Feeling tired, run down, low? Have some chronic fatigue going on to the point you’ve googled “spoonie” (meaning you have ZERO ounces of energy to expend) and can relate? How’s your endo pain, pretty bad? Dealing with some unexplained infertility? I’m sure you’re nodding at some of these.

Well, what if I told you there is one nutrient implicated in all of these issues, and a nutrient that nearly all of us with endo may be deficient in. In fact, some research points to the fact just having endometriosis (even without heavy periods and even when eating enough iron) can render us deficient. What’s the nutrient?

Iron.

Yup, just having endo may mean you’re automatically at risk for deficiency. Now add in super heavy and prolonged menstruation, gut inflammation preventing absorption (endo belly anyone?), and not eating enough iron to meet our daily requirements of 18mg/day (thanks to changing diets and many of us eschewing red meat, American’s best/most accessible source of iron). Now we may be looking at HOLY MOLY THAT’S SIGNIFICANT levels of iron deficiency. And, this may be directly impacting your endo body.

This is why testing for and reversing iron deficiency becomes extremely important if you have endo. Let’s learn some fun reasons why.

Why iron is important for endometriosis

Au contraire! Think of iron as your party animal mineral since iron is best known for energy production! It’s an essential ingredient to make hemoglobin, a protein within blood cells that carries oxygen to where it’s needed in the body. This is how iron makes us have loads of wonderful energy. No iron? No oxygen to muscles or organs (making us exhausted), and no oxygen to your ovaries, eggs, uterus, and pelvic cavity either (leading to poor ovulation and crappy immune response).

You can see why iron is extremely important to us endo sufferers dealing with fatigue, infertility, and immune dysfunction.

But iron does more than just oxygenate and energize the body, and this part is super important to know for endo: proper iron levels decrease oxidative stress in the body.

Remember that oxidative stress is a hallmark of endometriosis. It happens we inflammation goes on too long (i.e. chronic inflammation), it causes damage all by itself! This type of damage causes scar tissue and adhesions, which is why I talk about oxidative stress all the time and how we neeeeeed toooooo stopppppp itttttttt in order to slow or halt endo progression and damage.

Unfortunately, iron deficiency increases oxidative stress by reducing the number of antioxidants in the system. Antioxidants are the buggers that STOP oxidative stress. For example, anemic participants supplemented with iron for six weeks saw a significant decrease in oxidative stress. It’s why iron is necessary to heal the antioxidant defense system.

So, yeah, we need iron for reproduction, energy, stopping oxidative stress, and more.

Can endometriosis cause iron deficiency?

Having endometriosis can lead to iron deficiency. This may happen 3 ways:

1) Bleeding lesions: Iron overload refers to excess iron at the site of endo lesions, caused by excess bleeding. This is a localized bleeding problem, caused either by bleeding lesions or too heavy retrograde flow, altogether inundating the immune cleanup and causing inflammation. If you’ve heard of a gunpowder burn color of some lesions, this is thanks to iron overload nearby.

2) Heavy Period Flow: Many of us with endometriosis have very heavy periods, and some of us have prolonged periods and spotting on top of that. That's a lot of blood to lose every month!

3) Inflammation: Just having chronic inflammation can eat up iron stores.

But again, your iron levels have nothing to do with this, so please bring up your iron to sufficient levels without worry!

Am I iron deficient?

If you have endo, then it looks like … probably. Common iron deficiency symptoms may include fatigue, bruising, headaches, shortness of breath, dizziness, or pale skin (think symptoms of oxygenated blood not getting where it needs to be). As someone who’s had anemia, I can attest that having an iron deficiency can make you feel like your body is made out of lead. Again, with endo it may also culminate as a contributor to infertility or pain, so keep that in mind as well.

Of course, it’s important to know that you can also be sub-clinically deficient in iron and have no outward symptoms at all. This is why testing is key.

Luckily, iron levels are easy to test for. So, if you are reading this and have endometriosis, please go get tested. If deficient, you may start feeling better within mere days of supplementing.

I mean, what if your “body too heavy to move it off the couch” feeling was actually just a simple iron deficiency, and you could jump off the couch in a week? Or, what if you started taking iron and watched your endo pain minimize or unexplained infertility reverse? I’m not saying it is the magic pill, but what if it was for some of us? I say it’s worth investigating.

Testing for iron deficiency

Glad to hear you understand the importance! Now, go to the doctor. Tell them about your anemia symptoms (tired, bruising, heavy periods). Now ask for a CBC to look at your serum blood levels, and additionally, a ferritin test that measures your stored iron. Some doctors may be hesitant to order a ferritin lab test because of insurance pushback, but they might be more comfortable ordering it if you describe your anemia symptoms and beg them for the ferritin.

When you get your test results back, ask for the numbers. This is important because Western medicine doctors view ferritin levels above 11 as okay, but for optimal health, energy levels, and fertility, you will want your ferritin to be at least 50 ng/mL. This is a huge difference (!!) and why it’s important to know the number rather than have a doc tell you “everything is good” when your ferritin is actually low. I tell you this from a personal experience since I was exhausted, but left secretly anemic for two years when my doc told me ferritin (at 12, which she didn’t tell me) was normal. When I got it back to 50, I was a whole new woman!

