What is iron deficiency?
Iron deficiency is a condition resulting from too little iron in the body. Iron deficiency is the most common nutritional deficiency and the leading cause of anemia in the world. In the USA, despite food fortification, iron deficiency is on the rise in certain populations. Iron deficiency at critical times of growth and development can result in premature births, low birth weight babies, delayed growth and development, delayed normal infant activity and movement; iron deficiency can result in poor memory or poor cognitive skills (mental function) resulting in poor performance in school, work, military or in recreation. Lower IQs have been linked to iron deficiency occurring during critical periods of growth.

Signs and symptoms of iron deficiency
A person who is iron deficient may also be anemic and therefore have one or more symptoms of anemia—chronic fatigue, weakness, dizziness, headaches, depression, sore tongue, sensitivity to cold (low body temp), shortness of breath doing simple tasks (climbing stairs, walking short distances, doing housework), restless legs syndrome and loss of interest in work, recreation, relationships and intimacy.

Causes iron deficiency
Iron deficiency can be the result of numerous and multiple causes, which fall into two broad categories: an increased need for iron and a decreased intake or absorption of iron.

Increased demand:
Iron deficiency can occur during rapid periods of growth; for this reason nature makes certain that a developing fetus, newborn and infant up the age of about six months has an ample supply of iron. These conditions also can result in iron deficiency: blood loss from heavy menstruation, pregnancy, frequent or excessive blood donation, fibroids, digestive tract disease (including infections), surgery or accidents; medications, supplements or substances that cause bleeding such as pain relievers with aspirin; poisoning from lead, toxic chemicals or alcohol abuse.

Decreased intake or absorption  
Diets that do not include heme iron, the form of iron in red meat, which is absorbed more efficiently than non-heme iron found in plants and dietary supplements. or sufficient iron or other nutrients such as vitamin C, B12, folate or zinc.  Consuming foods, substances or medications that interfere with the absorption of iron such as: taking antacids, proton pump inhibitors (to treat acid reflux), calcium supplements, dairy products, coffee, tea, chocolate, eggs, and fiber. Or diseases and conditions that lower iron absorption, such as: not enough stomach acid, lack of intrinsic factor  (hormone needed to absorb vitamin B12); celiac disease, inflammatory conditions such as Crohn’s disease, autoimmune disease and hormone imbalances.

Most at risk for iron deficiency
Women, children and the elderly are most at risk. African American and Hispanic women and their young children are prone to iron deficiency, possibly because of diet or perhaps different hemoglobin needs.  Men are rarely iron deficient; when they are it is generally due to blood loss from the digestive tract, diseases that affect iron absorption (such as celiac’s) disease such as celiac’s or alcohol abuse. or because they areRarely, dietary deficiency is seen in strict vegetarians.

How iron deficiency is detected and diagnosed
The tests used most often to detect iron deficiency include hemoglobin (the iron-containing protein in the blood that carries iron and oxygen to cells), hematocrit which provides the percentageis a measure of of red blood cells in the blood and serum ferritin, which reflectsmeasures stored or contained iron). Serum ferritin is a very important test because it helps distinguish between iron deficiency anemia where you may need iron supplements and anemia of chronic disease (also called anemia of inflammatory response) where iron supplements are not helpful.could be harmful.

Other tests might include: a complete blood count, serum iron and IBC (either UIBC or TIBC), zinc protoporphyrin, free erythrocyte protoporphyrin or reticulocyte hemoglobin content (CHr)  To learn more about these tests visit the Iron Library.

The diagnosis of iron deficiency can be made when a person has both a low hemoglobin/hematocrit and low serum ferritin.  Serum iron and, transferrin-iron saturation percentage (TS%) will also be low in a person who is iron deficient. Iron deficiency without anemia is when a person has a normal hemoglobin, but below normal serum ferritin. Iron deficiency with anemia is when a person has low values of both serum ferritin and hemoglobin.

How iron deficiency is cured
The treatment(s) approaches used to cure iron deficiency will depend on the presence or threat of anemia and its causes, which may be increased demand for iron (pregnancy, growth spurt), blood loss (heavy periods, giving birth, surgery, injury, disease), diet or behavior, interference with iron absorption and abnormal blood cell formation or management. Some approaches are as simple as dietary changes; some involve taking iron supplements;, which come in heme and non heme form, some people may be so iron deficient that they require iron infusions or whole blood transfusions.

If you suspect that you are iron deficient, we encourage you to work with a medical professional to find out why your are iron deficient and then to increase your knowledge about the different ways low iron levels can be replenished. Visit the Iron library, getting started section and read the Anemia Starter Kit. Then, you might like to read about approaches to restore low iron levels.

Links to more information about iron deficiency:
MMWR http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5140a1.htm
US Centers for Disease Control and Prevention Division of Nutrition
http://www.cdc.gov/nccdphp/dnpa/nutrition/nutrition_for_everyone/iron_deficiency/
U.S. Preventive Services Task Force (USPSTF) http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9274&nbr=4965#s23