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Iron deficiency

Iron deficiency or anaemia can be defined as having too little of this powerhouse mineral in the body and leads to low levels of haemoglobin and haematocrit. This in turn leads to low levels of red bloods cells. Iron helps to form haemoglobin which is the protein in red blood cells that makes it possible to carry oxygen through our bodies -quite a big deal! Haematocrit is the ratio of red blood cells to the volume of total blood in one’s body.

Normal haemoglobin levels for females are 12.0 – 15.5 grams per decilitre (g/dL) of blood and 13.5 – 17.5 g/dL for males. The normal haematocrit percentage for females are 34.9 – 44.5 % and for males 38.8 – 50%.

Causes include:

  • Active bleeding
  • Stomach ulcers or slow active bleeding
  • Little or inadequate dietary iron intake
  • Chronic disease (cancer or chronic infection)
  • Pregnancy (Water weight and fluid gain dilutes the blood during pregnancy)
  • Intestine problems that lead to poor absorption of vitamin B12 (pernicious anaemia)
  • Abnormal haemoglobin molecule production (sickle cell anaemia)
  • Alcoholism

Signs and symptoms to look out for:

  • Fatigue and exhaustion
  • Lack of concentration and forgetfulness (children can present with learning problems)
  • Paleness (evaluate inside of lower eyelid, should be bright red).
  • Irritability
  • General body weakness
  • Inflamed, red tongue, known as glossitis (tongue can become swollen, pale or unusually smooth).
  • Corners of the mouth can also crack.
  • Shortness of breath
  • Heart palpitations
  • Restless leg syndrome
  • Dizziness or feeling faint
  • Infections that occur regularly
  • Headaches
  • Dry skin and brittle hair and nails. Nails can also become spoon-shaped.
  • Pica can also occur, where one has strange cravings for ice, dirt, metal or even paper.
  • Carbohydrate cravings are also seen quite often.
  • Feeling cold more easily, especially in one’s hands and feet.

What to do if you suspect that you have an iron deficiency

Make an appointment with your local GP as a simple blood test can confirm whether supplementation is needed or not.

Treatment options

The aim of treatment is to refill iron stores in the body and increase haemoglobin levels. If your levels are low, you can make some dietary adjustments to increase your iron levels. If your GP feels that it is still necessary, an oral supplement will be recommended. In very severe cases some patients might need intravenous iron or even a red blood cell transfusion when serious complications are present or a lot of blood has been lost. Please consult with a healthcare provider before taking any over the counter iron supplementation, as it can lead to other health issues (constipation, nausea and vomiting) if used unnecessarily. Iron supplementation can interact with other drugs, so make sure you discuss this with your healthcare provider as well.

Vitamin C and calcium intake

Vitamin C helps with the absorption of iron. The vitamin C binds to the non-heme iron and then becomes more easily absorbed by the body. Try including a food source that is high in vitamin C with every meal you eat to get the most iron out of it. Strawberries, tomatoes, citrus fruit, melons, sardines and green leafy vegetables (spinach, cabbage, brussels sprouts) are all high in vitamin C. Vitamin C also aids in the formation of red blood cells and are very important in keeping the blood vessels healthy in the body. Definitely a few reasons to add a small amount of orange juice to breakfast and some fresh tomatoes to your lunch time salad or sandwich.

Calcium interferes with the absorption of heme and non-heme iron. 300-600mg of calcium can have an effect on the absorption of both heme and non-heme iron. Any form of calcium supplementation should not be taken with iron supplementation, rather take calcium on its own at bedtime but consult your healthcare provider first. Foods that are high in calcium include milk, cheeses, yoghurt, broccoli, almonds, canned salmon and sardines.


Too much iron, known as an iron overload can have serious health consequences:

  • Joint pain
  • Abdominal pain
  • Cirrhosis of the liver or cancer
  • Diabetes mellitus
  • Elevated blood sugar
  • Irregular heart rhythm
  • Heart failure or heart attack
  • Skin discoloration (orange, bronze, ashen-grey green)
  • Enlarged liver or spleen
  • Elevated liver enzymes
  • Infertility
  • Hypothyroidism
  • Depression
  • Early onset of neurodegenerative disease
  • Adrenal function problems
  • Hair loss
  • Osteoporosis and osteoarthritis

There are iron reduction therapies available and a physician should be seen as soon as possible.

Your diet should support the proper distribution of iron throughout the body including muscles, haemoglobin, ferritin and elsewhere. Fresh vegetables, fruit, whole grains, limited dairy, enough protein, limited sugars and fats should ensure adequate iron and prevent disease, as this forms a well-balanced diet.