Iron deficiency


English: iron deficiency

Iron deficiency or Sideropenia means a lack of iron in the human body, which can be caused by various causes and usually runs without symptoms. If symptoms of iron deficiency occur before anemia (anemia), one speaks of Sideropenia. Depending on the symptoms and blood values, a distinction is made between different forms of iron deficiency. A latent iron deficiency means reduced iron without changes in the blood count, while a manifest iron deficiency is accompanied by changes in the blood cells and requires therapy.

You might also be interested in this topic: Iron in the human body

Epidemiology / frequency distribution

Iron deficiency is one of the most common deficiency diseases. Worldwide approx. 25% of the population under this deficiency disease. In Europe about 10% of women of childbearing age are affected, in developing countries> 50% of women. In addition, iron deficiency accounts for around 80% of all anemia (anemia).

Symptoms of iron deficiency

Subtle iron deficiency does not necessarily cause symptoms that can be felt directly and only manifests itself in the blood as a reduced ferritin level (latent iron deficiency).However, there are a variety of different signs that can indicate a deficiency early on, before the full picture develops.
Kick frequently

  • Difficulty concentrating
  • a headache
  • emotional irritability
  • depressive moods
  • persistent fatigue
  • Exhaustion
  • Burning at the tip of the tongue

on. In this context, physical fitness can also be impaired. There may also be a limited tolerance to cold. Other possible early signs can be found in the area of ​​the skin and mucous membranes. These include burning tongue, defects in the mucous membrane (e.g. canker sores in the mouth), angular rhinitis (small, inflammatory tears in the corners of the mouth), difficulty swallowing, but also brittle and deformed nails (in particular transverse grooves, upwardly curved watch glass nails or hollow nails sunk in the shape of a hollow) and hair that is falling out .

Read a lot more and extensive information on all symptoms under our topic: Recognize symptoms of iron deficiency and iron deficiency on the fingernail

Iron deficiency dizziness

A typical symptom that corresponds to an iron deficiency is non-specific vertigo, so-called postural vertigo. The iron deficiency leads to anemia, the iron deficiency anemia described above.

Read more about this under: Anemia due to iron deficiency

The reduction in the oxygen-carrying capacity in the blood results in relatively unspecific symptoms, especially dizziness. Iron deficiency anemia should always be ruled out, especially if dizziness is unclear.

Read more about this under: Dizziness from iron deficiency

Hair loss

Iron is also an important nutrient for the metabolism of the hair.
In the case of a slight iron deficiency, the remaining reserves are preferably used for vital functions, i.e. the formation of hemoglobin for the purpose of transporting oxygen in the body, so that hair (and nails) can quickly become undersupplied.
Hair loss and brittle, brittle hair can be an early sign of iron deficiency that occurs before other typical symptoms such as Anemia and fatigue are clearly noticeable.

However, since there are many other possible reasons for hair loss, the cause should be clarified at the first signs of hair loss, before simply resorting to iron tablets when suspected (because an excess of iron can also have a negative effect).
For clarification, especially the ferritin value (Storage form of iron) in the blood, as this, in contrast to the other iron values, can be reduced even with a slight, "hidden" iron deficiency.

Hair loss caused by iron deficiency can be easily treated by simply compensating for this deficiency. By changing your diet and / or taking suitable preparations, hair growth can be restarted.

Read everything about the symptoms under our topic: Symptoms of iron deficiency, hair loss due to iron deficiency

a headache

Headaches are one of the most common illnesses in Germany and have many different causes. With iron deficiency, headaches are mostly secondary and cannot be directly explained by the deficiency.

Iron deficiency leads to difficulty concentrating and sleeping, which can lead to headaches. In addition to these secondary disorders, those affected can also suffer from headaches such as migraines, regardless of their iron deficiency.

After successful treatment of the iron deficiency, those affected can sleep better again and are able to concentrate during the day, which often also reverses the headache. In the case of a known migraine, attacks of iron deficiency can occur more frequently, but this is more likely to be attributed to the lack of sleep than to the iron deficiency itself.

