163: Iron Deficiency Skin Rash

Have you ever heard of an Iron Deficiency Skin Rash?

It’s a thing!

So is itchiness triggered by low iron levels.

I was so fascinated by this topic that I wanted to dive deeper and help you understand just HOW important it is to get assessed for iron deficiency.

Unfortunately, it’s one of the most common deficiencies that I uncover in my practice.

If you’ve struggled in the past with iron (or have iron deficiency symptoms like hair loss), this episode is a MUST for you!

Assessment is way more complicated than just looking at labs. I’m going through my process that I take every client through so that you get a better sense of what it’s like to have a comprehensive evaluation.

Numbers on a paper only tell part of the story especially if you’re not feeling well and struggling with itchiness!

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In this episode:

• Iron deficiency + itchiness
• Type of rash that can appear due to iron anemia
• How low iron impacts your thyroid (+ ultimately your skin)
• Which diets make you more susceptible to low iron
• Best labs to check for iron status
• What I assess if I suspect iron deficiency
• Foods + supplements to help iron levels

Quotes:

Clients often take for granted that their body will just make the nutrients it needs like iron. And that mindset unfortunately can get them into trouble.

Iron deficiency must be taken seriously and assessed from several different angles especially if symptoms are present.

Iron Deficiency Skin Rash (FULL TRANSCRIPT)

Welcome back to episode #163 of the Healthy Skin Show!

In today’s episode, I want to talk about a very important nutrient — specifically iron — and how a deficiency of it in your body can be a trigger for itchy, rashed skin.

As a clinical nutritionist, I assess every single client for optimal nutrient levels because having deficiencies of certain nutrients is alarmingly more common than you would think.

Especially if you’ve been struggling for some time with your health and your skin… and possibly tried elimination diets along the way.

While you might not think iron is important for your skin — think again!

Iron is incredibly important for your body’s overall health so having low stores can be a skin rash dealbreaker.

If your iron is low, this can be a hidden reason you’re struggling with itchy rashes (plus loads of other issues going on).

Why Is Iron Important For Your Skin?

You probably never considered iron as an important nutrient for your skin. Most people only think of it to help with oxygen.

It’s not entirely clear why, but low iron can cause itchy skin.

The connection was first described back in the 1970s by C. F. H. Vickers and has been noted in other journals and research publications. So this is not a new phenomenon, but the research isn’t quite there to fully explain the exact relationship.(1,2,3)

And you might experience a strange rash that is made up of little splotches of dark red, purple or brown which are actually indicative of pinpoint bleeds under the skin.

Because low iron status puts a huge strain on your body from a few different physiologic levels, ultimately your skin will suffer.

Remember, I’ve talked many times about how your skin is the lowest organ of the organ priority totem pole. If other systems are struggling, so will your skin!

One example of this has to do with your thyroid. I’ve talked in the past about the importance of appropriate thyroid hormone levels for healthy skin, and iron plays a role here too!

The enzyme that converts the inactive thyroid hormone, T4, to the active version, T3, is called Thyroid Peroxidase (TPO).

To function properly, the TPO enzyme requires iron. So low iron can reduce the amount of active T3 available in your body that is necessary for healthy skin.

This is just one example of why iron is so important to properly assess.

Iron Deficiency Is More Common Than You Think

With all of the different diets to help your skin, it’s really easy to become overwhelmed. And my deeper concern after having worked with so many clients struggling with food fear is the consequence of low nutrient status.

Long-term elimination diets are a huge red flag for nutrient depletions because the smaller your diet becomes, so does the pool of nutrients you have access to.

Additionally, it’s well-documented that vegan and plant-based diets also can leave you deficient in iron no matter how much spinach and beans that you eat. This is due to the non-heme version of iron that is poorly absorbed. I recommend anyone following these diets to get labs run annually to ensure their iron levels are sufficient.

If you take away just ONE THING from this episode, it’s that your body doesn’t make iron.

I find that clients often take for granted that their body will just make the nutrients it needs. And that mindset unfortunately can get you into trouble.

While there are some nutrients your body does make (like niacin under the right circumstances), iron isn’t one of them.

It must be absorbed from food or supplemental sources.

Best Tests To Check For Iron Deficiency

If you want to stay on top of your health game, I highly recommend that you get certain labs run every year. This is especially true if you struggle with Celiac disease, IBD or autoimmunity!

I have a great lab testing resource for you HERE that I recommend clients request from their doctor.

But if we’re just talking about iron, then you want to focus on the following:

• Complete Blood Count (CBC)
• Full Iron Panel (includes serum iron, TIBC, Iron saturation)
• Ferritin

Within the CBC panel, I specifically assess your red blood cells (RBCs) for any sign of unusual size.

Values such as MCV, MCH, MCHC, and RDW tell us a story about the look of your RBCs and the amount of hemoglobin they contain.

And as already mentioned, another marker that’s important is hemoglobin. Hemoglobin requires iron and acts sort of like a magnet for oxygen and carbon dioxide.

When your RBCs pass through your lungs, the hemoglobin grabs a molecule of oxygen that’s been inhaled and travels with it through your body. The oxygen is released in peripheral tissue and that’s when your RBC grabs on to a CO2 molecule. When it makes its way back around to the lungs, the CO2 is released (and ultimately exhaled) so you can grab another oxygen molecule.

