Why it’s ‘notoriously underdiagnosed’ in women

Being an athlete – male or female – increases iron needs too, especially with endurance activities like running. But even women who exercise recreationally, like regular gym goers, should check their iron levels, says MacLean.

As for getting enough iron from food, it’s not just plant-based diets that can run short, says Theodosi. Even a healthy eating pattern like a traditional Mediterranean diet can be relatively low in iron because of a limited intake of red meat and other animal foods.

“For women with increased needs, it’s important to be mindful of iron intake, regardless of how healthy their overall diet may be,” she says.

Iron deficiency and mood

“Because iron is involved in so many of our body’s systems, a deficiency can cause diverse effects like muscle weakness, restless legs, shortness of breath, feeling cold, dizziness, anxiety, heart palpitations, hair loss, headache and even craving non-food substances like ice – and sometimes symptoms like fatigue, irritability or depression are attributed to other causes,” MacLean says. “One study found that 48 per cent of women with iron deficiency had been mistreated with anti-depressants.”

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Some studies also link low iron levels to mental health problems, including anxiety and depression, so it may be that iron deficiency is part of it, adds Dr Tetyana Rocks, Senior Research Fellow at Deakin University’s Food and Mood Centre.

“We know, too, that low iron is linked to changes in neurotransmitters like dopamine and serotonin that can affect mood. But it may also be that depression and anxiety develop as a result of ongoing fatigue,” she says.

Are low iron levels and ADHD linked?

People with iron deficiency often report symptoms like brain fog and inattention, and because iron is essential for regulating neurotransmitters, some research suggests a link between low iron and ADHD, MacLean says.

“When we screened more than 400 women at sporting events to explore a possible relationship between iron and ADHD, we found that women with symptoms suggestive of ADHD were more likely to report symptoms and risk factors that suggested iron deficiency too.

“We can’t say low iron levels were the cause because this was an observational study – but anyone with symptoms of ADHD might consider checking their iron levels.”

Should you self-prescribe a supplement?

Think you’re low on iron? Before you start taking supplements, make sure you see a GP and get a blood test to confirm, advises Theodosi.

Supplements may help restore iron levels, but you also need a “food-first” approach to maintain healthy iron levels in the long term – and a dietitian can help, she says.

Oral iron v iron infusion – what’s best?

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Oral iron supplements can improve low iron levels but sometimes cause side effects like constipation, bloating and nausea.

If you can’t tolerate oral iron or if iron levels need restoring quickly, an iron infusion may be the answer.

“An infusion delivers iron directly into the bloodstream, bypassing the gut and allowing for more rapid replenishment of iron stores,” Theodosi says.

Easy iron boosters

• Add vitamin C. Although there’s iron in plant foods like legumes, nuts and tofu, it’s not as well absorbed as iron from animal foods. Vitamin C helps by boosting iron absorption. You need at least 50 milligrams of vitamin C to boost absorption by three to sixfold, says Theodosi – think half a cup of cooked broccoli, a large kiwi fruit, an orange or a cup of strawberries.
• Iron for breakfast. We tend to absorb iron better in the morning, when levels of a hormone called hepcidin – which regulates iron uptake – are lowest. Try iron-rich foods like baked beans with wholegrain toast or an iron-fortified cereal with vitamin C-rich fruit.
• Go for iron-rich snacks. Cashews and dried apricots, grainy crackers with hummus, or bread with peanut butter can squeeze more iron into your day.
• Cook with cast iron. Cast iron pots can leach iron into food while it cooks, boosting the amount of iron you absorb. Or use a Lucky Iron Fish – a small food-grade iron fish – in saucepans when cooking. Like cast iron pots, it leaches iron into food.

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