Lethargy. Fatigue. Listlessness. Busy people attribute it to stress. Others are convinced that they need more sleep. But one possible cause is iron-deficiency anemia.
"I'm always tired, but I've gotten used to it," says Kathy, 49, an administrative assistant at a busy health clinic. "I come home from work, cook dinner, usually clean or do laundry. And I'm wiped out. Maybe I should get to sleep earlier, but it never seems to work out that way."
"I thought I was just run down and stressed out," says Julie, 28, a graduate student who admits that she often burns the midnight oil. "I just attributed everything to stress. I had no idea there was a medical cause."
Kathy and Julie both have iron-deficiency anemia. It is a condition that develops because the body's stores of iron are slowly depleted. Women of childbearing age are at risk for this condition because of the blood loss during menstruation. In addition, some women do not get enough iron in their diets to make up for these losses.
Symptoms of iron-deficiency anemia may include:
Menstruating women lose a significant amount of blood every month. That blood contains a lot of iron. Unless iron is replaced, these monthly losses can drain stores over time. While premenopausal women need more iron than men, they generally eat less. This complicates the challenge of getting enough iron from foods.
Iron deficiency is also common among:
Iron is the central component of heme. Heme is a molecule used to build hemoglobin, the oxygen-carrying part of red blood cells. Oxygen is used by your body to help make energy. When iron stores are low, the body cannot make enough hemoglobin. There is then less oxygen to help generate energy. Iron also allows the normal functioning of the immune system, the production of collagen (wound healing), and the formation of amino acids, which are the backbone of proteins.
As levels of hemoglobin in the blood decrease, the symptoms of anemia start to appear.
Anemia comes on slowly, so many people do not realize that they have it. Slight iron deficiency, too mild to cause anemia, may still cause symptoms, such as fatigue and decreased exercise capacity.
The following table shows the Office of Dietary Supplements' Recommended Dietary Allowance (RDA) for iron:
|Age||Males (mg/day)||Females (mg/day||Pregnancy (mg/day)||Lactation (mg/day)|
|7 to 12 months||11||11||–||–|
|1 to 3 years||7||7||–||–|
|4 to 8 years||10||10||–||–|
|9 to 13 years||8||8||–||–|
|14 to 18 years||11||15||27||10|
|19 to 50 years||8||18||27||9|
|51 years and older||8||8||–||–|
Do not take iron just because you feel tired. Make sure to get tested to see whether you are indeed deficient. With iron, more is definitely not better. Excessive iron intake can be harmful.
If you have been diagnosed with iron-deficiency, your doctor has probably advised you to include more iron in your diet. If anemia is severe, an iron supplement, such as ferrous sulfate, may be prescribed. Knowing which foods are rich in iron is the first step toward boosting your iron stores. Take a look at the list below to put more iron on your menu.
When adding iron to your diet, keep in mind that there are different forms of this mineral:
Nutritionists have traditionally grouped meat, fish, and poultry together as the best sources of heme iron. Liver has the highest heme iron content.
It is not enough to know where iron is lurking. You also have to get it into your system. This is somewhat more difficult for vegetarians since all nonmeat forms of iron are nonheme, and therefore less well absorbed. But, it is certainly not impossible. Here are some tips:
Office on Women's Health
The Vegetarian Society
Public Health Agency of Canada
Annibale B, Capurso G, et al. Gastrointestinal causes of refractory iron deficiency anemia in patients without gastrointestinal symptoms. Am J Med. 2001;111(6):439-445.
Iron. Center for Young Women's Health website. Available at: http://youngwomenshealth.org/2013/12/06/iron. Accessed April 6, 2017.
Iron. National Institutes of Health, Office of Dietary Supplements website. Available at: http://ods.od.nih.gov/factsheets/Iron-HealthProfessional. Updated February 11, 2016. Accessed April 6, 2017.
Iron deficiency anemia in adults . EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115986/Iron-deficiency-anemia-in-adults. Updated July 12, 2016. Accessed April 6, 2017.
Iron deficiency in children (infancy through adolescence). EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T435307/Iron-deficiency-in-children-infancy-through-adolescence. Updated November 21, 2016. Accessed April 6, 2017.
Iron rich foods. American Red Cross website. Available at: http://www.redcrossblood.org/learn-about-blood/health-and-wellness/iron-rich-foods. Accessed April 6, 2017.
Killip S, Bennett JM, et al. Iron deficiency anemia. Am Fam Physician. 2007;75(5):671-678.
Patrick LR. Restless legs syndrome: Pathophysiology and the role of iron and folate. Altern Med Rev. 2007;12:101-112.
Verdon F, Burnand B, et al. Iron supplementation for unexplained fatigue in non-anaemic women: Double blind randomised placebo controlled trial. Br Med J. 2003;326(7399):1124.
Last reviewed April 2017 by Michael Woods, MD, FAAP
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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