Everything iron

Iron is a notoriously tricky nutrient to get right. It can be tough to include enough in your diet and even then your iron levels may still not be where you want them to be

In this episode, I’ll talk through all of the things that might be impacting your iron levels, from iron loss, low dietary iron, poor absorption to increased inhibition, as well as a few tips about iron supplementation and iron infusions

If you or someone you know is struggling with their iron levels, give this a listen!

Time Stamps

00:00 Introduction and Importance of Iron
01:14 Symptoms and Diagnosis of Low Iron
03:11 Causes of Low Iron: Decreased Iron Intake or Absorption
05:24 Increasing Dietary Iron Intake
06:53 Improving Iron Absorption
10:19 Factors Inhibiting Iron Absorption
13:13 Iron Supplements and Infusions
14:10 Post-Iron Infusion Considerations


Welcome back to the Bite Me Nutrition podcast. Firstly, I apologize for the sound of my voice. I'm recording this a lot earlier in the morning than I usually would. And then you're also going to get some bird song in the background because of the time of day as well. So, I mean, that's quite nice, isn't it? So maybe we could enjoy that. But anyway, I'm not here to talk to you about bird song. I'm here to talk to you about iron. Low iron is something that we've had lots of clients struggling with because it can be quite difficult. But it is very very important. I'm going to go through what iron is, what it does, what could be contributing to low iron, and then some things that you can do about it and anything else that pops in my head along the way, but that's probably about it. Basically, iron helps transport oxygen around your body. That's really all you need to know about it, to be honest. The way I get people to think about it is, you know how you feel after you've done some hard training or you've done some hard activity and you're kind of puffed and a bit out of breath. If you don't have enough iron in your body, that's kind of how all of your tissues and all of your cells feel most of the time. They're kind of a little bit out of breath. So it is really important to make sure that we've got adequate amounts of iron, both in our diet, but more importantly in our body. The number one symptom because of that transport of oxygen of low iron is fatigue. Now we need to be careful because as I'm sure a lot of us know, there's about a hundred thousand different things that can contribute to fatigue. So we want to make sure that we're not self diagnosing. Ourselves with low iron, I know it can be very appealing to do that or I'm feeling tired, I'm going to go grab an iron supplement and take some of that. Please don't do that. If you are feeling fatigued and you're kind of thinking through other causes of fatigue in your life, and you feel like your level of fatigue does not match up with what else is going on. Absolutely go chat to your doctor. It's a very simple blood test to get done and make and check the your iron levels. Both your available line and then like your stores of iron and they just check all of that sort of stuff. And so you're not, you don't have to guess which is good. So if you suspect your iron is low, go to the doctor. Do not pass code and not collect 200 doctors. Do not collect $200. Go directly to the doctor. My goodness. Caffeine hasn't kicked in yet. Uh, so there's two main reasons why your iron might be low. Well, two umbrella reasons you have, you're having increased iron.Losses, so increased iron out, or you've got decreased iron in. So you're either having not enough iron in your diet, or you're struggling to absorb that iron, and we're going to kind of break those down. Now, increased iron out isn't really something that we can handle with diet, but it's an it's why it's really important to go talk to your doctor if you believe you have low iron. Because if your low iron is due to iron losses, it's important to investigate that sort of stuff. Right? Increased iron losses is typically due to blood loss. The most common reason for that is menstruation. And so if you have a particularly heavy flow, then it's extra important to be on top of your iron and to be chatting to your doctor and maybe supporting with a supplement if you need as well. But it can also be due to some more sinister stuff. Like I don't want to scare you. It's rare, but worth checking, you know. Internal bleeding, particularly in like the GI tract, so in your gastrointestinal, in your gut, essentially, you know, little things like that over time can add up to be giving you high iron losses. And so hopefully, you can appreciate in that context, increasing iron in your diet is not the primary focus, it's figuring out what's ever going on, whatever is going on there. Another common area with low iron is people that do a lot of endurance activity. You get a couple of different reasons for increased iron losses in that one of them being, we noticed a little bit of extra iron blood being lost in the gut during extended periods of endurance exercise. So something to be mindful of. And then there's also something called foot strike hemolysis, which basically means, that repeated, you know, striking of your foot on the ground during something