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Iron Deficiency and Anaemia – Symptoms or Conditions?

By Yvonne Gattung B.Soc.Sci, DipMedHerb, ND, MNZAMH, MNHAA, Natural Fertility Specialist

Iron is a mineral concentrate in the blood and is present in every living cell. Iron combines with

protein and copper to make haemoglobin and haemoglobin undertakes the important task of transporting oxygen from the lungs into the blood and out to the tissues. Iron is also found in muscle cells as myoglobin. Iron builds up the ‘quality’ of the blood and thus improves resistance to stress and disease because the blood is healthier and able to transport nutrients to the cell more efficiently. Iron is also found in many enzymes throughout the body which promote protein metabolism, hormones and neurotransmitters such as serotonin, dopamine and norepinephrine (noradrenaline). Calcium and copper must be present in small amounts for iron to function properly and if a person has copper toxicity this can appear as iron deficiency anaemia with many similar symptoms.


Definitions: Iron deficiency and Anaemia

Iron deficiency and anaemia are not the same thing. It is possible to be iron deficient without being anaemic, because iron deficiency occurs in stages. Anaemia is the severe reduction of haemoglobin in the erthyrocytes or a reduction of the number of erthyrocytes – both reduce the amount of oxygen available to body cells. Iron deficiency anaemia is one type of anaemia.


Are you iron deficient?

Despite iron being the fourth most common element on earth, iron deficiency is one of the most frequent nutritional deficiencies around the world. According to the World Health Organisation 80% of adults are deficient in iron and 28.4% have iron deficiency anaemia. (1) Worldwide iron deficiency is not necessarily evenly spread through populations.


The groups highest at risk of iron deficiency are vegetarians and vegans, menstruating women, those who undertake intense physical activity, infants under 2 years of age, teenage girls, pregnant women, the elderly and those with chronic disease.


The main signs and symptoms of anaemia include:

general weakness and poor stamina


shortness of breath on exertion or breathing difficulties

paleness in skin colour (due to less haemoglobin so the blood is paler)

palpitations or an awareness of your heart beating




lack of concentration

change or loss of appetite

poor digestion and abdominal pain (iron deficiency can both cause and be caused by low stomach acid levels)


reduced resistance to infection

a lowered ability to stay warm when cold

dizziness (brain cells deprived of oxygen)


angina and heart related chest pain

abnormal hair loss especially following a pregnancy

tendency for menstrual blood to clot

cracks at corners of the mouth, sore red tongue, difficulty swallowing

concave finger nails or pale finger nails with horizontal ridges, brittle finger nails

brittle, wiry, thin lack lustre hair

pale eye lining


Aetiology (causes) of anaemia

nutritional – a lack of iron, B12 or folate, Vitamin C or Vitamin B6 in the diet or excessive intake of dairy products, sugar and fat. (2)

liver disorders that affect the liver’s ability to build up blood

chronic diarrhoea where all minerals are most likely to be deficient

surgical removal of part of the stomach or other digestive issues which may cause bleeding or interfere with absorption such as peptic ulcers, celiac disease, crohns disease, gastric bypass surgery, chemotherapy or radiology treatments.

heavy use of antacids or antibiotics

a lack of hydrochloric acid secretion (especially in the elderly)

excessive amount of bacteria which steal the iron for their own use and thereby deplete the body

blood loss, haemorrhage or excessive menses, (especially over a long period of time or frequent)

microscopic bleeding as a result of medication

heavy tea/coffee consumption

chronic diseases e.g. renal failure, cancers including blood cancers such as leukaemia, rheumatoid arthritis, HIV/AIDS

other conditions which result in decreased red blood cell production, poor red blood cell maturation or increased red blood cell destruction


Other types of anaemias

There are over 40 different types of anaemia. (3)

Pernicious anaemia – this type of anaemia results from an autoimmune destruction of the parietal cells, resulting in a lack of intrinsic factor which leads to a deficiency in Vitamin B12. It is a severe condition in which there is a gradual reduction in the number of blood cells because the bone marrow fails to produce mature red blood cells. Vitamin B12 deficiency can also be due to low dietary intake, or from loss of instrinsic factor from other causes e.g. destructive gastritis. Pernicious anaemia occurs in both genders (although rarely affecting those under the age of 30), is usually inherited and can be fatal without treatment which is usually vitamin B 12 injections.

