Do you often feel tired, lethargic, or run down? Is it hard to concentrate? Are you experiencing shortness of breath? You may be suffering from iron-deficiency anemia, a condition that afflicts about one in five women of reproductive age, especially vegetarians or vegans who fail to eat enough iron-rich foods and have heavy menstrual periods.

Premenopausal women need at least 18 milligrams of iron daily, yet many consume 10 milligrams or less. "For most women, that's not a problem unless you're losing excessive iron through your periods, pregnancy, or your intestinal tract because of an ulcer or tumor," says Dr. Craig Kitchens, a professor of medicine at the University of Florida, Gainesville.

Iron helps carry oxygen to the tissues, including the brain. When iron levels dip, the body is short on oxygen, resulting in fatigue, memory loss, poor concentration, apathy, shortened attention span, and reduced work performance.

Other symptoms include: split nails, cold hands and feet, and restless legs. The mineral also plays a vital role in your immune system and metabolizing essential B vitamins. Without adequate iron, you have tired blood that can make you more susceptible to colds and other infections.

Iron-deficiency Anemia
A woman who is iron-deficient has just enough iron to get by, while an anemic woman doesn't have enough iron to meet her body's needs. Causes of anemia include a deficiency of vitamin B or folic acid, an ulcer, hemorrhoids, other internal bleeding.

Once iron stores are depleted, it can take anywhere from a few weeks to 6-12 months for them to be restored depending on the severity of the anemia. If you're treated for iron deficiency and don't feel any better after a month, Kitchens says to tell your doctor but don't stop taking your supplements just because your symptoms improve.

Dr. Sheldon Saul Hendler, co-author of the "PDR Guide to Nutritional Supplements" agrees. "If it takes longer than three months," says Hendler, "there may be more serious underlying causes."

Iron-deficiency anemia can only be diagnosed through a blood test by a qualified health care professional. The serum ferritin, serum iron, and total iron binding capacity measurement tests are used to detect iron deficiency anemia and the results are reviewed along with the hemoglobin, hematocrit, MCB and MCH concentrations.

If all are low, the patient has iron deficiency anemia. If ferritin alone is low, anemia or chronic disease is the probable diagnosis and Kitchens says he would then prescribe the most common form, iron sulfate, to his patients.

But medical professionals are split on the use of iron sulfate. Dr. Robert Rowan, an Anchorage, Alaska-based family practitioner and nutritionist, warns that iron sulfate can be harmful to the stomach and often causes black stools, diarrhea, constipation, bloating, and anorexia.

Rowan points to evidence that supplemental forms of iron can generate free radicals, by-products of oxygen usage that attack and damage brain cells and may advance the loss of memory and thinking. Iron is found in two forms heme and non-heme iron. Heme iron, which makes up 40 percent of the iron in meat, poultry and fish, is well absorbed.

Non-heme iron, 60 percent of the iron in animal tissue and all the iron in plants fruits, vegetables, grains and nuts are less well absorbed. Rowan contents that over-the-counter blood builders made of natural non-heme forms of iron are "much safer, more absorbable, and I see very good results in as little as 30 days but generally a couple of months."

The Dark Side of Iron
Stephen Sinatra, a Manchester, Conn.-based cardiologist and co-author of the book, "Heart Sense for Women," champions vitamin and mineral supplements but not iron supplements, except in severe cases.

Sinatra says excess iron is linked to heart disease. For iron-deficient patients, Sinatra recommends organic raisins, prune juice, more meats, red wine, and for vegetarians, trail mix, to boost iron levels. "Losing iron is very healing to the heart," says Sinatra.

As for heart disease, a study conducted among 1,900 middle-aged men in Finland, found that a high iron level was second only to smoking as a cause of heart attacks, meaning don't load up on iron unless absolutely necessary.

High levels of iron can be toxic. Experts warn that supplements should not be used to treat anything but iron-deficiency anemia and avoided by anyone with heosiderosis, a precursor to hemochromatosis (some 1 million people in the US or even more may have this hereditary disorder in which the intestines absorb too much iron.

Sufferers are more likely to develop diabetes, cancer, heart disease, and cirrhosis of the liver, as well as certain infections. "There is the lure that iron-tired blood requires iron...but we're learning that iron supplements also have a very dark side," Dr. Hendler warns. "(Iron) can be destructive to the cells and organs, including the liver, heart, and brain."

In fact, too much iron also may be life-threatening warns Dr. Eugene Weinberg, professor emeritus of microbiology at Indiana University at Bloomington. Both cancer cells and infectious organisms need iron from their host to grow, says Weinberg, who has studied the effects of iron for three decades.

Without iron and oxygen from the blood, these organisms cannot multiply. Hendler agrees, but says, "It's a long process. You're not going to die the next day from liver cancer, neurological disorders, or diabetes."

To get right amount — and kind — of iron:

• Include iron-rich meat at a meal.
• Consume a vitamin C-rich food, such as orange juice, with an iron-rich vegetable, such as spinach.
• Avoid drinking tea, antacids, tofu, soy, or tetracycline when taking iron supplements.
• Switch to another brand or form of iron supplement and take with meals if you develop constipation or diarrhea.
• Get plenty of vitamin B-12 and folic acid. The best food sources of B-12 are beef liver, clams, oysters, tuna, milk, yogurt, eggs and cheese. Whether or not you're pregnant, try to get the recommended amount of 400 micrograms of folic acid in your daily diet. Good food sources include asparagus, black-eyed peas, kidney beans and orange juice.
• If you opt for the non-heme form of iron, go for animal products such as liver, clams, salmon, oysters, and sardines. Good heme sources are: oats, soybeans, green leafy vegetables, broccoli, spinach, eggs, black currants, fish, dried fruits (figs, apricots), nuts, fortified breakfast cereals, chocolates, tofu; almonds, avocados, beets, blackstrap molasses, brewer's yeast, dates, kidney and lima beans, lentils, peaches, pears, rice and wheat bran, and sesame seeds.