In the event of sudden, unusually severe headache or in combination with a fever, a doctor should be consulted, as the cause is not iron deficiency anemia but can be an emergency.

Also read: Cause of headache, headache from iron deficiency


Fatigue is a very common symptom of iron deficiency. Since iron is required for blood formation and thus for the oxygen supply to the body, an iron deficiency can lead to an overall weakness of the body. Those affected report fatigue and sleep disorders more quickly, which also lead to daytime sleepiness.

Fatigue is also the symptom that restricts those affected the most in everyday life and therefore often leads to a doctor's visit. After starting therapy, many sufferers report a very rapid improvement in fatigue and feel more productive overall.


With many chronic illnesses that lead to a restriction in everyday life, depression occurs in the course of the illness. Chronic iron deficiency anemia is associated with impaired concentration and decreased performance. Affected people often cannot keep up with their circle of friends and cannot always go about their work.

This leads to social isolation and can thus trigger depression. Iron deficiency can make postpartum depression more likely, especially after giving birth. If the iron deficiency is corrected, the depression can also be reduced. However, those affected should contact a specialist, especially if symptoms persist.

Change on the nails

The fingernails and toenails are among the first parts of the body to change when there is an iron deficiency. This can be explained by the fact that the body has priorities which cells need to be supplied more urgently and in the case of an oxygen deficiency due to an iron deficiency anemia, the nails are not necessary for survival.

The cells that make up the nail are poorly supplied and the nails that grow back become brittle and thinner. Grooves and cavities in the nails are also possible. Even after the iron deficiency has been remedied, it will still take a few months for the slowly growing nails to fully recover.

Change in the tongue

Changes in the mucous membranes, especially on the tongue, are a specific symptom of iron deficiency, but they do not appear until the disease progresses and are not among the early symptoms.

Inflammations at the corners of the mouth, so-called rhagades, and increased canker sores of the oral mucosa are possible. There may also be a breakdown of the oral mucosa with difficulty swallowing, which is summarized as Plummer-Vinson syndrome. Those affected report tingling or numbness of the tongue. The symptoms are completely reversible if the iron deficiency treatment is successful.

Muscle pain and weakness

Iron deficiency leads to an energy-saving mode of the cells in the whole body, as these cannot be adequately supplied with oxygen. Muscle cells require a comparatively large amount of oxygen to maintain their function and to build new cells.

If there is a lack of oxygen, muscle cells then break down. This is where the body saves energy, especially when those affected no longer carry out their sporting activities due to fatigue and the muscles are less needed. Muscle weakness is also reduced when the iron deficiency is corrected.


Skin cells renew themselves relatively often and cells need a lot of energy when they are re-forming and growing. Since iron deficiency leads to a lack of oxygen, particularly short-lived cells show symptoms quickly.

The skin is poorly supplied and individual skin cell layers die. This leads to itching. Inflamed areas of the skin, such as the cracks in the corners of the mouth, can also be very itchy. Caring for irritated areas of the skin with fragrance-free skin care creams can relieve itching. Damage to the skin and mucous membranes is one of the late symptoms of severe iron deficiency.

Visual disturbances

Visual disturbances are also not a direct consequence of iron deficiency, but can occur secondary. This is usually not direct damage to the eye or retina.

Because of the iron deficiency, those affected can have fluctuations in blood pressure and dizziness, which can also lead to a blurred field of vision. In addition, some sufferers interpret their concentration disorders as a visual disorder, since the letters in front of the eyes are subjectively blurred.

High pulse / racing heart

If there is an iron deficiency, there is an insufficient supply of oxygen throughout the body, as the body cannot produce enough blood to carry the oxygen. Since the target cells cannot differentiate why not enough oxygen is arriving, they always respond to the body with the same information.

Too little oxygen is compensated for by pumping the blood faster through the body and thus more oxygen charges reach the cells. This means that the heartbeat needs to get faster as this is crucial for blood flow. Those affected feel this as a racing heart.

