Iron Deficiency
Understanding Anemia and Iron Deficiency
Across their lifetime, many women are told they are “anemic” or that they have “low iron”. It’s such a common experience that it’s difficult to even appreciate that it’s actually a serious issue with significant health concerns associated. Frisco Midwifery has created this link to help you understand iron deficiency and anemia, and take appropriate steps to improve your health.
The creation, storage, transportation and use of iron in your body is a fairly complicated process. We are over-simplifying the explanation of those processes so we an get to the important action points.
Your blood is made up of the liquid portion (plasma) and red blood cells (that carry oxygen) and white blood cells (immunity) and platelets (clotting factors).
Hemoglobin: The red blood cells are like vehicles that carry oxygen to the cells and remove carbon dioxide from the cells. The carbon dioxide and oxygen are loaded in the cargo space of the cells, called hemoglobin. The hemoglobin (cargo space) is made from iron. About 2/3 of the iron in your body is circulating in the blood.
Ferritin: The other 1/3 of iron is stored as ferritin in your bone marrow, spleen and liver. If you don’t have enough cargo space (hemoglobin) in your blood, you are “anemic.” If you don’t have enough iron to create the cargo space to begin with, you are “iron deficient.”
Hemodilution: Even if you start pregnancy with the perfect amount of hemoglobin in your blood, as pregnancy progresses you will expand the liquid portion of your blood, which will dilute the amount of red blood cells carrying hemoglobin. So, most pregnant women need to add iron to their diet just to compensate for the normal expansion of blood in pregnancy.
Checking your Iron: We will draw your labs at your initial appointment, 28-weeks and 36-weeks. Each time we draw your labs we will be measuring your blood count so we can see how much iron is circulating in your body, and how well your blood is expanding.
What should I see in my results?
Hemoglobin: The concentration of red blood cells (hemoglobin) should be around 14% at the start of pregnancy, may drop to 11.5% and should recover to at least 12% by the end of pregnancy. Low hemoglobin = anemia
Ferritin: Normal ferritin stores should be 50-170 mg/dL. If your ferritin is below 100, you are more likely to experience anxiety, attention deficit and hyperactivity, panic attacks, restless legs, and chronic fatigue or exhaustion. If you are low in ferritin you are “iron deficient”
Platelets: Your platelets should be between 150-400 million per milliliter of blood to have good clotting. Your platelets must be above 100 in order to birth safely in the community setting. If you are low in platelets, it is called thrombocytopenia. Low platelets can contribute to excessive bleeding in birth. They also may be an indication that your liver is not functioning optimally.
It is possible to have low blood cells (anemia) and low platelets (thrombocytopenia) separately, and low ferritin (iron deficiency) or all three at the same time.
The strategies for increasing platelets is roughly the same, and includes attention to your diet (dark green leafy vegetables, healthy fats like sesame oil, avocado, salmon) and very likely also supplementation.
Read below for specifics, but we suggest supplementing with a good iron, D3, B12, and a digestive enzyme. We can create a “basket” in FullScript or you can order them directly from your favorite source. (FullScript is a provider warehouse of supplements. We can get a 20% discount off of the retail cost, which we pass on to you to cover the cost of shipping).
Signs of anemia and iron deficiency
Symptoms of iron deficiency and/or anemia include fatigue, fast heartbeat, shortness of breath, headache, difficulty concentrating, dizziness, pale skin, leg cramps and insomnia, brain fog, anxiety, panic, restless legs, fatigue/exhaustion.hair loss, and more.
Iron deficiency anemia can cause preterm delivery, postpartum depression, and cause life-threatening issues for the baby.
Recovering from Anemia
The best way to improve iron deficiency & anemia is to increase your blood count by
a) good nutrition and
b) good iron supplementation
c) supplementing with vitamin C, vitamin A, and B12
d) increase muscle demand for energy by aerobic exercise
The rest of this link gives recommendations for each of those:
Supplements: Supplementation is essential during pregnancy if you are anemic, iron deficient or have low platelets. These supplements / combinations of supplements work really well. Pick one of them and use it consistently. When we re-draw your labs, if you are not seeing improvement, we will make additional recommendations.
We have created a link with supplements, pricing, recommendations. Scroll down to “Challenges” to see our recommendations. SUPPLEMENTS
HEME supplements include animal products. They absorb MUCH better and have MUCH better results.
