Lack Of Iron ? Iron Deficiency ?

Have you ever checked your serum iron level!
Does it matter?
The answer is a big YES!

The Prevalence
Did you know that one third of the global population is affected by anaemia and 50% of them are due to iron deficiency? Iron deficiency anaemia is the most common nutritional disorder in the world and a main public health problem that contributes to maternal and child mortality. In South East Asia, statistic in 2011 showed the prevalence of anaemia was 53.8% in children (6 months-5 years), 48.7% in pregnant women (15-49 years), and 41.9% in women of reproductive age (15-49 years)! Generally, there are 4 groups of high risk population:

  1. Infant and children - Rapid growth depletes iron stores
  2. Adolescent girls and women of reproductive age - Iron lost through menstruation  
  3. Pregnant women - Increased iron needs for maternal red cell mass and growth of foetus
  4. Vegan and vegetarian - Diet with low iron bioavailability

Understanding iron
Iron is an essential component for red blood cells and myoglobin in muscles. Its main function is to build healthy red blood cells for the transportation of oxygen throughout our bodies. That is why tiredness and weakness are common in people who lacks iron as their oxygen supply is inadequate. Other common symptoms of iron deficiency include paleness, cold hands and feet, dizziness, shortness of breath, frequent infection and hair fall. However, signs and symptoms of iron deficiency are often overlooked. Likewise, its risk factors are out of the spotlight too.

Risk of iron deficiency 
When the absorption of iron from diet is not enough to meet the body’s demand, the consequence is a risk of iron deficiency. The balance of iron stores is influenced by iron consumption from diet, iron absorption in the gut, iron utilization and blood loss. In other words, iron deficiency happens when the uptake of iron is less than its usage and loss. Common risk factors of iron deficiency are dietary pattern and diseases related issues.

Dietary factor
Plant-based iron (non-haem iron) has lower absorption rate compared to animal food sources (haem iron). Hence, people adhere on plant-based diet are more likely to be anaemic. Besides, some components in food may inhibit iron absorption such as phytates (from vegetables and cereals), polyphenols (from tea, coffee, vegetables, fruits, cereal, legume, wine), calcium, and proteins. In contrast, Vitamin C (ascorbic acid) enhances iron absorption.

Disease and disorder related factors
Various abnormalities and diseases may lead to iron deficiency anaemia. For instance, blood loss (due to gastrointestinal bleeding, gastric ulceration, haematuria), malabsorption (due to coeliac disease, gastrectomy, bypass gastric surgery, bacterial overgrowth) and chronic diseases such as cancer, chronic kidney disease, inflammatory bowel diseases and chronic heart failure.  

IRON Supplements
When sufficient iron intake from food sources is impossible, iron supplementation should be used to prevent iron deficiency anaemia or to treat those with proven diseases. When using an oral iron supplement, the dose per intake and type of iron compound should be taken into consideration as there are possible side effects. Popular iron preparations available in the market are iron gluconate, iron sulphate and iron fumarate. They can be ranged from liquid preparations to capsules and tablets.

Common side effects of oral iron supplements include constipation, gastric discomfort, nausea, diarrhoea, flatulence and black stained stools. Iron fumarate for example, tends to increase the frequency of side effects. Fortunately, there are two ways to reduce side effects from oral iron supplement: 

  1. Take smaller doses between meals or before bedtime.
  2. Replace with other type of iron compound. For instance, replacing iron sulphate with iron gluconate has been shown to effectively raise haemoglobin level while addressing the side effects.

This is because iron is more loosely bound in iron gluconate form, hence better released for absorption and utilization. On the other hand, smaller doses of intake on empty stomach ensures better absorption in the gut.

Never Supplement Blindly!
It is important to consult a doctor or dietitian in the case of suspected low iron level. Avoid taking high dose of iron supplement without performing blood test to validate the cause of anaemia.


Written by
C.L. Ng, Dietitian
PgD in Dietetics
BSc in Human Ecology

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  3. WHO (2015). The global prevalence of anaemia in 2011. Genave: World Health Organization.

  4. Zimmermann, M. B., & Hurrell, R. F. (2007). Nutritional iron deficiency. The Lancet,370(9586), 511-520. doi:10.1016/s0140-6736(07)61235-5