Iron Deficiency Anaemia

red blood cells

Are you exhausted? I mean really exhausted. On a scale of 1 to 10, with 10 being full-of-beans, do your energy levels hover around 2 or 3? It could be iron deficiency anaemia.  Iron deficiency anaemia is the most common nutritional deficiency in the world and once detected is easily fixed (mostly!).


Common symptoms of anaemia include fatigue, yawning, bruising easily, irritability, poor concentration, muscle weakness, dizziness, spots before the eyes, very pale complexion, headaches, palpitations and an increased tendency to pick up infections. Other signs include a red shiny tongue, pale nail beds or slightly concave nails (the opposite of normal). Pull down the lower eyelid; many tiny blood vessels live there, so if it is very pale, anaemia is a possibility. The signs and symptoms mentioned above all indicate anaemia, but the best way to make sure is to have a blood test arranged by your doctor.

No Iron. No oxygen.

The mineral iron is vital for human life. Iron forms part of haemoglobin, the molecule that imparts the red colour to red blood cells and is responsible for capturing oxygen inhaled by the lungs. Haemoglobin attached to red blood cells transports and delivers this oxygen around the body via the bloodstream. No iron, no haemoglobin. No haemoglobin, no oxygen. No oxygen, no life. Despite the importance of iron, the entire body stores a measly 2–4 grams, less than a teaspoon. However, unlike other nutrients, iron is stored in the body and does not need to be taken daily. As well, the body is pretty stingy with its iron, constantly recycling it, and unless there is blood loss via menstruation or other bleeding, iron levels can be maintained through eating a regular diet.

Dietary iron occurs in two forms: ‘Haem’ iron and ‘non haem’ iron. Haem iron is found in animal food, and while absorption is not fabulous (for example, only 25 per cent of the iron present in red meat is actually absorbed), it is superior to non-haem iron found in the vegetable kingdom (only 2–15 per cent of iron found in plant food is absorbed). Factors that decrease non-haem iron absorption include vegetable protein (which makes things worse for the iron-deficient vegetarian), oxalic acid (found in rhubarb and tea), phytic acid (found in grains but deactivated when cooked), zinc and calcium (so don’t take these supplements at the same time as an iron supplement or an iron-rich meal) and tea and coffee. Factors that increase non-haem iron absorption include animal protein (sorry, vegetarians), vitamin C (squeeze lemon juice over your vegetables), and copper (think about cooking your food in copper pans).

What causes it?

  • A diet deficient in iron. Those at special risk include vegetarians and vegans.
  • Poor absorption of iron. Iron is a tricky mineral to absorb at the best of times; having a condition such as coeliac disease or gluten intolerance compounds the issue.
  • Other causes of poor absorption include removal of the stomach or parts of the small intestine.
  • Low stomach acid (hypochlorhydria), where there is insufficient production of hydrochloric acid (stomach juice), decreases iron absorption.
  • People taking antacid medication will have lower levels of hydrochloric acid, which may impact iron absorption. This is not a reason to stop taking your medication, but it may explain your low iron levels.
  • Women who experience heavy menstrual periods can lose 100 mililitres of blood each cycle. This equates to a significant loss of 150 miligrams of iron. To add insult to injury, low iron levels may cause heavy periods. An injury or surgery often incurs blood loss.
  • More insidious causes of blood loss include a slowly bleeding ulcer, haemorrhoids, polyps and inflammatory bowel disorders such as ulcerative colitis and Crohn’s disease.
  • Various medications (as listed above, but check with your health practitioner) and tea and coffee may impact iron absorption.
  • Autoimmune gastritis.  This is a condition where there are antibodies to the parietal cells in the stomach, which may cause both iron deficiency anaemia and B12 or pernicious anaemia. 
  • Some health conditions, including low thyroid function and kidney disease, increase your risk of anaemia.

Although the most common cause of anemia is iron deficiency, other forms of anaemia include pernicious or megaloblastic anaemia – a deficiency of vitamin B12, macrocytic anaemia – a deficiency of folic acid (vitamin B9), and sickle cell anaemia – a hereditary disease where red blood cells are abnormally shaped which impairs their ability to carry oxygen around the body.

What To Do

If you are low in iron there is absolutely nothing else you can do for this condition except eat food that contains iron,  take an iron supplement or an iron infusion. First up, if your blood tests show you are anaemic, then the best remedy is to take an iron supplement. Once iron levels are in range, you should be able to maintain this by eating iron-rich foods. Follow up blood tests should reveal a positive change after a month. The following dietary advice will help prevent future recurrence.


