November 29). Retrieved September 6, 2023, from Fullscript website: https://fullscript.com/blog/iron-deficiency
Ning, S., & Zeller, M. P. (2019). Management of iron deficiency. Hematology, 2019(1), 315–322. https://doi.org/10.1182/hematology.2019000034
Piskin, E., Cianciosi, D., Gulec, S., Tomas, M., & Capanoglu, E. (2022). Iron Absorption: Factors, Limitations, and Improvement Methods. ACS omega, 7(24), 20441–20456. https://doi.org/10.1021/acsomega.2c01833
Córdova, A., Mielgo-Ayuso, J., Fernandez-Lazaro, C. I., Caballero-García, A., Roche, E., & Fernández-Lázaro, D. (2019). Effect of Iron Supplementation on the Modulation of Iron Metabolism, Muscle Damage Biomarkers and Cortisol in Professional Cyclists. Nutrients, 11(3), 500–500. https://doi.org/10.3390/nu11030500
Xie, X. C., Cao, Y. Q., Gao, Q., Wang, C., Li, M., & Wei, S. G. (2017). Acupuncture Improves Intestinal Absorption of Iron in Iron-deficient Obese Patients: A Randomized Controlled Preliminary Trial. Chinese medical journal, 130(5), 508–515. https://doi.org/10.4103/0366-6999.200549
Verma, A., Shete, S., Kulkarni, D., & Bhogal, R. S. (2017). Effect of yoga practices on micronutrient absorption in urban residential school children. Journal of physical therapy science, 29(7), 1254–1258. https://doi.org/10.1589/jpts.29.1254