Low Iron – A Gut Bacteria Connection

Recently I came across a PubMed article on iron deficiency with inflammatory bowel disease (IBD) which found “Shifts in gut bacterial diversity and composition associated with iron treatment are pronounced in IBD participants. Despite similar clinical outcome, oral administration differentially affects bacterial phylotypes and faecal metabolites compared with IV therapy…. Both per oral (PO) and IV treatments ameliorated iron deficiency, but higher ferritin levels were observed with IV…. PO treatment was associated with decreased abundances of operational taxonomic units assigned to the species Faecalibacterium prausnitzii, Ruminococcus bromii, Dorea sp. and Collinsella aerofaciens. ” [2016]

The superiority of IV over Oral  with IBD is cited in other articles:

  • “Intravenous iron treatment is better tolerated and more effective than oral iron treatment in improving ferritin.” [2012]
  • “Patients who received IV iron had a greater rise in serum ferritin and were less likely to stop treatment due to adverse events, when compared with those who received PO iron.” [2015]

Iron and CFS

This appears to impact a subset of CFS patients.

  • “The results indicate that  [CFS] patients had significantly increased serum aluminum and decreased iron compared to controls. In the females, serum iron and dehydroepiandrosterone sulphate were significantly decreased and correlated.” [2001]
  • “We reviewed, in this study, symptoms and syndromes associated with iron deficiency with or without anemia: fatigue, cognitive functions, restless legs syndrome, hair loss, and chronic heart failure. Iron is absorbed through the digestive tract. …Pathogenic micro-organisms or intestinal dysbiosis are suspected to influence iron absorption.” [2014]
  • Iron insufficiency and hypovitaminosis D in adolescents with chronic fatigue and orthostatic intolerance [2011].
  • “Although the cause of primary Restless legs syndrome (RLS) is still unknown, there is a strong connection between central metabolism of iron as well as dopamine levels and RLS manifestation.” [2011]

Probiotics and Iron

A quick summary is in “Gut microbes may play key role in iron status

Bacteria and Iron

I have heard people express the opinion that some bacteria, like Lyme, need iron, that you should avoid iron supplements. To me this is a gross and perhaps, dangerous simplification. It is like saying, “Mafia are Italians, so to solve the Mafia problem, we need to deport all of the Italians” (or Japanese, or Muslims, or…).

“A Syracuse University research team… discovered that some bacteria are equipped with a gene that enables them to harvest iron from their environment or human host in a unique and energy efficient manner.”[2008] Thus an overgrowth of Actinomycetes may result in iron deficiency.

Below is a table from [2006], some strains are good and other are bad. “Macrophages use iron for production of hydroxy-radical and superoxide reactions, which are necessary for microbial killing. Presumably, as a survival strategy, bacteria, which also require iron for survival, have adapted the ability to sequester iron from the host, thereby limiting the availability to macrophages.” [2007]


Bottom Line

First thing is that you cannot deal with all issues at the same time. You must choose which one you will direct your efforts towards improving. The gut bacteria dysfunction was a cascade of changes, and unwinding it means addressing one issue at a time. Where to start? There is no literature indicating the fulcrum that should be our start point — so my suggestion is simple: the very worst symtpom!!

If you have low iron and thus tiredness, low hemoglobin (and thus oxygen), insomnia, etc, you may wish to try to address that first. From the literature above, besides eating iron rich food, you should take, if available:

Streptococcus thermophilus is in most yogurts (see Probiotic Yogurt for a list, for example Chobani contains none), the problem is usually which strain is used!

You should also consider taking IV Iron, it improves the gut bacteria more than oral iron. In general, “The present results suggest that Fe[Iron] supplementation enhances the concentration of beneficial gut microbiota metabolites and thus may contribute to gut health.” [2014]

Note that all of these are specific strains. Streptococcus thermophilus JB004 did not show strong effects.

You should also avoid Mutaflor, Symbioflor-2, Bifidobacterium bifidum which will decrease iron availability.