Find balance and beat iron-deficiency anemia. Iron deficiency,
whether it is severe enough to lead to anemia or not, can result from a number of health
issues. According to research or other evidence, the following self-care steps may be
- Take iron as directed
- Follow your healthcare provider’s instructions
- Get your vitamin C
- Eating vitamin C–rich foods with meals and taking 100 to 500
mg of vitamin C with iron supplements will improve your iron absorption
- Don’t mix iron with beverage breaks
- Drinking coffee or tea with iron supplements inhibits
- Find the cause
- Iron deficiency can have many non-nutritional causes, including
some serious diseases, so work with your healthcare provider to investigate why you are low in
- Know your iron level
- To avoid possible problems related to iron overload, have your
blood tested regularly for both high and low iron while you are taking iron supplements
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full iron-deficiency anemia
article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and
dietary and lifestyle changes that may be helpful.
About iron-deficiency anemia
Anemia is a reduction in the number of red blood cells (RBCs); in the amount of hemoglobin
in the blood (hemoglobin is the iron-containing pigment of the red blood cells that carry
oxygen from the lungs to the tissues); and in another related index called hematocrit (the
volume of RBCs after they have been spun in a centrifuge). All three values are measured on a
complete blood count, also referred to as a CBC. Iron-deficiency anemia can be distinguished
from most other forms of anemia by the fact that it causes RBCs to be abnormally small and
pale, an observation easily appreciated by viewing a blood sample through a microscope.
Iron deficiency also can occur, even if someone is not anemic. Symptoms of iron deficiency
without anemia may include fatigue, mood changes, and decreased cognitive function. Blood
tests (such as serum ferritin, which measures the body’s iron stores) are available to
detect iron deficiency, with or without anemia.
Iron deficiency, whether it is severe enough to lead to anemia or not, can have many
non-nutritional causes (such as excessive
menstrual bleeding, bleeding ulcers, hemorrhoids, gastrointestinal bleeding caused by
aspirin or related drugs, frequent blood
donations, or colon cancer) or can be caused
by a lack of dietary iron. Menstrual bleeding
is probably the leading cause of iron deficiency. However, despite common beliefs to the
contrary, only about one premenopausal woman in ten is iron deficient.1 Deficiency
of vitamin B12, folic acid, vitamin B6, or copper can cause other forms of anemia, and there are
many other causes of anemia that are unrelated to nutrition. This article will only cover
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What are the symptoms?
Some common symptoms of anemia include fatigue, lethargy, weakness, poor concentration, and
impaired immune function. In iron-deficiency,
fatigue also occurs because iron is needed to
make optimal amounts of ATP—the energy source the body runs on. This fatigue usually
begins long before a person is anemic. Said another way, a lack of anemia does not
rule out iron deficiency in tired people. Another symptom of anemia, called pica, is the
desire to eat unusual things, such as ice, clay, cardboard, paint, or starch. Advanced anemia
may also result in lightheadedness, headaches, ringing in the ears (tinnitus), irritability, pale skin, unpleasant
sensations in the legs with an uncontrollable urge to move them (restless legs syndrome), and getting winded
Over the counter products focus on replacing iron. Common forms of iron include ferrous
sulfate (Feosol®, Fer-In-Sol®, Slow Fe®), ferrous fumarate (Femiron®,
Feostat®), ferrous gluconate (Fergon®), and polysaccharide-iron complex
Injectable iron (InFeD®, DexFerrum®) is available with a prescription, and may be
administered to those who cannot tolerate the oral forms.
Dietary changes that may be helpful
Iron deficiency is not usually caused by a lack of dietary iron alone. Nonetheless, a lack
of iron in the diet is often part of the problem, so ensuring an adequate supply of iron is
important for people with a documented deficiency. The most absorbable form of iron, called
“heme” iron, is found in meat, poultry, and fish. Non-heme iron is also found in these foods, as
well as in dried fruit, molasses, leafy green vegetables, wine, and most iron supplements. Acidic
foods (such as tomato sauce) cooked in an iron pan can leech iron into the food and thus also
be a source of dietary iron.
Vegetarians eat less iron than
non-vegetarians, and the iron they eat is somewhat less absorbable. As a result, vegetarians
are more likely to have reduced iron stores.2 Vegetarians can increase their iron
intake by emphasizing iron-containing foods within their diet (see above), or in some cases by
supplementing iron, if needed.
Coffee interferes with the absorption of iron.3 However, moderate intake of
coffee (4 cups per day) may not adversely affect risk of iron-deficiency anemia when the diet
contains adequate amounts of iron and vitamin
C.4 Black tea contains tannins
that strongly inhibit the absorption of non-heme iron. In fact, this iron-blocking effect is
so effective that drinking black tea can help treat hemochromatosis, a disease of iron
overload.5 Consequently, people who are iron deficient should avoid drinking
Fiber is another dietary component that can
reduce the absorption of iron from foods. Foods high in bran fiber can reduce the absorption
of iron from foods consumed at the same meal by half.6 Therefore, it makes sense
for people needing to take iron supplements to avoid doing so at mealtime if the meal contains
significant amounts of fiber.
