Always tired? Iron deficiency is worth ruling out

Tiredness is such a universal complaint that it tends to be shrugged off. Sometimes it is simply a busy life. Sometimes it is iron deficiency, which is extremely common, straightforward to confirm with a blood test, and entirely treatable — and which people live with for years because they assume feeling exhausted is just how they are.

What iron does

Iron is the central component of haemoglobin, the protein in red blood cells that carries oxygen from your lungs to every tissue in the body. Without enough iron you make fewer and smaller red cells, less oxygen is delivered, and everything from your muscles to your brain operates on a reduced supply.

That explains the symptom list, which otherwise looks random: exhaustion, breathlessness on mild exertion, a fast or pounding heartbeat, headaches, dizziness, pale skin and inner eyelids, cold hands and feet, brittle nails, hair thinning and difficulty concentrating.

Some people develop a craving for ice, soil or chalk, which is a recognised sign and worth mentioning if it applies to you, however strange it sounds.

Who is most at risk

• Women with heavy periods — the commonest cause by a wide margin.
• Pregnant and recently pregnant women.
• Growing children and teenagers.
• People who eat little or no red meat.
• Anyone with a condition affecting absorption, or with intestinal worms.
• Anyone losing blood slowly from the gut, which can be silent.

That last point matters. In men and in women past menopause, iron deficiency is not usually dietary and the cause needs looking for rather than simply correcting the level. Slow bleeding from the stomach or bowel is a real possibility and finding it early matters.

Getting more from food

There are two kinds of dietary iron. The kind in meat, liver, fish and poultry is absorbed readily. The kind in beans, lentils, green leafy vegetables, fortified flour and nuts is absorbed far less efficiently, which is why vegetarian diets need more attention to this than people expect.

Vitamin C dramatically improves absorption of the plant kind, so eating tomatoes, peppers, oranges or mangoes in the same meal as beans or sukuma wiki makes a real difference. Conversely, tea and coffee substantially reduce absorption, so the habit of tea with every meal is worth moving to between meals instead.

Taking iron tablets so they actually work

Take them on an empty stomach where you can tolerate it, with water or a vitamin C source such as orange juice. Keep them away from tea, coffee, milk, calcium supplements and antacids, ideally by a couple of hours, because each of those blocks absorption considerably.

Expect dark, almost black stools. That is harmless and simply shows unabsorbed iron passing through. Constipation and stomach discomfort are common and are the usual reason people stop. If that happens, tell us rather than giving up: taking them with a little food, switching preparation, or taking them on alternate days all help, and alternate-day dosing is now thought to improve absorption rather than reduce it.

Correcting a deficiency takes months, not weeks. Blood counts usually improve within a few weeks, but the body's stores take considerably longer to refill, and stopping as soon as you feel better is why so many people end up deficient again.

A serious safety point

Iron tablets are one of the leading causes of serious poisoning in young children. They look like sweets, and a handful can be life-threatening to a toddler. Keep them high, closed and out of sight, and if a child swallows any, seek help immediately rather than waiting for symptoms.

Getting the most from iron

• Take it between meals with water or orange juice.
• Keep it two hours away from tea, coffee, milk, calcium and antacids.
• Expect dark stools — that is harmless.
• If it upsets your stomach, ask about alternate-day dosing or a gentler form.
• Keep the bottle well out of reach: iron is a leading cause of child poisoning.

Questions we are asked about this

How long before I feel better?

Many people notice more energy within two to four weeks, but the blood count takes longer to normalise and the body's stores take months to refill. Stopping as soon as you feel better is the commonest reason people become deficient again within a year.

Can I take iron with my other medicines?

Separate it from thyroid medicine, some antibiotics, calcium supplements and antacids by a couple of hours, because each blocks absorption. Tea and coffee do the same, so take iron between meals rather than with a hot drink.

Is it safe to take iron without a blood test?

For a short course in pregnancy or alongside heavy periods it is often reasonable, but long-term iron without a confirmed deficiency is a poor idea. In men and in women past menopause, iron deficiency usually has a cause that needs finding rather than simply correcting.

The tablets upset my stomach. What are my options?

Try taking them with a little food, switching to a gentler preparation or a liquid, or moving to alternate-day dosing, which is now thought to improve absorption as well as tolerance. Tell us rather than stopping.

This article is general information from the Dantrio Pharmacy team. It cannot take the place of advice from a pharmacist or doctor who knows your medical history. If you feel seriously unwell, seek medical help straight away.