Endometriosis Supplements for more iron: food and pills

For menstruating women who are omnivores, the RDI for iron is 18 mg iron/day, although as someone with endometriosis, you may need more. The best iron-rich food sources are animal products because they contain a highly absorbable form of iron called heme iron. Best options include a

• 3.5-oz portion of chicken liver (9.9 mg),

• Canned oysters (6.65 mg),

• Beef liver (6.3 mg)

• Ground beef (2.68mg),

• To note, nearly all animal foods will have iron to some degree.

Plant options contain the less absorbable form, non-heme iron, so vegetarians and vegans must consume nearly double the amount of iron (1.8x more) to meet the basic vegetarian quota set at 32.4 mg/day. Best sources include dark leafy greens, broccoli, beans, and grains. Because 32.4 mg/day is a challenging amount to ingest daily, vegetarians are consistently found to have lower iron stores than non-vegetarians.

Meeting the basic RDI of plant-based iron would include eating about 5 cups of cooked spinach (equivalent to 55 cups raw) or 17 cups of cooked broccoli every day, which is why a vegetarian or vegan may consider continuous iron supplementation.

TO GET MORE IRON, TRY THESE TIPS:

• Combine heme iron, non-heme iron, and vitamin C in the same meal. Research shows that eating animal- and plant-based iron at the same meal increased the absorption of plant-based iron by about 250%, compared to a meal without animal-based iron. Additionally, consuming iron with a rich source of vitamin C may increase iron absorption by up to 414%. Think grass-fed beef patties over a bed of lightly sautéed spinach and bell peppers.

• Cook with a cast-iron pan. This alone can increase the amount of iron in foods between 2 and 21 times, depending on the acidity of the food being cooked. For example, an egg cooked in a cast-iron pan has 2 mg more iron than an egg cooked in another pan, while tomato sauce would have a whopping 5 mg more iron per 3-oz serving. These pans are an amazingly effective and simple way of increasing iron content.

• Avoid dairy products, teas, or coffee with your iron-containing meals, as well as avoid acid blockers like Tums. These prohibit iron uptake, so even if you’re eating iron-rich foods your body won’t be able to properly absorb it.

• Eat liver. Liver is an iron superhero, among other nutrients, although the taste is something to be acquired for most of us. Baby steps include liver paté, ground liver hidden in burgers or chili (seriously, this works), or even desiccated liver pills for the truly squeamish.

• If you have digestive issues like IBS, go get a gut test to rule out SIBO or other infections. These infections can steal the iron away from you (a lot of bacteria love iron, so if you have an overgrowth they will literally eat your meal for you!), so kill them off and then continue to bring your iron levels to sufficiency.

• Supplement. If you test first and know you’re deficient, it’s important to work with a professional to reverse deficiency since too much iron can be just as problematic as too little. When supplementing, consider a gentle iron that doesn’t cause constipation, such as Ferrochel Iron Chelate by Designs for Health.

References:

Chavarro, J. E., Rich-Edwards, J. W., Rosner, B. A., & Willett, W. C. (2006). Iron intake and risk of ovulatory infertility. Obstetrics and gynecology, 108(5), 1145–1152. https://doi.org/10.1097/01.AOG.0000238333.37423.ab

Soyano, A., & Gómez, M. (1999). Participación del hierro en la inmunidad y su relación con las infecciones [Role of iron in immunity and its relation with infections]. Archivos latinoamericanos de nutricion, 49(3 Suppl 2), 40S–46S.

Isler, M., Delibas, N., Guclu, M., Gultekin, F., Sutcu, R., Bahceci, M., & Kosar, A. (2002). Superoxide dismutase and glutathione peroxidase in erythrocytes of patients with iron deficiency anemia: effects of different treatment modalities. Croatian medical journal, 43(1), 16–19. 123  

Kurtoglu, E., Ugur, A., Baltaci, A. K., & Undar, L. (2003). Effect of iron sup- plementation on oxidative stress and antioxidant status in iron-deficiency anemia. Biological trace element research, 96(1-3), 117–123. https://doi. org/10.1385/BTER:96:1-3:117

Atkins, H. M., Appt, S. E., Taylor, R. N., Torres-Mendoza, Y., Lenk, E. E., Rosenthal, N. S., & Caudell, D. L. (2018). Systemic Iron Deficiency in a Nonhuman Primate Model of Endometriosis. Comparative medicine, 68(4), 298–307. https://doi.org/10.30802/AALAS-CM-17-000082

Haider, L. M., Schwingshackl, L., Hoffmann, G., & Ekmekcioglu, C. (2018). The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Critical reviews in food science and nutrition, 58(8), 1359–1374. https://doi.org/10.1080/10408398.2016.1259210

Zijp, I. M., Korver, O., & Tijburg, L. B. (2000). Effect of tea and other dietary factors on iron absorption. Critical reviews in food science and nutrition, 40(5), 371–398. https://doi.org/10.1080/10408690091189194

Hallberg, L., & Hulthén, L. (2000). Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron. The American journal of clinical nutrition, 71(5), 1147–1160. https://doi. org/10.1093/ajcn/71.5.1147

Brittin, H. C., & Nossaman, C. E. (1986). Iron content of food cooked in iron utensils. Journal of the American Dietetic Association, 86(7), 897–901.