By: Jackie Silver MHSc, RD

While it is known that women, children, vegetarians, vegans, and athletes are at increased risk for iron deficiency (ID) or iron deficiency anemia (IDA), there are also other lesser-known populations at risk. Let’s break down those groups and delve into why they’re at higher risk for.

 

1) People with Inflammatory Bowel Disease (IBD)

IBD is the term for two medical conditions: Crohn’s disease and Ulcerative Colitis. ID/IDA is the most common complication of IBD that occurs outside of the intestines. In fact, 60-80% of people with IBD are iron deficient and 33% have IDA. The numbers are even higher in children with about 88% of kids and 83% of adolescents with IBD being iron deficient.

There are many contributing factors to ID/IDA in individuals with IBD, such as blood loss from intestinal bleeding, chronic inflammation of the intestines compromising iron absorption, reduced intake of iron-rich foods, and certain medications.

The first line treatment of IDA in people with inactive Crohn’s or colitis is to increase oral iron intake, especially from sources with high absorbability. Intravenous iron is given to those going through an acute flare, when oral iron is not working, or for those experiencing negative side effects from supplements.

 

2) People with Celiac Disease

Celiac disease is when the small intestines cannot tolerate gluten-containing foods (gluten is a protein found in wheat and some grains).4 When left untreated without following a gluten-free diet, gluten will continue to damage the small intestine and prevent nutrient absorption.

ID/IDA is a symptom of celiac disease in more than half of adults. Sometimes celiac is discovered only after iron supplements are ineffective. Iron is absorbed in the upper small intestine and untreated celiac disease impairs iron absorption in this region, contributing to deficiency in this population.

Once someone is diagnosed with celiac disease and follows a strict gluten-free diet, the small intestine will start healing and nutrient absorption will return, including iron absorption.6 It can take between 2-18 months for small intestine function to return to normal so it’s important to maximize iron intake with sources that are gentle, easily absorbable and without harsh side effects.

 

3) People who have had Bariatric Surgery

Bariatric surgeries represent different procedures where changes are made to the stomach and/or small intestines to promote weight loss. Impaired nutrient absorption is a common side effect when surgical changes are made to the digestive tract, and people with bariatric surgery will need to monitor a range of nutrients (and possibly take supplements) for life. ID/IDA are also more common in women after bariatric surgery.

Iron deficiency is common after bariatric surgery, impacting between 18-53% of individuals with the most common type of bariatric procedure, called a Roux-en-Y gastric bypass. In this procedure, the parts of the small intestine responsible for iron absorption are bypassed, which reduces the intestinal absorption area for iron and increases risk for ID. Another contributing factor is that after bypass surgery, the size of one’s stomach is considerably smaller and the person will feel full quickly and reduce their food intake which can reduce iron intake.

It is important to maximize iron intake before and after bariatric surgery. People with bariatric surgery often have higher iron requirements compared to the general population. If iron levels don’t improve through food intake and/or supplements, then intravenous iron may be needed. Speak to a physician about the best course of action for you.

 

4) Children with Autism

Children with autism who are extreme picky eaters are at increased risk for ID/IDA. One of the main reasons for this is if a child has sensory difficulties with the textures, smells, and tastes of food, then they are more likely to avoid certain food groups (such as protein, whole grains, fruits, and vegetables) high in iron, among other nutrients, and rely on a select number of foods.
Furthermore, iron deficiency in this population may exacerbate a child’s communication or behavior.
The good news is there are many tips and tricks to increase iron intake in this population, such as cooking your daily foods with a Lucky Iron Fish in order to add tasteless yet easy to absorb iron particles to your meal.

 

5) Frequent Blood Donors

Frequent blood donors are at increased risk for ID/IDA because each time they donate, they are losing red blood cells which is where iron is stored. When a blood donor donates 500ml of blood, they lose roughly 250mg of iron each time. To put this into perspective, this amounts to 8-13% of iron stores in men and non-menstruating women, and up to 81% in menstruating women.
About 23% of female blood donors and 8% of male donors will deplete their iron stores. It is higher in females due to menstrual blood loss. In a study of over 2,400 blood donors, women who had donated blood at least twice and men who had donated at least three times in one year were five times more likely to be iron deficient as first-time blood donors.
Surprisingly, many blood donors are unaware of the increased risk for ID with donation and haven’t discussed it with their physicians. See below for strategies to mitigate this loss.