like a run in particular, you don't really get like, you don't get up for cycling and swimming because it is about that strike. Haemolysis means basically the hemoglobin is lies or breaks is broken down. So you have increased iron losses on that front as well. So important to figure out what the iron situation is, are you losing it for whatever reason, because that's going to affect what we do next. So hopefully you're picking up what I'm laying down. Go talk to your doctor. Now, what we're really going to talk about though is decreased iron in, so low levels of iron in your diet or maybe poor absorption of said iron. That's obviously more our wheelhouse and there's something that we can do a bit more specifically. So the most common thing is probably not enough dietary iron, right? It can be difficult to get enough through your diet, but… by focusing on a few core foods, you can significantly bump up those levels. Things like having red meat a couple of times per week, eggs, seafood, organ meats, if you're into that sort of thing, like liver, that sort of stuff, green leafy vegetables, spinach, kale, broccoli, bok choy, all your amazing Asian greens, lentils, beans, nuts, seeds, textured vegetable protein, a lot of fortified breakfast cereals, things like Cheerios, Wheat Bix. Those have iron fortified in them as well. Trying to include a good variety of those each day and across your week is just a good idea for everyone. Not just because of iron, like a lot of those foods contain lots of other good things as well. But regularly eating that stuff should give you a good amount of dietary iron. However, that's not the full story. There's other things that we can be doing as well. Now the next few things I'm going to be talking about, if your iron levels are fine, don't stress about these things. You don't need to do them. You don't get any bonus points for having extra iron. Yeah, in fact, you can get iron toxicity. You're not going to get it from the diet. That's probably when you're supplementing when you shouldn't. But if your iron levels are fine, you can stop listening now and go leave a review with the extra time that you saved. Wouldn't that be nice? But if you are struggling with your iron levels, and you've really focused on increasing the amount of iron in your diet, and it's still not really taking hold, we need to talk about absorption of iron and inhibition of iron. So your absorption of iron is really important. Just because you've eaten iron doesn't mean that you've digested and absorbed it, right? It maybe has just gone all the way through you. And the main factor influencing your absorption of iron is the form or the source of iron that you're having. There's two main forms of iron. There's something called heme iron and non heme iron. Heme iron is a form of iron that's found in animal foods, you know, meat, seafood, eggs, organ meats, those ones that I listed before, that is a form of iron that we are really good at absorbing. I think seven, I should have checked this before I recorded, I think it's about 70 to 80 % of that iron gets absorbed by us. So really great rates of absorption. Now non -heme iron is found in non -animal foods, you know, plant based stuff. Unfortunately, I think that's around the seven to 10 % mark of absorption. So as you can see, significantly less than the heme iron. Now, of course, not everyone chooses to eat animal products, or maybe you just are limiting them overall. And so that's limiting your intake of heme iron. But the good news is, if you combine your non heme iron with a source of vitamin C, that vitamin C significantly improves your absorption of that non heme iron. So if you're having non heme iron, that's fun to say, don't panic, you know, you're not going to be, you know, iron deficient for the rest of your life. Try and pair it with a good source of vitamin C, something like broccoli, berries, you know, having some strawberries after a meal, having some cranberries in a salad or something. Of course, citrus, you know, lime, lemon, orange juice, having something like that. There's another source of vitamin C that I'm missing. Anyway, it'll come to me, but basically, oh, capsicum, that's the one. Really, really good source of vitamin C as well. So trying to make sure that, I guess, that each of your main meals, you're including one of those things alongside a couple of different sources of iron. So, of, yeah, of iron. So remember berries, capsicum, citrus fruit, Broccoli. Yeah, those are the there's obviously more sources of vitamin C, but those ones are particularly high. So making sure you're having non-heme iron with a source of vitamin C will significantly increase your absorption of that bit of a tangent, but it's a lot of gut issues. And I use that term carefully because you know, in this day and age, everyone's being diagnosed with gut issues, but with like particularly inflammatory bowel diseases, IBD, Crohn's, colitis, and then things like celiac disease, those things can impact the gut in the region of the gut that deals with iron absorption. So it's not uncommon that someone gets diagnosed with celiac disease due to having low iron. Sometimes for example, with celiac disease, you have celiac disease, but