Some people may find they are always low in iron or other iron markers like ferritin despite eating plenty of iron-rich foods.
There can be a few key interferences to iron absorption, such as aberrant iron metabolism genetic mutations, so if you’re running low, here are some tips to maximise absorption.
Why do we need iron?1
When we’re about five months old, our need or iron rises drastically, and between ages 1-6, the body’s iron content is doubled. Kids and teens have the greatest need for iron, especially during growth spurts.
Girls have a growth spurt before puberty, while boys have it during puberty, with iron need at this time above what an adult woman getting regular periods needs – that to say, a lot.
The body stores 1000-3000mg of iron, and this is tightly regulated, a delicate balance between what we take in from food and what we lose every day through mucosal surfaces, such as the digestive tract and vagina. We naturally lose about 1mg of iron each day. During menstrual bleeding, this loss increases to 2mg per day.
Even mild to moderate forms of iron deficiency can be linked with functional impairments. Less than optimal levels of iron can affect cognitive development, the immune system (important in vaginal and urinary tract infections), and our capacity to get out of bed, walk up a flight of stairs, and go about our lives.
Iron deficiency during pregnancy is a known issue for babies and mothers, with a greater risk of sepsis, low birth weight and other more serious outcomes, including learning disabilities.
Plant and animal forms of iron
There are two forms of iron – heme (from meat) and non-heme (from plants). Plant iron is harder to absorb compared with meat iron. Some elements in food inhibit both heme and non-heme iron at the site of uptake, such as calcium, while others only inhibit non-heme plant iron, such as polyphenols.2
Animal proteins such as casein (in dairy products like milk, cheese and yoghurt), whey, egg whites and plant proteins like soy inhibit iron absorption. Oxalates, found in spinach, chard, beans and nuts, also bind and inhibit iron absorption.2
Orange juice or vitamin C with food – increases3–8
Orange juice and vitamin C both increase uptake of iron, and vitamin C can overcome the effects of all dietary iron-absorption blockers when it’s included in a diet rich in non-heme (plant-based) iron.
Ascorbic acid (vitamin C) binds with iron in the acidic stomach, which continues to hold as the pair make their way to the alkaline environment further down in the intestine, where it can be absorbed.2
In this sense, promoting stomach acidity while eating is very useful; for example, don’t drink with meals (except a little orange juice!) and don’t overfill your stomach. Both cause stomach acid to be diluted, thus making it less effective.
Orange juice was found to increase iron absorption even more than vitamin C, so drink a small amount of good quality fresh orange juice with meals, especially meals containing high-iron foods, to increase uptake.
If you take an iron supplement, drink some orange juice or take vitamin C at the same time as your supplement. Vitamin C works well; 500mg is enough, but more won’t hurt.
Black tea – reduces9–11
Black tea inhibits iron absorption by about 80-90%, so to maximise iron absorption, drink black tea away from food by at least one hour.
Coffee – reduces9–11
Coffee inhibits iron absorption by about 40% if consumed during or after a meal containing iron for about an hour. Stronger coffee has a stronger impact, and drinking coffee before your meal doesn’t affect absorption.
Polyphenols – reduce9–15
Polyphenols found in plants inhibit iron absorption to varying degrees. For example, peppermint tea inhibits iron absorption by 84%, while chamomile tea by 47%.
Polyphenols are healthy plant compounds, and we need them, so the idea is not to cut them out but to tweak your ingestion to maximise iron absorption. Use the orange juice or vitamin C trick to increase non-heme (plant-based) iron absorption.
Coffee and tea are high in polyphenols, as are berries, herbs and spices, cocoa, nuts, cereals, flaxseeds, wine, legumes, fruit and vegetables.
Use this searchable list of high polyphenol foods. Don’t skimp on polyphenols – they are excellent for your health and are not to be avoided; however, if you’re eating foods high in iron, consider what is in the meal and its ability to inhibit iron absorption.
Genetic mutations
If you have certain genetic mutations that impact how your body absorbs iron. The iron-related genetic mutations are TF, HFE, TFR2, TMPRSS6, and SLC40A1. Some are related to haemochromatosis (excessive iron absorption), while others are related to insufficient iron uptake and distribution in tissues.8
Zinc – take at different times
Take zinc and other supplements away from any meal containing iron, as zinc can compete for absorption with other nutrients, including iron.16–19
Tips for supplementation with iron
If you are taking an iron supplement, take minimal doses and only every three days, as this will improve absorption. Uptake receptors become full, and the excess iron that is not absorbed travels through the digestive system, creating disruptions to gut flora and, therefore, the digestive process.20–22
Bacteria utilise iron, therefore having an excess in the digestive system can create an imbalanced ratio of microbes.23–27
If you are eating enough red meat, skip the iron supplement, and work on these other factors instead, as a large load of iron can have the opposite effect, and cause a reduction in uptake, in some people.
