By Andrea Bartels CNP NNCP RNT
30 Jun 2023
Seniors are among the highest users of aspirin—taken for pain relief or cardiovascular disease prevention. But a newly published study in the Annals of Internal Medicine suggests that daily use of low-dose aspirin by seniors increases their risk of iron deficiency by more than 20 percent. If you’re a senior, how can iron deficiency affect your well-being? How might aspirin increase anemia risk?
Iron = Oxygenation
Iron is vital to the transport of oxygen from our lungs to our tissues, via hemoglobin—our red blood cells. Iron deficiency causes the red blood cells to shrink, making them poor carriers of oxygen. This is termed microcytic anemia. Its most common symptoms include fatigue, lack of stamina and pallor, but iron deficiency can also contribute to hair loss, depression and more. In the elderly, iron deficiency has been associated with additional complications. Here are a few of them:
Perhaps your ability to concentrate has decreased, or you have been caught “daydreaming” more often. Maybe your multi-tasking abilities are not as good as they used to be, either. These are all examples of ‘executive dysfunction’. While not everyone diagnosed with executive dysfunction is anemic, it’s important to consider that iron deficiency has been associated with this challenge in seniors. Having low blood iron levels makes it hard for the brain to acquire optimal oxygenation, making ordinary mental tasks more difficult.
On top of that, observational studies have also described short-term memory as another function affected by anemia in seniors. It’s also been observed that iron-deficiency anemia is a risk factor for depression and for dementia.
Anemic seniors have a three times greater risk of falling than non-anemic seniors. This is likely because iron deficiency causes poor muscle oxygenation and strength, creating weakness and postural instability. Falling increases risk of bone fracture, which is not usually life-threatening---but the long convalescence required after hip fracture can increase risk of pneumonia and other infections among the elderly. Anemia also reduces their exercise tolerance, furthering physical decline.
Increased illness and mortality
In general, seniors with low serum iron (as ferritin) experience more illness and greater risk of death than those whose iron levels are sufficient.
How aspirin use may cause anemia
Since many seniors take a low-dose aspirin as a prophylactic against heart attack and stroke on the advice of their physician, it’s important to understand how it may increase anemia risk.
Aspirin is acetylsalicylic acid. While it’s often effective as an analgesic for pain relief, it can be caustic to the mucosal lining of the digestive tract. Gastric bleeding and occult bleeding—that is, bleeding that is not visible to the naked eye—can gradually deplete hemoglobin, and the iron it contains. Put this together with the fact that the digestive system of an elderly individual is not as resilient as that of a younger person, and risk of damage to the mucosal lining of the stomach or intestine is higher.
Aspirin is an anti-coagulant, which means it separates the blood platelets designed to stop bleeding in instances of tissue injury, meaning clotting time takes longer, allowing more blood loss and with it, iron-rich red blood cells. This may make it an effective prophylactic against cardiovascular events, but it means that any tissue injury that involves blood loss may result in iron deficiency.
A third way aspirin may set the stage for iron deficiency is through its ability to block COX-1, an enzyme important to the health of the stomach lining. Without it, the integrity of the stomach and intestinal lining suffers, becomes weaker and allows for tissue injury. Even at the microscopic level, blood loss can be significant over time.
Iron: there’s no substitute
No other nutrient can fulfil the job description of iron. But if you’ve been anemic before, chances are you had a complicated relationship with iron supplements. Perhaps you took a dose or two, became nauseous or constipated, then took a break and started all over again, only to experience the same discomfort and lack of progress. Poor compliance with any supplement is an obstacle to achieving its intended purpose, regardless of quality.
Absorption = results
If the first key to results is compliance, the second is absorption. Pure Lab’s Carbonyl Iron is the least-constipating, most energy-enhancing and absorbable of all iron supplements. It’s a fine-particle metallic iron with an absorption rate of 69 percent--- a rate that cannot be beat by other oral iron supplements. With more iron absorbed, less remains in the bowel, lowering the risk of nausea and constipation. Pure Lab’s Carbonyl Iron formula also contains 100 milligrams of vitamin C (ascorbic acid)---providing a nutritionally essential acid that further enhances iron absorption.
For maximum benefit, remember that iron should be taken away from calcium supplements and calcium-rich foods, like milk and fortified milk substitute products. Iron should be taken separately from antacids or other medications, unless your pharmacist or prescribing physician says otherwise.
No matter what your age, it’s important not to ‘guess’ at iron deficiency. Don’t take it to improve your energy unless you’ve had testing that determined you’re deficient. If you’re taking aspirin regularly, speak to your doctor about blood testing your ferritin and hemoglobin counts to find out if you need to boost your iron levels.
Atti AR, Palmer K, Volpato S, Zuliani G, Winblad B, Fratiglioni L. Anaemia increases the risk of dementia in cognitively intact elderly. Neurobiol Aging. 2006;27(2):278-284.
Cleveland Clinic. “Executive Dysfunction.” Accessed online June 22, 2023.
Denny SD, Kuchibhatla MN, Cohen HJ. Impact of anemia on mortality, cognition, and function in community-dwelling elderly. Am J Med. 2006;119(4):327-334.
Gaskell H, Derry S, Moore RA. Is there an association between low dose aspirin and anemia (without overt bleeding)? Narrative review. BMC Geriatr. 2010;10:71. Published 2010 Sep 29.
Labos, Christopher. “Aspirin: to take or not to take? That is the question.” McGill Office for Science and Society, 6 Sep 2019.
Mayo Clinic. “Gastrointestinal bleeding: symptoms and causes.” Accessed online June 21, 2023.
National Institutes of Health. “Low-dose aspirin may increase risk of anemia in older adults.” Media Release June 20, 2023.
Thein M, Ershler WB, Artz AS, et al. Diminished quality of life and physical function in community-dwelling elderly with anemia. Medicine (Baltimore). 2009;88(2):107-114.
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