Vitamins that may be helpful
Before iron deficiency can be treated, it must be diagnosed and the cause must be found by
a doctor. In addition to addressing the cause (e.g., avoiding aspirin, treating a bleeding ulcer, etc.), supplementation with iron is the primary
way to resolve iron-deficiency anemia.
If a doctor diagnoses iron deficiency, iron
supplementation is essential. Though some doctors use higher amounts, a common daily dose for
adults is 100 mg per day. Even though symptoms of deficiency should disappear much sooner,
iron deficient people usually need to keep supplementing with iron for six months to one year
until the ferritin test is completely normal. Even after taking enough iron to overcome the
deficiency, some people with recurrent iron deficiency—particularly some premenopausal
women—need to continue to supplement with smaller levels of iron, such as the 18 mg
present in most multivitamin-mineral
supplements. This need for continual iron supplementation even after deficiency has been
overcome should be determined by a doctor.
Liver extracts from beef are a rich natural
source of many vitamins and minerals, including iron. Bovine liver extracts provide the most
absorbable form of iron—heme iron—as well as other nutrients critical in building
blood, including vitamin B12 and folic acid. Liver extracts can contain as much as
3–4 mg of heme iron per gram.
Taking vitamin A and iron together has been
reported to help overcome iron deficiency more effectively than iron supplements
alone.7 Although the optimal amount of vitamin A needed to help people with iron
deficiency has yet to be established, some doctors recommend 10,000 IU per day.
Vitamin C increases the absorption of
non-heme iron.8 Some doctors advise iron-deficient people to take vitamin C
(typically 100–500 mg) at the same time as their iron supplement.9
Hydrochloric acid produced by the stomach improves the absorption of non-heme iron from
food and supplements. 10 11 Some practitioners recommend a hydrochloric
acid supplement (e.g., betaine hydrochloride
[betaine HCl]), to enhance iron absorption in people with iron-deficiency anemia.
A high degree of association between iron-deficiency anemia and vitamin D deficiency in Asian children has been
previously reported.12 In three different ethnic groups living in England,
iron-deficiency anemia was found to be a significant risk factor for low vitamin D levels in
children.13 These findings suggest that children with iron-deficiency anemia should
be screened for vitamin D deficiency and be given vitamin D supplements if necessary.
Taurine has been shown, in a double-blind study, to improve the response to iron therapy in
young women with iron-deficiency anemia.14 The amount of taurine used was 1,000 mg
per day for 20 weeks, given in addition to iron therapy, but at a different time of the day.
The mechanism by which taurine improves iron utilization is not known.
Caution: People who are not diagnosed with iron deficiency should
not supplement with iron, because taking iron when it isn’t needed has no benefit and
may do some harm. Adult iron supplements are the most common cause of fatal poisonings in
children. Keep all iron supplements out of the reach of children.
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
1. Looker AC, Dallman PR, Carroll MD, et al. Prevalence of iron
deficiency in the United States. JAMA 1997;277:973–6.
2. Sullivan JL. Stored iron and ischemic heart disease.
Circulation 1992;86:1036 [editorial].
3. Morck TA, Lynch SR, Cook JD. Inhibition of food iron absorption by
coffee. Am J Clin Nutr 1983;37:416–20.
4. Mehta SW, Pritchard ME, Stegman C. Contribution of coffee and tea to
anemia among NHANES II participants. Nutr Res 1992;12:209–22.
5. Kaltwasser JP, Werner E, Schalk K, et al. Clinical trial on the effect
of regular tea drinking on iron accumulation in genetic haemochromatosis. Gut
6. Cook JD, Noble NL, Morck TA, et al. Effect of fiber on nonheme iron
absorption. Gastroenterology 1983;85:1354–8.
7. Mejia LA, Chew F. Hematological effect of supplementing anemic
children with vitamin A alone and in combination with iron. Am J Clin Nutr
8. Ajayi OA, Nnaji UR. Effect of ascorbic acid supplementation on
haematological response and ascorbic acid status of young female adults. Ann Nutr
9. Hunt JR, Gallagher SK, Johnson LK. Effect of ascorbic acid on apparent
iron absorption by women with low iron stores. Am J Clin Nutr
10. Schade SG, Cohen RJ, Conrad ME. Effect of hydrochloric acid on iron
absorption. N Engl J Med 1968;279:672–4.
11. Bezwoda W, Charlton R, Bothwell T, et al. The importance of gastric
hydrochloric acid in the absorption of nonheme food iron. J Lab Clin Med
12. Grindulis H, Scott PH, Belton NR, Wharton BA. Combined deficiency of
iron and vitamin D in Asian toddlers. Arch Dis Child 1986;61:843–8.
13. Lawson M, Thomas M. Vitamin D concentrations in Asian children aged 2
years living in England: population survey. BMJ 1999;318:28.
14. Sirdah MM, El-Agouza IMA, Abu Shahla ANK. Possible ameliorative
effect of taurine in the treatment of iron-deficiency anaemia in female university students of
Gaza, Palestine. Eur J Haematol 2002;69:236–2.