Mediaplanet  What motivated you to start the Iron Maiden blog?

Leona Dove  My work is primarily with preoperative anemia. However, the program was very difficult getting started here so I started looking at iron deficiency and anemia — period. I also interact with the weight loss surgery community a lot because of my history as a bariatric patient. I found a lot of the strategies applied in preoperative anemia are related to iron, and apply to the bariatric community. I realized through my continued research that iron deficiency is a very under-addressed issue. Most troubling is that it’s one of the easiest things to find, treat, and effect quality of life —yet it’s very undertreated.

MP  What causes iron levels to become low?

LD  There’s a number of issues that cause iron to be low: dietary issues, dysfunctional bleeding or medical history, and absorption issues. A lot of the diagnosis includes addressing why a patient is iron deficient in the first place.

"The World Health Organization identifies iron deficiency as the most common dietary deficiency in the world."

MP What is the connection between iron deficiency and anemia?

LD  Anemia is defined in the medical community as insufficient hemoglobin to transport adequate amounts of oxygen to tissues. Hemoglobin is what delivers oxygen to tissues and it’s derived from iron. So there are three main causes of anemia:

a) Not enough iron.

b) Not enough B12, which is a vitamin that converts iron to hemoglobin.

c) Not enough Erythropoietin, which is actually a naturally occurring hormone secreted by the kidneys.

When I explain the causes to patients I use the analogy that that iron is bricks, hemoglobin is a brick wall, and B12 is stone mason — helps converts the bricks to the brick wall.  Erythropoietin is Mike Holmes — the general contractor. An imbalance in any one or combination of these three things can cause the person to be anemic. Iron deficiency is a cause of anemia; which is the end stage of iron deficiency.

MP How common is iron deficiency amongst the population? Who is most susceptible?

LD  The World Health Organization identifies iron deficiency as the most common dietary deficiency in the world. The population most at risk is the female population. Their risk is attributed to the fact that they bleed monthly. When you look at the numbers in Canada — 20 percent of all females and 50 percent of pregnant females in Canada are iron deficient. Those numbers are scary.

Other populations at risk — vegetarians, patients that have chronic disease where inflammation and bleeding are involved (eg: GI Crohn’s Disease and Colitis), people that have had alterations to their GI tract because of absorption issues, patients that don’t eat a lot of red meat. That’s just adults. When you look at children that are born with low birth weight or premature, breast-feed longer than four years, consume a lot of dairy, have GI issues, or are picky eaters — these are all at risk child populations.

MP How serious of an issue can iron deficiency, anemia become if not addressed?

LD  Iron deficiency has three stages. The sooner it’s addressed the more conservative the therapy is. It could be something as simple as adding iron to your diet or taking an iron supplement — verses having to have a blood transfusion. Identifying and treating iron deficiency in the early stages is key. The quicker it is treated — the better you feel. You want to avoid devolving to the point of being anemic, which is when iron deficiency becomes very dangerous.

MP What are the symptoms that readers should be aware of relative to the stages of anemia?

LD Biggest problem with the symptoms, especially at the early stages, is that they coincide with many other disease pathologies. The earliest symptom you can have (referred to as stage one) are the triad of iron deficiency: difficulty concentrating, chronic fatigue, and irritability. Those three alone are enough reason to speak to your doctor to look for iron deficiency.

As you devolve into stage two iron deficiency you’re going to experience insomnia, lack of appetite, general weakness, and difficulty maintaining hair and nail growth. As you become anemic, which is the third stage, you’re going to start to have headaches, breathlessness on minimal exertion, dizziness, faintness, and low blood pressure symptoms. So as you progress through the stages, you progress through the symptoms.

In today’s society people commonly burn the candle at both ends. It’s easy to not realize that the “burned out” feeling is actually iron deficiency and not the result of a hectic work-life balance. People accept symptoms as the new normal and do not realize how huge of an impact on quality of life iron deficiency can have, or how easy it is to treat.

MP What’s the next step in finding an appropriate solution if you suspect you have symptoms?

LD  Your first stop is at your doctor’s office — ask them to check you for iron deficiency, and don’t stop at just the CBC (complete blood count). A lot of doctors will only check for iron deficiency when you’re anemic. They see that your hemoglobin is normalized, and they see that your blood is fine. Where if they went one step further and did an iron panel, or two steps and checked ferritin levels, they would find out that your stores are being tampered with.