 

6) Women with Endometriosis

Endometriosis is a condition where tissue that is similar to the tissue that lines the inside of the uterus, called the endometrium, grows outside of the uterus. The condition can be quite painful, especially around menstruation, and a common symptom presents as heavy menstrual periods. Over time, excess blood loss during menstruation increases one’s risk for iron deficiency with endometriosis, making a case for the importance of maximizing iron intake for this population.

 

THE SOLUTION FOR TACKLING IRON DEFICIENCY

If you fall into any of these groups, there are many ways to increase your iron intake.

1. Eat iron-rich foods, such as liver, organ meats, red meat, legumes, dark leafy greens, and more.
2. Maximize iron absorption by consuming vitamin-C rich foods, such as oranges, strawberries, or red bell pepper, with iron-rich foods or Lucky Iron Fish.
3. Boost iron intake by using Lucky Iron Fish to infuse your meals and beverages with extra iron. Click here for a list of recipes.
4. Make iron-infused water with the Lucky Iron Fish. Be sure to include a vitamin-C source such as orange juice or a few drops of lemon or lime juice.
5. Avoid consuming calcium (from dairy products, other calcium-rich foods, or supplements) and caffeine around the same time as using Lucky Iron Fish or eating iron-rich foods.

Please speak with your physician to ensure your action plan is right for your healthcare needs.

 

References

1. “Iron Deficiency Anemia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 18 Oct. 2019, www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/symptoms-causes/syc-20355034.
2. Stein, Jürgen, and Axel U. Dignass. "Management of Iron Deficiency Anemia in Inflammatory Bowel Disease - a Practical Approach." Annals of Gastroenterology, vol. 26, no. 2, 2013, pp. 104-113. https://pubmed.ncbi.nlm.nih.gov/24714874/
3. Charles, Christopher V, et al. “A Randomized Control Trial Using a Fish-Shaped Iron Ingot for the Amelioration of Iron Deficiency Anemia in Rural Cambodian Women.” Tropical Medicine & Surgery, vol. 03, no. 03, 2015, doi:10.4172/2329-9088.1000195.
4. “Celiac Disease.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 21 Oct. 2020, www.mayoclinic.org/diseases-conditions/celiac-disease/symptoms-causes/syc-20352220.
5. Freeman, Hugh J. "Iron Deficiency Anemia in Celiac Disease." World Journal of Gastroenterology : WJG, vol. 21, no. 31, 2015, pp. 9233-9238. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4541375/pdf/WJG-21-9233.pdf
6. “Celiac Disease and Anemia.” Gluten Intolerance Group, 8 Feb. 2021, gluten.org/2019/10/17/celiac-disease-and-anemia/.
7. “Roux-En-Y Gastric Bypass (RYGB).” UI Health: University of Illinois Hospital and Health Sciences System, hospital.uillinois.edu/primary-and-specialty-care/surgical-services/bariatric-surgery-program/our-services/roux-en-y-gastric-bypass-rygb.
8. “Iron Deficiency After Gastric Bypass Surgery.” Iron Deficiency After Gastric Bypass Surgery - Health Encyclopedia - University of Rochester Medical Center, www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=134&ContentID=108#:~:text=Iron deficiency and anemia are common after a gastric bypass,will probably prescribe iron supplements.
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19. Charles, Christopher V., Alastair J. S. Summerlee, and Cate E. Dewey. "Iron Content of Cambodian Foods when Prepared in Cooking Pots Containing an Iron Ingot: Iron Content of Food Prepared with an Iron Ingot." Tropical Medicine & International Health, vol. 16, no. 12, 2011, pp. 1518-1524. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1365-3156.2011.02878.x
20. Rodríguez-Vivaldi, Ana María, and Kathy Beerman. “Testing the Efficacy of the Lucky Iron Fish® in Reversing Iron Deficiency Anemia in Rural, Impoverished Regions of Guatemala.” Journal of Global Health Reports, vol. 2, 2018, doi:10.29392/joghr.2.e2018014. https://www.joghr.org/article/11950-testing-the-efficacy-of-the-lucky-iron-fish-in-reversing-iron-deficiency-anemia-in-rural-impoverished-regions-of-guatemala
21. “Endometriosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 16 Oct. 2019, www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
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