Is it possible I’m not getting enough iron in my diet?

DEAR DOCTOR K:

I’m a man in my 50s, and I’ve been feeling run-down. Is it possible I’m not getting enough iron in my diet?

DEAR READER:

Many patients ask me this question. I think it has to do with an old commercial for a popular vitamin and mineral supplement to treat iron-poor “tired blood.” Iron helps make hemoglobin. That’s the molecule that grabs oxygen in the lungs and transports it around the body to release it as a source of energy to the cells in the body.

The USDA recommends that adult men get 8 milligrams of iron per day in their diets. For women, the recommendation is 18 mg per day from ages 19 to 50, because women lose iron when they bleed during menstruation. For women age 50 and older, the recommendation is 8 mg per day.

If you feel run-down, lack of iron is probably not the cause, for two reasons. First, iron deficiency is unusual in men, unless they are losing blood (such as from a stomach ulcer that is slowly bleeding). You can easily get enough iron in your diet to avoid iron deficiency. Red meat, fish, poultry and egg yolks contain the most easily absorbed form of dietary iron, called “heme” iron. Foods that are artificially fortified with iron, such as breakfast cereals and grains, can also help to meet daily iron requirements. Whole grains, leafy greens, beans, lentils and nuts are also iron-rich.

The second reason your fatigue is unlikely to be due to iron deficiency is that until that deficiency is quite serious, it doesn’t produce fatigue. That’s because it takes severe iron deficiency to produce anemia bad enough to cause fatigue.

On the other hand, if you are feeling unusually run- down, it’s wise to see your doctor. It’s simple to see if you are iron-deficient. If you are, you would definitely want to know about it.

Iron deficiency is one common cause of anemia. Being anemic means you don’t have enough red blood cells or hemoglobin to carry oxygen to your cells. Anemia is uncommon in the general population, but it becomes more likely as we get older. A simple blood test can detect both anemia and whether you are iron-deficient.

While I think it’s unlikely that your run-down feeling is due to iron deficiency, it surely could be. I would be more worried that you had iron deficiency, or anemia from some other cause, or both, if you had any one of the following symptoms:

  • Bowel movements with blood (or black, tarry material);
  • Urine that is occasionally a pinkish color (unless you’ve just eaten beets);
  • Unexplained weight loss or loss of appetite;
  • Being unusually (for you) pale;
  • Unusual firm lumps in your neck, under your arms or in your groin.

A person who is iron-deficient can replace the iron he’s lost with iron pills. But don’t do that unless your doctor tells you to. Some people are born with a tendency to build up toxic levels of iron if they take iron pills without reason.