Scott Webb (Host): Young women often suffer from low iron levels, but the good news is that iron supplements usually help with the symptoms like fatigue and hair loss. I'm joined today by Alexandra Smith. She's a Certified Physician Assistant practicing at Franciscan Health. This is the Franciscan Health Doc Pod. I'm Scott Webb.

Alexandra, it's so nice to have you here. I was just telling you that I have an active 16 year old teenage daughter who plays lots of sports and she was low on iron, so we got her some iron supplements. So I have a little bit of a sense of what iron is and what it does for the body, but you're the expert here. So what is iron and how does it impact the body?

Alexandra Smith PA-C: Iron is a natural mineral that is available through foods that we in our bodies, then use to make hemoglobin, which is the compound in red blood cells that carry oxygen to the rest of your body. So that's why a lot of times when patients end up finding out that they are anemic from iron deficiency, it all kind of makes sense for them because it's like, Oh, I've been feeling so tired. And then they get the diagnosis. And that is why, because red blood cells in our body carry the oxygen to everywhere else and allow us to function and, you know, have clear minds and everything else that we need to do.

Host: Yeah, I see what you mean, that the diagnosis helps to explain some of the signs and symptoms they may have been having, and along those lines, what are the symptoms of low iron levels?

Alexandra Smith PA-C: Some of the symptoms that a patient could have with low iron is they would be fatigued, which I already mentioned, as well as hair loss. They can have cravings for non-food items, which is called PICA. Some of these cravings could be something as normal as ice. They're chewing on ice cubes, all the way to dirt, paint, mud, which kind of goes long line with dirt, baby powder, just things that normally would not be appealing to someone. They can also have restless leg syndrome, so cramping in their legs as well as experiencing headaches. Exercise intolerance, difficulty catching their breath when they're exercising, and just feeling overall weak.

Host: Yeah, those are some of the things that I could kind of see in my daughter, I saw her look a little winded early in a basketball game, and I was thinking to myself, like, she hasn't really done much yet. So like, why does she look so tired already? So that was one of the alarm bells that went off for me.

Uh, but just wondering for folks in general, especially women, if they think they're experiencing the effects of low iron, what should they do?

Alexandra Smith PA-C: So, obviously, I recommend that they go and see their primary care provider, or OBGYN, if that is kind of who they're working with based on where they're at in life right now. Iron deficiency is the number one cause of anemia worldwide, not just in the United States, and women are at higher risk solely, mostly due to the blood loss that occurs every month during the menstrual cycle, as well as in one pregnancy, you know, the women's, their red blood cells increase to then have more blood to give to mom and baby during that time while baby's growing, but that doesn't necessarily mean that their iron intake has increased. So they might not be making enough iron that then binds to the red blood cells to then give them enough oxygen throughout their body.

Host: Yeah, I see what you mean. Is there any particular reason why younger women, young women in general, likely, seem to be the ones that experience low iron levels?

Alexandra Smith PA-C: Not necessarily. I mostly believe that it is because, you know, they're, in the early stages of their menses kind of regulating. So they might have heavier menses when they're younger and it kind of levels out later on once they're into adulthood. But other than that, there really hasn't been like a known stated reason of why this happens more commonly in younger women than women who might be in their 40s or 50s.

Host: Yeah, that makes sense. And, uh, how do you replace iron? I know what we did with our daughter, which is to get a thing of pills from the store and have her take an iron supplement every day, but in general, is that the only way or are there some other ways as well?

Alexandra Smith PA-C: Definitely just taking, you know, the iron pills is going to be the easiest, most cost effective easiest way to replace your iron. If some patients are very anemic at that point, we'll recommend iron infusions. But that's not as common.

Host: Right. So the supplements, other treatments would be the iron infusions. Is there anything else or is that pretty much it? And that does that usually do the trick?

Alexandra Smith PA-C: That's pretty much it. Of course, you know, based on how anemic they are, they can try first, just increasing iron in their diet, like iron rich foods, such as like meats and vegetable sources. But if they, you know, feel like they would rather just take an iron supplement, then that's just going to be the easiest way for them to do it.

Host: Sure. Are there any, uh, complications, side effects, if you will, to be aware of? Is it possible to take too much iron? Is it possible to go too far and overdo things?

Alexandra Smith PA-C: Normally, you know, oral iron is very safe. Of course, you can overdo anything in medicine, but we make sure, by what dose we're giving you that that's not going to happen. The number one side effect of replacing the iron that some patients might experience is mostly just GI upset such as like abdominal pain, or they might be constipated. But there's kind of ways to mitigate that by maybe taking the iron supplement every other day, taking it with food.

Some of the studies that are coming out most recently is that vitamin C, in addition to the iron, helps increase the absorption of the iron. So, me and some of my colleagues are recommending that you when patients are trying to replenish their iron, they take their iron supplement with a glass of orange juice or they take it with a vitamin C tablet or just something that's rich in vitamin C, like an orange, you know, other fruits and vegetables that are high in vitamin C can do the trick as well.

Host: Sure. Yeah, I'm feeling pretty proud of myself. I didn't know that there were any studies that backed this up, but I just thought it was a good idea. So every day I put my daughter's iron pill out for her with a little glass of orange juice. So I'm feeling like a pretty good dad right about now.

Alexandra Smith PA-C: Yeah, it looks like you're doing everything right.

Host: Yeah, it sounds like it. Let's just finish up today. This has been educational, good stuff. Just wondering, are there any nutritional remedies besides iron supplements or infusions? You'd mentioned orange juice or vitamin C. Is there anything else, especially young women can eat, that will help them?

Alexandra Smith PA-C: Yeah, so iron rich foods are going to be very good for them. There's kind of two sources of iron from foods and the heme iron and the non-heme iron. The heme iron is going to come from your meat supplements, beef and pork meats are high in the heme iron. You can get the non-heme iron from vegetable or non meat sources such as like the fortified cereals that they sell at the grocery store. Nuts, sunflower seeds, beans, legumes, spinach, things like that as well.

Host: Well, that's perfect. As I told you before we got started today, this one hits close to home because it, you know, affected me in my home with our daughter and, good to know about the, vitamin C and the OJ and iron connection and, always good to know that just, you know, simple supplement or something usually does the trick. But of course, women, young women need to see their providers, you know, be tested, get prescriptions and so forth. So, thank you so much for your time today. I really appreciate it.

Alexandra Smith PA-C: You're welcome. Thank you for having me.

Host: And to learn more about low iron levels, visit franciscanhealth.org and search nutritional health. And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.