Iron deficiency is becoming more and more common, to a point where I often ask my clients when they last had their iron levels tested. Iron deficiency is not as common in men because they don't have a menstruation cycle each month and lose valuable iron stores. 90% of the female clients I've worked with either have an iron deficiency or have had one in the past.
Iron is an important nutrient, and it's rather scary how many people, especially women, are deficient in iron. It's also worth noting that too much iron is not healthy, and it's important to have your iron levels checked regularly. There is also a disorder called hemochromatosis which I've written about that before "Did Magneto have Hemochromatosis?."
Iron is responsible for transporting oxygen from the lungs to the muscles, into the cells and to produce energy (ATP). Unbalanced iron levels can cause a series of health implications. How can our clients perform at their best and recover without energy? We use energy to move, to sleep, to eat, to digest, to make our hormones (sex hormones, growth hormones, thyroid hormone, stress hormones, etc...), to help the immune system produce a bleach-like substance that kills pathogens in the body, and more...
Anyone with a complicated set of health problems which has an iron deficiency would be wise to address the iron deficiency as a matter of priority. Anemia is a deficiency that is caused by properly functioning red blood cells. One possible reason for this is iron deficiency anemia, a common condition that developed when your blood lacks enough healthy red blood cells, or a lowered ability for the blood to carry oxygen. Iron overload is also widespread, and yet most people have never heard of it, and most medical doctors fail to diagnose and treat the issue.
Iron levels have an impact on our gut health, our immune system, our hormones, our ability to produce energy, the transportation of oxygen around the body, and the list goes on...
Iron is found in food as either heme iron or nonheme iron. Heme iron is found in animal protein such as beef, chicken liver, lamb, clams, and oysters and is absorbed by the human body at much higher levels than nonheme iron. Nonheme iron is found in plants, dairy products, and in some meats. Nonheme iron absorption is influenced by the levels of vitamin C and other acids that are in the same meal. However, iron inhibitors such as phytic acid, polyphenols, and soy proteins found in plant foods can decrease iron absorption.
Vegetarians and vegans often have deficient iron levels because the diet is void of heme iron. It can be hard to address iron deficiency with vegetarian and vegan clients. Still, we must build awareness around the iron deficiency and recommend they get their iron levels tested regularly (every 3-4months). Below I list some ideas to help vegetarians and vegans increase their iron absorption.
The recommended daily allowance (RDA) for iron is:
8mg for men and postmenopausal women
18mg for menstruating women
27mg for pregnant women
Certain populations suffering from illness may require different intake levels of iron, and if you have an illness, you should talk to your clinician about your iron levels.
Low levels of B12, vitamin-C, or folate deficiency can also cause iron deficiency.
Iron Testing:
Clients should be asking their doctors for the following tests:
Serum iron - measures the level of iron in the liquid part of your blood. It only tells us part of the story and should not be the only marker we look at.
Ferritin - measures the amount of stored iron in your body. Ferritin is the main protein that stores iron, especially in the liver and the bone marrow (the inside cavity of the bones, where blood cells are made). It's important to be aware that ferritin scores can be affected by oxidative stress (inflammation markers should be checked, e.g. C-Reactive Protein).
Ferritin is our long term storage of iron, and it should not be seen as the bad guy. It is part of the antioxidant defence system and is an antioxidant. Ferritin stores iron and prevents it from becoming free iron.
Transferrin or total iron-binding capacity (TIBC) - A laboratory usually measures one of either transferrin or TIBC. Transferrin is the main transport protein of iron. TIBC is a good indirect measurement of transferrin. Your body makes transferrin in relationship to your need for iron; when iron stores are low, transferrin levels increase, while transferrin is low when there is too much iron. Usually, about one-third of the transferrin is being used to transport iron. Because of this, your blood serum has the extra iron-binding capacity, which is the unsaturated iron-binding capacity (UIBC). The TIBC equals UIBC plus the serum iron measurement. Few laboratories measure UIBC. Transferrin is our short-term storage of iron and is a good indicator of our recent iron intake.
Transferrin saturation: this is a calculation that represents the percentage of transferrin that is saturated with iron. It is a calculation using either the transferrin or TIBC value when the serum iron concentration is known. This should be between 30-40%. Transferrin is the primary marker that can be used to monitor iron status and clearly determines if the iron is going up, or down. Most medical doctors will wait until ferritin is super low before they take action. As always, the medical system waits until you are sick, instead of looking at preventative measures.
Iron replenishment strategies:
Include more animal protein in your diet. Eat beef, chicken liver, lamb, clams, and oysters on a regular basis. These foods contain the highest food sources of heme iron, the highly absorbable source of iron. Nonheme iron is found in plant foods, and it is poorly absorbed compared to heme iron, which is found exclusively in animal foods.
Take 250mg of vitamin C (as ascorbic acid) and 200-1200mg of betaine hydrochloric acid (HCL) 10-15min before meals. These supplements will increase iron absorption significantly. If you take the acid-suppressing drug, you should speak with you clinician before taking HCL, and you should read Chris Kresser's ebook on gut health.
Avoid consuming substances that impair non-heme iron absorption around mealtime - tea, coffee, dairy products, supplemental fibre, supplemental calcium and zinc. Be aware that calcium will also inhibit heme iron absorption, so we don't want to consume dairy products with our steak.
If you tolerate it, you can consider a glass of wine or alcohol with dinner, as alcohol also improves iron absorption.
Cook in cast iron pans or hotplates as often as possible
Don't smoke. Tobacco smoking robs the body of oxygen and depletes the immune system, which is already challenged by iron deficiency.
Vegans and vegetarians should consume iron-rich plant foods such as chard, collard greens, spinach, pumpkin, squash, pine nuts, pistachios, sunflower seeds, cashews, unhulled sesame seeds, white potatoes, and chocolate.
Consume vitamin C-rich foods paired with non-heme iron-rich plant foods, for example, Spinach & lemon juice, properly prepared lentils & tomatoes, kale & sweet potato.
Consume one to two cups of properly prepared legumes daily (especially lentils). Add in one to two tablespoons of blackstrap molasses daily.
Note: soaking and drying nuts and seeds improves nutrient bioavailability
If the steps recommended above do not improve your iron levels, and your clinician suggests it, take a heme iron supplement at the dosage recommended by you clinician. If you have high iron levels, you will want to do the exact opposite of the six points listed above.
Why should coaches and personal trainers care?
As personal trainers and coaches, we can build awareness around the importance of minerals like iron, and encourage our clients to work functional medicine practitioner or integrative doctor to investigate what is happening under the hood. Let's face it; most clients believe they eat a healthy diet. But in reality, they eat a diet low in key nutrients, they have underlying gut issues that prevent absorption, and they are easily misguided by "game-changing" movies and media articles that demonise certain foods and promote bad science.
As coaches and personal trainers, we can talk to our clients about the importance of a healthy diet, and we can create the perfect training programs, but this might not be enough for them to change their behaviours or belief systems. Sometimes clients need to see the facts. When we encourage clients to do blood work, there is no denying the results. Seeing the facts can often be the incentive clients needed to change their lifestyles and build a better understanding of healthy eating.