The symptoms of pernicious anaemia include weakness and gastrointestinal disturbances causing a sore tongue, slightly yellowing of the skin, tingling of the extremities, partial loss of coordination of the fingers, feet and legs, diarrhoea and loss of appetite.

Sickle cell anaemia – With sickle cell anaemia the red blood cells become bent (sickled) and hard and clog the circulatory system, depriving the body of the oxygen. This is a genetic abnormality in which haemoglobin sticks together in long sticks instead of staying separate, when the red blood cells are in low-oxygen environments (e.g. working muscles). Although not curative, folic acid is recommended because those with sickle cell anaemia lose red blood cells to the sickling.

Folic acid deficiency anaemia – The most common causes of folate deficiency are inadequate diet, alcoholism, pregnancy and malabsorption. Folic acid is found in green leafy vegetables, liver, kidney, lima beans, nuts, strawberries and whole grains. A deficiency results in poor growth, greying hair, inflammation of the stomach, gastrointestinal disorders and diarrhoea. In early pregnancy a deficiency can result in spina bifida.

Diagnosis of iron deficiency anaemia

The only definitive diagnosis is blood tests – CBC (complete blood count) will indicate haemoglobin levels, serum ferritin, B 12, folate, iron saturation. Diagnostic tests (e.g. colonoscopy, gastroscopy) to investigate the digestive tract for the source of any blood loss may be performed.

There are a number of other ways which can give you an indication whether you may have low iron levels and if found it may be prudent to have this confirmed via blood testing.

Look at your tongue in a mirror. The tongue will be bright red and shiny with little coating or fur and you will have pale lips

Gently press your fingers backwards. The creases of your palm will be pale pink instead of the normal healthy red.

Gently press on the nail. The colour should immediately return, if there is a delay of more than 2-3 seconds, suspect an iron deficiency.

Gently pull down your lower eye lid. If the lining is pink rather than healthy red, suspect an iron deficiency.

Iridology can indicate decreased hydrochloric acid levels


Understanding the terms used in blood tests

Haemoglobin – protein-iron compound that carries oxygen in the blood. The normal range is 115-165g/L for a adult female and 135 – 175 g/L for an adult male. These ranges can be influenced by the age and ethnic origin of the person.

Haemoglobin is measured as part of the full/complete blood count (or CBC) and decreases slightly during a normal pregnancy. Haemoglobin levels peak around 8am and are lowest at 8pm each day.

Haemoglobin levels increase with heavy smoking (reduced oxygen delivery to the tissues of the body will cause the bone marrow to produce more red blood cells and therefore more haemoglobin), and haemoglobin levels increase when living in higher altitudes (due to the decreased oxygen available at high altitudes) (4)

Ferritin – iron stored in the body. Normal range 10 – 225 g/L. With iron deficiency, ferritin levels fall before the haemoglobin starts falling. This is the body’s way of keeping the iron in the blood and available for use as even as possible. Ferritin is a dynamic molecule which is constantly undergoing synthesis and degradation, providing an intracellular pool of available iron. (5)

Ferritin levels are raised with haemochromatosis, when there is damage to any organ that stores blood and where there is injury, infection or inflammation (such as rheumatoid arthritis, chronic kidney disease, inflammatory bowel disease) due to ferritin’s role as an acute phase reactant.

Iron saturation – the volume of oxygen per volume of blood. Normal range 36-77 mol/L

Total iron binding capacity (TIBC) – total iron concentration in the blood. Normal range 40 – 8- umol/L

Transferrin – the blood protein that binds and transports the iron. Transferrin is typically one-third saturated with iron and the amount of iron taken up by the cells is influenced by transferrin saturation with higher iron content promoting increased uptake and the cells’ receptor numbers, which in turn is directly proportionate to the cells’ iron demand. (6)

TIBC and transferrin are not assessed in isolation. In iron deficiency the TIBC and transferrin may be high. This may seem odd, but the TIBC and transferrin are not measuring the amount of iron in the blood but the ability of the blood to carry iron. It seems that when the body lacks iron, it ‘turns up’ the production of the iron-binding protein transferrin.

