The World Health Organisation (WHO) estimates that one third of all women of reproductive age are anaemic. In Australia, one in four females do not eat enough iron. On top of this, heavy menstrual cycles and digestive problems can be making things a lot worse. This is a guide to keeping your iron levels up without having to reply on supplementation.
What is anaemia?
Low levels of red blood cells &/or haemoglobin, which lowers the amount of oxygen able to be transported around the body. There are a few different types of causes including low levels of iron, folate and B12, as well as red blood cell disorders like thalassemia.
Women are at higher risk of developing iron-deficiency anaemia due to a higher requirement during menstruating years and pregnancy. I also find a lot of women don't eat a lot of animal products, or opt for a plant-based diet which can also contribute to low levels.
Symptoms of low iron/iron-deficiency anaemia:
Fatigue
Weakness
Easy bruising
Shortness of breath
Hair loss
Poor immunity and wound healing
Poor memory and concentration
Low libido
Behaviour changes in children
How much iron do we need per day?
Boys (14-18yrs) - 11mg
Girls (14-18yrs) - 15mg
Males (19+) - 8mg
Females (19-50yrs) - 18mg
Pregnant women - 27mg
Causes of low iron:
Not eating enough iron-rich foodds
Being vegan, vegetarian, or pescaterian
Not eating enough food
Heavy &/or long menstrual bleeds
Low stomach acid
Digestive conditions such as Coeliac disease, IBS, SIBO, Crohn's disease, Ulcerative Colitis
Pregnancy
The good stuff- how to increase your iron levels
First thing is to determine if there is an underlying cause other than low iron-intake in food. This might involve addressing heavy periods or digestive issues. If the underlying cause if not resolved then the cycle will continue.
Increase iron intake from food, focus on improving stomach acid and absorption ability, reduce iron inhibitors.
Supplementation is the last step. I generally will only prescribe low-dose iron if iron level stay low (as seen via pathology) after improving food-based iron. Opt for gentle, well absorbed forms of iron like iron bisglycinate. Avoid ferrous sulfate or iron polymatose which can have negative effects on the gut. If you supplement iron before addressing the underlying cause it can make things a whole lot worse (e.g. feeding bacterial overgrowths).
Iron-rich foods to eat
Red meat - beef, lamb and kangaroo
Liver and pâté
Shellfish and fish - oysters and mussels, sardines
Cooked green vegetables; spinach, collard greens, swiss chard, beet greens
Legumes and grains; tempeh, tofu, chickpeas, white beans, oats
Nuts and seeds; pistachios, cashews, almonds, sesame seeds
Apricots and figs
Animal vs plant-based iron
Iron in food comes in two forms; haem iron (animal-based) and non-haem (plant-based). Haem iron is generally more well-absorbed in the gut where is is able to pass directly into the bloodstream. Non-haem iron is unable to do this, and is not well absorbed.
What helps to absorb iron?
Vitamin C
Lactoferrin
Lactobacillus plantarum 299v
More tips:
Adding vitamin C to an iron-rich meal is as simple as squeezing half a lemon over meals
Having ACV with meals can help to improve digestive capacity of iron. Combine lemon juice, ACV, and olive oil for a simple dressing
Coffee, black tea, green tea, and red wine all inhibit iron absorption - separate by 2 hours
Separate calcium and zinc supplements form iron supplements/rich-foods by 2 hours as they can compete for absorption
Slow cooked red meats are super foods! If you are trying to increase your iron intake this is a great place to start
If digestion is a little sluggish and you are trying to increase animal proteins, try increasing bitters for stomach acid production. Rocket and raddiccio are great sources, or Angostura bitters before meals if you are feeling fancy
What an iron-rich diet looks like
Non-vegetarian
Meal | Food | Amount of iron |
Breakfast | 2 x eggs + toast + avo + 1/2 cup cooked spinach | 4mg |
Lunch | chickpea salad with roast beetroot and slivered almonds | 8mg |
Dinner | chilli con carne with beef/kangaroo mince + kidney beans + rice + homemade salsa + guacamole | 5-6mg |
Snack | handful of dried apricots | 1mg |
Vegetarian
Meal | Food | Amount of iron |
Breakfast | oats cooked in nut milk + chopped almonds and dried apricots | 3mg |
Lunch | chickpea curry with rice | 8mg |
Dinner | tofu stir fry with spinach + broccoli and cashews | 6mg |
Snack | black bean & beetroot brownies | 2mg |
If you are struggling with low iron or an iron deficiency want to address underlying causes or improve your levels, feel free to book an appointment with me.
Written by Emily Starr, Naturopath and Clinical Herbalist.
