Finding the Right Fit: Choosing between Iron Infusions or Oral Supplementation for Iron Deficiency - By Dr. Chelsea Cole, ND

Testing and treating iron deficiencies happens multiple times per day, every day, in my practice. Iron deficiency and iron deficiency anemia are incredibly common, and can make people feel so depleted. Thankfully, there are effective options for treating this concern.

What are the symptoms of iron deficiency and iron deficiency anemia?

Iron deficiency anemia is what can occur if iron deficiency is left untreated. While anemia is more severe, iron deficiency without anemia still causes symptoms, and should be treated. 

Iron deficiency makes people feel tired. It can make you feel winded & weak from doing typical activities of daily living like: walking up stairs, housework, playing with your kids etc.

Other symptoms include:

• Lower exercise tolerance

• Hair loss

• Restless legs

• Shortness of breath

• Cold intolerance 

• Trouble concentrating

• Depression

• Impaired immune system functioning

What puts me at risk of developing iron deficiency?

1) Blood loss

• Heavy menstrual bleeding

• Blood donation

2) Pregnancy

3) Low intake

• Vegetarian or vegan diets

• Under-eating, disordered eating

4) Poor absorption

• Medications: proton pump inhibitors, antacids

• Digestive disorders: irritable bowel disease (crohn's, ulcerative colitis), celiac etc.

I was told my labs were normal, but I still feel fatigued

Of course, fatigue can be due to many different things, not just iron. However, I very often see a few scenarios play out that leave people walking around with untreated iron deficiency.

1) Incomplete testing. To diagnose iron deficiency and iron deficiency anemia, we need the following: complete blood count (red blood cells, hemoglobin etc), and ferritin (storage form of iron). You can have symptomatic iron deficiency (low ferritin) that has not yet progressed to iron deficiency anemia (low hemoglobin, low ferritin). If you are only looking at hemoglobin, you can miss iron deficiency. Another example is only testing serum iron, which can look normal in people with iron deficiency because many factors can make it fluctuate throughout the day.

2) No follow up. We need to know what happens after you supplement. Did you take a high enough dose? Do you need to take it for longer? Are you absorbing it? Without follow up iron testing, we really have no idea whether you are still deficient. Also, if your levels are now normal but you still feel awful, we clearly have more work to do. 

3) Ferritin is technically within “normal” range. If you have ever looked at your own lab work, you will see that the normal range is from 15-247 ug/L. The lab goes further to say that anything under 30 ug/L is likely deficient, but normal is likely above 100 ug/L. This is confusing! Research tells us that ferritin below 75 ug/L can be associated with symptoms of iron deficiency.

How do I increase my iron levels?

1) Nutrition 

• Incorporate iron rich foods regularly. There are two types of iron found in food: heme and non-heme. Heme iron is better absorbed, but is only food in meat & fish. Non-heme iron is found in plant based foods like: legumes, tofu, nuts, seeds, greens, fortified foods etc.

• Incorporating vitamin C rich foods when eating non-heme iron sources can help improve the absorption of iron. Vitamin C rich foods include: citrus, peppers, strawberries etc.

• Use cast iron cookware, and consider using an iron fish. 

2) Oral supplements

• If you are already deficient or anemic, food alone is likely not going to cut it. This is where supplemental iron comes in. There are many options when it comes to choosing an iron supplement. Some offer 10 mg of elemental iron, while others offer 150 mg! This is why it is so important to speak to a provider about what is right for you. Also, it is normal for it to take months to correct iron deficiency through oral supplements, especially if levels are really low.

• While iron supplements are safe, and usually really well tolerated, some people experience side effects (ex. constipation) that make it difficult to take continuously, or at all.

3) IV Iron

• Intravenous iron is a great option for correcting iron deficiency and iron deficiency anemia if you don’t tolerate oral supplements, if oral supplements are not working quickly enough, or if anemia is severe, among other reasons. It usually only takes 1-2 treatments for iron stores to normalize, which is much quicker compared to oral supplements. 

• Iron IV’s are not appropriate for everybody, so you will need to have a conversation with a health care provider before deciding on whether this therapy is right for you.

Book an appointment today to investigate your iron levels, and figure out which treatment option is the best fit for your needs. I offer IV iron in my naturopathic practice, and can help determine if you are a candidate for this treatment.

If you a patient at Juniper Family Health, I will accept IV iron referrals from other Juniper doctors. Talk to your naturopathic doctor about whether or not iron infusions are right for you.

In health & happiness,

Dr. Chelsea Cole, ND | Naturopath Victoria BC

References

1. Iron deficiency-diagnosis and management. BC Guidelines, 2019.

2. Vaucher P. et al. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ, Aug 2012, 184(11)1247-1254.

3. Verdon F, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003 May 24;326(7399):1124.

4. Krayenbuehl PA, et al. Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood. 2011 Sep 22;118(12):3222-7.

5. Khouly N. et al. Comparison of intravenous ferrous sucrose and oral ferrous sulphate in treatment of postpartum iron deficiency anemia. J Matern Fetal Neonatal Med, 2017 Apr;30(8):967-971.

6. Bhandal N, Russell R. Intravenous versus oral iron therapy for postpartum anaemia. BJOG. 2006 Nov;113(11):1248-52.

7. Muñoz M, Gómez-Ramírez S, García-Erce JA. Intravenous iron in inflammatory bowel disease. World J Gastroenterol. 2009 Oct 7;15(37):4666-74.

8. Bhavi SB, Jaju PB. Intravenous iron sucrose v/s oral ferrous fumarate for treatment of anemia in pregnancy. A randomized controlled trial. BMC Pregnancy Childbirth. 2017 May 8;17(1):137.

9. Allen RP, Auerbach S, Bahrain H, Auerbach M, Earley CJ. The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. Am J Hematol. 2013 Apr;88(4):261-4.

10. Richard P. Allen, et al. Evidence-based and consensus clinical practice guidelines for the iron treatment of restless legs syndrome/Willis-Ekbom disease in adults and children: an IRLSSG task force report. Sleep Medicine, Volume 41, 2018, Pages 27-44, ISSN 1389-945.