Iron Deficiency

What is iron deficiency and who is affected?

Iron carries oxygen to all cells in the body and takes part in many processes in the body. It cannot be replaced by anything else. All iron comes from the diet and when not sufficiently present, levels will drop. Low iron counts hamper the quality of life in many ways; physical and mental performace deteriorates as well as looks. Women lose more iron due to menstruation, up to every third woman needs supplementation.

Why is iron therapy problematic?

Not complying is easy because of slow change of status (but the quality of life will be lower). Side-effects are too common and inevitably leads to therapy failure.

Not all side effects are drastic, some are merely unpleasant (but lead to quitting all the same). Too much iron can be dangerous, slow and steady supplementation in moderate doses only when needed is preferable.

Iron is an important part of the red blood cells that carry oxygen to all the cells of the body. If we don´t have enough we eaily run short of breath, get tired and have problems concentrating. Our bodies contain 4-5 grammes of iron. It may be difficult to get enough of this important nutrient unless meat courses are part of the diet. Fruit, cereals and vegetables contain relatively little of useful iron.

Many of us minimize the use of meat products. At the same time we eat less than our voracious forefathers. Immobile and non-manual work makes man consume less calories and to have less of an appetite. This means that we get less iron. We also don´t use cast iron kettles for long cooking either like before.

Learning ability for children deteriorates

A negative iron balance causes not only physical and mental fatigue, but may also lead to anemia. Iron deficiency in children may disturb the learning ability, which cannot be substituted along the way. This concerns mainly psychomotor development and cognitive performance.

Low iron values. Why?

Almost every third woman has low iron values. The risk is especially high if menstruation lasts longer than three days, during pregnancy and lactation. During menstruation the woman loses an average of 35-40 mg of iron, or around 10 mg per day. This is why women need more iron than men. The symptoms of iron depletion are so common that they aren´t always recognised. Except for weakness and shortage of breath it also affects appearance. The skin grows pale and hair and nail lose strength and luster.

How long does the woman bleed?

Dr. Lars Ehn from Stockholm uses a simple method: "I ask my female patients who complain of tiredness, general uneasiness and concentration problems how many days they bleed during menstruation. If they answer four or more I´m pretty sure that they need iron supplementation. In reality no-one can replenish such losses with normal diet alone." Of course the diagnosis should be confirmed with a Hb- and serum ferritin level test. Today ferritin, which gives an indication of reserve iron stores is usually taken. This was not always the case. In earlier times the Hb would suffice, instead of taking a deeper approach.

The body regulates uptake

Only around ten percent of digested iron is taken up from the gut. When iron values are low, the uptake increases. If we get too much iron the uptake is blocked. In other words the body itself regulates uptake of the iron in the diet. The only exception to this is sudden large overdoses of iron. This can happen for instance when children believe iron tablets to be candy. In thi case the blocking mechanism is neutralized and iron poisoning is the result. The symptoms begin with nausea and vomiting. It is a serious condition and the reason why syntethic non-heme iron medication always should be kept out of reach for children. For heme iron it is not possible to overload. There are no reported serious side-effects or poisonings reported after over 30 years of use in Scandinavia.

Folic acid and pregnancy

26-year old Lena was pregnant well into the first trimester. Everything was looking good when the sudden bad news hit. The doctor told her that the foetus had a serious birth defect in the form of spinal injury and that now they had to decide wether to keep the baby or terminate the pregnancy. How could this happen? Lena thought she had done well by taking the prescribed medication of iron and folic acid supplements as soon as pregnancy was confirmed.

Modern medicine has concluded that a integral part of the central nervous system in the foetus develops during a stage at when the mother might not be aware of that she is pregnant. The so-called neural tube evolution is hampered by a lack of folic acid in the mother. The risk of birth defect is then high. If the baby is born with spinal defect it will be crippled for life.

Folic acid has been shown to reduce birth defects when taken during the initial stages of prenatal development. The risk of birth defects decreases significantly with a supplementation of folic acid. If pregnancy is possible it is crucial that folate levels are satisfactory, since otherwise it may be too late. The probability is relatively low, but not negligible.

How much folic acid is needed?

The RDA recommendation before and during pregnancy is 800 µg per day and 400 µg normally for men and women. The normal intake is between 200 and 400 µg per day. Folic acidd is needed for the cell genesis and during growth of the foetus. Folic acid is also believed to lower the risk of heart infarct. It is also believed that lack of folic acid may cause malignant cell changes in the uterus and sphincter.

Nutritional status and birth weight

In English studies it has been shown that the nutritional status of the mother, mainly as hemoglobin count has an effect on foetal development. This has also been tied to the healt of the infant throughout life. How is this possible? Professor David Barkers epidemological research sheds new light on the subject. From the beginning of the century new-born babies weight as well as the placenta has been recorded. We know today that a low nutritional status. Above all low hemoglobin values in the mother is reflected in placental weight versus baby weight. By combining these data for more than 5 000 persons and comparing them with health development throughout life certain conclussions could be drawn. It turned out that those born by mothers with low nutritional status suffered from various internal diseases such as low blood pressure, heart disorders and diabetes to a higher degree.

A substantial number of studies show that mineral- and vitamin supplements especially during the vital first trimester has a decisive influence on maternal nutritional status and birth weight of the baby.

It´s been said that even if the mother has low iron counts the baby will get what it needs. Then the symptoms would only concern the mother. Now we know better. New research shows that low iron counts on the mother has a lifelong impact on the baby´s health.

