Ironing out the health issues
Iron-deficiency anaemia is one of the most common nutritional disorders, yet many people are unaware of the signs. GP Dr Shahzadi Saleem tells Sophie Herdman why pumping up our iron intake could by life-changing
There are many different types of anaemia – from vitamin B12 to folate deficiencies – but by far the most common form is iron-deficiency anaemia, and it affects more people than you might think.
The World Health Organisation (WHO) says that over 30% of the world’s population is anaemic, mainly due to a lack of iron.
In fact, as Dr Shahzadi Saleem, a GP based in Oxford, points out, iron deficiency is one of the most common – if not the most common – nutritional disorders.
WHAT IS IT?
Put simply, it means that levels of haemoglobin, a protein that transports oxygen through the blood, are below normal.
Dr Saleem says that in the UK, normal levels are measured as 13.5g per decilitre in men, 11.5 in women and 11 in pregnant women.
SPOT THE SIGNS
The main symptoms are chronic tiredness and lethargy.
“That’s the most common thing that people present to the GP,” says Dr Saleem. “Then we expand upon it and they’re usually also feeling short of breath on exertion. They might also be suffering with palpitations, anxiety and hair loss.”
These symptoms might seem small, but they can have a big impact on your life.
“If you’re feeling anxious, that can make you feel depressed. It can have a domino effect on the quality of your life,” says Dr Saleem.
Other symptoms include headaches, constipation, recurrent coughs and colds, having a sore mouth and what Dr Saleem describes as a geographical tongue.
“You have a pattern on the tongue which is dermatitis, it’s classical to iron deficiency, but usually you just have a sore tongue, and sometimes people can have difficulty swallowing because they have a dry mouth.”
Sometimes children will develop pica – urges to eat non-food items, such as mud or paper.
Iron-deficiency anaemia can also occur as a result of another illness, like a stomach ulcer which causes chronic blood loss, inflammatory bowel disease which reduces the amount of iron absorbed in the body, and chronic kidney disease, where red blood cells are not produced at the normal rate.
When this is the case, people might not think that they’re anaemic, as they just assume their symptoms are caused by their ongoing illness.
“Or, if it’s slow bleeding from the stomach, it might be such a gradual process that people are not aware of it happening,” says Dr Saleem.
CAUSES
As mentioned, iron-deficiency anaemia can be a result of a chronic condition, but there are simpler causes too.
“The most common one is probably poor dietary intake,” says Dr Saleem. “You’re simply not taking in enough iron-rich food, such as red meat, nuts, lentils, chicken liver and green vegetables.”
Young women are particularly at risk of diet-related iron-deficiency.
“Women are often more conscious of what they’re eating, but if you are very health and weight conscious and don’t want to eat so much red meat, opting instead for lean white meat, you might miss out on iron.”
Some women may experience lower iron levels during their periods too.
Iron-deficiency anaemia can also be a common feature of coeliac disease, a digestive condition whereby the body responds badly to gluten. It can cause people to lose a lot of the villi on their intestine, which stops nutrients being absorbed. If you are concerned, your GP can refer you for tests if coeliac is suspected, as following a gluten-free diet is essential to long-term health.
Vegetarians might also be more at risk due to a lack of red meat, but if they eat enough other iron-rich foods, including dark, leafy green vegetables like kale, it’s less likely to be a problem.
Lastly, Dr Saleem says that she sees a lot of toddlers who, because they are difficult to feed, are given a lot of milk by their parents.
“Milk doesn’t contain iron, so although they are getting their calorific needs, they’re not getting the nutritional balance. Those parents need to cut back on milk and give their children more food that is similar to their own diet.”
TREATMENT
One of the good things about iron deficiency is that it’s easily treatable, notes Dr Saleem.
First, she says, you should address your diet by trying to incorporate more iron-rich foods.
“With red meat, people can be worried about the unhealthy aspects of it, but twice a week is fine as long as you’re eating lots of green vegetables, lentils and nuts.
“People can also be concerned about the cost of beef, so I tell students to buy mince, you don’t have to buy a sirloin steak.”
Daily iron supplements are also a great solution.
In fact, Dr Saleem says that any fit, healthy person who is feeling a bit tired and run down could take a daily iron tablet, unless they have a hereditary blood disorder like thalassemia. And it’s advisable for anybody who’s on medication or has existing health conditions to speak to their doctor before taking any new supplements.
“Recent studies have shown that, particularly with women, even if iron levels are within the normal range but at the lower end of normal, it’s worth suggesting they take an iron supplement, because it helps to boost energy levels and concentration, and helps to give you a better wellbeing effect,” she says.
“I’ve taken one a day for the last four years, because I’m busy – I work and I’m a mother – and it helps to keep me going.”
If you really want to feel the benefit of these supplements, take them with vitamin C, such as orange juice or a satsuma, as this improves the absorption of iron.
“But if you are experiencing more than two or three of the symptoms, then you should go to your GP and get it checked out,” says Dr Saleem.
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