Iron deficiency anemia

Iron deficiency anemia is the most common form of anemia (anemia) and is caused by a lack of iron. The red blood pigment (hemoglobin) in the red blood cells (erythrocytes) iron is needed to fulfill its function as an oxygen transporter in the body; if too little iron is available, this function is restricted and not enough hemoglobin can be provided.
In the laboratory, in addition to a reduced hemoglobin level in the blood, a reduced size of the erythrocytes (MCV = mean single volume of erythrocytes) and a decreased hemoglobin content in these (MCHC = mean corpuscular hemoglobin concentration). In this context one speaks of a microcytic, hypochromic Anemia.
At the same time, the iron deficiency in the blood is shown by a reduced concentration of both free iron and ferritin (Storage form of iron), but also due to an increased transferrin value (Transport protein for iron, which is more detectable when it has bound less iron).
If iron deficiency anemia has been diagnosed, it is important to identify the cause of the iron deficiency in order to be able to treat it accordingly.
An increased need (e.g. during pregnancy), an increased loss (e.g. over Bleeding), an inadequate diet or impaired iron absorption (e.g. in various gastrointestinal diseases).
Only when the body's iron stores are used up does the iron deficiency lead to anemia.

Read more on the topic: Iron deficiency anemia


Since iron deficiency in itself is only a secondary disease of other causes, special emphasis must be placed on finding and treating the original disease. For this reason, in order to diagnose iron deficiency, the patient must be thoroughly interviewed. Chronic diseases, pregnancy and an increased tendency to bleed in women during menstruation should initially be excluded. In addition, the blood test provides important information about the stage of iron deficiency.

  • A distinction can be made between a latent iron deficiency, which often does not initially require therapy, and a manifest iron deficiency. As this results in changes in the blood cells, it is important to take medical action and replace iron.

An abdominal ultrasound should be performed to rule out any suspicion of internal bleeding.
Blood in the stool is also an important indicator of bleeding in the gastrointestinal tract.

Read more on the topic: Blood in the stool

A colonoscopy (Colonoscopy ), Chest x-ray (thorax) and a close look at the esophagus, stomach and small intestine will reveal or rule out causes of bleeding.

To diagnose a disorder of iron absorption in the body, an iron absorption test can be done. 100 mg of iron are taken orally. The serum iron is measured after 2 hours. An increase in serum iron to twice the initial value is normal.

Iron Deficiency Test

There are various tests to diagnose iron deficiency as quickly as possible. Tests can be purchased online, at a pharmacy, or at a doctor's office.


Since iron deficiency is initially a finding, but not a cause (see also: cause of iron deficiency), this should first be recognized and treated in order to compensate for the iron deficiency in the long term. Nevertheless, at the same time, the iron deficiency is remedied by medication, provided that it is not enough to compensate for the deficiency with daily food. Iron is substituted in the form of tablets. These should be taken 1-2 hours before the next food intake, as iron can be better absorbed by the body in an empty state. A daily dose of 100-150 mg iron / day is recommended for adults.

Another option is the over-the-counter Floradix® that can be consumed as a liquid. Read more on this topic at: Herbal blood

Iron supplements can cause abdominal pain and nausea, among other things. If these side effects occur, a different preparation can be tested, as the different preparations are tolerated differently in individual cases, and the dose can be reduced initially. If the side effects persist, the drug can also be taken during or after a meal. The absorption in the organism is then no longer optimal, but the preparation is better tolerated. In addition, the stool turns dark during iron therapy because most of the iron is excreted. Because the iron stores in the body are only slowly replenished, this type of treatment often has to last for at least 2-3 months.

It is also possible to deliver iron directly through the vein. This type of substitution is only carried out if oral administration is not tolerated. Therapy should then take place 2-3 times a week and can lead to pain and swelling at the injection site. To avoid excessive venous irritation, administration should be carried out slowly through a large venous cannula. Anaphylactic reactions to iron are rare, but doctors should be prepared for such a reaction.

