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Do you feel tired and cold most of the time? Are you irritable? Looking pale? Finding it hard to concentrate?

You might think the winter blues are to blame, but it may be iron deficiency anemia, which is most common in young women. Iron deficiency in a man or post-menopausal woman usually indicates a more serious underlying problem. Knowing when to visit your doctor and ways to improve your diet can help you manage your risks.

What is iron deficiency anemia?

The Greek word anaimia literally means "without blood." Iron deficiency anemia is when your body lacks iron to make a certain protein in the blood. This protein is known as hemoglobin, which is found in red blood cells and is responsible for carrying oxygen from the lungs to the rest of the body.

Why is iron deficiency a concern?

Low iron levels can have an impact on work performance, judgment and the ability to focus. It can delay development in infants and children, and may lead to complications for women after giving birth. Low iron can also weaken the immune system, making you more susceptible to illness and infection.

One of the most common complaints from people with iron deficiency is fatigue. Other classic symptoms include frequent headaches, dizziness, rapid or irregular heartbeat and loss of consciousness. Feeling cold all the time, and having spoon-shaped fingernails that curve inward, can also point to iron deficiency.

Who is most at risk?

The risk of iron deficiency anemia increases when there is a loss of blood, such as for women during menstruation. Internal blood loss can also be a side effect of some medications. Those living with inflammatory bowel diseases such as Crohn's and colitis are at higher risk because of difficulty absorbing iron.

Increased demands on the body can also increase the risk for iron deficiency. This is the case for pregnant women, children experiencing growth spurts and athletes engaging in intense exercise. Finally, a diet that contains insufficient iron can lead to a deficiency. This can be caused by iron being less readily absorbed, such as in vegan or vegetarian diets that rely on plant-based iron sources.

How can iron deficiency be checked?

If you have been experiencing some of the symptoms listed above for a while and suspect your iron levels may be low, visit your doctor. Ask to have both your hemoglobin and ferritin levels checked. Measuring serum ferritin, one of the main and preferred diagnostic tests for determining iron deficiency, reveals the status of your iron stores, and your hemoglobin levels can tell you the severity of the anemia.

In the meantime, focus on your eating patterns. Are you including iron-rich foods in your diet? Become familiar with foods that are great sources of iron and how to increase your absorption.

What foods are high in iron?

Iron-rich foods that are more easily absorbed by the body come from "heme" sources, meaning they contain blood. Red meat, organ meats (such as liver), fish and poultry are your best sources of iron. Our bodies can absorb 14 to 18 per cent of the iron contained in these foods.

Plant-based foods containing iron are referred to as "non-heme," or without blood. Some examples include legumes, iron-fortified grains (such as cereals, pasta and oats), nuts, molasses, dried fruit, spinach and other vegetables. Approximately 5 to 12 per cent of the iron contained in non-heme sources is absorbed. Including vitamin C when eating non-heme foods can help with iron absorption. Foods rich in vitamin C include citrus fruits and juices, cantaloupe, strawberries, broccoli, tomatoes and peppers. So adding peppers and fresh tomatoes to a pasta dish or squeezing lemon juice onto leafy greens will help boost iron absorption.

Tea, coffee, cocoa and phytates (found in grains and legumes) and oxalates (found in spinach, among other sources) can interfere with iron absorption. Drink tea or coffee at least one or two hours before or after a meal to prevent this. If you eat whole grains, legumes and spinach regularly, be sure to include a food source high in vitamin C at the same time to enhance iron absorption. Also, calcium and phosphate supplements or antacids can interfere with iron absorption. Be sure to take these separate from food.

Are supplements necessary?

Never take an iron supplement without consulting your doctor and knowing your iron status first. Fatigue and other symptoms of iron deficiency anemia can be caused by many other reasons. Too much iron can lead to constipation, stomach pain, nausea, vomiting and, in severe cases, poisoning that leads to organ failure.

Generally, a supplement can be effective in restoring low iron levels. This usually takes about three months of having the supplement daily.

Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.

Maria Ricupero is a registered dietitian, certified diabetes educator​ and spokesperson for Dietitians of Canada. Maria specializes in cardiovascular health and diabetes and has 15 years of experience working in cardiac rehab. She currently works at the UHN Cardiovascular Prevention and Rehabilitation Program in Toronto.

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