Dr Sally Cockburn

from The House of Wellness Summer 2023 Magazine

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Dr Sa y Cockburn, GP GIVES HER UNIQUE VIEW ON ALL MATTERS MEDICAL

ARE YOU IRON DEFICIENT AND DON’T KNOW? Is this you: feeling tired? Poor concentration? Exercise tolerance not what it used to be?

While there are many possible reasons for these symptoms, it is worth considering low iron levels — and don’t wait until you are pale and short of breath to address this!

Iron is an essential mineral obtained through a healthy diet and it is vital for our body to function. Iron’s main job is helping transport oxygen from the lungs to all cells as part of haemoglobin, a protein in red blood cells.

Iron is also found in muscles as part of myoglobin, a storage protein that makes oxygen available quickly to muscle cells. Iron has other roles in immune function, as well as collagen and some neurotransmitter production.

Because iron is so important, along with blood, our body has a back-up storage system where iron is stored as part of a protein called ferritin, mainly in the liver. I think of this like the stock stored ‘out the back’ at the supermarket. Even if shelf stock looks low, it can be quickly replenished from ‘out the back’.

As you know, problems start when ‘out the back’ is empty! So, too, in our body, when new red blood cells need to be made, the liver gets a message to release ferritin so production of haemoglobin can continue.

If there’s not enough ferritin, red blood cells become smaller and can’t carry as much oxygen. We may then be unable to supply enough oxygen for our cells to function properly, and iron defi ciency anaemia happens, with potentially serious consequences. However, low stores of ferritin can be diagnosed before this happens.

It’s easy to measure ferritin with a simple blood test, but the cause also needs to be addressed.

WHY IRON STORES MAY BE LOW

1Not enough iron in your diet

Red meat is not the only source. Nuts, dark-green leafy vegies and even dried apricots are all sources. If you do have a restricted diet make sure you get advice on sources of iron.

2Problems absorbing iron from your gut

In particular, that may be because of coeliac disease or after stomach surgery for weight loss. Some medications can also interfere with iron absorption, such as preparations that reduce stomach acid.

3Blood loss Mostly you would be aware if you’ve had a signifi cant episode of acute blood loss. But chronic blood loss is not always as well recognised. A big one we want to pick is bowel cancer (which is why we tell you do that poo test!). But a more common cause of overlooked low ferritin is in women with heavy periods. Years of heavy menstrual loss can deplete your ferritin levels.

You may even have a combination of any or all of those three listed left.

So, your ferritin test is low — what now? Diet alone won’t get ferritin levels up to where they need to be. You need to be treated properly.

Your doctor will work with you to fi nd out why your ferritin is low and address that, and meanwhile may suggest starting a trial of oral supplements.

But this can take months to work and if absorption is the issue, may not work at all.

So you may be off ered an iron infusion, where a special medical iron solution is given via a drip — with immediate results (note: this is not a blood transfusion). I don’t recommend iron as injections into muscles as this can stain skin.

Your doctor will recheck your levels in about six weeks and then again in 6-12 months. So talk to your GP.