What Is Iron?
Meredith Bull, ND, is a licensed naturopathic doctor with a private practice in Los Angeles. She helped co-author the first integrative geriatrics textbook, "Integrative Geriatric Medicine."
Iron is an essential nutrient and one of the most important minerals for your body. While all human cells contain iron, it is mostly found in red blood cells (RBCs). Iron is needed for your body to produce hemoglobin, which helps the RBCs carry oxygen throughout the body.
Additional roles that iron plays in the body include:
- needed to make myoglobin
- supports a healthy immune system
- helps with brain development
- helps produce collagen and other proteins
- helps to convert beta carotene to vitamin A
Iron supplements play a vital role in treating anemia (low levels of healthy RBCs), particularly iron deficiency anemia (IDA).
Most people get all the iron they need from their diets. However, iron deficiency is the most common cause of anemia.
This article explains what iron does for your body and when it would be appropriate to supplement iron.
Dietary supplements are not regulated in the United States, meaning the FDA does not approve them for safety and effectiveness before products are marketed. When possible, choose a supplement that has been tested by a trusted third party, such as USP, ConsumerLabs, or NSF. However, even if supplements are third-party tested, that doesn't mean that they are necessarily safe for all or effective in general. It is important to talk to your healthcare provider about any supplements you plan to take and to check in about any potential interactions with other supplements or medications.
- Active ingredient: iron
- Alternate name(s): ferrous sulfate, ferrous gluconate, ferric citrate, ferric sulfate
- Recommended Dose: RDA ranges 7-27 mg/d depending on age/gender, TUL ranges 40-45 mg/d, treatment for IDA is 50-100 mg/d divided into separate doses
- Safety Considerations: Discuss with healthcare provider regarding proper dose before taking, avoid exceeding the tolerable upper limit (TUL) for iron unless recommended to treat iron deficiency, accidental iron poisoning has occurred in young children – keep adult supplements and medications out of child's reach,
Uses of Iron
Supplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian, pharmacist, or doctor. No supplement is intended to treat, cure, or prevent a disease.
The benefits of iron supplementation are mainly restoring low iron levels. Treating iron deficiency alleviates the symptoms you could experience with low iron and anemia. It also helps to avoid complication down the road as iron deficiency progresses to anemia.
Iron supplementation is of no benefit to people who are not deficient.
Iron is helpful for treating anemia related to iron deficiency. It’s one of the most common nutritional deficiencies in the world.
Symptoms of anemia include fatigue, dizziness, shortness of breath, fast heart rate, and an overall feeling of sickness and weakness.
Iron deficiency can lead to arrythmias, heart murmur, enlarged heart, and heart failure. Iron deficiency has also been shown to increase the risk of developing fibromyalgia.
In pregnant women, iron deficiency can also lead to pre-term delivery and low birth weight in infants. In children, iron deficiency left untreated can lead to development and behavioral problems.
Anemia results when hemoglobin is below normal ranges.
Daily iron supplementation has been shown to reduce the prevalence of anemia and low iron status.
Iron deficiency is the most common nutrient deficiency. Left untreated, it can lead to numerous health issues. If you suspect you may be deficient, discuss with your healthcare provider so that a deficiency can be appropriately confirmed and treated.
Iron may help manage unexplained fatigue, even in someone who isn’t anemic but has a low ferritin level (an indicator of iron stores). This is especially common in women during their reproductive years. Daily iron supplementation was shown to reduce fatigue in menstruating women.
A randomized trial studied women aged 18-53 who complained of fatigue. If they had a ferritin less than 50 ug/L and hemoglobin greater 12 g/dL, they were randomized to receive either 80 mg elemental iron or placebo. The group receiving iron, reports greater improvement in fatigue but no improvement in overall quality of life.
Iron supplementation may improve fatigue in women with low ferritin levels.
Improves Athletic Performance
Iron is needed to make myoglobin, the protein that provides oxygen to muscle.
Many athletes may have adequate intake of iron from their diet to support performance.
However, athletes involved in endurance training like marathon running or endurance cycling events can lose more iron. Add to that being female or vegetarian and all of these can put an athlete at a higher risk for iron deficiency and anemia.
It is important for athletes to make sure their iron intake is adequate for peak performance. Monitoring for low levels of iron in the blood and supplementing iron if needed will also ensure adequate intake of iron.
Daily iron supplementation in menstruating women has been shown to improve exercise performance. It has also been shown to improve maximal and submaximal exercise performance in females of reproductive age.