I really caution against people going ahead and treating themselves with iron supplements without it being confirmed by a physician. Depending on the results of the blood tests — your doctor will know what treatment protocol you need to follow. If you’re waiting to see your doctor and you suspect your iron deficient – the safest thing you can do is increase the iron in your diet.  It’s a good way to build your reserves even if your hemoglobin is in check. Iron rich foods include meats, fish, and eggs — especially dark poultry.  Non-heme irons include your green leafy vegetables (plant source irons), iron fortified cereals, whole grains, and your legumes.

Heme irons are not affected by what you’re eating and drinking – non-heme irons are. If you’re hoping to get lots of iron from your spinach salad – the moment you put that creamy dressing on it, which is high in calcium, you’re going to obstruct the absorption of the non-heme irons. Same with coffee, tea, cola, chocolate, and dairy within an hour of consuming non-heme irons. I never say give up these items if you’re anemic – just wait an hour so that they’re not preventing absorption. Eat mindfully. You can also enhance absorption of non-heme irons by pairing with something rich in vitamin C: tomatoes, bell peppers, and citrus juice for example.

MP Why is it discouraged against to self-medicate if you suspect you have iron deficiency or anemia?

LD  Iron itself is liver toxic. If your iron levels are too high you can effect liver functions. These symptoms can be related to other disease processes. If you assume your iron deficient and start taking an iron supplement – you could potentially injure your liver. Iron supplements shouldn’t be taken without consultation with a healthcare professional who is tracking it with you. You could have enough iron on board but you could actually be B12 deficient — making the blood test a key prerequisite to treatment.

MP Are all iron products/solutions created equally?

LD  There are three classes of iron supplements out there: iron salts, polysaccharide irons, and heme irons. Iron salts are covered by some health plans but they are like the non-heme irons we can get from our diet: they’re effected by what you’re eating and drinking, and calcium containing foods and supplements. They need to be converted from the type of iron they are to the type of iron our body likes to absorb.The conversion needs acid to occur.Mild coffee, tea, cola and chocolate hinder the conversion. The amount that is available for absorption varies depending on whether the person has a normal gut or not. If you’re someone that is on a PPI (Proton Pump Inhibitor) inhibitor or H2 inhibitor – someone that takes a lot of acid reflux or heartburn medication — then the iron salts are not something that are of consideration for you.

Polysaccharide irons and heme irons are already the kind of iron our body likes to absorb – so there’s no conversion necessary. You don’t have to avoid coffee, tea, cola, or chocolate when you take them. Difference between polysaccharide and heme irons is that polysaccharides are manufactured iron that mimics naturally occurring heme iron but is not heme iron. Heme irons are manufactured from cow’s blood. So if there’s a patient who, for religious reason or conscious objection, doesn’t consume meat products — I can’t suggest a heme iron in good consciousness. One hundred percent of the iron in these two types is elemental iron and ready for absorption

MP Are there other conditions or life events that can contribute to or trigger iron deficiency or anemia?

LD  Certain surgeries, bleeding events, traumas, women having children or during menarche (when you get your period). In children it’s during the rapid growth spurts. So a child that is between one to three and pre-adolescent – those are the ones that are susceptible to iron deficiency.

We also see an increase in iron deficiency in the winter time. People are not eating those green leafy vegetables, people compress their days and eat a lot of convenience foods instead of fresh veggies. Iron deficiency starts to spike. As well, people think their symptoms are related to shorter, darker days when in fact it can still be iron deficiency causing it.

MP  How does maintaining a proper iron balance factor into ones overall health?

LD Like I said when we first started, iron deficiency is one of the most prominent deficiencies in the world. There is nothing that effects quality of life that is so easily fixed as iron deficiency. Because a lot of physicians do not treat iron deficiency or look for iron deficiency until you’re anemic – it is up to the patients (the population) to advocate for themselves to be checked.

I encourage people to be health care consumers not consumed by health care. I get asked quite frequently – why don’t our doctors know about this? When we think about the volume of knowledge our general practitioners are required to have — and now we have to ask them to be aware of and alerted too something that is usually available over the counter? I think we’re over-taxing them. However, I think physicians as a group have to be open to the fact that patients are more knowledgeable, have access to the Internet, and are starting to take responsibility for driving their own care. Knowledge is power, but only if you share it.

Concerned you or someone you know is iron deficient? Check out the symptoms checker on the Iron Maiden blog by clicking here.