Don't Forget Iron


Are you missing IRON?

Iron is a critical nutrient for women, and yet as many as 30% of women of child-bearing age are deficient. Iron deficiency causes fatigue, breathlessness, and hair loss. Pregnant women have a particularly high need for iron. Others risk factors for deficiency include low dietary intake, heavy periods due to fibroids or other condition, under-active thyroid, gluten sensitivity, or other gastrointestinal conditions.

Good food sources of iron include meat, poultry, eggs, fish, legumes, beetroot and dark green vegetables. Excess iron is toxic, and iron tablets should be supplemented only when a need has been demonstrated by blood test. Iron tablets can prevent absorption of thyroid medication and some other medications.

Iron is necessary for healthy ovulation

The Nurses' Health Study ( a long-term study of 18,000 participants) has provided data that shows that women with adequate iron intake are less likely to suffer problems with ovulation. (1)

The ovary produces important iron-binding proteins. It is one of only a few organs to do so, so it is not surprising that iron is important for ovulation. According to lead author Jorge Chavarro from the Harvard School of Public Health, "It could be that iron is important for the maturation of the egg."

Are your heavy periods caused by iron deficiency?

Iron deficiency can cause the body to skip menstrual periods, or it can cause abnormally heavy menstrual flow. (2) Heavy periods, in turn, cause iron deficiency, which can become a vicious cycle.

You cannot "detox" without iron

Our body's ability to eliminate chemicals and toxins depends on a complex system of detoxification enzymes, the first of which is cytochrome p450. Cytochrome p450 enzymes attach an oxygen atom to toxins, which renders them more water soluble and ready to flush out. The enzyme's ability to do this important job depend on the iron molecule in its centre. If you are deficient in iron, you cannot detoxify properly.

You cannot make thyroid hormone without iron

The thyroid gland requires adequate iron to make thyroid hormone. (It also requires the minerals iodine and selenium.)

You need adequate thyroid function to be able to absorb iron

The body requires adequate thyroid hormone to absorb and assimilate dietary iron. (3) Both iron deficiency and under-active thyroid cause fatigue, and unfortunately, one condition exacerbate the other. This is a double whammy for many women. Under-active thyroid can also cause heavy periods which further deplete iron.

Don't combine thyroid medication with iron tablets

Iron and other mineral supplements can interfere with the absorption of thyroid hormone supplements. Patients are advised to take thyroid medication first thing in the morning. Nutritional supplements containing iron, calcium or magnesium should be taken at least several hours after thyroid medication. Popular stomach medications cause iron deficiency Certain stomach medications, called proton-pump inhibitors or PPIs' (eg. Losec, Nexium) can cause iron deficiency with long-term use (4). PPI's shut down the production of stomach acid, which is a problem because acid is necessary for the absorption of minerals. PPI's effect on calcium absorption has linked the drug to a risk for osteoporosis (5).

Are you certain that your doctor tested for iron?

Most blood tests will include a "full blood count", which tests for (among other things) an adequate number of red blood cells. This rules out severe, long-standing iron deficiency, but is not sensitive enough to pick up a more recent or moderate iron deficiency. To determine if you have enough (or too much) iron, you should be tested for "iron studies" or "serum ferritin". Many, many times this will show a deficiency even when red blood cell count is normal.

Don't test for iron during an infection

During infection and inflammation, the body changes the way that it handles iron. This can result in an artificially elevated iron (ferritin) on blood test.

High iron (ferritin) on blood test can indicate diabetes or other inflammatory condition

If the blood test "serum ferritin" is elevated, it may mean iron overload (such as hemochromatosis), but there are other possible diagnoses. Elevated serum ferritin can indicate inflammation or chronic disease such as diabetes (6). In such cases, an
additional test for the inflammatory marker C-reactive (C-RP) protein may be required.

Avoid iron tablets during an infection

Iron is necessary for healthy immune function, but iron tablets should not be taken during an active bacterial infection, because they may feed the bacteria (7). Wait until the infection clears to resume an iron supplement. (Iron tablets can also interfere with some antibiotics.)

Use chelated iron to avoid digestive side effects

Conventional iron tablets cause nausea and constipation, but there is an alternative. Chelated iron (iron bisglycinate) is gentle on the gut, and it is actually easier to absorb than ferrous sulphate.



  1. Chavarro, JE et al. Iron Intake and Risk of Ovulatory Infertility. Obstetrics & Gynecology. 2006. 108(5): 1145-1152
  2. Taymor ML et al. The Etiological Role of Chronic Iron Deficiency in Production of Menorrhagia. Obstetrical & Gynecological Survey. 1964.19(4): 674-677
  3. Cinemre H et al. Hematologic Effects of Levothyroxine in Iron-Deficient Subclinical Hypothyroid Patients: A Randomized, Double-Blind, Controlled Study. J Clin Endocrinol Metab. 2009 Jan;94(1):151-56
  4. Ali, T et al. Long-term Safety Concerns with Proton Pump Inhibitors. Amer J Medicine. 2009. 122(10): 896-903
  5. Targownik LE et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ. 2008; 179 (4):319-26
  6. Forouhi, NG et al. Elevated serum ferritin levels predict new-onset type 2 diabetes: results from the EPIC-Norfolk prospective study. Diabetologia 2007. 50(5): 949-956.
  7. Sritharan M. Iron and bacterial virulence. Indian J Med Microbiol 2006;24:163-4

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