However, other things can turn the production of transferrin ‘up’ or ‘down’ apart from iron deficiency. For example, in people with chronic inflammatory conditions the transferrin (and TIBC) tend to be low. In women on the oral contraceptive pill, transferrin tends to be high. (7)

Folic acid – part of the vitamin B complex group. Normal range 4 – 28 nmol/L

Red cell folate – the amount of folate (folic acid) in the blood. Normal range 240 – 1200 nmol/L

Absorption of iron

Iron can switch between two ionic states – ferrous and ferric and the body can utilise either ferric or ferrous forms of iron. However, the naturally occurring ferrous iron is used more efficiently by the body with all forms of iron are converted to the ferrous form before being absorbed. Absorption occurs in the duodenum, stomach and upper jejunum. Medically prescribed iron is the ferric form and can cause gastrointestinal upset, diarrhoea, constipation, nausea, heartburn and bloating in some people.

There are a number of ways to increase the absorption of iron within the diet and when taken as supplements.

Combine iron-rich food with vitamin C-rich food. Vitamin C is known to increase iron absorption because it reduces ferric iron to the ferrous form. Ascorbic acid also binds (chelates) to the ferrous form which enhances absorption across the mucosa

Add an acid dressing such as lemon juice to iron rich foods

Eat bitter vegetables, fruit or herbs before eating meals will increase the secretion of HCl which will improve digestion

Eat both haem and non haem iron foods together

Avoid drinking tea (especially black tea) or coffee with meals. This is particularly important with non-haem iron foods, as the tannins in tea bind with iron and minimise iron absorption.

Phytates and oxalates in food can also reduce iron absorption

Minimise the consumption of calcium and fibre-rich foods with meals high in iron. These can bind with the iron and reduce absorption.

Treat diarrhoea promptly and avoid laxative use

Excess phosphorus hinders iron absorption although if calcium is present in sufficient amounts, it will combine with the phosphates and free up the iron for use by the body

Avoid (if possible) medications that reduce gastric acidity, as this will interfere with absorption of iron (and all other minerals and vitamins)

Key drug/mineral interactions (8)

Interaction Drug/Medicine Solution

Fe decreases drug absorption ACE inhibitors Separate doses by >2 hours


L-dopa and carbidopa

Quinoline antibiotics


Drug decreases Fe absorption Antacids Separate doses by > 2 hours

Cholestyramine and monitor Fe levels


H2-receptor antagonists

Proton pump inhibitors

Decreases Fe and decreases Penicillamine

Separate doses by 2 hours absorption when co-administered

Sulfaselazine Tetracylcines Decreases Fe levels independent Haloperidol

Increased Fe intake may be of absorption required during long term treatment

Additive pharmacological effect Erythropoietin Beneficial interaction possible.


How much iron do we need? (9)

Age                                                                                                         RDI* – Iron (mg/day)

Infants                                        7-12 months                                   11
Children                                     1-3 years                                           9
4-8 years                                          10
Boys                                             9-13 years                                         8
14-18 years                                       11
Girls                                             9-13 years                                         8
14-18 years                                      15
Men                                              Over 19 years                                   8
Women                                        19-50 years                                      18
Pregnant women                      14-50 years                                      27
Breastfeeding women             14-18 years                                       10
9-50 years                                          9
Women                                       Over 50 years                                    8


Which foods contain iron?

There are two types of iron in food: haem (hFe) and non-haem iron (n-hFe).  Haem iron contain iron in the intact ferroprophyron ring and is more easily absorbed across the brush border of the mucosa. Before entering the blood stream, the iron is then cleaved from the ferroporphyrin complex and complexed with apoferritin to form ferritin. Non-haem iron must be absorbed into the GI mucosal cells and then it is delivered to the blood via the same apoferritin protein mechanism (10)

It is estimated that 20-20% of haem iron is absorbed, but only 5% of non haem is absorbed. Non haem iron absorption requires gastric secretions to improve solubility and absorption. This may be of concern to vegetarians, vegans and those that consume low levels of animal foods.

