Your red blood cells play an important role in your body: they’re responsible for transporting oxygen to your tissues and organs so they can function properly. However, red blood cells rely on a vital nutrient, iron, to perform this task. When you don’t have enough iron, your body doesn’t get the oxygen it needs, and you can experience problems ranging from fatigue and shortness of breath all the way to organ failure in severe cases. Fortunately, we can successfully treat iron-deficiency anemia by simply giving your body the iron it needs, and there are two methods to do this. You can take oral iron tablets daily for several months, or you can receive intravenous (IV) iron once weekly for several weeks. To determine which method is best for a patient, we must look at the root cause of the anemia. There are several reasons why you’re not getting enough iron naturally. What’s causing your anemia? 1. Blood loss Patients may be lacking in iron because they’ve lost a lot of blood. The most common group of people we see with iron-deficiency anemia are young women who are menstruating. Women with very heavy menstrual periods lose a fair amount of blood each month, and over time, that can absolutely put a strain on the iron levels in their bodies. Some patients may be losing blood through their gastrointestinal (GI) system. They might have ulcer disease, which can cause them to have some bleeding in their stomach lining. Patients might also have diseases that affect their intestines, like Crohn’s disease or ulcerative colitis; these inflammatory bowel diseases can cause bleeding in the intestines. Over time, this can lead to iron deficiency. As people get a little older, reaching their fifth or sixth decades of life, the risk of colon cancer increases. Colon cancer can cause bleeding in the bowels that’s hard to notice, and this can also cause iron deficiency. 2. Pregnancy or postpartum childcare It takes a lot of iron to build a baby, so being pregnant can really deplete your iron stores. Multiple pregnancies, especially over a relatively short period of time, can result in iron deficiency. And breastfeeding also takes up a lot of iron, as mothers give their children lots of iron through their milk. This can also lower levels of iron in your body. 3. Inability to absorb iron Patients may also have low iron levels because their bodies aren’t absorbing iron properly from food they eat. For example, people with celiac disease are unable to absorb iron due to damage in their gastrointestinal tract. And the most common cause of iron absorption problems in our society today is weight loss surgery. These surgeries arrange for the digestive system to bypass the small intestine or stomach, which can lead to an inability to absorb iron. Over time, these patients become iron deficient. 4. Lack of iron in the diet It’s possible some patients with iron-deficiency anemia just aren’t getting enough iron from their diet. We see this especially in strict vegetarians and vegans, as they avoid meat, which is very high in iron. Other people who restrict their diets because of gluten intolerance or other perceived intolerances may also become iron deficient since they’re not getting a good variety of iron-rich foods. It’s important for everyone to eat plenty of dark, leafy green vegetables; the darker they are, the more iron there is. Successfully Treating Iron-Deficiency Anemia Oral iron tablets are typically the first treatment for most patients; however, oral iron can cause challenging gastrointestinal side effects like constipation and bloating, so sometimes patients with GI conditions like inflammatory bowel disease prefer IV iron. Additionally, patients with absorption issues won’t benefit from oral iron, so we turn to IV iron for them as well. One thing that causes repeat iron-deficiency anemia is not properly treating it the first time. I have a couple goals in mind when I treat iron-deficiency anemia. First, of course, I strive to correct the anemia by adequately supplying you with the iron your body needs to function. But the second goal is to make sure we’ve given you enough iron to prevent your anemia from returning. It’s important to understand that successfully treating iron-deficiency anemia means replenishing what I call the two “buckets” of iron in your body. One “bucket” consists of the readily available iron circulating in your blood at all times, coming in from food you eat. This iron is used immediately by your red blood cells, and recycled constantly so it stays in the blood stream. But there’s another “bucket” of iron that’s more important—it’s the iron placed in storage in your body, waiting to be used in case you don’t take in enough from your diet. It’s important to consider these two buckets when we think about treating iron-deficiency anemia, because we need to make sure we supplement with enough iron to satisfy both of them. When I treat iron-deficiency anemia with oral tablets or IV iron, I make sure to continue iron supplementation even after patients cease being anemic, to ensure they have enough iron in their bodies to prevent anemia from recurring. I see a lot of patients who are frustrated because their iron-deficiency anemia reoccurs; their frustration really stems from them not having a good conversation with their doctor to really understand why they became iron deficient in the first place. I encourage everyone to develop a partnership with your doctor in which you communicate clearly, understand the initial cause of your anemia, and feel empowered about fixing it and preventing it from recurring.