Improve symptoms in Restless Leg Syndrome (RLS)
Restless leg syndrome is condition in which in people have an uncontrollable urge to move their legs. This usually occurs at night and can disrupt sleep.
A meta-analysis published in 2019 concluded that iron supplementation is associated with improvement in the International Restless Leg Syndrome score (IRLSS) .
Research shows that cognitive levels drop with iron deficiency. In fact, when iron levels in the blood drop, concentration and attentiveness are affected almost immediately.
Getting iron levels restored to a normal range can improve concentration and boost cognitive performance.
A study in adolescent girls who were not anemic but had low levels of iron, found that iron supplementation improved verbal learning and memory. Additionally, supplementing iron in children with IDA improved hemoglobin levels and reduced deficits in cognitive and motor skills.
Iron deficiency is one of the most common nutrient deficiencies. Iron deficiency progresses through phases: 1) storage iron depleted resulting in low serum ferritin levels, 2) iron supply available for erythrocyte production is low but hemoglobin levels are still normal, 3) iron stores are depleted resulting in anemia with small RBCs and low hemoglobin concentrations.
Those who are at greater risk of developing iron deficiency are menstruating women, pregnant women, and children. Additionally, long term use of antacids may put you at a greater risk of iron deficiency.
What Causes Iron Deficiency?
Iron deficiency results from either too little intake in the diet or excessive losses. Losses may occur from blood loss, reduced absorption in the intestines, or prolonged exercise (e.g. -athletes that compete in marathon running or cycling endurance events).
Menstruating women are at a greater risk of anemia and iron deficiency due to blood loss.
People with intestinal diseases, such as Crohn's disease or a history of gastrointestinal surgery, such as bariatric surgery may be at greater risk of iron deficiency. This is because they may not absorb adequate amounts of iron.
Iron is absorbed in the duodenum, the most proximal part of the small intestine. People that have had gastric bypass (a type of bariatric surgery) can only absorb nutrients beyond the duodenum. Also, stomach surgeries may reduce production of acid in the stomach which is needed for iron absorption.
The incidence of iron deficiency is almost 25% in people who underwent a roux-en-y gastric bypass and about 12% in people who had a gastric sleeve procedure.
Vegetarians may also be at risk of iron deficiency. Plant based sources of iron are not absorbed as well as animal sources.
How do I know if I Have Iron Deficiency?
Symptoms of iron deficiency include fatigue, shortness of breath, dizziness, headaches, palor (pale skin), and weak and brittle nails. People with iron deficiency also have difficulty concentrating and a poor memory.
If you suspect you have an iron deficiency, you should discuss your symptoms with your healthcare provider. A complete blood count (CBC) will include a hematocrit and hemoglobin level. Low levels of hemoglobin suggest anemia. It is important to note that there are several causes of anemia. Therefore, additional tests may be needed to determine if the cause of anemia is iron deficiency.
A serum ferritin is the preferred blood test for diagnosing iron deficiency and it can identify low levels of iron before it progresses to iron deficiency anemia. A serum ferritin less than 30 mcg/liter suggests iron deficiency and a level less than 10 mcg/liter suggests IDA.
The World Health Organization (WHO) recently updated the recommended cut off values to indicate iron deficiency. In children under the age of 5 years, less than 12 mcg/liter indicated deficiency and in school age children and adults, less than 15 mcg/liter indicates deficiency. Different thresholds were suggested for individuals with infection or inflammation. They are less than 30 mcg/L and less than 70 mcg/liter, for children under 5 and adults, respectively .
An upset stomach is the most common side effect of iron supplements.
Constipation is another very common side effect of some forms of iron.
The risk of iron overload in a diet is low in most healthy adults. Most of the time, if there is more iron in the body than necessary, the body will save it for future use.
However, people with certain genetic disorders are at risk for an iron overload if their conditions cause them to absorb more iron from food.
Iron overload may cause a buildup of iron in the liver and other organs. It can also cause the creation of free radicals that damage cells and tissues. This increases the risk for certain cancers.
Taking high doses of iron supplements can cause nausea, vomiting, and stomach pain. There are very rare cases of iron overdoses leading to internal bleeding, seizure, coma, and even death.
Iron supplements can decrease the effects of certain medications, including those for treating restless legs syndrome and thyroid problems. Reflux disease medications can reduce the amount of iron that the body absorbs from food and supplements.
It is always important to discuss with a healthcare provider whether you should take an iron supplement. This is especially true if you take any prescription medication.
People with hemachromatosis should avoid iron supplements. Iron can build up to dangerous levels in the body if you have hemachromatosis.
The recommended dietary allowance (RDA) for iron varies by age and gender.