References3,28–30
- 1.Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(2):164-174. https://www.ncbi.nlm.nih.gov/pubmed/24778671
- 2.Ems T, St Lucia K, Huecker MR. Biochemistry, Iron Absorption. National Library of Medicine. Published 2024. https://www.ncbi.nlm.nih.gov/books/NBK448204/
- 3.Li N, Zhao G, Wu W, et al. The Efficacy and Safety of Vitamin C for Iron Supplementation in Adult Patients With Iron Deficiency Anemia. JAMA Netw Open. Published online November 2, 2020:e2023644. doi:10.1001/jamanetworkopen.2020.23644
- 4.Cade JE, Moreton JA, O’Hara B, et al. Diet and genetic factors associated with iron status in middle-aged women. The American Journal of Clinical Nutrition. Published online October 2005:813-820. doi:10.1093/ajcn/82.4.813
- 5.Shah M, Griffin IJ, Lifschitz CH, Abrams SA. Effect of Orange and Apple Juices on Iron Absorption in Children. Arch Pediatr Adolesc Med. Published online December 1, 2003:1232. doi:10.1001/archpedi.157.12.1232
- 6.von Siebenthal HK, Moretti D, Zimmermann MB, Stoffel NU. Effect of dietary factors and time of day on iron absorption from oral iron supplements in iron deficient women. American J Hematol. Published online June 26, 2023:1356-1363. doi:10.1002/ajh.26987
- 7.Skolmowska D, Głąbska D. Effectiveness of Dietary Intervention with Iron and Vitamin C Administered Separately in Improving Iron Status in Young Women. IJERPH. Published online September 20, 2022:11877. doi:10.3390/ijerph191911877
- 8.Kotze M, van V, van R, Erasmus R. Pathogenic Mechanisms Underlying Iron Deficiency and Iron Overload: New Insights for Clinical Application. EJIFCC. 2009;20(2):108-123. https://www.ncbi.nlm.nih.gov/pubmed/27683335
- 9.Ahmad Fuzi SF, Koller D, Bruggraber S, Pereira DI, Dainty JR, Mushtaq S. A 1-h time interval between a meal containing iron and consumption of tea attenuates the inhibitory effects on iron absorption: a controlled trial in a cohort of healthy UK women using a stable iron isotope. The American Journal of Clinical Nutrition. Published online December 2017:1413-1421. doi:10.3945/ajcn.117.161364
- 10.Nelson M, Poulter J. Impact of tea drinking on iron status in the UK: a review. J Human Nutrition Diet. Published online January 12, 2004:43-54. doi:10.1046/j.1365-277x.2003.00497.x
- 11.Fan FS. Iron deficiency anemia due to excessive green tea drinking. Clinical Case Reports. Published online October 5, 2016:1053-1056. doi:10.1002/ccr3.707
- 12.Ma Q, Kim E, Lindsay EA, Han O. Bioactive Dietary Polyphenols Inhibit Heme Iron Absorption in a Dose‐Dependent Manner in Human Intestinal Caco‐2 Cells. Journal of Food Science. Published online May 4, 2011. doi:10.1111/j.1750-3841.2011.02184.x
- 13.Xu T, Zhang X, Liu Y, et al. Effects of dietary polyphenol supplementation on iron status and erythropoiesis: a systematic review and meta-analysis of randomized controlled trials. The American Journal of Clinical Nutrition. Published online August 2021:780-793. doi:10.1093/ajcn/nqab068
- 14.Mascitelli L, Goldstein MR. Inhibition of iron absorption by polyphenols as an anti-cancer mechanism. QJM. Published online December 15, 2010:459-461. doi:10.1093/qjmed/hcq239
- 15.Speer H, D’Cunha NM, Botek M, et al. The Effects of Dietary Polyphenols on Circulating Cardiovascular Disease Biomarkers and Iron Status: A Systematic Review. Nutr Metab Insights. Published online January 2019:117863881988273. doi:10.1177/1178638819882739
- 16.Hunt JR, Beiseigel JM, Johnson LK. Adaptation in human zinc absorption as influenced by dietary zinc and bioavailability. The American Journal of Clinical Nutrition. Published online May 2008:1336-1345. doi:10.1093/ajcn/87.5.1336