Sources of haem iron are meat, chicken and fish.  Non-haem iron is found in plant foods, such as vegetables, cereals, beans and lentils. Iron is fortified in a number of foods, commonly in breads and breakfast cereals however the amount that is bioavailable may be low depending on the form of iron used.


Iron content of foods (11)

Foods containing haem iron

Iron (mg)

1 grilled lean beef fillet steak (173g)                             5.8
½ cup green mussels, marinated                                  4.6
2 grilled lean lamb leg steaks (116g)                            4.0
1 slice fried lamb liver                                                       4.0
90g can salmon                                                                  2.1
1 grilled chicken breast (107g)                                       2.0
1 grilled lean pork loin chops (74g)                              1.4
1 baked tarakihi fillet                                                        0.8


Foods containing non-haem iron

Iron (mg)

100g tofu                                                    5.4
½ cup porridge                                         2.3
1 Wheat biscuit                                         2.2
½ cup cooked red kidney beans           2.2
½ cup cooked red lentils                        1.8
½ cup muesli                                             1.6
½ cup cooked chickpeas                        1.6
1 cup boiled broccoli                                1.3
½ cup baked beans                                  1.3
10 dates                                                       1.3
10 Brazil nuts                                            1.1
1 cup boiled spinach                                1.1
1 boiled egg                                                1.1
1 slice multigrain bread                          0.7

Iron and Fertility

While it is important to have good levels of iron for fertility and going into a pregnancy, an excess can also cause problems.

Iron is required for healthy maternal membrane integrity, healthy foetal blood, bone, brain and eye development.

A deficiency of iron can lead to iron deficiency anaemia, ovulatory disorders, clotting of menstrual blood, poor foetal development of brain, bone and eye and poor foetal growth. An increased risk of low birth weight, pre-term delivery and placental vascularisation at term (placental weight at birth associated with low birth weight and increased risk of Cardio vascular disease in adult life)

An excess of iron (which is rare) can lead to decreased zinc, manganese, chromium and selenium levels and has been linked to increased risk of gestational diabetes/oxidative stress/foetal growth restriction/pre-term delivery/pre-eclampsia. This is the reason for having your iron levels checked BEFORE supplementation.

What about herbs?

There are many herbs that either contain iron, assist the body to absorb iron from the diet or help by increasing the quality of blood. Many can be eaten in salads or used as infusions. Examples include

Urtica dioica, Taraxacum offinicale, Stellaria media, Petroselinum sativum, Symphytum spp, Rosa canina, Cichorium intybus, Rumex acetosa, Rumex crispus, Nasturtium officinale, Sonchus spp., Articum lappa, Withania somnifera, plus other bitter and nourishing herbs.

Some herbs in more detail:

Withania somnifera is regarded as a rejuvenative tonic from the Ayurvedic tradition. It has been traditionally used to treat a variety of disorders including anaemia, general debility, fatigue, nervous exhaustion and more. Withania’s blood-building properties have been demonstrated in double-blind, placebo controlled clinical trials of children and the elderly in which it increased red blood cell count and haemoglobin. The children treated with Withania also showed increases in serum iron and body weight. (3gms for 1 year was used) (12)

Codonopsis pilosula is regarded as a tonifying herb (with particular emphasis on spleen and lung qi) within traditional Chinese medicine. The enhancement of qi generates blood and fluids and Codonopsis root indirectly contributes to this. This herb is indicated if fatique, weakness, poor appetite, loose bowel movements, shortness of breath, blood deficiency following illness or haemorrhage is evident. The dried root powder has increased red blood cell count and haemoglobin in vivo. (13)

Rumex crispus has long been regarded historically as a treatment for weakened conditions. Thought to contain iron, it is often used to treat anaemia (14)

Urtica dioica – a commonly eaten herb around the world. The leaves especially contain a large variety of vitamins and minerals including iron. Water based extraction method is preferred. Explain to your clients the benefits of making medicinal infusions (30gms dried nettle to 1 litre boiling water, infuse for 4 hours, 1-3 cups a day for an adult)

