Iron deficiency is a global public health concern. How does it affect sufferers and what can be done to help?

What is iron deficiency?

Iron is an essential nutrient required for the maintenance of both our physical and mental health. We should be able to absorb all the iron we need from our food, but a deficiency can develop when the body’s demand outstrips its supply.

Iron is used to produce red blood cells, which help store and carry oxygen in the blood around the body. Oxygen is vital for the body and is required to maintain everything from concentration and energy to a healthy immune system. Over time, an iron deficiency can mean the body produces fewer healthy red blood cells, causing iron deficiency anaemia. If a person has fewer red blood cells than is normal, their organs and tissues will not get as much oxygen as they need.

Who is affected?

Iron deficiency is the most common and widespread nutritional disorder in the world, according to the World Health Organization, and it is the only nutrient deficiency significantly prevalent in both developing and industrialised countries. Over 30 per cent of the world’s population (around two billion people) are believed to suffer from anaemia – many because of iron deficiency. And up to 30 per cent of women of reproductive age are affected, meaning women require up to twice as much dietary iron as men.

What causes it?

There are many different factors that can contribute to a lack of iron in the body. In women of reproductive age, the most common causes of iron deficiency anaemia are heavy menstrual bleeding and pregnancy. Iron deficiency during pregnancy is particularly common as extra iron is required for the growth of the placenta, the baby’s development and to protect against blood loss during childbirth. Forty per cent of women begin pregnancy with insufficient iron supplies, yet the need for red blood cells increases by 35 per cent during pregnancy. Therefore, it is often recommended that pregnant women take an iron supplement or increase their dietary sources. Women are particularly at risk of iron deficiency if they have children who are close in age or if they have a multiple birth.

In men and post-menopausal women, the most common cause of iron deficiency is internal bleeding in the stomach and intestines. This can be caused by NSAIDs or it can occur in patients suffering from stomach ulcers, or stomach or bowel cancer. Most people with gastrointestinal bleeding don’t notice any blood in their stools or changes in their bowel habits. However, blood in vomit or stools can occur alongside a stomach ulcer.

Other less common causes of iron deficiency anaemia include:

• Inflammatory bowel disease (IBD), e.g. Crohn’s disease. Between 36 and 76 per cent of patients with IBD experience iron deficiency anaemia. This may be due to long-term internal bleeding within the intestines, reduced iron absorption due to intestinal inflammation or reduced dietary intake if avoiding certain aggravating foods
• Blood donation
• Recurrent nose bleeds
• Traumatic injury lHaematuria (blood in the urine)

Aside from during pregnancy, iron deficiency is rarely caused by a lack of iron in the diet. However, an individual on a lowiron diet may be more likely to develop anaemia if they suffer from one of the aforementioned problems.

What are the symptoms?

Common symptoms of iron deficiency anaemia include persistent exhaustion and lethargy; shortness of breath; heart palpitations, and a pale complexion. Less common symptoms include:

• Headaches
• Tinnitus
• Itching
• An altered sense of taste
• A sore or abnormally smooth tongue
• Dry mouth
• Painful ulcers or cracks at the corners of the mouth
• Hair loss
• Difficulty swallowing
• Spoon-shaped (concave) nails.

Left untreated, iron deficiency anaemia can increase a person’s susceptibility to illness and infection, as iron contributes to the normal function of the immune system. In severe cases, iron deficiency anaemia may increase an individual’s risk of developing complications that affect the heart or lungs, such as tachycardia (an abnormally fast heartbeat) or heart failure (when the heart is not able to pump blood around the body sufficiently).

Pregnant women with severe anaemia have an increased risk of developing complications, particularly during and after birth, including postnatal depression. Research suggests that babies born to mothers with untreated anaemia are more likely to be premature (born before 37 weeks), have a low birth weight or have low iron levels themselves.

How is iron deficiency treated?

If a patient is presenting some of these symptoms, a simple blood test can usually confirm the diagnosis.

To determine the underlying cause of the condition, a GP may ask questions regarding lifestyle and medical history including diet, medication, a woman’s menstrual pattern, family history, blood donation and any other medical conditions.

Treatment varies depending on the underlying cause. For instance, if it is thought to be the result of taking an NSAID, the medication may be stopped (this should only be done on the advice of a doctor). Generally however, the first-line treatment for iron deficiency is supplementation, which is usually effective and rarely produces long-term side effects. A sufferer may also be advised to increase the amount of iron in their diet. Good food sources include:

• Meat, fish and tofu
• Dark green, leafy vegetables, e.g. kale, watercress and parsley
• Beans and pulses, e.g. lentils and chickpeas
• Brown rice
• Nuts and seeds
• Eggs
• Dried fruit, e.g. prunes and raisins
• Fortified cereals and bread

It’s also important for people to ensure they eat a healthy, balanced diet that is rich in vitamin C, as vitamin C can aid iron absorption. All fruit and vegetables are a source of vitamin C, but citrus fruits, peppers, broccoli and sweet potatoes contain particularly high levels.

It’s also important to note that tea and coffee, excessive amounts of dairy and certain antacids and proton pump inhibitors can prevent iron absorption.

Intravenous iron may be delivered directly to the bloodstream in severe cases, or via a blood transfusion if an individual’s levels are extremely low.

Signposting

A new website – irondeficiency.com – aims to raise iron deficiency awareness among specialists and the general public. It provides interactive tools that allow people to recognise the signs of the condition, including a symptom browser and a survey to measure fatigue – a key symptom of iron deficiency. The initial focus will be on women’s health, such as heavy menstrual bleeding and childbirth. However, additional sections will be added throughout the year. These will include cardiology, gastroenterology, oncology, nephrology and patient blood management.