Recognizing and treating iron deficiency

Constantly tired, pale, exhausted, perhaps with hair loss and concentration problems? Behind this is often an iron deficiency — one of the most common deficiency states worldwide, especially in women. Iron is vital for the transport of oxygen in the blood, and a deficiency shows itself in varied, often non-specific ways.

1. Why iron is so important

Iron is a vital trace element. Its most important job: it is a component of the red blood pigment haemoglobin, which transports oxygen in the blood. Without enough iron, the body cannot form enough functioning red blood cells — the oxygen supply to the organs suffers.^¹

• Oxygen transport: iron in haemoglobin binds the oxygen and brings it to all cells
• Energy metabolism: iron is involved in producing energy in the cells — a deficiency makes you tired
• Other functions: iron is important for muscles, the immune system, the brain and many enzymes
• Storage: the body stores iron (above all as ferritin) — these stores empty first in a deficiency, before anaemia develops

Because iron has so many functions, a deficiency affects the whole body — and the symptoms are correspondingly varied and often non-specific. That makes iron deficiency on the one hand often overlooked, on the other hand readily treatable once it is recognized.

2. Symptoms: how to recognize iron deficiency

The symptoms of an iron deficiency are varied and often develop gradually. The leading symptom is fatigue:

• Fatigue, exhaustion, a drop in performance — the most common and often first sign
• Paleness (skin, mucous membranes, lips)
• Concentration and memory problems, "brain fog"
• Hair loss and brittle nails
• Dizziness, headache
• Shortness of breath and palpitations on exertion (with a pronounced deficiency/anaemia)
• Cracked corners of the mouth, a sensitive/burning tongue
• Sensitivity to cold, cold hands and feet
• Restless legs — can be connected with iron deficiency
• An increased susceptibility to infections, skin and mucous-membrane changes

Because these symptoms are non-specific and can also have many other causes, an iron deficiency cannot be reliably determined from the complaints alone — that needs a blood test. But with persistent fatigue and exhaustion, the iron status is one of the first values that should be checked.

3. Causes of iron deficiency

An iron deficiency arises when the body loses or uses more iron than it takes in. The causes can be divided into several groups:

Increased loss (the most common cause)

• Menstruation: heavy or long periods are the most common cause in women of childbearing age
• Bleeding in the gastrointestinal tract: e.g. from ulcers, inflammation, polyps or tumours — often unnoticed; therefore important to clarify
• Frequent blood donation, operations, injuries

Increased need

• Pregnancy and breastfeeding: a clearly increased iron need
• Growth: children and adolescents, competitive athletes

Reduced absorption

• An iron-poor diet: e.g. with a one-sided or purely plant-based diet without good planning
• Absorption disorders: e.g. with coeliac disease, inflammatory bowel disease, after stomach operations, with certain medications (e.g. stomach-acid blockers)

The search for the cause is a central part of the treatment — because an iron deficiency is always a symptom, not a "standalone" problem. Especially in men and in women after the menopause, a source of bleeding in the gastrointestinal tract must be ruled out.

4. Who is especially affected

Some groups have a clearly increased risk of an iron deficiency:

• Women of childbearing age — through the monthly blood losses the largest risk group
• Pregnant and breastfeeding women — a strongly increased need
• Children and adolescents — during growth
• People with a vegetarian/vegan diet — plant iron is less well absorbed (manageable, but to be noted)
• Competitive athletes — an increased need and losses
• People with chronic bowel diseases or absorption disorders
• Frequent blood donors
• Older people — often through unnoticed bleeding or reduced absorption

Anyone who belongs to a risk group and has corresponding symptoms should have their iron status checked. Important: even those who eat healthily can have a deficiency — for example with heavy menstruation or unnoticed bleeding.

5. Diagnosis: the ferritin value

An iron deficiency can only be reliably determined through a blood test. The most important value is the ferritin:^¹

• Ferritin: reflects the body's iron stores — the most meaningful and earliest value. A low ferritin shows empty iron stores, often before anaemia develops
• Serum iron: the pure iron value in the blood fluctuates strongly over the course of the day and is not very meaningful on its own
• Transferrin/transferrin saturation: shows how well the iron is transported
• Haemoglobin (Hb) and blood count: show whether anaemia is already present; a low MCV (the size of the red blood cells) points to iron deficiency

6. Iron deficiency with and without anaemia

An important point for understanding: an iron deficiency goes through stages, and not every iron deficiency means anaemia right away:

• Empty iron stores (iron deficiency without anaemia): the ferritin is low, but the haemoglobin is still normal. Symptoms such as fatigue can nevertheless already occur — the stores are empty, even though blood formation still works
• Iron-deficiency anaemia (with anaemia): with a further deficiency, the haemoglobin also drops — anaemia develops, with more pronounced symptoms (paleness, shortness of breath, palpitations)

This explains why you can already have a treatment-requiring iron deficiency with "still normal" haemoglobin — when the ferritin is low and symptoms are present. Whether and from when treatment is given is decided by the doctor based on the values, symptoms and individual situation.

