Iron Deficiency Anemia

This is the number one nutritional deficiency in the world and is easily explained. However, lets look at it from a very simple diagnostic perspective. If a patient is low in iron, then there are three basic reasons why that would occur. That person is either not consuming enough iron OR they are losing iron somewhere in their system (e.g. blood loss to the outside) OR they are not absorbing the iron that they are consuming. Pretty simple so far, right?

Looking at the first scenario, the reader can easily see that the lack of iron-containing foods in our diet could be a problem. Iron comes primarily from the consumption of meats, vegetables, and (we are told) grains. In fact, according to most nutritional charts, the majority (49% plus) of our iron comes from grains. Another fact is these grains are usually iron-fortified, as one will find on the labels of breads and cereals. I just have to ask a question right here: If this is so and we know that we eat so much bread and so many grain-based foods with iron-fortification, then why are we iron deficient. (Note: There is an exact parallel in the issue of osteoporosis, which is covered below.) Well return to this momentarily.

What about the second situation…blood loss? Yes, this does occur of course but not in the majority of cases of iron deficiency. It is, however, always a rule-out when working up a case of iron deficiency. Chronic bleeding in the gastrointestinal and urinary tracts should always be checked for in these cases.

The scenario I want to concentrate on is the third one: malabsorption of the iron that is consumed. Once again, most of you can skip right over this part because you have heard it all before. But briefly, the same duodenal damage previously discussed will lead to iron deficiency. Yes, the duodenum is responsible for iron absorption, just like it is for the uptake of calcium, iodine, and other nutrients. In fact, iron deficiency anemia is the big red flag for celiac disease. It was the ONLY laboratory/diagnostic work-up abnormality in my brothers case and he was deathly ill with celiac disease.

Iron deficiency should immediately make us take a long, hard look at what is going on in that duodenum. Once we understand that iron deficiency is only one of the potential problems in that individual, we can often build a case for duodenal damage as the source of the iron problem by looking for more and related clinical signs and symptoms. Do they have heart burn, intestinal problems, allergies, osteoporosis, thyroid problems (iodine) or other conditions covered on this site and in this section? There is a great chance that the iron deficient person does have other problems. I do this trick in the exam room all of the time…they tell me that they’re iron deficient and I tell them what else is wrong with them…and the client thinks I’m psychic. No, I say. I’m just describing my symptoms to you. I’ve had them all with my celiac disease.

So once again, we took the long way home but we now come to the point where I say that I believe that the most common cause of iron deficiency is the malabsorption of the iron that we DO consume. Surprise, surprise. But, it is so obvious, isn’t it? Ask yourself these questions: Why do they iron fortify the grains if we eat so many of them and they are a good source of iron? Why do many pediatric websites recommend that no cow milk be given until an iron-rich diet is begun? ( Hmmm…How did that one get in there?) Why would we be iron deficient if iron-fortified grains are such a good source of iron (making up 49% of our dietary source of iron) and wheat alone makes up 20-25% of the American diet? Hmmm….

The answer to all of these questions is because the gluten (the glue-ten) in the grains blocks the absorption of the iron in those grains. End of story. Well, it could be anyway. I like to pour it on thick… so I will. The bad news is that the gluten potentially blocks the absorption of the iron in anything that is consumed along with that grain, like the meat sitting on that bun. Oh oh. Now were getting somewhere. No wonder they fortify the grains with iron.

Wait ’til you read about osteoporosis. (Oh yeah. Why do they recommend avoiding cow milk until an iron-rich diet is begun? Because glutens evil twin, casein from cow milk, does the exact same thing. Now we also know why the countries that drink the most milk have the highest rate of osteoporosis, the second most common nutritional problem. That is an epidemiological fact.)

Dogtor J