If you have a plant-based lifestyle, you can supplement with NON-HEME supplements.
Three Arrows, Simply Heme. (click here for their link)
The directions on the bottle are very low dosage for people who are already in a healthy range. If we have shared this link with you, and asked you to supplement to get your ferritin or hemoglobin high enough for birth, you will need a much higher dose. We generally recommend taking 6 capsules in 3 doses before noon.
Ferritin + (non-heme) supplement. Plant based iron is much more difficult to absorb. It will take a lot of work to bring your ferritin and hemoglobin up using a plant-based supplement. Ferritin+ is a brand with lower side effects. (You an find this on Amazon or at health food stores). The dosage ‘on the box’ says 1 tablet per day. In order to increase your iron sufficiently, please refer to the Dosage Chart for how much to take / when to take it.
Other Supplements to Improve Iron:
B12 - 1000 mcg daily
D3 - 5,000 ỉu per day (20,000 if you are obese)
Vitamin C - 2000 mg per day
phosphorous - found in coconut water, and coconut milk
magnesium - 350-400 mg
Nutrition:
Foods with absorbable, dietary iron include: blackstrap molasses, beets, liver, red meats, fish & poultry, egg yolks, legumes, nuts, Beef liver, Sesame seeds, Banana, Rye flour, Tuna / Salmon, Shiitake mushrooms
Foods with Folate (B-9) include: dark leafy vegetables (spinach and kale) beans, lentils, peas, nuts,
Foods with B-12 include: red meat, fish, milk and cheese, eggs.
Other foods that may help: poultry, shellfish, liver, beans, cherries, nutsFoods with Vitamin A: spinach & kale, sweet potatoes, squash, carrots, red peppers and melons
Foods that may increase platelets: Omega 3 fatty acids found in fish, tuna, wild salmon and flax oil.
Drink adequate fresh room temperature water (rather than cold water).
Avoid or eliminate processed foods, junk food and refined sugar from your diet. Also, avoid caffeinated drinks which may interfere with bone marrow activity and reduce platelet count.
What else can I do?
Exercise is one way to support a healthy circulatory system. Raising your body’s demand for oxygen causes your body to make more red blood cells. You should be walking briskly for at least 30 minutes per day.
IV Therapy: IV Therapy with B12 can help a lot if you are B12 Deficient. We can check your B12 if you want to check on this kind of supplementation. We can refer you to a local IV Bar.
Iron IV Therapy: If your ferritin is critically low, or if your hemoglobin is low enough to be concerning, we may recommend you get an iron IV infusion. If you have insurance, we can refer you to a hematologist. If you are cash pay, we can refer you to someone who does the IV infusions at another birth center.
What if I’m anemic and/or iron deficient at the time of birth?
If you are anemic or iron-deficient at the 36-week appointment, we will recommend supplements. It usually takes about 2-weeks for the iron or platelets to recover. So, she will draw your labs (with your consent) at 38 weeks.
Our goal for your hemoglobin level is 11.0 or greater. If it is between 10.0 - 11.0, she will request that you continue taking iron supplements. But, at the birth, we will manage postpartum bleeding more aggressively, which may mean you will need a shot of Pitocin in your thigh soon after the birth.
If your hemoglobin is below 10.0, we will discuss transferring your care so you can birth in a hospital setting where they are more equipped to manage significant blood loss. Iron deficient anemic clients may need more support if they bleed.
If your ferritin is extremely low, or if you have very low hemoglobin, we will refer you for intravenous iron infusions.
The emphasis here is: —
everyone should:
·Eat a healthy diet with 80-100 grams of protein
Walk / exercise 7-days a week
Supplement with iron
Supplement with vitamin C and add vitamin C to your diet
Supplement with B12
Supplement with D3
· . . . everyone is better off if your hemoglobin is 11.0 or greater.
You may also need
B12 higher dose 1000 mcg a day
IV Iron infusions
D3 higher dose 10,000 iu daily (20,000 iu if you are obese)
Sources / Further Reading:
https://www.webmd.com/baby/guide/anemia-in-pregnancy#3
https://facty.com/ailments/body/what-is-hemoglobin/10/
https://www.reference.com/health/normal-hemoglobin-level-4ad3fcf551715e48
https://academic.oup.com/ajcn/article/81/5/1218S/4649796