7. Treatment with iron preparations

The standard treatment of an iron deficiency is the administration of iron preparations — usually as tablets/capsules to take, an infusion if needed:

• Oral iron preparations (tablets/capsules): the usual first choice — mostly with the active ingredient iron(II) (e.g. ferrous sulfate)
• Duration of treatment: iron preparations often have to be taken over several months — also after the values have improved, to refill the stores (ferritin)
• Patience: the symptoms often improve after a few weeks, but completely refilling the stores takes longer
• Monitoring: the success is checked through blood tests; the therapy is steered by the doctor

8. Taking iron tablets correctly

With oral iron preparations, the correct intake decides effectiveness and tolerability, because iron absorption in the gut is limited and is influenced by many factors:

• On an empty stomach iron is absorbed best (e.g. one hour before eating) — if this irritates the stomach too much, with some distance from the meal.
• With vitamin C (e.g. a glass of orange juice) the absorption improves.
• Distance from inhibiting substances: coffee, black tea, milk/dairy products (calcium) and certain medications (stomach-acid blockers, calcium/magnesium preparations) inhibit absorption — keep a time gap.
• Regular intake according to the doctor's instructions — some benefit from taking it every other day (this can even improve absorption; clarify with the doctor).
• Patience: keep going for the prescribed duration (often months), even if you already feel better.

These intake instructions are crucial, because incorrectly taken iron is poorly absorbed and the therapy then seemingly "does not work". More general information in the guide taking medications correctly.

9. Side effects of iron preparations

Oral iron preparations are not well tolerated by everyone — the most common side effects affect the gastrointestinal tract:

• Gastrointestinal complaints: nausea, abdominal pain, a feeling of fullness
• Constipation — very common; pay attention to a fibre-rich diet and enough fluid
• Diarrhoea (rarer)
• Black colouring of the stool — harmless and normal, no cause for concern
• A metallic taste

With intolerance there are options: a different preparation, a lower dose, taking it every other day or with a meal (at the cost of somewhat lower absorption). If oral preparations are not tolerated at all or are not enough, an infusion comes into question. Talk to the doctor if there are problems, instead of stopping the therapy.

10. When an iron infusion is needed

In certain situations iron is given not as a tablet but as an infusion (intravenously). This is decided by the doctor:

• Intolerance or ineffectiveness of oral preparations: when tablets are not tolerated or do not work sufficiently
• Absorption disorders: when the gut cannot absorb iron sufficiently (e.g. with inflammatory bowel disease)
• A severe deficiency or rapid refilling needed: e.g. before operations, with heavy blood loss
• Certain chronic diseases (e.g. advanced kidney disease, heart failure)

The iron infusion fills the stores faster and bypasses the gut — it is given under medical supervision, because allergic reactions can rarely occur. It is not a "wellness boost", but a medical treatment with a clear indication. An infusion "on request" without a proven deficiency is not sensible and not without risk.

11. An iron-rich diet

Diet can treat and prevent an iron deficiency supportively — but correcting a pronounced deficiency through diet alone is difficult (then preparations are needed). Important: there are two kinds of dietary iron:

• Haem iron (from animal sources): is well absorbed — e.g. in (red) meat, liver, fish
• Non-haem iron (from plant sources): is less well absorbed — e.g. in legumes, whole grains, nuts, green vegetables, pumpkin seeds
• Improve absorption: vitamin C (e.g. peppers, citrus fruits) with plant iron clearly increases absorption
• Inhibit absorption: coffee, black tea, dairy products (calcium) and certain substances inhibit iron absorption — keep a time gap from iron-rich meals
• Vegetarians/vegans: should specifically pay attention to plant iron sources plus vitamin C and keep an eye on their iron status

12. Do not forget the cause

A central, often neglected point: an iron deficiency is always a symptom, not a standalone problem. Just as important as refilling the stores is the search for the cause:^¹

• In women heavy menstruation is the most common cause — but not the only one
• In men and in women after the menopause a source of bleeding in the gastrointestinal tract must be ruled out — this is especially important, since serious causes can be behind it
• Recurring iron deficiency despite treatment should be thoroughly clarified
• Accompanying symptoms (e.g. blood in the stool, weight loss, digestive complaints) should always be clarified with a doctor

Anyone who only refills the stores without clarifying the cause treats the symptom, not the problem — and the deficiency returns. That is why the search for the cause always belongs to the treatment of an iron deficiency. That is the medical task that a self-test or a dietary supplement cannot replace.

13. How brite helps you with iron deficiency

An iron-deficiency therapy often lasts months and makes some demands on the intake logistics (on an empty stomach, with vitamin C, away from coffee/milk). The brite features support exactly that:

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