The need for iron increases to 11 mg/day in infants once they reach 6 months of age. From there, the requirement ranges from 7-10 mg until the age of 14 years. After which, the requirement for males stays about the same but increases for females up to 15-18 mg daily. After age 50 for women (or when they reach menopause), the requirement drops to 8 mg again.
During pregnancy the requirement increases to 27 mg/day and for breastfeeding mothers the requirement is 9-10 mg/day.
The tolerable upper limit (TUL) for iron is 40 mg/day for children under the age of 13 and 45 mg for older children and adults. For general healthy people that are not iron deficient, supplements providing more than the TUL for iron should be avoided.
For treating iron deficiency, 50-100 mg iron is frequently recommended divided into 2-3 doses. This is usually done under medical supervision, after iron deficiency has been confirmed with lab work.
Iron supplements should be taken with food.
It is often suggested that iron should be taken with vitamin C to help with absorption of iron. However, a recent trial in iron deficient subjects found that there was no difference in laboratory indices (hemoglobin and serum ferritin) between subjects given iron with vitamin C or iron alone.
What Happens if I Take Too Much Iron?
There is minimal risk of developing iron overload from your diet.
Taking too much iron from supplements can lead to stomach upset and constipation.
Taking iron supplements may also reduce zinc absorption.
In severe cases of taking too much iron (60 mg/kg body weight), overdoses resulted in organ failure, coma, and death.
can lead to excessive stores of iron. Excess iron can cause toxicity, cirrhosis, heart disease and congestive heart failure.
In some cases, excessive iron has led to gastric ulcers and bleeding.
An observation study has found that excessive levels of stored iron may increase the risk of cancer, diabetes, and stroke.?
It is important to know that iron poisoning can occur in children. It can cause serious injury and death and may occur if young children accidentally ingest adult iron capsules or pills. To avoid this, be sure to keep supplements out of children's reach and keep them in child proof containers. Seek medical attention if you think your child may have taken adult iron pills.
Iron supplementation may interact with several medications including:
- ACE inhibitors
- quinalone antibiotics
- tetracycline antibiotics
Consuming black or green teas may reduce the amount of iron you absorb, therefore, avoiding these teas if repleting iron levels is recommended.
Iron supplements may reduce the absorption of other key micronutrients including zinc, copper, magnesium and manganese.
Calcium may interfere with the absorption of iron so it is recommended to take iron and calcium supplements at different times of the day.
How to Store Iron
Food Sources of Iron
Iron is readily available in the diet. Iron in foods comes in two different forms – heme and nonheme. Meat, poultry, and fish provide both heme and nonheme iron, whereas, plant-based foods provide only nonheme sources of iron. Heme iron tends to be better absorbed.
Common sources of heme iron in the diet include lean meats and seafood. Oysters and sardines are a great source of iron.
Good sources of nonheme iron include beans, lentils, tofu, and spinach.
In the United States, wheat and some other flours are fortified with iron. Breakfast cereals are also fortified with iron and may be able to meet iron requirements alone.
For infants, breastmilk has enough iron until they reach 6 months of age. After which, the introduction of foods provides additional iron. Infant formulas are fortified with 12 mg iron/liter.
Cooking on cast iron can also help you add more iron to your diet.
Iron supplements come in many different forms – pills, gummies, chews, and liquids. There are also intravenous forms of iron that can be provided under medical supervision.
It is also important to note that most iron supplements provide iron as a compound, such as ferrous sulfate, ferrous gluconate, or ferrous succinate. The amount of the compound in the supplement is not the same as the amount of iron in the supplement. For example, 250 mg ferrous sulfate typically provides 50 mg elemental iron. The supplement facts on the label should indicate the amount of elemental iron.
Intravenous iron is also available and one time dose was more effective than oral supplementation for patients that had a roux-en-y gastric bypass .
Iron is one of the most important minerals your body needs to remain healthy. When you don't have enough iron in your body, you may experience fatigue, inability to concentrate, and sleeplessness. Your muscles get tired more easily and your immune system may not operate as well as you need it to.
Fortunately, if your doctor determines you need more iron, they can help you find ways to include more iron in your diet. They may also suggest you take iron supplements to boost your iron levels.
Frequently Asked Questions
Diet. This minimizes the risk of overdose and ensures good intake of other nutrients as well. What you pair iron with also matters. Vitamin C enhances iron absorption. Calcium limits absorption. Chemical compounds called tannins, such as those found in tea and coffee, limit absorption too.
