IRON: Are You Red-Blooded, Hot-Headed or Pale-Faced?

Iron levels are like most nutritional issues: too much or too little can leave you tired, sick, even fatally so.

If you tend to: low blood pressure, fatigue, dizziness, depression, restless leg syndrome; swollen, sore or bright red tongue; acne; mouth corner sores; frequent infections or slow to heal; menses heavy, missed or with spotting; are cold, pale, weak or breathless, you might be low in iron. If you tend to: high blood pressure, fatigue, irritability, depression, inflammatory conditions such as cardiovascular disease (CVD); dislike heat, get red in the face; bronze or gray skin; joint or abdominal pain, you might be high in iron.

A single drop of your blood contains millions of red blood cells (RBCs). These are responsible for delivering oxygen to every cell and carting away wastes. Without this service you would slowly die. These blood cells are distinctively coloured because they contain a complex, brilliantly red protein called hemoglobin containing about 70% of your body’s iron. As blood passes through lungs and other tissue the oxygen it carries is released. Empty hemoglobin bonds with carbon dioxide and ferries it away. RBCs have an average life cycle of 120 days. Your bone marrow only produces more with the help of iron, B12 and folate. Erythropoietin regulates production. About 90% of this hormone is produced in the Kidneys (see TIPS article) which can be compromised by acidic diets, diuretic beverages, and low alkaline minerals. As RBCs age they are removed by specialised white blood cells in the liver and spleen. Iron is stored in the liver, spleen, bone marrow and in muscles for extra energy when hard at work.

Be cautious about taking iron supplements without a registered nutritionist’s tailoring. Classic symptoms can relate to other issues such as Thyroid problems. Iron deficiency despite supportive diet and supplements can be due to poor Gut absorption such as with Coeliac Disease, colitis, Crohn’s. Excess iron is hard to eliminate. If storage sites fill, iron can build up in and damage organs such as the liver and heart. Iron can impair the absorption of copper and Zinc. Different forms of iron suit different symptom profiles. Some forms tend to encourage constipation, nausea, vomiting or diarrhea.

Absorption More Significant than Diet

In good health iron loss is balanced by increased absorption. Adult males average a loss of about 1 mg daily; women a loss of 2 mg due to menstruation. A whopping 500 mg is lost during pregnancy to cater to the needs of the fetus. Any woman prone to pre-term delivery or post natal depression must have her iron status checked as a possible factor. Serum Ferritin on blood tests is a measure of the iron in your blood (ferritin is a protein inside cells that stores iron). Normal range: 20 – 250 ug/L. This can be falsely elevated at times of illness such as viral infection so avoid testing then. Iron saturation is an indication of total body iron. Normal range: 20% – 45%. Saturation can be increased after a high iron meal so a fasting blood test is recommended. Alcohol and Medications such as oral contraceptives can increase iron levels while antacids, aspirin, stress, Sleep deprivation and low stomach acid can decrease them.

Most New Zealanders eat meat regularly. Yet when doctors check iron levels many women, children, teens and those 60-plus are low. This is because even more important than intake (such as of iron through food or supplements) is how well you absorb, utilise and eliminate. Age counts too. Since men do not have menses for regular blood letting they are more prone to gradual excess storage. Women with irregular menses or after menopause face similar risk (Sex Hormones). However in clinical practice there are young men in their 20s and 30s who need more iron – and a few middle-aged men and post-menopausal women defy statistics too. A deficiency may worsen into anemia (low hemoglobin or RBC numbers). It can then take about 6 months to re-establish optimal levels for use and storage. Small doses can be the most effective and safe protocol when accompanied by specific nutrient team players.

A key indicator of low iron is – even subtle – blood loss. This can be due to hemorrhoids; nose bleeds; heavy menses or with clots; IUDs; endurance exercise (hard training increases RBCs; iron is lost with sweat); medications such as blood thinners; or any internal bleeding perhaps from ulcers, stomach, lungs or bowel (have this medically examined). Easy bruising (ruptured blood vessels); slow growth, repair (eg hair, skin, nails); acne, especially with menses can indicate low iron. People on restricted diets such as vegetarian or vegan can be low in iron and its critical colleague B12. Only animal foods have active or bioavailable (utilisable) B12; without it pernicious anemia can result. Megaloblastic anemia is due to low folate or B12. Other causes of low iron are: types of hemolytic anemia such as thalassemia and malaria involving excessive RBC destruction; and sickle cell anemia due to abnormal low-oxygen-carrying RBCs.

Include Vitamin C but not Black Leaf Tea

Iron in food is in two forms: heme (meat, fish); non-heme (plants, eggs, dairy). Absorption is 3 x higher from heme; and the redder the meat the greater the iron. Some culinary acids especially vitamin C (such as from raw fruit and veg) eaten with non-heme make iron more soluble and 4 x better absorbed. Iron content varies with location, season (see Seaweed below). Calcium, zinc pills, and tannins (high in black leaf tea) can decrease absorption in an accompanying meal up to 60% (wait 90 minutes before consuming).

