If your GP has told you you’re anaemic and your iron is low, or you have been feeling more tired than your week explains, food is one of the first places to look. Iron deficiency is the most common cause of anaemia in Australia, and it is also one of the most diet-responsive. If you have low iron anaemia, the right foods, eaten in the right combinations, can carry a lot of the work, but not all of it.
01 . The basics
What iron deficiency anaemia is, and why iron matters
Anaemia is a state where your blood is not carrying enough oxygen for your body’s needs. The clinical marker is a low haemoglobin level, and the World Health Organization uses thresholds of 130 grams per litre for men, 120 for non-pregnant women, and 110 in pregnancy. The symptoms people notice first are usually fatigue, breathlessness on stairs, pale skin, brittle nails, and a tongue that feels sore or smooth.
Iron is at the centre of haemoglobin, a protein in red blood cells responsible for transporting oxygen from your lungs to the rest of your body. Without enough iron your bone marrow cannot keep up with red blood cell production. This is why iron deficiency is the most common cause of anaemia, both globally and in Australia. The link between being anaemic and your diet runs through every stage of how the body takes iron in, uses it, and loses it.
Iron is not the only nutrient involved. Vitamin B12 deficiency and folate deficiency can cause a different kind of anaemia, and the anaemia of chronic disease is a separate pathway driven by inflammation rather than what you eat. These are diagnosed by your GP and are beyond what diet alone can correct, but they are worth naming, because being anaeic or just seeing “anaemia” on a blood test can mean more than one thing.
02 . Who is most at risk?
Who is most at risk of developing anaemia?
Iron deficiency is not evenly spread across the population, and some groups are more affected than others. Iron deficiency is one of the leading contributors to ill health worldwide, and it particularly affects children and people who menstruate.
The patterns are mostly biological. People who menstruate lose iron with each cycle, and heavy bleeding can push the loss above what an average diet replaces. Pregnancy lifts iron needs sharply, because the developing baby and the rise in the mother’s blood volume both call on iron. Infants and toddlers in their fastest growth window can outpace what their diet supplies, especially after about twelve months as iron-fortified formula or breast milk gives way to family foods.
Other groups carry a higher risk for different reasons. People on plant-based diets take in non-haem iron only, which is absorbed less efficiently (more on that in the next section). Endurance athletes lose small amounts of iron through the gut, through sweat, and through faster red blood cell turnover. People with coeliac disease, inflammatory bowel disease, or a history of gastric surgery may absorb less iron whatever their intake. Frequent blood donors can also slip below the line if their diet does not keep up.
03 . What to eat
Haem and non-haem iron, and what to eat
Dietary iron comes in two forms. Haem iron is found in animal foods, red meat, poultry, fish, and offal, and the gut absorbs it efficiently. Non-haem iron is found in plant foods, legumes, wholegrains, nuts, seeds, dark leafy greens, tofu, and iron-fortified breakfast cereals, and its absorption is more variable. A useful working number from a bioavailability review is that mixed Western diets deliver about 14 to 18 per cent of their iron into the bloodstream, while vegetarian diets sit closer to 5 to 12 per cent, depending on what else is in the meal.
The practical point is not that plant-based diets cannot meet iron needs or impact anaemia, because they can. It is that the amount and the combinations of foods matter more. The five food groups in the Australian Dietary Guidelines are a good place to start, and iron-rich choices that combat the symptopms of being anaemic turn up across them:
- Lean meats, poultry, fish, eggs, legumes, tofu, nuts, and seeds. Red meat sits at the top of the haem list. Lamb, beef, and kangaroo are particularly iron-dense. Tinned sardines and tuna add a little, and eggs contribute modest iron. Among plant proteins, lentils, chickpeas, kidney beans, tofu, pumpkin seeds, and cashews carry the most.
- Wholegrain breads and cereals. Iron-fortified breakfast cereals (check the label) and wholegrain breads carry useful non-haem iron.
- Vegetables and legumes. Dark leafy greens such as spinach, silverbeet, and kale, plus broccoli and the legumes already mentioned.
- Fruit. Not a major iron source, though dried fruit such as apricots and prunes adds a little, and fruit brings the vitamin C question into the next section.
- Dairy. Not an iron source, and in fact dairy slows iron absorption when eaten in the same meal.
For most adults, an everyday pattern with a serve of lean protein or legumes at the main meal, wholegrains across the day, and a generous serve of vegetables will cover the iron needed. To improve iron levels and combat anaemia, consistency of consumption patterns matters more than any single food.
