Low iron is a health risk exacerbated by COVID. How to get more without reaching for supplements
“Beauty is an iron mine,” says Australian mining magnate Gina Reinhart. He talked about a valuable resource, but iron is also very important for living organisms: from bacteria and fungi, to mammals like us.
Iron acts as a key to various metabolic functions in our body. But iron deficiency remains one of the top global health risks recognized by the World Health Organization (WHO).
Iron deficiency has become the most common micronutrient disorder worldwide, and COVID may exacerbate the problem.
Iron is hard to come by
The type of iron we mine is different from the biologically usable “free form” iron. Free-form iron has a tendency to jump between two chemical states, allows it to bind to various molecules, and participates in all sorts of important reactions in our bodies.
But we see a different story again during the digestion of food. In our upper small intestine where iron is most effectively absorbed, free form iron tends to bind to oxygen, other minerals, and food components. This often results in insoluble rock-like lumps (like the ones we mine!). It is too large to pass through or between our cells.
This means that even if we consume enough iron, usually only ~15–35% is absorbed. It also means the availability of iron can be increased, or inhibited depending on how we eat it or what we eat it with.
For example, heme iron from animal flesh has a cage-like structure, which carries iron in a soluble form that prevents it from clumping during absorption. In many Western countries, heme iron accounts for only 10% of the iron eaten, but two-thirds of the total iron absorbed.
Illustrator: Ren Guo, Author provided
More of us are at risk of shortage
Getting enough iron sounds like simple math: we want add enough for our food intake to make up for iron is lost from the body, such as through feces, exfoliation, menstruation (for women) and sweat. But both sides of the equation can change depending on who and where we have been throughout our lives.
Generally, iron deficiency occurs when the iron stores in our body are depleted due to not consuming or absorbing enough iron to meet our needs.
This can happen when people restrict their diet, such as for religious, social or medical reasons. Some people also have difficulty meeting their increased iron needs, such as pregnant women and growing children.
But iron deficiency can also occur when the body has enough iron, but cannot effectively transport it into cells. It is common in those with acute and chronic infections, heart and autoimmune conditions, and cancer. In these cases, the underlying disease needs to be treated first, rather than increasing iron intake.
The table below summarizes some of the common causes of iron deficiency. Sometimes several causes can coexist – for example, for many elite athletes (35% women and 11% men), iron deficiency is due to reduced absorption due to inflammation, in addition to increased loss through sweating and breakdown of blood cells.
COVID is not helping
The ongoing COVID epidemic has also introduced several risk factors for iron deficiency.
We know severe infection with SARS-CoV-2 (the virus that causes COVID) can change how some people metabolize iron, leading to lower iron levels for up to two months after infection. This contributes to symptoms commonly reported after infection, such as fatigue and lethargy.
The recovery from the pandemic itself has also exacerbated food supply problems, as well as rising global income inequality.
This means more people are facing barriers to food security – and nutrient-dense foods that help increase our iron intake such as red meat or leafy green vegetables may not be available or affordable to them.
Read more: Why we should take a woman-centred approach to diagnosing and treating iron deficiency
Before you take the pill
It may be tempting to take one of the many widely available iron supplements to try to increase your intake. However, we must bear in mind that conventional iron supplementation is associated with some negative side effects.
These include damage to the lining of our intestines, nausea, diarrhea and constipation. Iron supplementation has also been associated with changes in the gut microbiome, an important determinant of health.
WHO has recommended two other approaches: diet diversification and food fortification.
Diet diversification is exactly what it sounds like: having a diet with a variety of whole foods such as fruits and vegetables, whole grains and legumes, meats, dairy, and nuts and seeds.
This approach not only ensures that adequate levels of iron are found in the foods we eat, but also that they come in different forms or “vehicles” to enhance absorption. This approach works even with plant foods.
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Read more: What to take with dinner to get the most iron from your diet (and what to avoid)
Food fortification, where iron is added to processed foods, is also a fairly safe but accessible option due to its lower dosage. In Australia, iron is generally fortified in products such as breads, cereals and ready-to-drink mixes.
It can be difficult to get iron into our body and where it is needed. But before turning to supplements, we must remind ourselves that the food source should always come first. In the case of a diagnosed deficiency, your healthcare professional will provide you with more information where supplements are needed.
Read more: Lemon water won’t detox or energize you. But it can affect your body in other ways
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