Overdosing can lead to severe symptoms of intoxication. In small children, 500-1000mg are enough to cause symptoms of poisoning, 2000-3000mg can be fatal. This level can be found in around 20-30 tablets. As a result, children are particularly at risk of overdosing, since access to the appropriate number of tablets is relatively easy. The first signs of an overdose are fever, nausea, drop in blood pressure and vomiting.

The hemoglobin concentration should have reached its normal value after 2 months at the latest, serum ferritin after 3 months. If this is not the case, various options can be considered. On the one hand, it is possible that the prescribed preparations were not taken properly, that blood loss continues, that absorption into the organism is disturbed or that a wrong diagnosis has been made. In any case, a new search for the cause is necessary in order to avoid more serious diseases.

Due to mutual absorption disorders, iron tablets should not be used at the same time as:

  • Antibiotics (Tetracyclines)
  • Antacids (to neutralize the Stomach acid)
  • Colestryamine, a resorption inhibitor for high cholesterol levels.

Also read the article on the topic: This is how you fix an iron deficiency and Diet for iron deficiency

Herbal blood

Many herbs contain a very large amount of iron. Herbal blood is a juice made from various herbs and added bivalent iron. The human body can utilize bivalent iron particularly well.

  • Herbal blood can therefore be taken as a prophylaxis if there is a threat of iron deficiency or a slight iron deficiency.
  • If the iron deficiency is severe, however, iron tablets are required.

Risk groups who often receive herbal blood for prevention are pregnant women, breastfeeding mothers and people who follow a vegetarian or vegan diet.

Homeopathy as a therapy option?

Iron deficiency is a measurable deficiency in the blood and this can only be compensated for by getting iron either through food or medication.

Globules and other alternative substances hardly contain iron and therefore cannot compensate for the deficiency. If conventional medical iron substitutes are rejected, those affected should be advised which foods contain a lot of iron so that the deficiency can be compensated for through diet.

Please also read: Homeopathy for iron deficiency

Long-term consequences of iron deficiency

Iron deficiency brings a variety of symptoms, with most of the symptoms resolving once the iron deficiency is corrected. Since iron is required for blood formation, a deficiency leads to an insufficient supply of oxygen to the whole body. Sufficient oxygen supply for cells in growth is particularly important. In the case of iron deficiency, the lower blood formation is compensated for by the heart beating faster.

  • Those affected with chronic iron deficiency anemia can therefore develop heart muscle weakness in the long term, as the heart cannot meet the requirements in the long term.

Long-term consequences of iron deficiency also show up in pregnancy.

  • The oxygen supply to the unborn child is directly dependent on the oxygen supply to the mother. A maternal iron deficiency can therefore lead to growth disorders and premature births.
  • Brain development also depends on an adequate supply of oxygen during pregnancy and can be delayed or inhibited by iron deficiency.
  • Mothers with iron deficiency are more likely to have postpartum postpartum depression than mothers with an adequate iron supply. Short-term iron deficiency usually has no long-term consequences.


By balanced and rich in iron nutrition deficiency symptoms can be avoided. A lot of iron is found in parsley (97.8mg iron / 100g), spearmint, dried Nettles, Pork liver and thyme. In comparison, there is relatively little iron in poultry, pork, beef and whole-grain bread. In addition, the iron absorption in the body can be increased vitamin C Improve intake. Here about 100mg are sufficient vitamin C which should be taken no more than 1 hour before iron intake, as the vitamin C must still be in the digestive tract. 100mg of vitamin C are e.g. contained in 200ml freshly squeezed orange juice or a few strips of paprika. But others too fruit and vegetables can improve iron absorption in the body.

Tannin has an inhibiting and therefore counterproductive effect in the case of iron deficiency black tea and coffee is contained, calcium and magnesium in larger amounts, oxalic acid e.g. in cocoa, spinach and rhubarb and phosphates in meat and cheese.

