10 Things You Didn’t Know About Iron Deficiency

There is so much more to iron deficiency than just not getting enough iron! I’ve rounded up the top 10 things my patients are surprised to learn about iron deficiency. Knowing these things can help you make better choices. Here we go… 

  1. Iron makes up a part of every single cell in our body;
  2. Globally, 1.62 billion people are affected by anemia according to the World Health Organization (WHO);
  3. Children have a higher risk of iron deficiency because of the amount of iron needed to accommodate growth spurts. Iron deficiency in children has been linked to poor cognitive development;
  4. Iron deficiency commonly causes a triad of symptoms that many people often chalk up to just being busy or overworked. They include: chronic fatigue, irritability, and difficulty concentrating;
  5. Iron deficiency can affect your appearance by way of hair loss and brittle nails;
  6. Pica, which is a pattern of eating unusual materials, is linked to iron deficiency anemia. Though it mostly affects children (anywhere from 10% – 32% of children aged 1 – 6) it can also affect adults. Those with pica may eat dirt, paper, ice, and even animal feces. Adults with pica often crave a certain texture in their mouths.
  7. Coffee, tea, cola, and chocolate block the absorption of non-heme iron (iron found in plants and iron-fortified). The absorption of heme iron (iron found in meat and fish) is not affected by these foods;
  8. Steel-cut oatmeal is a great source of iron, until you add milk or even milk alternatives which can interfere with your body’s ability to absorb the iron properly;
  9. Antacids, which many of us pop like candy, block absorption of iron salts and non-heme irons while Proton Pump Inhibitors (PPIs) and H2 inhibitors (that are commonly prescribed for acid reflux and heartburn) also block absorption of iron salts putting you at risk for iron deficiency;
  10. Donating blood can lead to iron deficiency if you do it often. A study of 2,425 blood donors found that men who had given blood at least three times and women who had given blood at least two times in the previous year were over five times as likely to have low iron stores, compared to first-time donors.

Content and advice provided on The Iron Maiden is for information purposes only and should not serve as a substitute for a licensed health care provider, who is knowledgeable about an individual’s unique health care needs

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21 thoughts on “10 Things You Didn’t Know About Iron Deficiency

  1. Mahmoud Heidarian Vancouver says:

    Hi there, You have done a great job. I will certainly digg it and personally recommend to my friends. I’m sure they’ll be benefited from this website.

  2. cathy Dolan says:

    My iron is only 4 and I am having a hard time to raise it my doctor has me on proferrin
    22mg. I try to eat right foods rich in iron I just don’t seem to be absorbing it. I’m so tired all the time and feel like I have brain fog all the time. Its getting so frustrated because I have so much to do and I just can’t get motivated. When are you coming to Ottawa? Thank you Cathy

    • Tai says:

      You can’t absorb minerals without either citrus or a vitamin c supplement. I take FerraMax and Natue’s Bounty Vit C and D comlex. I noticed a difference right away with no side effects. I live in Canada as well.

      • Karen Wisz says:

        If you are taking vitamin C for other reasons, there is no need to stop, however there is also no need to start taking vitamin C with FeraMAX® if this is not already a part of your daily routine. Thank you.

  3. Leona, RN & Blood Specialist says:

    Hi Cathy – an iron level of four is difficult to comment on… serum iron (part of the iron panel) may be stage 2 iron deficiency… a ferritin level of 4 may be a stage 1… levels that low are difficult to build with oral therapy alone.

    I am booked to speak in Ottawa early March but am always accepting invitations to speak!


  4. Elizabeth says:

    Hi Leona,

    I have been prescribed FeraMax for my iron-deficiency anemia. As I was looking at the website, I saw an advertisement for your blog. Since you seem very knowledgeable about the subject, and my doctor provides me with very limited/poor information, I figured I would ask you a question.

    It took a year for my ferritin level to get from 4 to 11, but then it recently dropped back down to 4 again. This time, my hemoglobin levels were slightly affected, thus gaining the title of “anemic”. I was, however, only on 20mg per day through a liquid supplement that I purchased at a health food store (my doctor said that it was okay). This time around, I am taking 150mg per day of FeraMax.

    The range provided on my bloodwork is 11-145. I realize that everyone is different, and having too high of a level can contribute to iron toxicity, but what is the best level to be at? I have heard from certain individuals (other than my own doctor) that it should be somewhere from 50-80 for optimal functioning. My doctor seems to have no clue where it should be.

    Also, do you have an email where I can ask more questions and provide more information about my anemia-related issues?

    Thanks for your help,

  5. Leona, RN & Blood Specialist says:

    Hi Elizabeth – Thanks for your question and yet another opportunity to clarify what numbers people are talking about.

    Ferritin Levels are the first line in identifying Stage One Iron Deficiency (iron stores in the liver), my control lab’s normal range is 20-300, however patients may be symptomatic once this value drops below 50. It can also give a false high in the presence of an infection of other inflammatory process. I have found Ferritin levels less than 20 are very difficult to replenish using oral iron alone.

    As always, your physician and personal pharmacist are the best people to turn to for specific advice, sometimes they need a little reminding about what is new in the area of identifying and treating iron deficiency, and now unfortunately your iron deficiency anemia. The Iron Maiden provides a good deal of information that you, and others, can use to advocate for yourself and actively participate in decisions that effect your health and well-being.

    Please let me know if I can help further!


  6. Leona, RN & Blood Specialist says:

    Hi Susan,

    When you say your iron is 10 I am not sure if you are referring to your Ferritin Level, in which case it is too low for any oral iron to replete, or your serum iron level which using my common lab parameters would be low normal range. Unfortunately health care professionals often refer to these very different lab values as “Iron Level”.

