How can iron deficiency affect your energy levels?
Neil Goffart
Neil Goffart
Fatigue is a state of physical or mental weakness that can affect your quality of life. One of the most common causes of fatigue is iron deficiency. This kind of shortfall can lead to anaemia, characterised by a reduced number of red blood cells in the blood. In this article we look at the link between iron levels and fatigue, review the symptoms of iron deficiency and point you towards the iron best absorbed by the body.
Iron is essential to the body, because it helps produce two important proteins:
When oxygen levels in the blood are low because of a lack of iron, the body can struggle to produce enough energy to meet its needs, which may cause fatigue.
Iron also plays an important role in the immune system, in growth and development (particularly in children), in energy production (ATP) and in cognitive development, such as memory and concentration. By carrying oxygen to the heat-producing cells, iron also helps regulate body temperature.
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Iron deficiency can cause a number of symptoms, which vary with the severity of the deficiency. Here are some common symptoms associated with iron deficiency:
These are the most common symptoms, because iron is involved in energy production. An iron deficiency means too little energy in the body.
Because red blood cells are reduced when iron is lacking, the blood no longer does its job properly. This tends to lower body temperature and cause pallor, particularly of the skin, the lips and the gums.
Particularly during physical activity.
Particularly when the deficiency progresses to anaemia.
When the lack of iron reduces the body's optimal oxygenation.
Irritability, anxiety and a reduced ability to concentrate.
Digestive complaints
Abdominal pain, nausea, vomiting and constipation.
When iron deficiency is already severe or has been present for a long time, the symptoms worsen and may lead to heart palpitations, frequent infections and cracks at the corners of the mouth.
It is important to note that these symptoms can be caused by other conditions and that only a blood test can confirm an iron deficiency. If you have symptoms of iron deficiency, it is important to consult a healthcare professional for an accurate diagnosis and appropriate treatment.
Haem iron, found in red meat and poultry, is better absorbed by the body than non-haem iron, found in vegetables and cereals. Non-haem iron can, however, be improved by combining it with foods rich in vitamin C, such as acerola, peppers or citrus fruits. The absorption of dietary iron can also be optimised by taking a vitamin C supplement at the end of a meal. This is why people following a vegetarian, plant-based or vegan diet tend to be more prone to anaemia. Fortunately, there are very good iron food supplements to make up the shortfall. Iron bisglycinate, a processed form of iron, is one of them.
Also known as chelated iron bisglycinate, this type of iron is better absorbed by the body than other common forms of iron supplement, such as iron sulphate or iron gluconate. It is bound to molecules of glycine, an amino acid that facilitates iron absorption in the small intestine. This bond between iron and glycine allows better iron bioavailability, meaning that the iron can be more easily absorbed and used by the body.
What is more, iron bisglycinate tends to cause fewer gastrointestinal side effects than other forms of iron supplement because, being better absorbed, it does not remain in the intestine for long. It therefore does not cause nausea, vomiting, diarrhoea or constipation.
It is important to note that iron bisglycinate should only be taken under the supervision of a healthcare professional, as an iron overdose can be dangerous. People with chronic illnesses or health problems should also consult their doctor before taking iron supplements, including iron bisglycinate.
The people most likely to develop an iron deficiency are those with significant blood loss, such as women of childbearing age with heavy periods, but also pregnant or breastfeeding women, and infants and young children (2) whose iron needs are higher for their growth and development.
Anyone with a chronic illness or an autoimmune condition also runs a greater risk of developing insufficient iron. This is notably the case for people with intestinal conditions such as coeliac disease, inflammatory bowel disease or bariatric surgery. The same applies to vegetarians and vegans, as well as anyone following an iron-poor diet, as is the case in certain regions. Identifying and treating an iron deficiency quickly is important in order to avoid serious complications such as iron-deficiency anaemia.
Pregnant women are particularly vulnerable to iron deficiency because of the increased demand for iron during pregnancy. The developing baby creates and feeds its own red blood cells through the umbilical cord. In addition, during pregnancy the mother's blood volume increases to support the growth of the foetus, which also requires an increase in the amount of iron in the blood.
Monitoring your iron levels reduces the risk of anaemia and helps avoid symptoms that can prove dangerous for the mother and the foetus.
Untreated anaemia increases the risk of complications during pregnancy or delivery, such as premature birth, low birth weight, intrauterine growth restriction, gestational diabetes, infections or pre-eclampsia.
The symptoms of iron deficiency in pregnant women (3) may include increased fatigue, muscle weakness, dizziness, nausea and pallor.
Fatigue is one of the most common signs of iron deficiency. It can, however, also bring a range of symptoms that affect quality of life. Maintaining a balanced diet and monitoring iron levels is important in order to prevent iron deficiency. If you think you may be deficient, consult a healthcare professional for a diagnosis and appropriate advice.
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FREQUENTLY ASKED QUESTIONS
Iron is involved in several functions directly linked to energy. It contributes to the normal formation of red blood cells and haemoglobin, to normal oxygen transport in the body and to normal energy-yielding metabolism. It also contributes to the reduction of tiredness and fatigue. When iron stores become insufficient, some of these functions can be affected, particularly if anaemia develops. Fatigue remains a very non-specific symptom, however, and cannot on its own establish an iron deficiency.
Yes. An iron deficiency can precede the onset of anaemia: iron stores fall while the haemoglobin concentration is still within normal values. Some randomised trials in non-anaemic women with low iron stores observed a reduction in fatigue after supplementation, while others did not find this effect across all populations. It is therefore important to assess iron status rather than rely on symptoms alone.
A blood test is needed to assess iron status correctly. Ferritin is an important marker of iron stores, while haemoglobin makes it possible to identify anaemia. Interpretation must take the context into account, however: ferritin can rise in the presence of inflammation or infection. The WHO therefore recommends an adapted interpretation and, in certain situations, the concurrent use of inflammatory markers. A simple « serum iron » measurement is not enough on its own.
The risk is greater in particular when needs increase, blood losses are significant or digestive absorption is reduced. Women with heavy periods, pregnant women and some people with digestive disorders or who have had bariatric surgery may be particularly concerned. A plant-based diet also calls for attention to iron sources and their bioavailability, without this meaning that a vegetarian or a vegan is automatically deficient.
Haem iron, found in meat and fish, is generally absorbed more easily than the non-haem iron in plant foods. For the latter, vitamin C is a useful nutritional lever: the European claim « vitamin C increases iron absorption » is officially authorised. Combining pulses or cereals with a source of vitamin C — peppers, citrus fruits, kiwi and so on — within the same meal therefore makes sense. There is no need to conclude that a vitamin C supplement is systematically essential.
[1] https://pubmed.ncbi.nlm.nih.gov/30280670/
[2] https://pubmed.ncbi.nlm.nih.gov/35213686/
[3] https://pubmed.ncbi.nlm.nih.gov/1578961/
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