Grains, legumes, nuts and seeds are good sources but those high in natural phytates (oats, wheat especially bran) lower absorption (soaking or fermenting reduces phytates), as can foods high in oxalates (spinach, beer, beets, rhubarb). Moderate use is fine for most. A small amount of heme iron in a meal will magnify the utilisation of non-heme. Cast iron pans supply a little iron. Vitamin A can help make stored iron more available. Average RDI in mg: babies 11; children, men, women post-menopause 8; teens 13; women (age 19-50) 18; pregnancy 27.

Excess iron increases free radicals to proportionate levels. These can oxidise or damage blood cholesterol, which is then more likely to adhere to arterial walls and other blood vessels. Blood flow gets impeded with oxygen and nutrients prevented from reaching heart or brain. This can lead to heart attacks, stroke and other CVD. Free radicals up your dementia and cancer risks. They can oxidise cellular DNA and lead to uncontrolled growth. Cancer cells are hungry for nutrients, especially iron, while they starve the host.

High iron levels can be due to liver or kidney problems; high alcohol or lead intake; low antioxidants from fruit and veg. About 1 in 200 has high iron absorption due to hemochromatosis: Caucasians’ most common genetic disease. Severity, childhood or adulthood symptoms relate to the degree of iron accumulation. Polycythemia is marked by too many red blood cells, often due to overproduction in bone marrow. Blood thickens and can enlarge the spleen or liver. This can lead to a feeling of fullness or breathing difficulties, vertigo, headaches, itchiness and reddened face. Considered incurable, without treatment it is life threatening. For both conditions phlebotomy (taking blood from veins) is done regularly to reduce blood volume and cell numbers. One 500 ml venesection removes 1 g of iron from the blood. This is equivalent to 250 days worth or 750 standard meals.

Typical medical practice is to recommend aspirin to lower Inflammation but this can weaken the stomach lining (already now prone to open sores) and is more work for the Liver to detoxify. Instead Omega 3 Fish Oils (The Fats of Life) can diminish excess clotting, lower inflammation and protect cells from free-radical damage.

Heme Iron Foods; 100 gram amounts (iron content in miligrams):

Kidneys 11.4
Mussels, Clams 11.2
Liver, beef/lamb 10.0
Oysters 4.8
Beef, lean 3.8
Sardines, tinned 2.9
Lamb, lean; Prawns 2.2
Sausage, lean 2.0
Pork, lean 1.5
Chicken, lean; Squid 1.2
Fish, white to dark 0.6 to 1.8

Non-Heme Iron Foods; 100 gram amounts (iron content in miligrams):

Spirulina; Chlorella 29.0
Cocoa powder 16.0
Sesame; Tempeh 9.0
Pumpkin kernels 8.07
Molasses, blackstrap 6.5
Parsley; Cashew 6.0
Linseed/flaxseed 5.5
Amaranth, cooked 5.0
Oats, dry; Tofu 4.9
Pistachios; Pine nuts 4.6
Muesli; Chocolate, dark 4.5
Sunflower kernels 3.8
Almonds; Soybeans 3.7
Yeast flakes; Carob 3.6
Lentils, dark cooked 3.5
Quinoa, cooked 3.5
Olives, black; Dates 3.3
Legumes; Nuts 3.25 (average)
Apricots, dried 3.1
Popcorn; Cornbread 3.0
Seaweed, dried 2.85 to 54
Spinach, cooked 2.8
Chilli/Soy sauce; Bread, multi-grain 2.5
Miso; Brazils 2.4
Watercress; Sultanas 2.2
Figs, dried; Currants 2.1
Peanut butter; Egg 1.9
Raisins; Coconut 1.85
Potato; Asparagus 1.7
Cake; Bun; Biscuit 1.5 (average)
Peas green; Hummus 1.5
Avocado; Pesto 1.4
Lettuce; Rice, dry 1.2
Leek; Prunes; Kale 1.0

Data from NZ Food Composition Tables; USDA Nutrient Database; dependent on season, soil, variety and style of preparation.



I am desperately looking for recipes for my son who has been diagnosed with hemochromatosis. His reading was 1800 instead of 50. Please help us to get more info via Internet. Books are very expensive. My son is JP Claassen and lives in Auckland New Zealand. I am in South Africa and do not know how to help him. Thanks Lynn.

Maria Middlestead

Lynn, that must be so concerning. Since your son is in Auckland he could make an appointment to see me. A tailored diet could then be offered. Meanwhile he could order books through the library.


Also worth pointing out that iron deficiencies are not any more common for vegetarians or vegans. And most B12 deficiences are due to inability to absorb it, not through lack of dietary intake.

Maria Middlestead

Emma, thanks for your input. The study sited on many vegetarian websites about iron deficiency for vegetarians used a small sample base. If you find a better one, please let me know. B12 food sources need to have “active B12” (almost entirely found in animal foods) to be absorbed.

Diane O'Hagan

Just trying to get information on Hemochromatosis. I have had very high iron saturation for years, with low tibc and high iron,



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