    If you are symptomatic of iron deficiency it may be time to have a discussion with your physician and consider switching to another iron supplement with higher elemental iron and better bioavailability.

    Please let me know if I can help further!


  7. Tanya says:

    I too have been told that my ferritin level is at 10 (normal range is 11-145). When you say that oral methods of repleting iron aren’t very successful; what are the “non-oral” ways to replete iron stores; and what is a good range to be in? I am a College student who is finding it very difficult to concentrate, am tired ALL the time, and have a hard time getting out of bed (also have poor sleep where Im waking during the night up to 7-8 times). Also, how long will it take to start feeling somewhat ‘normal’ again? By the way, I have started taking nu-life’s ‘HEMOPLEX’ that has 45mg of iron in it. How many should I take a day? Right now I’m taking only 1 tab daily.

    Thanks in advance for your help!


    • Leona, RN & Blood Specialist says:

      Hi Tanya,

      I’m a bit confused – you mentioned that your Ferritn level is 10 but cited parameters that are more in line with serum iron. This is a common error as many, even medical professionals, use the terms interchangeably. Ferritin level (normal range is 20-300) is an indicator of the level of iron in your liver. It is often falsely elevated because of things like inflammatory processes, but seldom falsely low. Since a majority of my work is in iron deficiency, it is a good tool for me. Serum iron on the other hand is part of the “iron panel” and often appears on the lab result by the chemical symbol for iron (FE); the normal range is in line with what you quoted. This is an indicator of stage 2 iron deficiency. Because Ferritin is often falsely elevated, it is rarely done in common practice; usually relying on the iron panel is sufficient.

      In your case, you do seem to be symptomatic of stage 1 iron deficiency. If the number you quote is indeed your Ferritin Level then yes, anecdotally it would be very difficult to increase it to a normal range with oral iron supplementation alone. In my practice, I would refer you for intravenous iron. In some communities this would involve referral to a haematologist. If this is your serum iron, then it is barely outside normal parameters, given your symptoms I would consider doing a Ferritin Level test. While a normal Ferritin is 20-300 we know people can be symptomatic with Ferritin Levels less than 50.

      HEMOPLEX is a plant based iron supplement which is considered a non-heme iron. This means it needs to be converted in the presence of acid in your stomach to be absorbed. Foods such as coffee, tea, cola, chocolate and dairy, calcium supplements and medications to decrease the acid in your stomach can prevent this conversion and may decrease what is being absorbed. You may want to speak with your personal health care provider and/or pharmacist about switching to a heme iron such as Proferrin, or a Polysaccharide-iron such as FeraMAX, which I say is already the type of iron our bodies like to better absorb (is more readily absorbed).

      Please let me know if I can help you further!

  8. t says:

    I have a ferritin level of 34. I have lost nearly 1/3 of the hair on my head- would this level cause hair loss? I am grasping at all straws to figure out why my hair has thinned so much. Thank you in advance for your reply.

    • Leona, RN & Blood Specialist says:

      Hi T,

      I’m sorry to hear about your hair loss – this can have many causes which could include iron deficiency, hypothyroid, low protein stores, medication reactions, etc.

      We know that a normal ferritin level is 20-300, however patients can be symptomatic of iron deficiency with a ferritin less than 50. At a ferritin of 34, it may be possible to replete your iron stores with appropriate oral iron therapies. You may want to discuss this with your primary physician or pharmacist. For information on available iron supplements click here.

      Since hair loss is a symptom of many things, I would advise to speak with your primary physician about your concerns and to help get to the bottom of your hair loss.


  9. Bonnie Jean says:

    I am desperate to find the cause of my iron deficiency. I have received eleven doses of 200 mg Venofer over the past year and a half and I take Feramax everyday. My ferritin level is currently 10. It goes up to close to 200 after an infusion but in one month will be back to 41 and a month later down to 10. I am having another infusion tomorrow and they hope to schedule them every month now. This is a good plan for maintenance but no one can find why it drops so fast. I have had a CT Scan, an ultra sound, a gastroscope, a colonoscopy and a bladder scope. All have been normal. I am not celiac. I am 69 yrs. old and this has been going on for three years. Where could the iron be going?

    • Leona, RN & Blood Specialist says:

      Hi Bonnie,

      This is a very interesting question that leads me to want to ask a few questions of my own.

      When you say you are receiving Venofer Infusions, “eleven doses of 200 mg Venofer over the past year”, are you receiving serial infusions? I normally recommend a minimum of 3 given 5-10 days apart. The first restores the Serum iron, the second your bone marrow, and the third your liver stores. If your only getting one at a time, you’re likely only restoring your serum iron levels.

      When in relation to the Venofer infusion, is the ferritin level drawn? Is there an Iron panel also drawn? When you have finished your infusions has anyone “titrated” your FeraMAX dose to discover what is the optimum dose for you? Has anyone looked at your B12 or Folate levels? What is your Hemoglobin? Have you had any gastro-intestinal surgeries or problems?

      Finally, have you been referred to a clinical haematologist? I think after 18 months, and the suggestion that you are IV iron dependent, a referral to a clinical haematologist may be prudent.

      As you can see, there are many questions here. I look forward to your reply and I will help in any way I can.



      Hi Susana,

      This is certainly a “loaded” question. There are many things that can result in anemia, two of the most common being B12 deficiency and iron deficiency. Based on the progression of iron deficiency (there are three stages), your health care provider has missed two opportunities to treat your iron deficiency.

      If iron deficiency is the root cause of your anemia, then an ion rich diet should be employed, being mindful of things that may inhibit the conversion and absorption of non-heme irons specifically coffee, tea, cola, chocolate, dairy and dairy substitutes.

      In summary, your health care provider first needs to test you to identify the cause of your anemia and then explore the necessary treatment options. I hope this information is useful!


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