Clinical trials

The content of Ca, Mg, Fe and Cu in selected species of herbs and herb infusions. By Katedra Ekologii i Ochrony Srodowiska, Wydział Rolniczy Instytut Biologii, Akademia Podlaska, 08-110 Siedlce, ul. B. Prusa

The aim of the study was to determine the amount of calcium, magnesium, iron and copper in 6 herb species (Matricaria chamomila, Tilia cordata, Equisetum arvense, Melissa officinalis, Mentha piperita, Hypericum perforatum) and in the herbal infusions. The mineral concentration was determined by the AAS method. (atomic absorption spectrometry) The following levels of Ca, Mg, Mg and Cu in the herbs were determined: 6872-19802 mg/kg Ca, 4630-8530 mg/kg Mg, 149.9-415.6 mg/kg Fe and 15.15-24.64 mg/kg Cu. The values of extractions in the infusions of herb were as follows: 16.1-73.8% Ca, 14.4-37.3% Mg, 5.1-9.7% Fe, 13.1-21.8% Cu. This indicates, that a very small part of the iron can be potentially treated as a bioavailable fraction for those using plant as infusions. One glass of infusion (250 ml) contain elements in quantities corresponding to: 0.78-2.61% average daily dietary intake (ADDIs) of Ca, 0.76-1.36% ADDIs of Mg, 0.26-0.38% ADDIs of Cu and only 0.15-0.33% ADDIs of Fe. (15)

Pilot trial in 1990’s

In the late 1990’s (some reading this article will remember being part of this), a trial was conducted at the Waikato Centre for Herbal Studies with 19 students participating. The trial indicated that: 1 tablespoon of Organic Blackstrap molasses daily with 2 mls Rumex crispus plus a glass of citrus drink before morning and evening meals improved the absorption and utilisation of iron.

Rumex cripsus on its own did not produce the same improvements, and molasses on its own resulted in some increase in haemoglobin and iron stores.

Other foods:

Molasses is a heavy black syrup produced as a by-product of sugar manufacture and refinement. The more sugar extracted the thicker and darker the remaining molasses becomes. Blackstrap molasses is just one type of molasses, the dark liquid byproduct of the process of refining sugar cane into table sugar. It is made from the third boiling of the sugar syrup and is therefore the concentrated byproduct left over after the sucrose has been crystallised.

2 tsp Blackstrap molasses (13.7 gms) contains 18% manganese, 14% copper, 13.2% iron, 11.7% calcium, 9.7% Potassium, 7.3% magnesium, 5% Vitamin B6, 3.4% selenium, 1% calories. (16)

Molasses tastes similar to liquorice; it can be eaten from a spoon, added to plain organic yoghurt or used in baking. Children usually like it. Not a personal favourite of mine, as I do not like the taste of liquorice, and I have always been a little suspicious of anything to do with white sugar, but for many people this may be an option.

Spirulina is a species of micro blue-green algae and contains an extremely vast array of vitamins, minerals, amino acids, anti oxidants, carbohydrates, fatty acids and protein. It has been used since the 16th Century by the Aztecs and North Africans and is now used throughout the world. As with any sea food, it is possible it may contain heavy metals or be contaminated in some way so it is important to purchase only from a trusted source.

7% of Spirulina is composed of minerals. As far as iron is concerned, for every 10 gms Spirulina, 15mg is iron. (17)

Spirulina smoothie:

3 cups apple juice,

3 bananas,

½ cup blueberries.

1 ½ tblspoons spirulina powder.

Blend well and drink. Pineapple juice added is also delicious.


Iron Tonics by Janet Hicks UK Herbalist (from yahoo chat group)

1Kg unsulphured dried apricots

1Kg molasses

3 litres red Wine

5ml/litre tinctures of Ginger, Gentian, Saw Palmetto, Yellow Dock, Damiana, Nettle tops.

0.5ml/litre tincture of Capsicum (optional)


Cover the apricots with water and simmer for 6 hours. Add molasses and simmer for a further 2 hours. Cool, and liquidise in a blender. Add red wine, stir for 5 -10 minutes until pourable. Add the tinctures. 1 Kg apricots makes about 4 litres tonic. Bottle it up in 500ml airtight bottles and keep refrigerated once opened.


