Menstruation & Iron
August 1, 2016
Women and young adolescent females that suffer from heavy menstruation are at significant risk for low iron levels which affect their energy level, sleep quality and learning.
In a retrospective analysis of 114 young female patient's experiences with heavy menstrual bleeding at the Nationwide Children's Hospital in Columbus, Ohio, Dr. Stephen Johnson and colleagues found a better way to track low iron levels than the current model of cellular blood count.
When they changed to analyzing a ferritin level (storage form of iron) to assess for iron sufficiency they were able to identify twice as many patients in need of iron. Using this test mirrors the neurologic workup for restless sleep issues.
Iron is a critical nutrient for many cellular functions. (See newsletter excerpt below) Having heavy menstrual periods is a clear risk factor for an iron insufficiency state. Knowing this can help your physician target iron dietary and supplemental needs for you.
If you or your daughter fit this pattern, ask to have a ferritin level checked and aim for a value >50 ng/ml which is ideal for both neurologic and hematologic function.
Replay of the iron Micronutrient article:
A mineral primarily necessary for carrying oxygen around our body via hemoglobin proteins on our red blood cells. It is also found in a storage form called ferritin in our liver, spleen and bone marrow or as myoglobin in our muscles.
It is critical for the function of oxygen transport, muscles metabolism, neurologic and intracellular signal transmission. It is also critical for hormone function growth and development. Critical to learning and developing as a baby/toddler.
Infants and teenagers need the most iron daily at 11 grams per day for males and more for females that menstruate. Most people may actually need more than this to support optimal function.
Dietary sources of iron come in two forms, heme and non heme. Heme iron is found primarily in animal muscles including fish. Non heme is found in vegetables, beans, nuts and grains. The distinction is important from a utilization perspective. Heme iron is more bioavailable than the vegetable based non heme. Vegetarians need 2X more non heme iron to get the same effect.
Vitamin C is critical for enhancing the absorption and utilization of non heme iron. Eating vegetables along with meats also enhances the non heme iron utilization. Hence the reason for a balanced diet at all meals.
Phytic acid decreases absorption. Foods loaded with phytic acid like unsoaked beans and grains will reduce the absorption of non heme iron in food or supplements. Certain polyphenols found in tea and vegetables are also inhibitory.
Calcium can inhibit iron absorption. Keep these supplements away from each other.
Deficiency states occur with inadequate intake and certain diseases. Acute or chronic blood loss is a common cause of iron deficiency. GI malabsorption diseases like celiac, Crohns and ulcerative colitis are common causes of concern with iron. People from third world countries can experience iron deficiency from parasitic disease.
Symtoms of deficiency include fatigue, anemia(pallor), mental fog, restless sleep, temperature regulation issues and immune system depression. ADHD and other neurologic problems are worsened by low levels of iron.
My real concern with iron is the insufficiency state. Many children suffer from learning dysfunction, sleep parasomnias, attention issues, fatigue, and general weakness. Checking a ferritin level and aiming for 50 ng/ml is optimal.
Iron in the supplemental form is very useful but dangerous in overdose. All iron supplements should be stored clear of children. Acute iron toxicity will cause vomiting, stomach pains, organ failure, seizers and death. Iron and zinc should not be taken at the same time as iron reduces the zinc's absorption.
Iron supplements affect drugs including thyroid and antacid medicines. Consult your pharmacist when using these medicines and taking iron supplements.
If you have any of the above symptoms, I recommend a standard CBC and a ferritin level. I do not recommend supplements unless advised by a provider. Iron is an oxidant and can promote inflammation in an excessive state and as stated earlier can cause severe liver disease.
Work hard to get adequate heme and non heme iron through your diet (roughly 11 gm daily for adults) and make sure that you are taking vitamin C rich foods as well. These include citrus fruits and red, yellow and orange vegetables as well as cabbages. Cooking in a cast iron skillet will also help increase iron levels.