The symptoms of iron deficiency can be vague; feeling tired, hair loss, headaches and cold feet and hands, so it’s often missed or confused with something else. This might explain why iron deficiency is the most common and widespread nutritional disorder in the world, affecting around one billion people, according to the World Health Organisation (WHO).
The problem of iron deficiency seems to be getting worse – and women are more affected than men. A rise in plant-based eating and a reduction in the consumption of red meat, by which iron is most readily absorbed, could be a factor, as is our addiction to processed foods. Older people are also susceptible, and as our population ages the numbers with iron deficiency go up.
Yet iron is crucial for our immune systems, skin health, energy levels and muscle performance, and deficiencies can lead over time to the more serious condition of anaemia.
In the first instance, experts advise trying to add more iron-rich foods to our diets. But if that isn’t effective then supplements are recommended. But it isn’t as simple as popping a pill. When to take them, what foods to take them with, and how to avoid side effects can be tricky to navigate. Here is everything you need to know.
- What happens when you have an iron deficiency?
- What are the benefits of iron supplements and what are they used for?
- What sort of supplement should I take?
- What is the recommended dosage?
- When to take your supplements, and how to make sure they are absorbed effectively
- Possible side effects of iron supplements
What happens when you have an iron deficiency?
When you have an iron deficiency, your body struggles to produce enough haemoglobin and red blood cells to meet its oxygen-carrying needs, leading to several different symptoms.
Alex Ruani is a nutritionist and researcher at University College London and the chief science educator at the Health Sciences Academy. She has also suffered from iron deficiency herself.
“Your life quality declines yet you don’t know why. You’re tired, feel weak, have shortness of breath, and you may not be able to concentrate as well. It’s easy to think, ‘What is wrong with me? Am I falling apart, am I depressed?’ Yet really you’re dealing with a lack of iron. My mum, my sister and I have all had anaemia so in our family we have to watch out for it all the time,” she says.
What are the benefits of iron supplements and what are they used for?
Iron supplements, either bought over the counter from a chemist or in stronger doses prescribed by a GP, can replenish depleted iron stores and improve oxygen transport throughout the body, resolving many of the unpleasant symptoms associated with iron deficiency and anaemia.
Iron supplements can be used for:
- Iron deficiency and anaemia
- Combating fatigue
- Improving cognition
- Hair growth
- A healthy pregnancy
- Athletic performance
Iron deficiency can lead to symptoms such as fatigue, weakness, pale skin, shortness of breath, dizziness, and cold hands and feet.
“Over time, untreated iron deficiency can progress to iron deficiency anaemia, exacerbating symptoms and potentially causing complications such as impaired cognitive function, decreased exercise tolerance, and increased susceptibility to infections,” says Rhiannon Lambert, a nutritionist, author and the founder of the Harley Street clinic Rhitrition. “Therefore, it’s essential to address iron deficiency promptly through dietary changes, supplementation, or medical intervention to prevent further complications.”
Iron supplements can be particularly important for women and pregnant women, babies and young children. “In the UK, 12 per cent of premenopausal women have iron-deficiency anaemia and 23 per cent of pregnant women. This is because iron is needed for the rapid growth and development of babies and children. During menstruation, the loss of blood means that women need more iron to produce more blood cells,” says Dr Emily Porter, a dietitian at the Gut Health Clinic.
Low iron levels are also linked to changes in hair and nail health, mouth ulcers or palpitations in more severe cases, and can be also found in athletes as intense exercise uses a lot of iron.
“Iron is important for exercise performance; if you have low iron levels you may feel exhausted when you exercise and be more likely to give up. Athletes often need a good dose of iron to sustain their performance,” says Ruani.
It’s also important for a strong, functioning immune system. “Iron helps in the development and functioning of immune cells, and an iron-rich diet can improve your resistance to infections and support recovery when you’re sick,” Ruani adds.
What sort of supplement should I take?
Firstly it’s important to be sure that you need a supplement as high levels of iron can be toxic.
Your GP can do a comprehensive blood test, but for an initial indication of low iron levels, you can buy a test from your chemist in which a pinprick blood sample will look at your ferritin levels, which shows how much iron is circulating in your system. If this indicates a deficiency, it’s worth going to your GP for a full blood count which includes haemoglobin and other red blood cell measurements.
Unless you have anaemia, or an underlying health condition which affects iron absorption like coeliac disease, Crohn’s disease, gallstones and arthritis, most experts advise that iron supplementation should be a temporary fix while you add more sources of iron to your diet, although the supplements can take some time to work.
“If you suspect you’re not getting enough iron in your diet, there’s no harm in temporarily supplementing with a low-dose ‘gentle’ iron supplement made from iron bisglycinate, at around 20-50mg a day, while you focus on incorporating more iron-rich foods,” says Ruani.
Some supplements have added vitamin C to help with absorption and some might include B12 and folate, as these are nutrients that have benefits for red blood cell health.
Supplements prescribed by your GP will tend to have much higher concentrations of iron but can lead to side effects (see below).
What is the recommended dosage?
There is no recommended official dose, although iron supplements are considered to be safe up to 50mg per day. Still, a GP may prescribe more than that if you’re anaemic.
How much iron you take will depend on your levels of deficiency, age and sex. However, the NHS recommends that adults need these levels of iron daily, ideally from our diet:
- 8.7mg a day for men over 19
- 14.8mg a day for women aged 19-49
- 8.7mg a day for women aged 50 and over
“If you’re iron deficient you’d be looking for a supplement for at least 50 per cent of this recommended amount,” explains Dr Emma Derbyshire, a nutritionist from the Health and Food Supplements Information Service. “If your GP prescribes you a supplement it will be a higher dosage and they should follow up and re-check your blood levels. They may then move you onto a gentler formulation.”
When to take your supplements, and how to make sure they are absorbed effectively
Taking iron effectively can involve a bit of trial and error. Studies have shown that vitamin C increases absorption so many recommend taking your supplement with a glass of orange juice, or some fruit.
Calcium, tea and coffee however inhibit absorption so don’t pop your pill with milk or cheese or your morning coffee or tea.
Taking iron on an empty stomach can be the most effective for absorption, but in some, this can lead to side effects. Prescription-dose-strength iron can lead to feelings of nausea, dizziness and stomach upsets on an empty stomach, so taking them with or after food may make them more manageable, but can also halve the absorption.
It’s also best to take iron around two hours apart from other medications, as they can interfere with how other drugs work. It’s a bit of a minefield, but with trial and error, you should be able to find a time and supplement that works for you.
Possible side effects of iron supplements
Fortunately, not everyone will experience side effects from iron supplements. Gentle iron at low levels should be problem-free. Nevertheless, some people do experience symptoms, and the stronger the iron, the more likely the side effects are to occur. Common side effects, says Lambert, include:
- Gastrointestinal discomfort, such as nausea, constipation, flatulence, metallic taste in the mouth and diarrhoea.
- In some cases, iron supplements may cause a change in colour of stools, which may turn to a green or black colour.
Side effects are often worse if iron is taken on an empty stomach. If this is the case, try taking it with a small amount of food (but not calcium foods), swapping to a lower dose, trying a different formulation or taking every other day instead of daily. Consult your GP for more information.
Do not take high levels of iron without checking with your doctor first as too much iron can be dangerous, and be careful to keep any supplements away from children as high levels can be toxic.
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