Tired Mums: How enough iron can help you get your bounce back

It is wholly normal to feel tired when you are a mum of young children, but when it feels like every day is as exhausting as the next, and you feel shattered all the time… this might boil down to low iron levels. Low iron can affect energy, immunity, mood and executive function. And it can make you feel like you are walking through treacle all the time!

A woman is not just at risk of being low in iron when pregnant and after giving birth, but equally several months or even years later. This is partly because you need to consume plenty of iron-rich foods every day and also partly because we lose quite a bit of blood when we menstruate. As mothers of young children, we often don’t prioritise our own diet and can exist on snatched meals and kids’ leftovers. This can be especially so when juggling more than one child, a child with special needs or trying to balance work and motherhood. Bringing all these factors together means that it can be hard to maintain adequate levels of iron to feel well, and once you are low in iron it is hard to catch up!

Iron is a crucial mineral in the human body that helps make haemoglobin, the part in red blood cells that carries oxygen throughout the body. Without enough iron, the body is unable to make this important haemoglobin, resulting in fewer red blood cells which can lead to a plethora of symptoms.

Symptoms of low iron in women

• Fatigue
• Weakness
• Dizziness or lightheadedness
• Headaches
• Heavy legs or restless legs
• Low body temperature – feeling cold all the time
• Pale skin
• Yellow “sallow” skin
• Inflammation or soreness of the tongue
• A rapid or irregular heartbeat
• Shortness of breath
• Brittle nails
• Thinning hair or hair loss
• Heavy periods or bleeding with clotting
• Pica (unusual cravings for ice and very cold drinks, or non-food items like dirt, clay or paper)

How to find out if you have low iron levels

A routine full blood count test from your medical doctor will show if you have low or low normal haemoglobin level. If this is the case, then a further test to check ferritin levels will determine if this is the result of an iron deficiency. Ferritin is an indicator of the amount of iron stored in the body and if your levels are less than 12 you may well be diagnosed with anaemia. It is recommend that menstruating and pregnant/breastfeeding mums have at least a ferritin level of over 27. However, the optimal level is more than 70 for best energy levels, immunity, cognitive function and to prevent thinning hair. It is very common if you are someone suffering from fatigue, poor immunity or anxiety for your ferritin levels to hover around the 15-25 mark.  

The best ways to increase your iron levels

The easiest way to prevent an iron deficiency or to restore iron levels is to eat foods rich in iron. But increasingly, lower iron diets are more common these days as more women are choosing plant-based foods or lean white meats and fish, which contain very little iron. How much iron you need to consume per day varies according to your circumstances and you need to consume much more iron when you are pregnant or if your periods are very heavy. In general, women aged 19 and over need 18mg iron per day and this goes up to 27mg when pregnant. A large 225g beef steak or 400g of black beans contain around 8mg iron.

Heme or non-heme iron sources

Our bodies are not that efficient at absorbing iron from the foods we eat, even at the best of times.

There are two types of dietary iron: heme and non-heme. Heme iron is found in animal products such as liver, beef, lamb and venison as well as eggs. Non-heme iron is from plant-based sources such as pulses, tofu, beans (i.e., kidney beans, black beans), spinach, nuts and seeds and black olives.

The bioavailability (the uptake of nutrients from food into the body) of heme iron is approximately 14% to 18%, and non-heme plant sources achieve only 5% to 12%. This means that the body is not so adept at absorbing the non-heme form of iron from plants and you need to pile your plate up with quite a bit more.

Vitamin C is key for helping iron to be absorbed more efficiently and so it should ideally be consumed alongside iron rich food – for example lemon or lime juice squeezed over shredded beef or a tangerine eaten after a bean chilli.

Unfortunately, the absorption of iron can be blocked by milk products and if you are trying to raise your iron levels then avoid dairy one hour either side of eating an iron-rich food or taking an iron supplement.

The tannins in tea and coffee may also hamper absorption of iron, so you may want to switch to herbal teas whilst you are trying to increase your iron levels, or otherwise take iron supplements separately from your morning cuppa!

There is some evidence that phytates and antioxidants in some grains, cereals, seeds, nuts and legumes (beans, peas and lentils) may partially slow up iron absorption. So try to steer clear of these foods around the time when you eat other iron-rich foods, or again consider taking your iron supplement separately away from food, if you eat these as the mainstay of your diet.