04 . Absorption matters
Helpers and inhibitors, and how absorption works
How much iron you absorb from a meal depends on what else is on the plate. The most useful helper is vitamin C. It keeps iron in a soluble form as the food moves from the acidic stomach into the less acidic upper small intestine, and it can noticeably lift the amount of non-haem iron the gut takes up from the same meal.
In practice, to improve your iron levels and combat anaemia, it is beneficial to pair iron-containing meals with a vitamin C source. Capsicum, broccoli, tomato, citrus, kiwi fruit, strawberries, and many other vegetables and fruit all qualify. A lentil and vegetable curry with tomato. A bowl of cereal with strawberries. A stir-fry of tofu, capsicum, and broccoli. The amount does not need to be large, a single piece of fruit or a good handful of vegetables alongside the iron-rich food is enough to make a difference.
The other half of the picture is the inhibitors, or the foods/drinks that reduce you iron intake. Tea and coffee contain tannins that bind non-haem iron and reduce how much you absorb when you drink them with the meal. Calcium-heavy meals, such as a large glass of milk or a high-cheese dish, compete with iron for absorption. Phytates in unprocessed wholegrains and legumes also bind iron, although soaking, sprouting, fermenting, and cooking all reduce them.
The simplest absorption strategy has two parts: put a vitamin C source on the iron plate, and move tea or coffee to between meals rather than with them.
The strategy is timing rather than going without. You do not need to give up tea or dairy. Shifting them out of the iron-containing meal by an hour either side is usually enough. People on plant-based diets, or those who are anaemic, benefit most from being deliberate here, because non-haem iron is the only form on the plate.
05 . Next steps
When food alone is not enough
Diet does a lot of the work in combating anaemic symptoms and low iron status, but it does not do all of it. If your iron stores have dropped far enough to show up as anaemia on a blood test, food alone is usually not the fastest way back to normal. A common pattern in Australian general practice for anaemia, is a course of oral iron supplements alongside dietary change, with the dose, the form, and the length set by your GP based on your blood results and how you tolerate the tablets.
Iron supplements should not be self-prescribed. Too much iron is harmful, particularly in conditions like haemochromatosis, where iron builds up in the body, and taking iron without a diagnosis can also hide the real cause of the anaemia. If you suspect low iron, the first step is a GP visit for a full blood count and a ferritin test.
The split between professions is straightforward. Your GP orders the blood tests, makes the diagnosis, prescribes any supplements, and investigates the underlying cause if the picture does not fit. Your Accredited Practising Dietitian at Optimum Health Solutions helps build up your iron levels to combat anaemia by working with you to build eating patterns that keep the deficiency from coming back once a supplement course finishes. This personalised dietry program works with your real situation, whether you eat meat or not, are pregnant or not, on a budget, feeding a fussy toddler, or managing coeliac disease.
A good time to book a Dietetics appointment is after a GP visit that has confirmed you are anaemic, have low iron or low ferritin, when you are planning a pregnancy, when you are moving towards a plant-based diet and want to keep your iron intact, when a child’s eating has narrowed, or when you in remission from an episode of iron deficiency anaemia and want the eating pattern that keeps it from returning. If your situation also touches type 2 diabetes or metabolic health, our companion guide on Dietetics and Exercise Physiology for type 2 diabetes covers coordinated care.
You do not need a referral to book Dietetics. A Medicare GP Chronic Condition Management Plan can cover some sessions if you qualify, and NDIS, the Department of Veterans’ Affairs, or private health funding may also apply. Our reception team can check what is available for your situation.
References
- Hurrell and Egli, 2010. Iron bioavailability and dietary reference values. American Journal of Clinical Nutrition, 91(5), 1461S-1467S. DOI: 10.3945/ajcn.2010.28674F. (According to PubMed.)
- Lynch and Cook, 1980. Interaction of vitamin C and iron. Annals of the New York Academy of Sciences, 355, 32-44. DOI: 10.1111/j.1749-6632.1980.tb21325.x. (According to PubMed.)
- Pasricha and colleagues, 2021. Iron deficiency. The Lancet, 397(10270), 233-248. DOI: 10.1016/S0140-6736(20)32594-032594-0). (According to PubMed.)
- Camaschella, 2015. Iron-deficiency anaemia. New England Journal of Medicine, 372(19), 1832-1843. DOI: 10.1056/NEJMra1401038. (According to PubMed.)
- National Health and Medical Research Council, Australian Dietary Guidelines. Eat For Health.
- Dietitians Australia. National peak body for the Dietetics profession in Australia.
- RACGP. Royal Australian College of General Practitioners, iron deficiency resource.