The most important sources of iron in everyday life are meat, sausage and liver. Milk and eggs, on the other hand, inhibit absorption. At vegetarian diet Iron can be ingested from legumes, nuts, spices and whole grains.

Since pregnant women have a 100% higher iron requirement, the normal intake with food is often insufficient to avoid iron deficiency. Therefore, 50 mg iron / day should be taken preventively during pregnancy.

Read more on the subject at: Foods with iron


The prognosis of iron deficiency is directly related to the cause. If it is possible to cure the causal disease, it is likely that the Iron deficiency can be fixed.

Iron Deficiency During Pregnancy

For the child to have adequate blood circulation and development, women must produce approx. 30-40% more blood during pregnancy.
Since for blood formation in general If iron is required, the iron requirement increases significantly during pregnancy, about twice as much, so that there is an increased risk of iron deficiency.

Women with multiple pregnancies or pregnancies in rapid succession are particularly at risk, but low body weight and an unbalanced diet are also risk factors. The anemia that may be caused by the iron deficiency (anemia) presents other dangers during pregnancy in addition to the usual symptoms, both for the mother and for the child.

Read more on this topic at: Iron Deficiency During Pregnancy

The baby can be through a poorer oxygen supply on the other hand, it can be that the placenta (placenta) not fully developed.
If this is too small, a sufficient supply of the child with important nutrients is no longer guaranteed. Ultimately you can Stunted growth or intrauterine infant death (i.e. within the uterus, even before birth) may result.

In addition, there are certain risks for the child's development after birth, e.g. motor development disorders, mental retardation or Behavioral problems.
The mother generally shows a lower physical resilience and has reduced blood reserves at birth, so the risk for necessary Blood transfusions is increased.

Other possible consequences are pre-eclampsia (a clinical picture with, among other things, high blood pressure and protein loss via the urine) or a Pelvic inflammation.
All of these circumstances can lead to more frequent and / or longer hospital stays.

But iron deficiency alone without accompanying anemia can already be responsible for various complications. These include premature labor, premature birth and a low birth weight.
Since the body gives preference to the iron available to the baby during pregnancy, the deficiency in the mother exists long before it manifests itself in the child. The German Nutrition Society (DGE) therefore recommends a daily iron intake of 30 mg for pregnant women, 20 mg for breastfeeding women (in contrast: non-pregnant adults approx. 10-15 mg). During pregnancy (especially from the second trimester) it is particularly important to have adequate intake ferrous foods to be careful, preferably in combination with vitamin C (e.g. a glass of orange juice), as this improves absorption in the body.
However, the simultaneous use of substances that inhibit iron absorption should be avoided; these include Calcium supplements, Antacids (gastric acid binding agents) and certain Antibiotics (Tetracyclines).
Routine checks during pregnancy also check the blood for iron deficiency (i.a. Ferritin) and anemia (i.a. hemoglobin) examined. Conspicuous values ​​should always be clarified with regard to the causes. If the hemoglobin value is below 10 mg / dl, in general from one High risk pregnancy the speech.

If there is still an iron deficiency even with a balanced diet, additional Iron tablets be taken. However, this therapy must be over several months can be maintained and various side effects, especially Gastrointestinal complaints have as a consequence.
Some pregnant women take such iron supplements as a precaution without any abnormal blood values, which, however, does not have to be recommended in principle.
Alternatively, a intravenous administration should be considered (especially with a Hemoglobin value below 9 mg / dl), with which very high doses can be administered in a short time without hitting the stomach and intestines at the same time.

The procedure for iron deficiency during pregnancy should always be discussed individually with the attending physician; there are no general therapy recommendations in Germany so far.

Iron deficiency in children

Iron deficiency is also a common deficiency symptom in childhood. Around one in ten children has at least mild symptoms of iron deficiency. Since cells have a particularly high oxygen requirement during growth, the iron requirement also increases significantly in growth phases.

