Doctors frequently are confused about iron testing. Many feel that, if a hemoglobin level is normal, then the iron level is normal. That is not true. It takes moderate to severe iron deficiency to result in a lowered hemoglobin level. Therefore, a patient can have a low iron level long before he or she displays a low hemoglobin level. The testing to order for diagnosing an iron problem includes not only a hemoglobin level but also a ferritin level.
Ferritin is a measure of the iron storage cells in the body. A ferritin level is the best single test to order when checking an iron level. However, in patients with inflammation, ferritin can be abnormally elevated. In these cases it is best to also get a total iron level and a TIBC (total iron-binding capacity).
Checking all of these factors can lead to the proper evaluation of the body’s iron status. As previously mentioned, iron can be either too high or too low. This section will deal with iron deficiency. Iron deficiency is one of the most common nutritional deficiencies worldwide.
Iron deficiency can be mild, moderate or severe.
• Mild iron deficiency results from iron depletion, yet there are no impairments in hemoglobin levels. Patients usually feel well and this is picked up on routine blood work that looks at iron levels.
• Moderate iron deficiency is due also to iron depletion. Other than low iron levels, there are no other abnormalities of the blood tests but patients with this problem complain of being fatigued and having aching muscles and joints. Headaches can be common for sufferers of moderate iron deficiency.
• Severe iron deficiency manifests as low iron on blood testing and, additionally, lowered hemoglobin levels. This is how iron-deficient anemia is diagnosed. In this stage, the red blood cells cannot carry adequate amounts of oxygen to the tissues. Patients have a myriad of complaints of severe fatigue, coldness, poor hair and nail qualities, shortness of breath with exertion, and a pale skin color. Severe iron deficiency is not uncommon in my practice.
Two main factors which cause iron deficiency: increased iron needs and inadequate iron intake or absorption from the diet. Infants and young children have higher iron requirements compared with older children because their bodies are growing so rapidly.
Children who drink a large amount of milk or eat a large amount of dairy products can have problems with iron absorption. Milk products have been shown to inhibit iron absorption.
One of the first things I recommend for children with iron deficiency is to avoid dairy products. Vegetarian diets are notoriously deficient in iron. Although there is some iron in plant products, it is not absorbed as well as iron from animal products.
In fact, iron from meat, poultry, and fish is absorbed from three to five times more efficiently as iron from plant-based foods. Also, antacid medications, especially proton-pump inhibitors such, by their action of decreasing the amount of hydrochloric acid, will decrease iron absorption. Iron absorption requires and uses hydrochloric acid from the stomach.
Calcium, phytates (from nuts), and polyphenols from tea and coffee have been shown to decrease plant-based iron. Phytates from nuts are a problem with raw nuts. They can be minimized by soaking and roasting the nuts. Finally, you can increase iron absorption by eating foods high in vitamin C.
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