Iron deficiency as one of the most common nutritional deficiencies

Iron is one of the essential trace elements in the body, i.e. that its need is relatively low, but still essential to maintain our health. Iron fulfills a number of important functions in the body, for example it is part of the red blood pigment hemoglobin and participates in the transport of oxygen. A lack of iron can manifest itself in fatigue, but also in more serious health complications. The human body cannot synthesize iron on its own, so we are dependent on its intake from food. However, it should be borne in mind that not only a lack of iron, but also its excessive intake can cause health problems.

What will you learn in this article?:

1. What roles does iron play in the body and where is it located in the body?
2. Anemia and manifestations of iron deficiency
3. Iron supplementation and its risks
4. Supplementing iron naturally from food
5. What affects iron absorption?
6. The risk of iron supplementation during an infectious disease

What roles does iron play in the body and where is it located in the body?

Iron is essential for our health! It maintains the normal function of the immune system , as it is needed for the proliferation and maturation of immune cells. It is also important for the normal formation of red blood cells and hemoglobin , which in the body transports oxygen from the lungs to all parts of the body. We also need it for the proper functioning of the thyroid gland – it is necessary for both the synthesis and metabolism of thyroid hormones. [1] Last but not least, it should be mentioned that iron participates as a cofactor in many enzymatic reactions in the human body .

Below is a simplified overview of the distribution of iron in the human body:

• About 60-70% of iron is found in circulating red blood cells as part of the blood pigment hemoglobin .
• Approximately 20-30% of iron is stored in the liver in the storage form of ferritin and hemosiderin. From these stores, iron can then be released into the bloodstream when needed. It is ferritin that is a suitable indicator of iron status in the body.
• 5-10% of iron in the body is found in myoglobin – the protein that provides oxygen to the muscles.
• Approximately 1-5% of iron is found as part of various enzymes and cofactors.
• Only less than 1% of iron is found in transferrin , the protein that transports iron through the bloodstream.

Anemia and manifestations of iron deficiency

Iron deficiency is one of the worldwide widespread nutritional deficits and is the most common cause of anemia . It is estimated that roughly 2 billion people worldwide, or a quarter of the world’s population, suffer from iron deficiency anemia . [2]

Iron deficiency anemia is characterized by small blood cells. There may be enough blood cells, but they are small, have little hemoglobin, and the blood therefore carries less oxygen . This leads to typical symptoms such as fatigue, paleness, shortness of breath or cold limbs . Other manifestations of iron deficiency include brittle nails, hair loss, reduced concentration, insomnia or immune disorders .

In the case of iron deficiency anemia, the cause must be determined . The reason may be a low intake of iron from the diet, blood loss (for example, with heavy menstrual bleeding in women or with gastrointestinal bleeding), but also, for example, an intestinal disease , when the patient is unable to absorb the received iron.  However, there can be more reasons for anemia and iron deficiency is not always the cause. Anemia can also be caused by a lack of vitamin B12 or folate . This type of anemia is characterized by a smaller amount of large blood cells and is called megaloblastic anemia.

Among the risk groups of people at risk of iron deficiency and anemia are menstruating women, pregnant women, young children, vegetarians, frequent blood donors, or for example people with inflammatory bowel disease or those who have undergone gastric resection.

Iron supplementation and its risks

Although many people may appear to be iron deficient based on symptoms, hasty supplementation can be dangerous . Supplementing with iron is only appropriate if its deficiency is proven. Our organism is not equipped with any mechanism to eliminate excess iron.

The balanced level of iron in the body is controlled primarily by the regulation of its absorption in the small intestine, which is influenced by many mechanisms, with the hormone hepcidin playing a crucial role . However, the production and function of this key hormone are also affected by some genetic mutations, which can ultimately lead to excessive absorption of iron in the body (so-called hemochromatosis ). For this reason, it is not reasonable to add iron to every multivitamin, since without knowledge of the nutritional profile and individual genetic polymorphisms, such a multivitamin could be dangerous for some people due to the added iron.

An excess of iron in the body is a burden for the body – it increases oxidative stress, can damage DNA molecules, lead to premature aging and the development of other diseases. [3]  Toxic iron overload can occur with long-term use of high doses or if we overdose on iron supplements. Symptoms of poisoning include, for example , abdominal pain, nausea, vomiting or diarrhea . Small children are most at risk of acute iron poisoning , who may mistake iron tablets for candies.

If we do not know whether we are really lacking in iron, it is not advisable to use multivitamins with iron content for the reasons mentioned above. Iron is therefore intentionally not included in our Daily F20 Complex multivitamin supplement , which is intended for long-term use by virtually everyone. However, if these are specialized multivitamins for, for example, pregnant and lactating women or for athletes who may have increased requirements for iron intake, the presence of iron in the formula is, on the contrary, important.

Supplementing iron naturally from food

We find iron in food in two forms, the so-called heme iron and non-heme iron.  Heme iron is found in animal products , it is more easily absorbed and its rich sources include mainly organ and red meat. The non-heme form of iron is found abundantly in plant sources , but can also be found in animal products. This form is less absorbable and less usable . It turns out that people receiving little heme iron from their diet (vegetarians or vegans) are at greater risk of iron deficiency and anemia . [4]

What affects iron absorption?

Iron absorption is influenced by many factors . Iron absorption is governed by the organism’s demand . In cases of higher need for iron (for example during pregnancy), its absorption is also higher. On the contrary, its absorbability decreases with age.

Regarding non-heme , i.e. plant-based iron, an acidic stomach environment with sufficient hydrochloric acid is required for proper absorption. Therefore, for example, people taking drugs that reduce stomach acidity (antacids or proton pump inhibitors) will have a harder time absorbing iron from food.

Dietary factors also play an essential role in the absorption of plant iron . Phytates , which are abundantly found in cereals and legumes, form insoluble complexes with iron and make its absorption difficult . However, the amount of these anti-nutritional substances can be reduced by proper preparation of legumes and cereals (soaking, sprouting). The absorption of non-heme iron is also reduced by oxalates , a large amount of fiber , or, for example, caffeine or tea . Calcium then acts as an antagonist , meaning it competes with iron for the binding site.  In order to avoid a possible iron deficiency, it is not recommended to consume dairy products together with iron-rich foods. And iron supplements should be taken at a distance from food and not taken with coffee, tea or milk.

On the other hand, the absorption of vegetable iron is supported by vitamin C , so it is advisable to eat meat with vegetables, sprinkle lemon on leguminous dishes or just add green leaves. Also, the combination of heme and non-heme iron increases absorption.

The risk of iron supplementation during an infectious disease

In conclusion, it should be mentioned that iron supplementation is not suitable during acute inflammation or infectious diseases . The growth and reproduction of many bacteria depends precisely on the intake of iron, and the connection between the availability of iron and the ability of pathogens to cause disease has been proven . Conditions associated with an excess of iron can therefore increase the risk of