It can be. Iron supplements are only recommended in cases of diagnosed deficiency or when someone is at high risk for it, as too much iron can be dangerous. Talk to your healthcare provider to confirm the true cause of your symptoms and get advice on proper treatment.
Marijuana and Anemia: What You Need to Know
Anemia affects about a third of the global population. It’s the most common blood disorder with iron deficiency being the number one cause.
Anemia is more common in women than men, while pregnant women, children and the elderly are especially vulnerable groups. Children and the elderly are particularly susceptible to anemia caused by iron deficiency.
There are certain types of treatment depending on the type of anemia, but not all are effective long-term. Marijuana is in the early stages of research for its effects on anemic patients.
Let’s explore this condition in more detail, and see if there is a beneficial connection between marijuana and anemia.
What is Anemia
Anemia is a condition where the blood lacks enough red cells or hemoglobin to meet one’s physiological needs.
Blood consists of four main components: plasma, red blood cells, white blood cells, and platelets. Red blood cells or erythrocytes contain hemoglobin, an iron-containing protein responsible for transferring oxygen through the body.
The normal amount of red cells and hemoglobin varies depending on age, sex, body constitution (especially height), and pregnancy status.
Having anemia means that the blood lacks the ability to carry adequate amounts of oxygen to tissues.
Types of Anemia
There are more than 400 types of anemia. They are divided into groups based on their cause (1):
- Anemia caused by blood loss
- Anemia caused by decreased or faulty red blood cell production
- Anemia caused by the destruction of red blood cells
Some types are more severe than others, and anemia can be a long term or temporary condition.
Anemia caused by blood loss can happen in the following cases: injuries, surgeries, gastrointestinal conditions (ulcers, gastritis, cancer), excessive menstrual bleeding, to name just a few.
Red blood cells can experience rupture or be too fragile due to some genetic conditions, like sickle cell anemia, or infections like malaria. It can also be a secondary symptom in cancer patients.
The more common types of anemia are those caused by decreased red blood cell production. These include:
- Iron deficiency
- Vitamin deficiency (B-12, C, or folic acid)
- Bone marrow or stem cell problems
- Other conditions or diseases
The production of red blood cells starts in bone marrow from stem cells. The stem cells that reside in the bone marrow are transformed into blood stem cells. Bone marrow can fail to make this transformation in many different ways, one of them being aplastic anemia – the lack of production of all types of blood cells, not only erythrocytes.
Some chronic diseases can cause anemia of inflammation, also called anemia of chronic disease. This type of anemia is caused by the underlying conditions, usually when there are not enough hormones that take part in red blood cell production. These chronic conditions are (2):
- Rheumatoid Arthritis
Iron deficiency anemia is the most common type of anemia. It is responsible for more than half of the recorded cases of anemia worldwide. It occurs due to insufficient iron, which usually happens because of one of the following reasons:
- Blood loss
- Insufficient dietary iron intake
- Poor absorption of iron
If the anemia is too mild and developing over a longer period of time, it can be present without any symptoms. In other cases, the signs and symptoms vary depending on the type of anemia. However, most types of anemia have the following symptoms in common:
- Pale skin
- Unusual tiredness
- Difficulty concentrating
- Short breath
- Heart palpitations
The abovementioned symptoms are all seen in iron deficiency anemia, but there are some symptoms associated with specific types of anemia. Patients suffering from sickle cell anemia can also experience delayed growth or development in the early years, recurrent infections, as well as abdominal or chest pain.
The treatment of anemia depends on the specific type of anemia and its cause.
Iron deficiency anemia is treated with iron supplements and a high intake of iron-rich foods like red meat, broccoli, spinach, and legumes.
When it comes to other types of anemia, like thalassemia, an inherited blood disorder, the treatment may include regular blood transfusions, folic acid supplementation, as well as spleen removal, and bone marrow transplantation, in more severe cases.
Aplastic anemia is similar in treatment to the above-mentioned type. The usual treatment includes blood transfusions and bone marrow (also called stem cell) transplants.
For patients who, for some reason, can’t undergo bone marrow transplant, the usual solution is immunosuppressants. This is usually the case when aplastic anemia is a secondary disease caused by an autoimmune disorder, as well as in older patients.
Though this treatment is effective in treating the symptoms, it also weakens the immune system, has many side effects, and it’s not a long-term solution. The symptoms come back as soon as the patient stops taking the therapy.
Marijuana and Anemia
Though the cardiovascular actions of cannabinoids and endocannabinoids have been extensively explored in the past couple of decades, research on (endo)cannabinoids and blood is in the early stages (3).
What do we know so far?