  • The first critical phase for a child's iron deficiency is in the first and second year of life. The child grows very quickly during this time and brain development is also in full swing. However, the iron content of breast milk continues to decrease after the birth, so that the children are dependent on additional iron-rich food at around six months.
  • The second phase of increased iron requirements begins with the onset of puberty. In addition to rapid development, girls also have their first menstrual period and thus regular blood loss, which the body has to compensate for.

The symptoms of iron deficiency in children are similar to symptoms in adults.

  • The early symptoms are usually hair loss and brittle fingernails
  • Later it comes to paleness, difficulty concentrating and tiredness.

Particularly in childhood and adolescence, a balanced diet should be observed in order to counteract iron deficiency and prevent the consequences of a deficiency. Particularly in young girls who follow a vegetarian diet, a medical supply of iron may be necessary until growth is complete.

Read more on the subject at: Iron deficiency in the child

Iron deficiency in vegetarians

A distinction is made between two different forms of iron in food: the so-called heme iron contained exclusively in foods of animal origin and the so-called non-heme iron, which is not only, but mainly, found in vegetable food.
The heme iron (bound to animal hemoglobin) can be used to a greater extent by the human body (higher bioavailability) than the non-heme iron, i.e. From the heme iron, more iron can be absorbed by the body with the same amount.

(Ovo-lacto-) vegetarians and vegans have to cover most or all of their iron requirements with plant-based foods. Apart from the fact that iron deficiency is often linked to genetic predisposition or other causes, a vegetarian / vegan diet does not necessarily lead to an iron deficiency.
Many plant-based foods, such as various types of grain (Millet, amaranth etc.), Pumpkin seeds, sesame seeds, lentils or peaches contain large amounts of iron. The poorer usability of this iron can be compensated on the one hand by a larger total amount of iron supplied, on the other hand by a balanced, sensibly combined diet.
E.g. the simultaneous intake of vitamin C (in many fruits and vegetables) or fermented soy products significantly increase the iron availability of non-heme iron, while phytates (in legumes and raw cereals), Tea, coffee, milk, egg and soy proteins inhibit iron absorption.

Are you interested in this topic? Read more about this at: Iron deficiency in vegetarians

Iron deficiency in stress

Not only is stress a psychological phenomenon, it also has many accompanying physical symptoms. This does not directly trigger an iron deficiency, but stress leads to an increased need for oxygen in the body and thus to symptoms similar to those of a mild iron deficiency.

In the event of permanent stress, digestion can also be restricted and thus the absorption of iron in the intestine can be reduced. In addition to these direct physical causes, however, stress also leads to poorer nutrition for many people and the iron content of the food decreases.

Read more on this topic at: Consequences of stress

Iron deficiency after surgery

In many cases, operations mean a loss of blood to the body. Iron is absolutely necessary for blood formation, so that iron requirements may be higher after operations.

After the loss of blood, the body uses the body's own iron reserves to increase hemoglobin formation and has to replenish these stores. In most cases, this iron deficiency can be quickly remedied through diet alone.
Read more at: Foods with iron

After operations with high blood loss, including childbirth, iron substitution with herbal blood or tablets may be necessary.

Ferrous foods

Iron deficiency can often be prevented or treated with a balanced diet alone. Various foods contain particularly high levels of iron, although spinach, the alleged iron king, contains an average amount of iron.

  • Animal products contain a particularly large amount of iron. Beef liver and pork liver top the list.
  • Egg yolks also have a high iron content.
  • Vegetarian foods can also be high in iron. These include, in particular, white beans, chanterelles and lentils, as well as wheat bran.

In addition to an adequate intake of iron, attention should also be paid to the adequate intake of vitamin C. Vitamin C, if taken at the same time as iron-containing foods, can improve the absorption of iron in the intestine. However, a reduced absorption in the intestine can also be caused by various foods.

  • Coffee, black tea, milk, red wine and white flour reduce iron absorption and should therefore be avoided in the event of iron deficiency. These foods should be left out or at least not consumed at the same time as the tablets, especially in the case of additional drug therapy with iron tablets.

Also read: Diet for iron deficiency