"I’m strong to the finich 'cos I eats me spinach!"
There were two nutritional facts I really internalized as a child: Sunny D could make you turn yellow (bad) and that if you necked a tin of spinach à la Popeye the Sailor Man, you'd get strong and be able to defend your girlfriend (good).
Turns out that being cautious of my Sunny D intake wasn’t really necessary beyond the early 2000s, but my belief that spinach = iron which = good continues to this day. And while the whole premise of Popeye rests on a scientific typo (a rogue decimal point meant we assumed spinach contained 35mg of iron per 100g, not 3.5mg), the fundamental truth remains that iron is a vital nutrient.
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Iron deficiency is the most prevalent nutritional deficiency worldwide. It is one of the essential minerals we need to live and can be sourced from a variety of food groups. But despite this, for the most part, we struggle to get enough, which is making us more tired, pale and lacking in energy, according to the NHS.
What is iron and why is it so important? According to Bahee Van de Bor, specialist paediatric dietitian and spokesperson for the British Dietetic Association (BDA): "Iron is a mineral that is essential for making a protein called haemoglobin. Haemoglobin housed in red blood cells transports oxygen in the blood to the various major tissues and organs in the body." It is also an important mineral in immunity. Basically, it is fundamental for giving you energy and protecting you from infection. So far, so important! But a number of things can affect your iron levels, leading them to dip.
Bahee says that the symptoms of iron deficiency vary in severity. If you are mildly deficient, you may "often feel tired, lacking in energy and tend to be more susceptible to infections." When it gets more serious and becomes what is called iron deficiency anaemia, "symptoms such as heart palpitations, brittle nails, thinning hair, itchy skin (pruritus) and mouth sores or ulcers can develop."
The most common source of iron (and the most common way your levels can be affected) is diet. According to the BDA, animal-based foods (like red meat and, to a lesser extent, fish and poultry) are particularly rich sources of iron and are most easily absorbed, while plant-based sources tend to have a lower iron content and are harder (though not impossible) to absorb. This means that if you follow a vegetarian or vegan diet, you may not be getting the amount of iron you need to maintain normal levels.
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Bahee points out other, less obvious factors that can affect your iron levels. "[They] can dip if you consume too many tannins found in tea and coffee. It's best to have these drinks between meals or reduce intake if necessary. Phytate in vegetarian foods can also affect how well the plant source of iron (called non-haem iron) is absorbed. Usually, soaking and cooking beans until cooked will help reduce phytate levels."
Various medical conditions can also have an effect, including "coeliac disease, peptic ulcer, inflammatory bowel disease, diverticulosis etc; bleeding disorders (such as factor deficiencies); cancer; excessive menstrual flow (including that due to disorders); and the use of certain medications."
This makes it particularly important, if you menstruate, to keep an eye on your iron levels. Heavy periods can be caused by any of the frequently misunderstood conditions that women and people who menstruate deal with, including polycystic ovary syndrome, fibroids, endometriosis, adenomyosis and even womb cancer. It seems obvious but it bears mentioning that any iron lost through bleeding should be supplemented and replaced so as not to be at risk of iron deficiency anaemia. Bahee points out that this is also important if you’re pregnant, as pregnancy can increase iron requirements. There are over-the-counter supplements available which are tailored to pregnancy and include iron – these can be helpful if pregnancy means you struggle to eat iron-rich foods.
You shouldn’t be too overzealous as, while less common, too much iron can be as problematic as not enough, and it is possible to overcorrect. When functioning properly, the body regulates iron levels by adjusting the rate at which iron is absorbed in the gut. Too many iron supplements "could lead to overdosing and iron toxicity, which can cause damage to some organs like the liver if untreated." This is not to be confused with the inherited condition haemochromatosis, when iron levels build up in the body over the years, resulting in iron overload and requiring treatment to remove blood. In the case of the former, you can just cut back on the supplements.
So what should you do if you think your iron levels are off? If you’re a meat-eater, you’re in luck: meat, chicken and fish are all iron-rich foods and can be easily incorporated into your diet (even sustainably). For vegetarians and vegans, lentils are also a great source, as well as dark leafy greens, beans and some types of nuts and seeds. You can see a full list here. If you have persistent symptoms, such as feeling tired with repeat infections, it is always worth seeking medical advice as the longer you leave it, the longer it can take to build your iron back up.