Increase your intake of iron-rich food. Choosing from both haem and non-haem foods, such as:

Iron-rich foods

  • Dried fruit – prunes, raisins, dates
  • Dark leafy green vegetables – kale, bok choy, gai lan, spinach.  Eat these cooked to reduce phytates and oxalic acid which may reduce iron absorption.
  • Legumes – lentils, kidney beans, soybeans
  • Seaweed
  • Parsley
  • Blackstrap molasses
  • Molluscs – oysters, clams, mussels
  • Red meat – beef, lamb, kangaroo, venison, goat
  • Egg yolks
  • If you prefer to eat less animal food or are a vegetarian or vegan, add some vitamin C-rich foods to your meal to increase the absorption of iron. For example, squeeze some lemon juice over your meal, add raw capsicum or cabbage or enjoy some vitamin C-rich fruit for dessert: kiwi fruit, guava, strawberries, papaya and any citrus.
  • The liver is where iron is stored, so it makes sense to eat liver if you are anaemic (and are not a vegetarian). Remember that the liver is also where toxins can be stored, so if paté, liverwurst or sauteed liver appeals, please make sure the liver product you are eating has come from an animal raised on an organic farm.
  • Avoid drinking tea or coffee half an hour before and one hour after meals. One study showed that drinking a cup of coffee after a meal containing minced meat reduced iron absorption by 39 per cent, whereas drinking a cup of tea reduced absorption by a whopping 64 per cent.
  • All is not lost; a glass of alcohol consumed during a meal increases iron absorption.
  • Uncooked bran is another iron antagonist due to the phytates in the whole grain. However, heat inactivated phytates, so cooked cereals, such as porridge, are safe.
  • Bitter foods improve the functioning of all digestive organs, including the production of hydrochloric acid from the stomach. Bitter foods include grapefruit, rocket, olives, and radicchio. Or enjoy a bitter aperitif or digestif before or after your meal.


Before you go charging into the pharmacy and scoff down iron tablets, it is best to be certain you are iron-deficient, as taking iron excess to your body’s needs is not good. Excess iron in the body will oxidise or rust. Additionally, iron and zinc compete in the body, so excess iron may create a zinc deficiency. Although iron deficiency is relatively common, it is worth bearing in mind that the opposite can happen too. This is most often caused by hereditary conditions such as haemochromatosis. Haemochromatosis is a condition where excess iron is stored in the body, which if left untreated will ultimately damaging the liver and other organs. Treatment for this condition is giving blood. Interestingly, the symptoms of excess iron can mirror those of a deficiency, feeling tired, etc. Another reason to obtain a correct diagnosis before taking an iron supplement.

  • Iron supplementation is the obvious and most effective course of treatment. As is the case with many minerals, iron needs to be chelated (kee-late-ed)or bound with something to cross the barrier from belly to blood. There are several forms of chelated iron available, including ferrous (ferrous means iron) fumarate, ferrous amino acid chelate, ferrous succinate, ferrous carbonate and ferrous sulfate. The latter sometimes leads to tummy upsets or constipation. If this happens to you, don’t persevere. Just swap to another form. Iron bisglycinate is one of the better tolerated.  Take your supplement in the morning as it better absorbed at this time.  There is evidence that taking an iron supplement every second day can be just as effective as daily, and will help prevent tummy upsets.
  • Liquid iron preparations made from herbs and fruits may offer less iron per dose, but are generally well tolerated and a good choice if you are ‘topping up’ your iron levels, say after a heavy menstrual period.
  • Iron-rich herbs include nettles, yellow dock and dandelion root.
  • Traditional Chinese Medicine has a group of herbal remedies that help to ‘build’ the blood, working as general tonics and assisting the body to absorb more of this precious metal. These are nice to take if anaemia is ‘your thing’, by this I mean you have a history of low iron levels. These herbs include Codonopsis, Rehmannia and Dong Quai. Withania, from the Ayurvedic (a traditional Indian medicine) materia medica has similar properties.
  • Vitamin C assists in iron absorption. Take 500 miligrams with your iron supplement, if it doesn’t already contain vitamin C. Take vitamin C with meals containing non-haem iron-rich foods, for example leafy greens and check out the list in the diet section above.


  • Use iron cookware

At a glance


  • Eat iron-rich foods including red meat, liver, green leafy vegetables, dried fruit and legumes.
  • Squeeze lemon juice over your green vegetables to increase iron absorption.
  • Avoid drinking tea or coffee half an hour before and one hour after meals, as they interfere with iron absorption.


  • If iron levels are low, take an iron supplement. Some forms of iron can cause constipation or tummy upsets, if this is the case, don’t give up on iron, choose another form such as iron bisglycinate.
  • Herbs that contain iron and help with iron absorption include nettles, yellow dock, dandelion root, Codonopsis, Rehmannia, Dong Quai and Withania.


  • If you are low in iron, you are low in iron. There is nothing else to be done except eat foods that contain iron, take an iron supplement or infusion.
  • Use Iron cookware

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