Restoring Iron Levels

Replenishing Iron Stores

Yolandi Rademeyer R.D

For women 18 years and up the recommended daily intake is 27 mg – 32 mg /day

During pregnancy the recommended daily intake is 27 mg / day remains the same [1][2]

Iron comes in two forms, heme iron and non heme iron. Generally, heme iron is better absorbed than non heme iron.

Animal products = 40% heme + 60% non heme [3]

Plant foods = 100 % non heme



Heme iron and non-haem iron are both absorbed in the small intestine, but via different mechanisms. Because we have a limited ability to excrete excess iron, the body has prevention mechanisms for iron overload: Haem iron is absorbed through the gut wall in an intact form, regardless of how much we need. Non-haem iron absorption is more carefully controlled, as it is more readily absorbed when the body has need for iron.[4]


  • With non heme iron, the  absorption is regulated according to how much the body needs iron
  • Non-haem iron is nearly as well absorbed as haem iron by people with very low iron stores[4]
  • In pregnant women, who need the most iron, absorption can increase by 60% relative to normal [5][6]


There are three levels of iron deficiency, in increasing order of severity:

  1. Depleted iron stores
  2. Early functional iron deficiency
  • limits oxygen delivery to cells
  • resulting in weakness, fatigue,
  • reduced immunity
  • shortness of breath
  • sensitivity to cold
  • heart palpitations
  1. Iron deficiency anaemia (most common nutritional deficiency in the world)

           In pregnant women can result in: 

  • premature delivery
  • low birth weight in infants and higher infant mortality
  • delayed psychomotor development in infants and impaired cognitive function [7]


Causes of iron deficiency :

  • Other than the fact that as women we loose blood on a regular basis?
  • Gastrointestinal inflammation (eg, in Crohn’s disease or coeliac disease)
  • Gastrointestinal blood loss (eg, associated with colorectal cancer, aspirin use or genitourinary diseases)
  • Excessive intake of zinc (due to zinc supplementation)
  • There is a higher prevalence of iron deficiency in obese people
    • inadequate iron intake
    • higher blood volume
    • Chronic inflammation in obese people is associated with higher levels of hepcidin, which  downregulates intestinal iron absorption



Heme iron table1

non Heme iron table[8][9][10]




Habits to remember when trying to replenish iron levels:

  • Cooking in cast iron skillets (the longer the cooking process the higher the iron content of the meal will be)
  • Combining citrus / Vit C rich foods and iron foods
  • Taking Vit C supplements with meals high in iron


Habits that Inhibit iron absorption:

  • Tannins
    • Tea
    • Red wine
    • Coffee
    • Some berries (cranberries)
    • cacao
  • Calcium
    • Not combing dairy and iron foods
    • Not taking calcium supplements close to meals that are high in iron
  • Excess Zinc supplementation
    • Not taking high doses of zinc with meals high in iron



Iron supplements may be prescribed and should be taken according to the directions of the healthcare professional.

The above habits to avoid still applies for iron supplementation

Iron supplementation often cause constipation and can be taken with one of the following:

  • Prune juice (100%, no sugar)
  • Prunes

The following may be used to relieve constipation 

  • 2 tablespoons Ground flax & psyllium husk mixed in water
  • Magnesium citrate supplement




[2]National Health and Medical Research Council and New Zealand Ministry of Health. Nutrient reference values for Australia and New Zealand including recommended dietary intakes. Canberra: NHMRC, 2006. (accessed Apr 2012)

[3] Hurrell R, Egli I. Iron bioavailability and dietary reference values. Am J Clin Nutr 2010; 91: 1461S-1467S.

[4]Hunt JR. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003; 78 (3 Suppl): 633S-639S.

[5] Hunt JR, Roughead ZK. Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lacto ovo vegetarian diets for 8 wk. Am J Clin Nutr 1999; 69: 944-952.

[6] Whittaker PG, Barrett JF, Lind T. The erythrocyte incorporation of absorbed non-haem iron in pregnant women. Br J Nutr 2001; 86: 323-329

[7]Expert Rev Gastroenterol Hepatol 2008; 2: 287-290. 3 Food and Nutrition Board and Institute of Medicine. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: National Academy Press, 2001. http://www.nap. edu/openbook.php?record_id=10026&page=R1 (accessed Apr 2012).


[9]Food Standards Australia New Zealand. NUTTAB 2010 online searchable database. consumer information/nuttab 2010/nuttab 2010 online searchable database/online version.cfm (accessed Jun 2011)



Saunders et al . Iron and vegetarian diets. MJA Open 2012; 1 Suppl 2: 11–16 doi: 10.5694/mjao11.11494






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