Why 1 Billion People Have Iron Deficiency

Good morning!

Ever notice how "I'm just tired" has become the default answer to "How are you?"Between work, family, endless to-do lists, and trying to maintain some semblance of a life, exhaustion feels normal. But what if it's not just stress? 

This week, we're talking about iron. I’ll break down what iron does, why women in particular are vulnerable to deficiency, and what you can do about it.

Key Takeaways

• Iron powers oxygen delivery to every cell in your body, and low levels can leave you feeling like you’re constantly running on empty.

• For women, especially during perimenopause, iron deficiency is often about absorption, inflammation, and blood loss, not just intake.

• Before supplementing, explore root causes and optimize digestion, food choices, and nutrient synergy.

CORE

Iron’s Role in the Body

Unlike other minerals, iron has one main job, and it's a big one: transporting oxygen throughout your body. It accomplishes this through hemoglobin, a protein packed onto your red blood cells. Each red blood cell carries about 180 million hemoglobin molecules. Each hemoglobin can grab four oxygen molecules. Here’s how it works:

Step 1: You Breathe (Hopefully). The first step of the “life cycle” of iron in the body is when we breathe. Oxygen from the air attaches to the iron that’s in the hemoglobin. Your red blood cells are now fully loaded oxygen delivery trucks.

Step 2: Delivery Time. The oxygen gets delivered to your body's cells including muscles, brain, bone and everything in between. Oxygen is required for aerobic metabolism and we generate CO2 as a byproduct.

Step 3: The Exchange. That carbon dioxide travels back to the lungs through the bloodstream. In the lungs, gases move by simple diffusion (meaning they naturally flow from areas where they’re more concentrated to areas where they’re less concentrated). Oxygen moves from the air in your lungs into your blood, while carbon dioxide moves from your blood into your lungs to be exhaled. It’s interesting because it actually doesn’t require any energy to make happen, it just does. 

This is primarily due to a gradient in concentrations, which basically means that when blood gets to the alveoli, there is a lot of CO2 and low oxygen in the red blood cells, this is a stark contrast to the concentrations in the air we breathe (roughly 21% of air is O2 and only 0.04% is CO2!). Below you can see how the gases move through the alveoli.

What is Iron Deficiency Anemia?

Iron deficiency anemia (IDA) affects about one billion people worldwide, which is a staggering number for something most of us barely think about. In a summed up fashion, IDA means your body doesn't have enough iron to produce adequate hemoglobin. Without enough hemoglobin, your red blood cells can't carry sufficient oxygen. So your entire body goes into "low power mode" to stretch what little oxygen it's getting.

What’s interesting is that women are affected the most. An estimated 20% of women have iron deficiency compared to just 2% of men. The symptoms? Extreme fatigue, constant coldness (especially hands and feet), dizziness, lethargy, and brain fog that makes you forget why you walked into a room. ¹

Unfortunately, the main symptom, being excessively tired, is already part of our day to day lives in most cases. So iron deficiency hides in plain sight, dismissed as "just life".

The (Iron)y

For such a critical nutrient, our bodies are shockingly bad at absorbing iron. Nearly a third of the U.S. population is iron deficient, and it comes down to two main issues:

Poor absorption: Iron is without a doubt one of the top contenders for the least absorbed minerals that we have. We absorb roughly 15-18% of the iron we eat. That’s it. Here’s why: ²

• Iron has 2 forms, animal (heme iron) and plant (non-heme). For now, just know that your body absorbs heme iron far better than non-heme iron. And wouldn’t you know, most of the iron we consume comes from plant sources. (Learn about plant-based vs animal meat here)

• On top of that, non-heme iron is very reactive. It’s missing the heme protein which gives it a tendency to bind with different molecules that could be floating inside the digestive tract, forming complexes your body can’t absorb.
  

So with this in mind, and the fact that 85-90% of dietary iron comes from plant sources, you start to understand why the average absorption hovers around 15%. ³

Blood Loss: As you may have guessed, the main reason why women are most affected by iron deficiency and consequently by IDA is because of menstruation. The continuous loss of blood cells over long periods of time can cause a strain on the bodies reserves. The FDA recognizes this, seen in their recommendations of just 8mg a day for men and postmenopausal women and 18mg a day for premenopausal women.

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Dietitian’s Take: Should You Take Iron Supplements?

What I would typically recommend when it comes to iron is to try to hold off on supplementation for a following reasons:

• Iron is a potent oxidant, which means that high dose iron supplements can increase the oxidative stress and inflammation in your body.

• If you’ve ever taken iron supplements you know that not only do they taste horrible but they also can cause really bad stomach aches, nausea, constipation, diarrhea, etc.

• For most people, tweaking diet and absorption strategies can increase iron intake by the few milligrams needed to meet your body’s requirements.

Important Note: If you’re already iron deficient, then taking supplements can very well be the best course of action, as long as it is recommended and overseen by your doctor.

IDA Prevention

If you want to increase iron levels safely, here's what works:

Eat More Iron-Rich Foods. Making sure that you are eating enough is a good place to start. Including enough red meats, duck, chicken, clamps, cashews, spinach, beets and chickpeas are all great ideas. You can access the USDA’s handy iron containing foods to plan your meals. ⁴

Keep Calcium and Iron Separate. Calcium blocks iron absorption. One of the largest contributors to our iron intake is fortified cereals, which most people eat with milk. You're essentially pouring iron down the drain. If you're eating high-iron foods, skip the dairy or other calcium containing foods at that meal.

Pair Iron with Vitamin C. Vitamin C dramatically boosts iron absorption. Add vitamin C-rich foods to every iron-containing meal: oranges, strawberries, bell peppers, kiwi, broccoli, Brussels sprouts. This one change can significantly increase how much iron your body actually absorbs.

ENDNOTE

Final Thoughts

There’s a lot to iron, but this edition gives you a solid base for understanding how it works, and how you can optimize your meals accordingly. As always, if you have any questions, don’t hesitate to ask! Just reply to this email.

This week’s newsletter was inspired by a question from one of our readers, and it was too good not to explore. Thank you for your curiosity!

Until next week!

Adrian Macdonald | Team Dietitian | The 8% Newsletter Author