The Truth About Iron



A lot of my patients take a daily iron supplement because they “feel tired” and a friend suggested they try it. I’ve sat on the toilet at the supermarket pondering at the sign on the back of the door, “tired? fatigued? irritable? Maybe you’re iron deficient?” – insert product placement here. Every time I see the ad I answer yes to all questions (don’t you? Who isn’t tired and irritable?) but it doesn’t necessarily mean I need iron replacement. The truth is the medication can have annoying side effects like nausea, constipation and abdominal pain – so you want to be sure you need it before you start taking it. What you need to know is, are you at risk of iron deficiency and are you getting enough iron from your diet?


Iron is vital. It plays an integral role in your red blood cells carrying oxygen throughout the body and is also required for enzyme function and energy production. Patients who are deficient in iron can therefore experience symptoms such as fatigue and shortness of breath when they exercise (because they cannot carry the oxygen around as effectively). It doesn’t mean though if you’re tired you are definitely iron deficient. What we know is that fatigue is USUALLY going to be due to lifestyle factors (poor sleep quality, not enough sleep) or stress – the studies tell us this. And IF it is something medical causing your fatigue then LOADS of other conditions from a simple virus to hypothyroidism to pregnancy to malignancy can be the cause – we can’t blame iron every time.


Having said all that – it’s worth knowing if you are at risk of iron deficiency (because maybe then you do need a blood test and replacement) and if you are getting enough in your diet.


Iron is in more than steak. If you’re vegetarian eggs are a great source – you can also get some iron from nuts (like almonds and walnuts) and legumes- but the truth is it’s better absorbed from meat. Meat (ideally lean) is the main source – chicken, beef, lamb, pork, seafood. Lots of patients are not aware but vitamin C improves the absorption of iron – so a glass of orange juice with your steak may just help your gut get more of the good stuff!! The amount of iron you need varies according to your gender and your age – for a women under 50 generally 18 mg per day of iron is recommended whereas males require 8mg per day. Want me to break that down for you? (Because let’s be honest who knows how to count the number of mg of iron you are eating!) The general recommendation is to eat 1-3 foods from iron rich groups per day. I get my iron intake from poultry (mainly chicken), fish, nuts (mainly almonds), lentils and chickpeas.


As you can imagine there are some groups of people who are at higher risk of iron deficiency due to diet factors (vegetarians, vegans), gut absorption issues (inflammatory bowel disease, coeliac disease for instance) or issues with increased demand such pregnant and breast feeding women. Mensturating women (especially those with heavy periods) are also at higher risk given they are losing blood and iron with every period.


My point is only that not everyone needs to take iron supplements and it certainly isn’t a medication I would just start taking because I feel tired (like I find lots of my patients do). Perhaps your fatigue and irritability is due to motherhood or exams or balancing work and a social life. Perhaps you’re feeling off due to a virus that is lingering. Perhaps you’re tired because you don’t get enough sleep and the sleep you do get isn’t of the best quality. Or perhaps you are deficient in iron – but there is only one way to find out – a chat with your doctor and a blood test if it is needed.