5 – 10 ml 3 times a day. 30ml per day is said to provide 2mg of absorbable iron.

Succus as an iron tonic

Stellaria media or Urtica dioica succus. Juice the fresh herb. 2-3 tablespoons per day

Iron Toxicity

Iron is stored in the bone marrow, blood, liver and spleen as ferritin and hemosiderin. The total body stores of iron is 3.5 – 6 gm (18)

Toxic levels of iron may occur due to repeated blood transfusions, prolonged use of oral intake of iron or a condition called haemochromatosis. Haemochromatosis is considered to be the most common genetic disease in the world. In New Zealand approximately 1 person in every 200 (0.5%) has the condition, while approximately 1 in 7 people of European descent are carriers. (19) The gene responsible is known as the HFE gene which is located on chromosome 6. Haemochromatosis is characterized by an accelerated rate of intestinal iron absorption irrespective of the body’s stores of the mineral, and progressive iron deposition in various tissues that typically begins to be expressed in the third to fifth decades of life, but may occur in children. (20) In later stages, haemochromatosis can lead to liver cancer and there is an increased risk of developing diabetes.

The usual treatment is periodic blood removal, phlebotomy (in the past referred to as bloodletting) with the aim to maintain the ferritin level below 100 ug/L. This situation can become very complicated because it is possible to have haemochromatosis and low hemoglobin levels, and require iron supplementation. Also, other minerals beside iron are removed this can lead to depletion. Whenever I have come across haemochromatosis in clients, I always recommend Silybum marianum as part of the treatment plan. The hepatoprotective properties of Silybum marianum have been firmly established and it can be used long term.


In adults, iron exists within our body as functional iron in haemoglobin, myoglobin and enzymes or as storage iron in ferritin, haemosiderin and transferrin.

Inadequate iron is a serious health concern and can lead to iron deficiency anaemia. This carries a host of problems and issues as outlined in the article. Iron nutrition can seem a complex issue and for some people it is, however for the majority of us a well-balanced and wide range of haem and non haem iron containing foods along with our herbal allies will be sufficient. For the young, teenagers, pregnant women or those wanting to become pregnant, the elderly, those with nutritional deficiencies or those suffering chronic illness may need to consider their intake of iron more closely and to supplement their dietary intake.


1. Worldwide prevalence of anaemia 1993-2005. WHO Global Database on Anaemia. Available at

2. New Zealand Nutrition Foundation information. Available at

3. The free dictionary by Farlex. Available at

4. Haemoglobin at a glance. Available at

5. Arthur, R. Iron – nutritional notes. Journal of Complementary medicine May/June 2007

6. Arthur, R. Iron – nutritional notes. Journal of Complementary medicine May/June 2007

7. Ferritin at a glance. Available at

8. Arthur, R. Iron – nutritional notes. Journal of Complementary medicine May/June 2007

9. New Zealand Nutrition Foundation information. Available at

10. Andrews C & Morgan M. Nutrients and herbs for healthy blood: Mediherb enhance –A nutritional perspective No 9 September 2005

11. New Zealand Nutrition Foundation information. Available at

12. Bone K. Clinical Applications of Ayurvedic and Chinese herbs. Phytotherapy press, Queensland 1996

13. Andrews C & Morgan M. Nutrients and herbs for healthy blood: Mediherb enhance –A nutritional perspective No 9 September 2005

14. Fisher, C. Materia Medica of Western Herbs, Vitex Medica, Nelson NZ, 2009

15. Raczuk J, Biardzka E, Daruk J. The content of Ca, Mg, Fe and Cu in selected species of herbs and herb infusions. Available at

16. The world’s healthiest foods: Blackstrap molasses. Available from

17. Spirulina’s Typical Nutritional Analysis. Available from

18. Osiecki H, The Nutrient Bible 7th Edition, Bioconcepts Publishing, Queensland, Australia

19. Southern Cross Healthcare Group, Southern Cross Medical Library. Available at ItemID/169/Haemochromatosis.aspx

20. Iron overload, Wikipedia the free encyclopedia available from

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