Love your gut

The gut microbiome plays an vital role in the extraction and absorption of iron from food. Studies show that having plenty of lactobacillus strains in the gut from kefir, yoghurt and other cultured foods can help with iron uptake and help to raise ferritin levels. If you don’t eat these foods or are intolerant to dairy products or are histamine sensitive, then you may need to consider increasing lactobacilli through a live bacteria supplement containing lactobacillus strains. This is especially important if you have recently taken antibiotics or proton pump inhibitors for reflux, as these two medications can reduce the diversity of beneficial bacteria in the gut.

The gut microbiome thrives on a diverse diet of colourful vegetables, pulses and fibre-rich foods, so try to include as many as possible each day. My recipe pages are a great place to start.

As well as your gut microbiome, you also need to consider if you are creating enough gastric juices. The ability of your gastric tract to extract the iron from the food you eat is vital for the effective absorption of iron. When stomach acid is not adequately acidic and the pH is too high; or the hydrochloric acid is suppressed by an acid suppressing medication; or if you are a carrier of a bacterial infection called Helicobacter Pylori which resides in the stomach and blocks acid production, then iron absorption will also be much reduced.

The other reason for low iron levels is sometimes the presence of intestinal parasites such as giardia which can cause malabsorption in the small intestine. A chronic threadworm or hookworm infection can also pose a risk for anaemia.

Equally if you suffer from an inflamed gut such as Crohn’s Disease or Ulcerative Colitis, or you have chronic diarrhoea, Irritable Bowel Syndrome (IBS) or Coeliac disease, then it is important to monitor your ferritin levels regularly and keep your iron topped up. These conditions can lead to nutrient malabsorption, and some sufferers may well struggle to maintain adequate iron levels through diet and supplements alone, and may need iron infusions.

Food Supplements

A medical doctor can prescribe high strength iron (around 200mg per day) which can be helpful in raising iron levels. It is expected for the stools to go black when taking high strength iron in the form of ferrous fumarate or ferrous sulfate. However, women with sensitive guts may experience constipation or gastric pain from taking these forms of prescription iron.

Sometimes when someone has chronic low ferritin levels, a referral to a haematologist for an iron infusion may be suggested, and this can now be organised quite easily intravenously for women aged 18 or over in private IV clinics.

Food supplements can be very helpful when trying to raise ferritin levels. The most natural bioavailable options are food-grown iron infused into beetroot or ferrous gluconate or ferrous citrate which are gentle on the tummy. You can also find iron supplements which also contain other blood builders alongside the iron such as vitamin B12, folate and B6, as well as lactobacillus and vitamin C to help with iron absorption. These tend to be capped at 14mg of iron per capsule as food supplements are not meant to be equivalent to medicines. These food supplements are there to augment a diet with additional iron if there is a mild shortfall.

Round up

Low iron levels can often be the primary cause of excessive tiredness and fatigue in busy mums. It is easy to increase your iron levels by eating iron-rich foods including liver and red meat as well as using a good quality iron supplement. Make sure that you support the absorption of the iron by following my diet tips and maximizing the health of your gut and the diversity of your microbiome. You’ll soon have buckets of energy again!

Please contact NatureDoc Clinic if you’d like to investigate why your iron levels are consistently low or other factors which maybe causing your tiredness. We can carry out a variety of blood and stool tests to pinpoint any underlying issues, and help you to make any necessary changes to your diet.

References

• Measurement of iron absorption from composite meals
• Iron absorption in man: ascorbic acid and dose-dependent inhibition by phytate 
• Regulation of iron absorption: proteins involved in duodenal mucosal uptake and transport
• Iron bioavailability and dietary reference values  
• Increased iron bioavailability from lactic-fermented vegetables is likely an effect of promoting the formation of ferric iron (Fe3+)
• A lactic acid-fermented oat gruel increases non-haem iron absorption from a phytate-rich meal in healthy women of childbearing age
• Fermentation and lactic acid addition enhance iron bioavailability of maize 
• Absorption of iron from Western-type lunch and dinner meals 
• Soil-Transmitted Helminths and Anaemia: A Neglected Association Outside the Tropics
• Enterobius vermicularis, the small human pinworm: a chronic infestation diagnosed by Pillcam. Incidental observation on Capsule Endoscopy