Dragging yourself through a packed workday, ending it with supper at a tze char stall after 10pm, and still feeling flat the next morning? Poor sleep is the usual suspect, but low iron is another one worth knowing about.
Iron is an essential mineral that your body needs to make haemoglobin, and the body cannot make it, so it must come from food. Haemoglobin is the protein in red blood cells that carries oxygen from your lungs to every part of your body.
Iron is also part of myoglobin, a protein that supplies oxygen to muscles. It supports growth, brain development and the making of some hormones.
Food iron comes in two types. Haem iron, found in meat, poultry and seafood, is absorbed more easily. Non-haem iron, found in plants and fortified foods, is harder for your body to take up. Meat and seafood actually contain both types.
When iron runs short, your bone marrow cannot make enough haemoglobin. Less oxygen reaches your tissues, and since cells need oxygen to make energy, fatigue follows. Think of it as a delivery fleet with too few vehicles.
Common warning signs include constant exhaustion, pale skin, a racing heartbeat, breathlessness on the stairs, dizziness and brittle nails. A Singapore General Hospital pharmacist notes that iron deficiency is the most common cause of anaemia here. Anaemia simply means too few healthy red blood cells.
One caution: if you are not iron deficient, there is no evidence that taking iron supplements for energy will help.
Myoglobin acts like a small oxygen tank inside your muscles, so the oxygen is on hand when you move. Iron is also one of several vitamins and minerals your immune system needs at every stage of its response.
Long-distance runners are among the groups more likely to end up with low iron. Running can cause tiny amounts of bleeding in the gut and break down red blood cells faster. Worth remembering if your weekends are spent on long runs along the park connectors.
In children, iron is needed for growth and brain development. A shortage can delay development, and the effects may be permanent. Toddlers and teenagers are at risk because they grow quickly and often eat unevenly.
Milk is a very poor source of iron, so toddlers who drink lots of milk and skip other foods can develop what is called milk anaemia. In adults, iron-deficiency anaemia can show up as low energy and problems with concentration and memory.
Women need more iron than men because of blood lost through menstruation. Pregnancy raises the need further because of the growing baby and extra blood circulation. In younger women, iron deficiency anaemia is mainly due to heavy menstrual loss that is not replaced, and it can go untreated or undetected.
Iron deficiency is the most common cause of anaemia in pregnancy. HealthHub notes that in 2011, up to two in five women of reproductive age in Southeast Asia had iron deficiency anaemia.
Routine check-ups, such as those under the Screen for Life programme, are a good habit. But if you have felt tired for weeks, ask your doctor whether a blood test for iron makes sense. Long work hours make it easy to shrug off the signs.
Not all the iron on your plate ends up in your body. Haem iron is absorbed better than non-haem iron, and other foods affect it less. That is why people who eat no meat, poultry or seafood need almost twice as much iron.
Some partners help. HealthHub suggests pairing plant iron with vitamin C fruits such as guava, papaya, oranges and kiwi. Mixing a little meat, fish or poultry with beans or dark leafy greens can improve absorption of the plant iron up to three times. Kailan stir-fried with a few prawns, followed by a slice of papaya, is a good example.
Other things get in the way. Coffee and tea contain caffeine and tannins that inhibit iron absorption, so HealthHub advises having them a couple of hours away from meals. Bran fibre, large amounts of calcium and plant substances called phytates and tannins can also reduce absorption. SingHealth also advises keeping iron apart from milk and calcium-rich foods. A teh tarik straight after lunch is tea and milk together, so it is worth spacing out.
Your body excretes very little iron, so it controls absorption tightly. A hormone called hepcidin blocks iron absorption when your stores are already sufficient. More is not always better. Cooking in cast-iron cookware can also add a little iron to your food.
Most healthy people can meet their needs through food. Supplements are different, because iron is a nutrient where too much causes real problems. Excess iron can damage the liver, heart and other organs.
High-dose iron supplements, especially on an empty stomach, can cause an upset stomach, constipation, nausea, abdominal pain, vomiting and diarrhoea. Large amounts may also inflame the stomach lining and cause ulcers. Too much iron can also lower zinc absorption.
Some people need extra care:
Regular use of anti-inflammatory painkillers such as aspirin and ibuprofen can cause stomach bleeding, which in turn drains iron. Supplement awareness is growing among younger working adults, while older generations tend to be more sceptical. Both instincts have a point: take tiredness seriously, but do not self-prescribe. Taking too many iron supplements without supervision can be dangerous, so speak to your doctor or pharmacist before starting.
Iron is a quiet nutrient. You rarely notice it until you run low, and then everything from your morning commute to your concentration feels harder. Food is the best starting point, and a few smart pairings, like greens with vitamin C fruit, make a real difference.
If you suspect low iron, get it checked rather than guessing. A simple blood test tells you far more than a pill bottle can.
This article is for general informational purposes and is not a substitute for professional medical advice. Please consult a qualified healthcare professional before making any changes to your diet or supplement routine.
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