Do hereditary factors matter?

We know today that every third woman has too low iron counts. Body iron storage is on a 75 percent level. Those who have a tendency to bleed much often have the same problem in earlier generations as well, since low iron counts are often inherited. One might answer yes to the question: Are your bleedings normal? Menstruation bleedings are perceived as normal since they don´t vary from time to time. Which they are, of course, for the particular person. The difference being that some bleed normally for two days, other for four days.

Women, protect yourselves against cadmium and save yourself from osteoporosis!

Together with lead and mercury among others cadmium is one of the heavy metals. These are extremely harmful to the human organism. "Women who have low iron values (and especially those who smoke) are in the risk zone of getting too much cadmium." says Marie Vahtner, prodfessor of metal toxicology at Karolinska Institutet in Stockholm.

In a study several dietary nutritional factors were observed, among these cadmium. It was oserved that in different diet groups the cadmium intake was roughly the same. In spite of that there was a negative correlation with low iron counts and high cadmium content in the body. "When we have low iron stores the uptake from the gut increases. Cadmium intake also increases because the mechanism for uptake is related" says Marie Vahtner.

Until now the large group associated with cadmium has been smokers, tobacco leafs contain large amounts of cadmium and the lung uptake is greater than gut uptake. This is the reason smokers often have cadmium levels that are close to damaging.

Cadmium is stored mainly in the skeleton and once there replaces and blocks much-needed calcium uptake in the bone structure leading to osteoporosis. Therefore the risk for osteoporosis is considerable for those who have low iron counts and depleted iron stores.

Normal Hb-value and iron deficiency at the same time?

An ordinary Hb-test says nothing about stored iron. The iron stores of the body are measurable with a so-called serum ferritin count. When serum ferritin lies above 30 ug/l the iron stores are full. If this value drops the uptake from the gut will increase. In a comparative study vegetarians had lower serum ferritine levels, but comparative Hb-levels as omnivores. This was because the Hb-levels don´t start to drop before the reserves are running out.

"You have to remember that general symptoms start to occur only when reserves are empty and the Hb-levels drop drastically. That´s why it´s very important to check serum ferritine levelss as well." says Dr Lars Ehn. This is a question for workplace health care mainly. If and when a hard-working woman gets fatigued from iron deficiency without being aware of it the results can be quite serious. Stress and burn-outs all too common these days.

Hidden iron deficiency –a problem in company health care

Iron deficiency can give the following symptoms:

  • tiredness, fatigue, passivity and drowsiness
  • concentration difficulties and increased need for sleep
  • impaired performance
  • lessened learning ability
  • Research for preventing iron depletion anemia has been going on since the 1960:ies mainly focusing on blood-donors and the pregnant. One of the pioneers is Dr. Lars Ehn. He has shown that heme iron preparations are more safe and efficient than traditional high-dose iron tablets. He is one of those who have developed new iron preparations through studies.

"I have a number of patients that have taken heme iron preparations for years. They have kept a satisfactory iron balance without the unfortunately all too common side effects that are often assocated with iron preparations" Today he works in the company health care sector where there are a large number of iron deficient female patients. Many have a hidden iron defiency i.e. normal Hb but very small or no body iron reserves. This especially if she bleeds more than three days in menstruation. The iron depots are tested by measuring serum ferritin levels.

Two kinds of iron

Modern women often eats a varied diet and lives healthily. Despite this iron deficiency is more common today than 50 years ago. This is mainly because women eat less in total and comparatively less heme iron. There are two kinds of dietary iron: the inorganic iron found in vegetables and as enrichment or supplements and organic iron, also knomn as hemoglobin or heme iron, found in meat courses. Women of today eat less meat and more vegetables and thus get less heme iron than before.

Heme iron

Dr Lars-Göran Kjellin, medically responsible at the Curera clinic in Stockholm and Solna Läkarcenter is one of many satisfied doctors who use heme iron tablets for their patients.

"This is an excellent and welcome complement to current iron preparations. Too many patients can´t handle the usual iron medications due to side-effects in the form of stomach problems. When we put them on heme iron tablets serum iron and hemoglobin readings are corrected and they become free from symptoms. In our company care health examinations of we check women for hidden iron deficiency among other things. This is surprisingly often the case in patiens with fatigue symptoms. When they get medication blood iron levels return to normal and the patients feel better without side-effects."

Uptake and side-effects

Heme iron is different from the iron salts also in that the hemoglobin molecule is taken in without prior splitting in the gut. The uptake itself is thus more efficient and is not affected by other simultaneously digested foodstuffs. In the uptake of non-heme iron there can be large differences if tea, coffee, milk or coarse bread is present. All of these affect the absorption in a negative way. A glass of orange juice makes for better absorption.

In a normal varied diet there is around 15 mg of iron salts per day. 14,5 mgs will not be absorbed. Of heme iron, which constitutes a smaller part of the diet more than a quarter will be utilized.

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The OptiFer® Series of original Heme-Iron products are made in Sweden under full HACCP quality standards.


I have a number of patients that have taken heme iron preparations for years. They have kept a satisfactory iron balance without the unfortunately all-too-common side effects that are often associated with iron preparations.

Dr. Lars Ehn, MD.  

Dietary-based treatment containing heme iron has few side effects and can be used efficiently to improve the iron status of women of reproductive age.

Hoppe et al. Nutrition. 2012  

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FerroCare handles heme iron production, marketing and development. FerroCare is a subdivision of MediTec Group.