(Even When You Eat Well)

There’s a common belief that iron deficiency anaemia is just a dietary issue.
Not eating enough red meat? That must be the cause.

But here’s the reality: many women face this problem again and again. They increase iron in their diet, maybe take supplements, yet their blood tests barely improve. Frustrating, isn’t it?

Let’s look at the possible causes first—and then I’ll share practical steps to actually move the needle.

Possible Causes: Dietary factors

Dietary reasons are the most obvious—and always the first thing to rule out. Quite simply, not enough iron in the diet can cause anaemia. There are two main types of dietary iron:

Heme iron (animal sources): found in red meat, liver, poultry, and fish. This form is absorbed much more efficiently by the body—and it even helps your system absorb non-heme iron from plant foods.
Non-heme iron (plant sources): found in lentils, chickpeas, beans, tofu, tempeh, spinach, kale, pumpkin seeds, quinoa, broccoli, and dried apricots. Non-heme iron is valuable, but it needs a little help—proper preparation and correct pairing.

A sensible reminder: too much heme iron can backfire, contributing to oxidative stress and upsetting gut balance. Red meat once every week or two is plenty—choose organic, grass-fed where possible.

And don’t forget about vitamin B12. It’s often overlooked, but without B12 (and folate), your body simply cannot build healthy red blood cells—no matter how much iron you eat.

Hormonal health

Heavy periods are one of the most common causes of low iron in women. Each cycle can drain iron stores faster than they’re replaced.
Thyroid imbalance often worsens heavy bleeding.
If hormones aren’t addressed, iron will keep slipping despite diet and supplements.

Gut health

Pathogens such as H. pylori, E. coli, Klebsiella, parasites (giardia, hookworm), or bacterial overgrowth (SIBO) can literally feed on iron and fuel inflammation.
Inflamed or “leaky” gut lining reduces absorption—not only of iron but also B12 and other nutrients.
So you may be eating well, but the iron never gets where it’s needed.

Symptom Spotlight: Iron vs B12 Deficiency

Both deficiencies can cause anaemia, but symptoms aren’t identical:

Low Iron: fatigue, pale skin, brittle nails, hair loss, breathlessness, restless legs, cravings for ice.
Low B12: fatigue with brain fog, tingling hands/feet, mood changes, memory issues, sore tongue, balance problems.

Often, both iron and B12 are low together, especially if absorption is impaired.

What’s Considered Low?

Ferritin (iron stores): <30 µg/L often depleted; women usually feel best 50–100 µg/L.
Haemoglobin (Hb): women <120 g/L (12 g/dL) = anaemia.
Vitamin B12: <200 pg/mL = deficient; 200–350 pg/mL = grey zone.
Folate: <4 ng/mL typically low.

What to Do

Correct the diet

Eat 1–2 iron-rich foods daily.
- Heme: small amounts of red meat (weekly/fortnightly), liver, poultry, fish.
- Non-heme: lentils, beans, tofu, tempeh, cooked spinach, kale, seeds, quinoa, broccoli, dried apricot.
Why soak legumes and grains? Soaking them for 8–24 hours reduces phytates—natural compounds that bind minerals like iron, zinc, and magnesium. This makes iron far more bioavailable (usable by your body).
Pair with vitamin C: citrus, peppers, berries, guava, broccoli, kale. A squeeze of lemon juice on salads goes a long way.
Daily B12 sources: nutritional yeast, seaweed, shiitake mushrooms, liver, fish, chlorella powder.
Supportive teas:
- Nettle tea – naturally rich in iron and vitamin C, a traditional tonic for low iron.
- Dandelion tea – supports the liver, which plays a key role in hormone balance and iron storage.

Consider supplements

Iron bisglycinate – chelated iron, gentle, well absorbed.
Ferrous citrate – well absorbed and generally tolerated well.
Ferrous fumarate / gluconate – well absorbed but may inhibit the absorption of vitamin E.
Liquid irons – good for dose flexibility and sensitive digestion.

💡 Take iron with vitamin C, away from dairy, tea, or coffee.

Support hormones

Yarrow tea – traditionally used to reduce heavy menstrual flow.
Peppermint tea – soothing, and shown in some studies to support hormonal balance (especially with PCOS).
Magnesium – eases PMS and supports progesterone.
Agnus Castus (Vitex) – supports cycle regularity.
Seed cycling – using flax, pumpkin, sunflower, sesame seeds through the cycle.
Cruciferous vegetables (broccoli, Brussels sprouts, kale, cauliflower) – support the liver in metabolising excess oestrogen.
Low GI diet – stabilises blood sugar, which in turn supports hormone health.

Heal the gut

Consider a comprehensive stool analysis with a Nutritional Therapist to check for pathogens, parasites or dysbiosis.
Remove pathogens if they are present, and then focus on soothing and restoring the gut lining.

Some gentle, natural ways to support gut healing include:

Liquorice root (DGL form): calms inflammation in the stomach lining.
Marshmallow root: coats and soothes irritated mucosa.
Aloe vera juice: helps reduce gut inflammation and supports healing.
Slippery elm: forms a protective layer along the gut lining.
L-glutamine: an amino acid that supports repair of the intestinal wall.
Probiotics & fermented foods: help restore a balanced microbiome after clearing pathogens.
🌿 Working with a Nutritional Therapist can help you decide which of these are right for you, and in what order—since if pathogens are present, they need addressing first before the rebuilding begins.

Reducing gut inflammation and repairing the lining helps iron and B12 absorption return to normal.

Manage stress

Stress disrupts digestion, absorption, and hormone balance.
Gentle practices—daily walks, breathwork, prioritised sleep, and steady meals—support your whole system.

The Heart of the Matter

If your iron isn’t improving, it’s rarely just about diet.
Anaemia is your body’s signal that something deeper is out of balance.

With the right mix of nutrient-dense food, supportive supplements, hormone care, gut healing, and stress management, you can restore your iron and reclaim your energy.

You don’t need to push harder or eat more steak—you need to uncover the underlying cause.

And remember: working with a Nutritional Therapist can be truly helpful here. It sometimes takes longer than we expect, and it often means making changes in your lifestyle and diet. But that deeper, step-by-step work is what brings lasting results—not just a quick fix.

With love, Lana xx

Why Your Iron Stays Low