Iron Deficiency – Anaemia & Beyond

As commented in the review by Al-Naseem et al (2021), iron deficiency anaemia currently affects 1.2 billion people. However, iron deficiency without anaemia is at least twice as common. 

Signs and Symptoms of Anaemia

Tiredness, pale skin, brain fog, hair loss, ridged or brittle nails, heavy menstrual loss, other blood loss, pregnant, achy and restless legs, avoid exercise because of feeling tired, anxiety, low mood or depression, shortness of breath not related to asthma, unexplained palpitations, undiagnosed celiac disease, vegan lifestyle.

When to Visit your GP

If any of the above are your concerns, you may be suffering from iron deficiency anaemia. You should see your GP who will order a full blood count (FBC) test to check the number of your red blood cells. These cells contain a protein called haemoglobin, which transports oxygen around the body. Your GP will prescribe iron tablets to replete your iron stores if your red blood cell count is low.  


However, as explained by Al-Naseem et al (2021), as iron has other functions than haemoglobin synthesis within the body, you can present with iron deficiency without having symptoms of anaemia. Therefore, the FBC test will also give your GP an indication of your general health, as any other abnormality in your blood count can provide important clues about certain health problems you may have.

What is the Role of Iron in the Body?

The main function of iron in the body is oxygen transport, hence iron is found primarily in highly metabolic cells such as haemoglobin, a protein in red blood cells (erythrocytes) and myoglobin, a protein in skeletal and heart muscle.  

However, iron is not only crucial for energy production, but it is also a critical constituent of many enzymes involved in cell proliferation, DNA repair, and many other functions (Hentze et al 2010).

In addition, iron is also an essential micronutrient for healthy brain function and development; therefore, iron deficiency can result in widespread and lasting effects on behaviour and cognition (Carpenter et al 2016).

Your Daily Iron Requirements

Population group

Daily iron requirements

Adolescent males (11-18)


Adult males (19+)


Females 11-50 years (pre-menopause) 


Adult females (post-menopause)


Source: BDA (2021) Iron: Food fact sheet (online) last accessed 12 05 22 at

Iron Safety

Iron balance must be tightly controlled in the body as iron is highly reactive, and excess iron is damaging to the body. Iron forms harmful unstable molecules, called reactive oxygen species, which easily react with other molecules in a cell, leading to   cellular damage (Cappellini et al 2020), e.g. damage to DNA, RNA, and proteins, and may cause cell death.  

Fe should not be supplemented during an active infection as it can stimulate bacterial or fungal growth during an infection (bacteria use iron as a food source) (Bruhn & Spellberg 2015).

Prevention is Better Than Cure

As explained by Romeu et al (2013), there are two forms of dietary iron: heme iron, a well absorbed iron found only in animal flesh like meat, liver, fish, poultry and seafood, and nonheme iron, which is not as well absorbed, found in vegetables and legumes (Sharp 2010).

Clénin (2017) suggested that a dietary strategy to manage iron deficiency should include consuming meat, poultry, or fish at least five times a week, with complementary wholemeal products, legumes, and vegetables.

As noted by DeLoughery (2017), although meat is the richest source of iron, it is also  found in a variety of other foods:

2 tablespoons of black strap molasses contain 7.2mg of iron

1 cup of lentils: 6.6 mg

4 ounces of tofu: 6.4 mg

1 cup of cooked spinach: 6.4 mg

1 cup of cooked chickpeas: 4.7mg

1 cup of tempeh: 4.5 mg

1 cup of cooked lima beans 4.5 mg

1 cup of cooked black-eyed peas; 4.3 mg

1 cup of cooked Swiss chard: 4mg

Foods & Drinks to Prevent Iron Deficiency

INTRODUCE Beetroots / Beetroot Juice

Regular consumption of beetroots may improve your iron deficiency as beetroot is rich in iron, and vitamin C, required for rapid iron absorption (Pushpaanjali et al 2020).

INTRODUCE Golden Kiwi Fruits

Stonehouse et al (2013) reported that consuming 2 gold kiwifruit a day with iron-rich meals improves poor iron status, due its high vitamin C, carotenoid, lutein and zeaxanthin content, all of which increase iron bioavailability (Beck et al 2011).

INCREASE Vitamin C-rich Foods

Introducing Vitamin C-rich foods such as citrus fruits, berries, tomatoes, potatoes, and green leafy vegetables with every meal, improves for non-haem iron absorption (Pushpaanjali et al 2020). This is particularly important if you are a vegan.

AVOID Ultra Processed Foods

Ultra-processed foods such as refined carbohydrates may be contributing to iron deficiency, as these foods are grossly depleted or devoid of micronutrients such as iron (Elizabeth et al 2020)

AVOID Excess Phytate Rich Foods

Phytate rich foods such as such as cereals, legumes, nuts & seeds can contribute to iron deficiency, as phytates (naturally present in a wide variety of plant foods), form insoluble complexes with minerals such as iron, preventing its absorption (Brouns 2021). However, soaking and sprouting these foods reduces their phytate levels, as does leavening of bread (Harland & Morris 1995)

AVOID Excess Coffee & Tea Intake

Studies show that polyphenols in tea and coffee can bind to iron, reducing its absorption into the bloodstream, potentially contributing to iron deficiency (Lopez et al 2016). The authors suggested one should wait at least 1 hour after eating before drinking tea or coffee.

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