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Iron deficiency:
how to recognise and treat it

Iron has important functions in the body. If the trace element is not present in sufficient quantities, symptoms such as tiredness, skin changes or hair loss may occur. A diet rich in iron can prevent iron deficiency. If iron deficiency anaemia has already developed, iron supplements can help.


Iron deficiency means that there is too little iron in the body. The trace element is an important component of the haemoglobin, a protein found in red blood cells that gives them their colour. If not enough iron is available, the stores drain until no new blood cells are formed. A form of anaemia called iron deficiency anaemia then develops.
Five to ten percent of people in Europe suffer from iron deficiency. As women have an increased need for iron (due to menstrual bleeding (periods), for example), they suffer from iron deficiency more frequently. In Europe, 15% to 20% of women of menstrual age are affected.
Newborns, infants and adolescents (especially girls) are also susceptible. Some 10% to 15% of children in Europe are iron-deficient.

Doctors distinguish between three stages of iron deficiency:

  • Stage 1: iron storage depletion. The iron stores (a protein complex called ferritin) are depleted.
  • Stage 2: iron deficiency without anaemia. The iron stores are empty, but anaemia has not yet developed.
  • Stage 3: iron deficiency anaemia. The body is no longer able to produce sufficient haemoglobin and, consequently, no new red blood cells can be formed, resulting in anaemia.

The trace element iron performs many tasks in an organism. For example, it plays an important role in oxygen supply, energy metabolism and cell protection. A deficiency can therefore manifest itself in very different ways depending on its duration and severity:

  • Fatigue
  • Weakness
  • Pale skin and mucous membranes (e.g. conjunctiva in the eye)
  • Muscle weakness
  • Decrease in physical performance
  • Problems with regulating body temperature
  • Poor concentration, memory impairment
  • Headache
  • Shortness of breath
  • Palpitations
  • Dizziness

Skin changes and mucous membrane problems usually only occur once iron deficiency anaemia has developed:

  • Nails that are brittle or develop ridges or spoon-shaped changes in children
  • Hair loss
  • Dry skin
  • Itching
  • Aphthae (painful ulcers in the mouth)
  • Rhagades (cracks) in the corner of the mouth
  • Smooth tongue

Iron deficiency occurs when the body loses more iron than it absorbs. There are many reasons for this:

  • Increased iron loss, e.g. due to blood loss during childbirth, severe menstruation, frequent blood donations, tumours in the gastrointestinal tract, excessive skin flaking in psoriasis
  • Increased iron requirements, e.g. during pregnancy, growth or high-performance endurance sports
  • Reduced iron intake, for example due to insufficient intake through food (vegetarians and vegans are more susceptible) or insufficient absorption (absorption) in the intestine in diseases such as coeliac disease, Crohn’s disease and ulcerative colitis.

In rare cases, iron deficiency is inherited (iron-refractory iron deficiency anaemia).

After a medical history discussion and a physical examination, the doctor will take a blood sample to determine the patient’s laboratory values.

Blood count, for example, provides information on the haemoglobin value (Hb) and the number and average volume of the red blood cells. These parameters may confirm the suspicion of iron deficiency.

For example, an Hb value of less than 12 g/dl in women and 13 g/dl in men indicates iron deficiency anaemia. In pregnant women, an Hb value of less than 11 g/dl (at the start and end of pregnancy) or 10.5 g/dl (in the second trimester) is considered to require treatment.

In addition, the ferritin concentration indicates how well the iron stores are filled. A ferritin level below 15 ng/ml indicates anaemia if corresponding iron deficiency symptoms are also present.

A transferrin saturation (transferrin is a protein that transports iron in the blood) of 20% or less is also a sign of iron deficiency.

If these values do not indicate a clear diagnosis, the concentration of soluble transferrin receptor (sTfR) and the haemoglobin content of the reticulocytes (precursor of red blood cells) can be determined.

The body cannot produce iron itself, but must absorb it through food. A balanced diet usually covers the body’s iron requirements.

Only 10% of the iron from food can actually be utilised. Because about 1 mg of iron is lost every day – e.g. through shedding skin, stool or sweat – the recommended iron intake for adults is 10 to 15 mg per day and for pregnant women it is 30 mg per day.
Good sources of iron are:

  • Fish, meat (especially red meat and offal such as liver)
  • Wholegrain products (oats, wholegrain pasta, rice and bread)
  • Pulses such as lentils, chickpeas and soybeans
  • Nuts and seeds (e.g. sesame, pistachios, linseed, hazelnuts, sunflower seeds)
  • Potatoes, vegetables (especially green leafy vegetables such as spinach) and herbs
  • Cast-iron cookware increases the iron content of meals.

The minerals phosphate and calcium and the secondary plant compound polyphenol can inhibit iron absorption. Food and drinks containing phosphates (e.g. cola), calcium-rich dairy products and foods containing polyphenol (such as tea and coffee) therefore should not be consumed with meals, but as snacks between meals.

Fermented foods such as sauerkraut and organic acids in fruit juices, on the other hand, promote iron absorption and are therefore the ideal supplement to a meal containing iron.

In the case of iron deficiency anaemia, iron is supplied to the body (iron substitution). However, where a patient has iron deficiency without anaemia, doctors do not recommend the administration of iron on a universal basis since the benefits have not been sufficiently demonstrated.
Oral therapy – e.g. iron tablets, juice or capsules – is the standard treatment, with 100 to 150 mg of iron being taken every other day (the body can absorb it better this way). However, it may take several months for the body’s iron stores to be replenished.
If patients cannot tolerate oral iron supplements or they are poorly absorbed by the intestine, iron may also be administered intravenously.

Only use iron supplements if you have been diagnosed with a deficiency and have checked with your doctor. Excess iron consumption can be harmful, as it is thought to promote the formation of free radicals. If the levels of these substances become too high, they can cause oxidative stress. This is the name given to a metabolic situation that is associated with numerous diseases (such as cancer and cardiovascular conditions). In some cases, excess iron is also deposited in organs (iron storage disease).

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