If you don’t have enough iron, it’s hard to make adequate hemoglobin. As a personal example, when my dad became ill, he needed blood transfusions when his hemoglobin dropped below 7.

It’s also important to add that someone with a genetic condition called Thalassemia will have trouble producing enough hemoglobin.(4)

And if you can’t make enough hemoglobin, you’ll start to experience symptoms of iron deficiency anemia (and suboptimal oxygenation levels).

A full iron panel helps you better understand what your body has to work with.

And ferritin helps from two perspectives.

First, ferritin is the storage form of iron — so it basically tells you how much do you have in reserve.

Second, it’s also a marker of inflammation if your level is high.

Assessing For Iron Deficiency

Unfortunately, iron deficiency in women is often blamed on a heavy menstrual cycle when that’s not always the case.

I’ve worked with many clients who struggled with low iron for a long time only to be told that it was their “normal” or their periods must be too heavy (when neither were true).

Iron deficiency must be taken seriously and assessed from a few different angles.

Labs are very important and the basis for how serious (or even severe) the situation is.

And then diet must be considered since iron is absorbed from the food you eat. Lower levels of iron can result due to:

• Low stomach acid (Test yours with these at-home directions!)
• Vegan or plant-based diets (which focuses on non-heme sources that are less absorbable)
• Poor or impaired absorption especially if a digestive disease like Celiac disease is present

Blood loss is another area of assessment that includes:

• Monthly menstrual flow that is heavy
• Occult or hidden blood in your stool indicative of bleeding in the GI tract

Toxic environmental exposure to lead must be assessed in:

• Food
• Drinking water (ie. tap water levels)
• Paint + glass artistry

Gut dysbiosis can also drive iron levels lower since some gut bugs will literally steal iron from your diet and supplements so that you can’t absorb it. These bugs become stronger as a result and can make dysbiosis worse. That’s why I’m careful to assess the gut microbiome before just recommending an iron supplement.(5)

And assessing potential symptoms of iron deficiency that include:(6,7,8,9)

• Grey complexion
• Paleness that lingers after pressing on your fingernails
• Feeling cold
• Chronic fatigue
• Feeling dizzy
• Heart palpitations, irregular heartbeat, arrhythmia
• Hair loss
• Headaches
• Bleeding gums or nose bleeds
• Weakness
• Restless legs
• Cracks in the corners of your mouth
• Difficulty catching your breath with exertion (like trouble going upstairs)
• Desire to eat non-food items like chew on ice (called Pica)
• Itchy skin
• Tiny petechiae on the skin (small dark red, brown or purple spots due to bleeding under the skin that can also be suggestive of aplastic anemia and other nutrient deficiencies)

Sources Of Iron (If Your Levels Are Suboptimal)

If you discover or know that your iron levels are subpar, it’s important to start by assessing how serious the deficiency is.

This is especially important before starting supplementation!

So, if your blood markers are low and you have symptoms of iron anemia despite a diet with appropriate amounts of iron and no evidence of inappropriate blood loss, I’d recommend getting a referral to a gastroenterologist.

Severe iron deficiency is not the time to “wait and see” how you make out since it ultimately compromises so many systems.

Because if you can’t absorb iron, taking a supplement may end up being a waste of time.

For example, if your hemoglobin is at 7.1, you might require medical intervention (via IV infusions or blood transfusions) to bring your levels back up to a healthier spot.

When appropriate, diet interventions that can be helpful include:

• Blackstrap molasses
• Red meat + organ meats
• Shellfish
• Cooking food in cast iron pans
• Freshly squeezed citrus juice (lemon, lime) overtop of meat just before eating

Sometimes supplementation may be appropriate, however the form matters because certain forms can increase constipation (which is not ideal for someone already constipated).

Iron glycinate supplements may be a better option, but again, should be taken based on the recommendation of your practitioner after reviewing your labs and the other factors I already discussed.

If you take thyroid medication, leave 3 to 4 hours between your thyroid medication and the iron supplement so that the iron doesn’t interfere with your thyroid medication.(10)

I hope this episode clarifies for you why getting assessed for nutrient status (especially iron) is so critical!

If you’ve got questions or comments, leave your thoughts below. I’d love to hear your thoughts on iron deficiency!

And if you know anyone who’s dealing with low iron or has weird itchiness they can’t figure out, share this episode with them!

Thank you so much for turning in and I look forward to seeing you in the next episode!

REFERENCES

1. https://jamanetwork.com/journals/jama/article-abstract/352253
2. https://www.researchgate.net/publication/328534606_Iron-deficiency_and_pruritus_a_possible_explanation_of_their_relationship
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464269/
4. https://www.medicalnewstoday.com/articles/319050
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6315993/
6. https://www.verywellhealth.com/fixing-low-iron-thyroid-3232716
7. https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia
8. https://www.healthline.com/health/anemia-rash#diagnosis
9. https://www.medicalnewstoday.com/articles/319488
10. https://www.verywellhealth.com/fixing-low-iron-thyroid-3232716