you don't have the symptoms of it. So you don't know that you have it but it's still damaging the gut. And so it's reducing your iron absorption in that part. So I've had a couple of clients over the years who've gone to the doctor feeling tired. They found out that iron is low, gone through a few other steps and it's actually turned out that they've got celiac disease. And that's been why all of the iron in the world has not allowed them to increase their iron levels because they just haven't been able to absorb it. So again, I'm not trying to scare you. That is definitely rare, but it is also why don't just self -diagnose with low iron and go on a. Go talk to your doctor. Anyhow, coming back to things that we need to be mindful of with iron absorption. The next point is inhibition. There are things that inhibit your iron absorption. The two biggest ones. Well, sorry, I'll go with the less common one, but a big dose of calcium, calcium and iron compete for absorption. They get absorbed through the same channels. Look, what we see in studies with kind of dietary calcium and iron. So like we're talking about milk with a source of iron, for example. That doesn't seem to have a huge impact over time. It's more massive doses of calcium. So it could be, I guess, if you've got a, you know, there's a few yogurts out there that have really high sources of calcium. There's a John West calcium tuna, which is a phenomenal source of calcium, but you probably wouldn't want to be pairing that with your iron rich foods, or if you're supplementing with iron, your iron supplement. And then of course, calcium supplements as well. If you're taking a calcium supplement, you want to make sure that you are not, um,pairing that with your iron supplement or with high sources of iron in your diet. So that's the main thing with calcium, but I'd say the most common form of inhibition is your tea and your coffee. Unfortunately, sorry team, tea and coffee can inhibit your absorption of iron, particularly with your non, actually, sorry, not particularly, mostly just with your non heme iron. So don't worry about, again, the animal food sources of iron, but if you're predominantly eating plant -based sources of iron, Be mindful of when you have your tea and coffee around that. It's not really the caffeine in that drink that's the problem. It's things like tannins and chlorogenic acid and just other polyphenols and other compounds that are in tea and coffee. So what you want to be doing is leaving 30 minutes either side of your meal and waiting. So you're either having tea or coffee more than 30 minutes before your meal or more than 30 minutes after your meal. That will just ensure that the iron rich food has time to get in, get absorbed before you have tea or coffee that might come in and reduce the inhibition. What's that song? Release your any, it doesn't matter. Far out. So tea, coffee 30 minutes before or 30 minutes afterwards, try not to have it at the same time if you are struggling with your iron levels and if you are predominantly eating non -heme iron. Last two quick points. If you've gone through though, you've seen the doctor, you've ruled out any scary things. Uh, you've, you've focused on increasing iron. You focused on absorption. You focused on inhibition. You've done all of those sorts of things. We're still struggling with our iron levels. Um, the doctor recommends an iron supplement. The main thing I would just say with an iron supplement is to make sure that you're taking it on alternate days, not every day. Taking an iron supplement every other day to every second day actually increases the amount of iron that you absorb from that supplement. So why not? Right. Less supplement saves some money, less iron hitting the gut, which can make your gut feel a bit funky if you're not careful. So iron supplements on alternate days. Now the next step you go through all of that, you know, you're still struggling or for whatever reason, the doctor actually recommends an iron infusion. Great. I'm not anti -iron infusion, so I do what the doctor says. So I would still recommend focusing on everything that we've spoken about above because A, it builds good habits, which is important anyway, and B, it helps you just maintain your long term iron stores after maybe the iron infusion has worn off. That's not really what they do. But once those levels have reduced, reduced back down. Quick note around iron infusions, though, if you've had an iron infusion, and like for a week or so afterwards, you're still feeling really rubbish. Maybe check back in with your doctor about getting your phosphate levels checked. Iron infusions can impact your phosphate levels, and that can make you feel really crummy. So if that's you just book back in, flag that with them, and they might be able to help. So that's everything iron. That's probably what I should call this episode. Maybe I will, maybe I won't, but hopefully that's been very helpful. If you or someone you know is struggling with low iron, pardon me, I would be forever grateful if you could send this their way so we can help give them more energy, give them more oxygen, and give them some strategies to not feel that way again. But I'll chat to you guys next time.