Causes And Treatment Of Chronic Iron Deficiency

In these days of food abundance and calorie excess it is surprising to find out that iron deficiency is very common among both Australian adults and children.

While most cases of iron deficiency are due to a lack of iron in the diet, some people struggle to get their iron levels up despite ongoing supplementation with iron tablets. As this is one of the most common nutritional deficiencies we see in clinic, I thought I’d give you a recap as to the causes and treatment of chronic iron deficiency.


Iron deficiency comes in many guises. Symptoms’ severity increases as stores become more depleted. While an experienced clinician can suspect iron deficiency when several of these signs and symptoms are present, it is not advisable to self diagnose or self-prescribe iron supplements as there could be other causes for those symptoms, such as chronic infections or malignancies.

  • Fatigue
  • Headaches
  • Dizziness
  • Poor immunity
  • Pale skin
  • Weakness
  • Cold hands and feet
  • Slow physical and mental growth in kids
  • Poor appetite, especially in children
  • Sore tongue
  • Brittle nails
  • Craving for unusual foods like ice or dirt


Diet: The most common cause is a lack of iron rich foods in the diet. Most people assume that eating chicken will cover their iron needs when this isn’t the case, particularly for menstruating women.

Poor absorption: diagnosed or undiagnosed coeliac’s disease, gluten intolerance, Small Intestinal Bacterial Overgrowth (SIBO), IBS, low stomach acid, ageing, low copper status, zinc, calcium or magnesium supplementation, gut microbiota imbalance can all contribute to poor intestinal absorption of iron.

Blood loss: excessive menstrual loss, fibroids, endometriosis, Crohn’s disease, Ulcerative colitis, haemorrhoids, gastritis, ulcers, parasitic infections and colon cancer can cause chronic blood loss that will impact the body’s iron stores.

Increased need: childhood, chronic exercising, pregnancy, lactation, chronic infection, wounds all increase the body’s demand for iron.


Iron from good quality food sources is better absorbed than most supplements. The problem is that many people are just given a dietary list without explaining that certain iron-rich foods contain a form of iron or anti-nutrients that vastly decrease its absorption.

Red meat: The richest source of dietary iron is red meat such as beef, lamb and pork. While we don’t advocate you eat masses of red meat daily, having a regular serve 2-3 times a week for women of reproductive age and 1-2 times a week for men, will go a long way to ensure your iron stores are replete. Chicken and fish do contain some iron but not in great quantities.

Lentils, beans and dark green leafy veg: Vegetarian sources such as spinach or silverbeet or pulses are touted as being iron rich when, in fact, they’re high in a non-absorbable form of iron called non-heme, as opposed to absorbable heme iron from red meat.

However, there are a couple of ways you can increase absorption of vegetarian iron. Just eating one tbsp of red meat at the same time as a vegetarian source of iron such as lentils or spinach will greatly improve the absorption of non-heme iron. Another trick is to eat lemon or other vitamin C-rich source at the same time. This could be in the form of a lemon vinaigrette or a good squeeze of lemon or orange in water to accompany your meal.

Cast iron pots and pans: Far from being an old wives’ tale, cooking in iron pots really does increase your intake of iron. Sure, the iron isn’t in the absorbable heme form but it will certainly add to your iron status, especially if you squeeze a bit of lemon juice on your food (not in the iron pan) after cooking.

In fact, Dr Christopher Charles resolved an entire Cambodian village’s iron deficient anaemia by coming up with an ingenious solution: he designed a little iron implement in the shape of a fish, and asked all the villagers to add it to their cooking pots for at least ten minutes, then removing it and adding some lemon juice to the meal. 75% of the villagers no longer had iron-deficiency 12 months after the iron fish was introduced.

Prebiotics: There is emerging evidence that inulin and oligofructose, two forms of soluble fibre commonly found in onions, Jerusalem artichokes and garlic, alter the expression of iron-transporter proteins in the gut, increasing its absorption in the small intestine. You can read more about this here.

Address any gut infections: parasites and an imbalanced gut flora have been shown to literally gobble up any iron that makes its way into your gut as well as utilise it to form protective biofilms. Chronic, unresponsive iron deficiency is usually a sign that not all is well in your intestines.


I wouldn’t recommend self-prescribing iron tablets for several reasons. Iron is a very strong pro-oxidant, meaning it oxidises readily in the body, causing inflammation. It is also a source of nutrition for bad bacteria so if you have a chronic infection you’re not aware of – and these are extremely common, especially if you have digestive issues – then you’ll be feeding the pathogens without meaning to. Also, about 1 in 300 Australians carry the HFE C282Y or H63D gene for hemochromatosis, a condition where the body just loads too much iron leading to severe tissue and organ damage.

I’m not a big fan of over the counter iron supplements. I’ve seen many people do very poorly on them, developing constipation issues, nausea and more importantly, not improving their iron status. The same goes for iron IV infusions. Many people respond badly, with severe headaches and malaise following the treatment. Again, please remember that you could be inducing massive oxidative stress when agreeing to undergo IV infusions.

Our favourite type of supplement contains an easily absorbed form of iron such as ferrous bisglycinate, ascorbic acid and lactoferrin, a molecule that helps transport the iron, making it unavailable for bad bacteria. While we do this, we investigate the cause of the iron deficiency and improve the person’s diet and digestion.