Iron is often better absorbed when taken with foods such as citrus, alliums and meat.
More of us are at risk of deficiency
Getting sufficient iron sounds like simple maths: we want to add enough to our dietary intake to make up for the iron being lost from the body, such as through faeces, skin shedding, menstruation (for women) and sweat. But the two sides of the equation can change depending on who and where we are throughout our lifetime.
Generally, iron deficiency occurs when our body’s stores of iron are depleted from not having consumed or absorbed enough iron to meet our needs.
This can happen when people restrict their diets, such as for religious, social or medical reasons. Some people also have a tough time keeping up when their iron needs increase, such as pregnant women and growing children.
But iron deficiency can also happen when the body has enough iron, but can’t effectively transport it into cells. This is common in those with both acute and chronic infections, heart and autoimmune conditions, and cancers. In these cases, the underlying disease needs to be treated first, rather than improving iron intake.
Sometimes multiple causes of iron deficiency may occur simultaneously – for example, for many elite athletes (35% of women and 11% of men), iron deficiency results from reduced absorption due to inflammation, on top of increased loss through sweat and breakdown of blood cells.
COVID hasn’t helped
The ongoing COVID epidemic has also introduced multiple risk factors for iron deficiency.
We know severe infection with SARS-CoV-2 (the virus that causes COVID) may change the way some people metabolise iron, leading to lower iron levels up to two months after infection. This contributes to symptoms commonly reported after infection, such as fatigue and lethargy.
Recovery from the pandemic itself has also exacerbated food supply issues, as well as the rising global income inequality.
This means more people face barriers to food security – and the nutrient-dense foods that help boost our iron intake like red meat or leafy greens may be unavailable or unaffordable for them.
Before you pick up a pill
It may be tempting to pick up one of the many widely available iron supplements to attempt to boost your intake. However, we have to keep in mind that conventional iron supplementation is associated with some negative side effects.
These include damage to our gut lining, nausea, diarrhoea and constipation. Iron supplementation has also been linked to changes in the gut microbiome, a critical determinant of health.
The WHO has recommended two other approaches: diet diversification and food fortification.
Diet diversification is exactly as it sounds: having a diet with a variety of wholefoods such as fruits and vegetables, grains and legumes, meat, dairy, and nuts and seeds.
This approach not only ensures sufficient levels of iron are found in the foods we eat, but also that they come with different forms or “vehicles” to improve absorption. This approach works even with plant-based foods.
Food fortification, where iron is added to processed foods, is also a fairly safe yet accessible option due to its lower dose. In Australia, iron is commonly fortified in products such as bread, cereals and ready-to-drink mixes.
It can be challenging to get the iron into our body and where it’s needed. But before turning to supplements, we must remind ourselves that food sources should always be first-in-line. In cases of diagnosed deficiencies, your healthcare professional will provide you with further information where supplements are necessary.