After dozens of studies, the endocannabinoid system has been established as a scientific fact. Based on current research, we can conclude that:
- The endocannabinoid system takes part in regulating the immune system
- Cannabinoids have anti-inflammatory properties, as well as positive effects on pain
The effects of cannabinoids on some types of anemia, like sickle cell anemia, have been explored on mice. Researchers were examining the effects of cannabinoids on pain-related behavior in mice with human sickle hemoglobin. They discovered that cannabinoids can reduce pain (4).
At the moment there is no research on people who explore the treatment of anemia with medical marijuana.
However, one anonymous questionnaire study in London explored the use of cannabinoids in sickle cell anemia patients. The patients were taking a self-administered questionnaire to provide a guarantee of anonymity since cannabis is not legal in the United Kingdom. The results showed that 36% have used cannabis to relieve symptoms of sickle cell anemia in the past year (5).
Since the legal status of marijuana is changing for the better, we can expect more scientific insights into cannabinoids’ role in treating these medical conditions.
In the meantime, cannabis can be used for alleviating the symptoms of anemia.
Best Strains for Pain
Marijuana can be used as a symptom reliever, especially since many states have included chronic pain as a qualifying condition for medical marijuana. This is especially helpful for patients with sickle cell anemia. Cannabinoids can be beneficial in this case because the pain in sickle cell anemia patients is initiated by inflammation. Here are some of the best strains for pain relief:
- Sensi Star is an earthy indica strain for late night consumption. It relieves stress, pain, and insomnia.
- Henik (Alien Dog)is a hybrid strain with high levels of THC. It has flowery flavor and can be consumed throughout the day. It relieves stress and will leave you feeling relaxed and happy.
- Sachigo (Sour Kush) is another hybrid high in THC. It’s best for depression, stress, and pain relief.
Marijuana for Pain Relief—Here’s How to Reclaim Your Life Back
Best Strains for Fatigue
If you are experiencing problems with fatigue, sativa strains are the way to go. They are energizing and stimulating and should be consumed during the day. Some of the best strains for fatigue are:
- Delahazeis a strain perfect for awakening your body. This citrus-flavored strain will make you feel energetic and uplifted.
- Houndstooth has a citrusy and spicy pine-like aroma. If you are looking for an interesting combination of flavors, this is the way to go.
- Ultra Sour is a woody and citrusy sativa strain for a good mood. It leaves you feeling happy, euphoric, and relaxed at the same time.
Best Strains to Stay Focused
If anemia is making it hard for you to concentrate and keep on track, there are strains to help you out with that. Some of the best strains for staying focused are:
- Jacky White is a high-THC sativa strain with a sweet, earthy and tropical aroma. The typical effects are feeling creative, focused and relaxed.
- CBD Skunk Haze is a spicy and buttery hybrid with a 1:1 ratio of THC and CBD. It relieves stress and makes you feel relaxed, focused and energized.
- Spoetnik #1 is a strain with woody and pine-like flavor. If you want to feel euphoric, but at the same time relaxed and focused, then this is the one for you.
If you haven’t found your perfect match, or you’re just a bit more curious, you can use Strainblazer, our strain recommendation tool, to discover more strains on the market.
How to consume marijuana?
Since dizziness is one of the most common symptoms of patients with anemia, you should probably stay away from smoking and vaping. This doesn’t mean you have to stay away from marijuana completely.
Luckily, there are other ways to get cannabinoids into your system. These include:
- CBD oils
CBD oils can be used as sprays or drops. You can apply it to your skin topically for quick pain relief. This is the easiest way, and it doesn’t require much knowledge. However, you may need greater amounts.
Another popular way is taking CBD oil orally, by applying it under your tongue (sublingual). After applying it under the tongue, you should hold it in your mouth for half a minute and then swallow.
You can also take CBD oil by adding it to your food or drinks. It should be noted that the effects of oral consumption take time. The first effects of CBD oil usually kick in after a couple of hours, so be patient when getting started.
There are also plenty of recipes online for making marijuana edibles. You can try cupcakes, candies, cannabutter, or if you prefer marijuana-infused drinks, you can make yourself a nice cup of weed tea.
A word of advice
Always be careful with edibles. You won’t feel the effects of marijuana immediately, because the edibles usually start to kick in after 30-60 minutes. So, be patient, and don’t rush for another serving until you feel the effects of the first one.
The effects of edibles are also prolonged, lasting much longer than with smoking or vaping.
It’s important to start with small doses and introduce yourself to edibles gradually. That way you’ll be able to find your way up to the right amount for your needs. You can also download this free cannabis dosage guide to help you get started.