- 17.Sian L, Hambidge K, Westcott J, Miller L, Fennessey P. Influence of a meal and incremental doses of zinc on changes in zinc absorption. The American Journal of Clinical Nutrition. Published online October 1993:533-536. doi:10.1093/ajcn/58.4.533
- 18.Casey CE, Walravens PA, Hambidge KM. Zinc absorption and plasma response. The American Journal of Clinical Nutrition. Published online July 1981:1443-1444. doi:10.1093/ajcn/34.7.1443
- 19.Couzy F, Kastenmayer P, Mansourian R, Guinchard S, Munoz-Box R, Dirren H. Zinc absorption in healthy elderly humans and the effect of diet. The American Journal of Clinical Nutrition. Published online November 1993:690-694. doi:10.1093/ajcn/58.5.690
- 20.von Siebenthal HK, Gessler S, Vallelian F, et al. Alternate day versus consecutive day oral iron supplementation in iron-depleted women: a randomized double-blind placebo-controlled study. eClinicalMedicine. Published online November 2023:102286. doi:10.1016/j.eclinm.2023.102286
- 21.Pasupathy E, Kandasamy R, Thomas K, Basheer A. Alternate day versus daily oral iron for treatment of iron deficiency anemia: a randomized controlled trial. Sci Rep. Published online February 1, 2023. doi:10.1038/s41598-023-29034-9
- 22.Stoffel NU, Zeder C, Brittenham GM, Moretti D, Zimmermann MB. Iron absorption from supplements is greater with alternate day than with consecutive day dosing in iron-deficient anemic women. Haematologica. Published online August 14, 2019:1232-1239. doi:10.3324/haematol.2019.220830
- 23.Abbas M, Hayirli Z, Drakesmith H, Andrews SC, Lewis MC. Effects of iron deficiency and iron supplementation at the host-microbiota interface: Could a piglet model unravel complexities of the underlying mechanisms? Front Nutr. Published online October 4, 2022. doi:10.3389/fnut.2022.927754
- 24.Yilmaz B, Li H. Gut Microbiota and Iron: The Crucial Actors in Health and Disease. Pharmaceuticals. Published online October 5, 2018:98. doi:10.3390/ph11040098
- 25.Rusu IG, Suharoschi R, Vodnar DC, et al. Iron Supplementation Influence on the Gut Microbiota and Probiotic Intake Effect in Iron Deficiency—A Literature-Based Review. Nutrients. Published online July 4, 2020:1993. doi:10.3390/nu12071993
- 26.Finlayson-Trick E, Nearing J, Fischer JAJ, et al. The Effect of Oral Iron Supplementation on Gut Microbial Composition: a Secondary Analysis of a Double-Blind, Randomized Controlled Trial among Cambodian Women of Reproductive Age. Zech Xu Z, ed. Microbiol Spectr. Published online June 15, 2023. doi:10.1128/spectrum.05273-22
- 27.Paganini D, Zimmermann MB. The effects of iron fortification and supplementation on the gut microbiome and diarrhea in infants and children: a review. The American Journal of Clinical Nutrition. Published online December 2017:1688S-1693S. doi:10.3945/ajcn.117.156067
- 28.Moustarah F, Daley SF. Dietary Iron. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Published 2024. https://www.ncbi.nlm.nih.gov/books/NBK540969/
- 29.Piskin E, Cianciosi D, Gulec S, Tomas M, Capanoglu E. Iron Absorption: Factors, Limitations, and Improvement Methods. ACS Omega. Published online June 10, 2022:20441-20456. doi:10.1021/acsomega.2c01833
- 30.Moretti D, Goede JS, Zeder C, et al. Oral iron supplements increase hepcidin and decrease iron absorption from daily or twice-daily doses in iron-depleted young women. Blood. Published online October 22, 2015:1981-1989. doi:10.1182/blood-2015-05-642223
Specially formulated probiotic for vaginal application to promote a healthy vaginal microbiome.
Unique, comprehensive BV, AV and 'mystery bad vag' treatment guide, one-of-a-kind system, with effective, innovative treatments.