Iron Deficiency

Iron deficiency is the most common nutrient deficiency worldwide. The most vulnerable population for iron deficiency is infants. Iron deficiency is associated with neurocognitive impairments that last for a long time. Since iron supplements are effective in preventing iron deficiency anemia (IDA), numerous studies proven that iron supplements can have some adverse consequences. One large study in Kenya found that iron supplements cause intestinal inflammation because iron supplements change the gut microbiota, which is an important factor in infant morbidity. It has been proven that the gut microbiota, which is located in the gastrointestinal tract, plays a significant role in body health by regulating immune homeostasis. Any changes in gut microbiota can cause immune malfunction. Iron supplements affect the immune system through alterations of gut microbial communities.

It has been proven that the human gut has a strong connection to the immune system. Scientists believe that some autoimmune diseases, such as obesity, irritable bowel disease, Crohn's disease, cancer, diabetes, and depression, are related to the malfunction of the immune system. There have been many studies to prove that the malfunction of the immune system is related to the miscommunication in the human gut, which is responsible for protecting the body from invading external and internal pathogens. Since a major part of the immune system is inside the human gut, the immune system and gut microbiota interact with each other constantly. Irritable bowel disease affects 10 to 20 percent of the population and causes gastrointestinal infection, inflammation, and chronic stress, which affects the quality of life. Ulcerative colitis (UC) and Crohn's disease (CD) are two types of inflammatory bowel disease (IBD). Dysfunctional mucosal immune response to beneficial bacteria causes IBD and CD.

Anemia is the most frequent comorbid condition in patients with inflammatory bowel disease. It is a common complication of inflammatory bowel diseases and, in most cases, one of the reasons that patients stay longer in hospitals. Iron is an essential nutrient that the life of bacteria and microorganisms depends on for metabolic processes and respiration. Bacteria with several metabolisms can detoxify iron or oxidative stress directly. DNA-binding protein from starved cells (DPS) binds to DNA and protects it from oxidation. The iron storage proteins can store the iron in a non-toxic and soluble form and lower the concentration of intracellular free iron. Iron can be released from these bacterial stores in case of iron deficiency. Oxidative stress is the result of the imbalance between the production of free radicals and antioxidant defenses, which may have a possible role in the cause of tissue damage in some diseases, such as diabetes mellitus.

Iron comes with some side effects, even if taken in normal doses. Constipation or black stool is a common side effect. Some iron supplements have magnesium to prevent constipation. Education is very important, patients must be educated and well-informed, and not be taken above the recommended amount to prevent overloading and toxicity. It can damage the heart, pancreas, and other organs, and some studies show that iron overdose can cause cancer. Hemochromatosis is a condition that means too much iron in the body. The care providers must be well informed that many blood diseases can cause anemia, and taking iron supplements can only mask the disease. The underlying causes of the disease must be diagnosed first before starting any iron supplementation. Some blood diseases, such as sickle cell anemia, hereditary spherocytosis, hereditary elliptocytosis, genetic hemochromatosis, and thalassemia can cause anemia.

Iron can interact with many medications, such as antacids, which can prevent iron absorption. Ascorbic acid or vitamin C can enhance iron absorption. Some medications, such as tetracycline and its family, can bind to iron and prevent the absorption of antibiotics and iron as well. Parkinson’s medication, such as levodopa absorption can interfere with the iron supplement. Some foods, such as eggs, milk, and tea, decrease iron absorption. These foods should be taken within two hours of taking iron.