Iron Deficiency: Hiding in Plain Sight

Author: Gerald Cheruiyot

Reviewed by: Dr Kathy Martyn, Sarah Anderson

One in four people worldwide is living with anaemia. According to the World Health Organization, approximately 25% of the global population is affected, with iron deficiency accounting for around half of all cases. Among women, the burden is even greater, affecting an estimated 31% globally compared with around 18% of men.

Despite its scale, iron deficiency rarely receives the attention it deserves. Public conversations often focus on vitamin D, protein intake, and the latest wellness trends, while one of the world's most common and readily treatable nutritional deficiencies continues to affect billions of people. Iron deserves a far more prominent place in discussions about health and nutrition. 

The Warning Signs We Too Often Dismiss 

Iron plays a vital role in human health. It is a key component of haemoglobin, the protein in red blood cells that transports oxygen throughout the body. When iron stores become depleted, oxygen delivery is compromised, affecting multiple organs and systems. 

The symptoms often develop gradually. Persistent fatigue, shortness of breath, reduced concentration, headaches, dizziness, and pale skin are among the most common signs. Yet many people, particularly women, come to regard these symptoms as a normal part of everyday life rather than indicators of an underlying deficiency. 

This normalisation is concerning. Iron deficiency anaemia, often preceded by deficient iron stores, remains the most common nutritional disorder globally, affecting quality of life, productivity, educational attainment, and overall well-being. What is often dismissed as tiredness may, in fact, be a sign of a condition that can be identified and treated. 

Who Is Most at Risk? 

Although iron deficiency can affect anyone, some groups face a considerably higher risk. Women of reproductive age are particularly vulnerable because of iron losses associated with menstruation. Heavy menstrual bleeding remains one of the leading causes of iron deficiency, yet conversations around prevention and early detection are often limited. 

Iron requirements also increase during pregnancy to support foetal development and the expansion of maternal blood volume. Adolescent girls face similar challenges, as rapid growth combined with the onset of menstruation increases their iron needs. 

Dietary patterns can also influence iron status. Individuals following vegetarian or vegan diets, or moving towards a plant-based diet, can meet their iron requirements but may need to pay closer attention to food choices because non-heme iron from plant foods is absorbed less efficiently than heme iron from animal sources.

Meanwhile, conditions such as coeliac disease and Crohn's disease can impair iron absorption regardless of dietary intake. 

Collectively, these groups account for millions of people worldwide, highlighting that iron deficiency is not a niche nutritional issue but a widespread public health concern. 

From Plate to Prescription: Addressing Iron Deficiency 

Iron deficiency is both preventable and treatable. For many individuals, improving iron status begins with dietary change. Foods such as lean red meat, poultry, fish, fortified cereals, beans, lentils, tofu, nuts, seeds, some dried fruits and dark green leafy vegetables can all contribute meaningfully to iron intake. 

Understanding how iron is absorbed is equally important. Consuming vitamin C-rich foods alongside iron-containing meals can enhance absorption, while tea and coffee consumed around mealtimes may reduce it. 

However, food alone is not always sufficient. When iron deficiency is confirmed, supplementation may be necessary. Ferrous sulphate and ferrous fumarate remain among the most prescribed forms of oral iron, and current evidence suggests that once daily on an empty stomach or with a vitamin C-rich drink, or alternate day dosing may improve tolerance while maintaining effectiveness. 

Treatment should continue beyond symptom resolution to fully replenish iron stores. Equally important is identifying and addressing the underlying cause of the deficiency rather than focusing solely on restoring iron levels. 

The Cost of Looking the Other Way 

Perhaps the most frustrating aspect of iron deficiency is that it is both common and highly treatable. Yet many people continue to live with symptoms for months or even years before seeking advice or receiving a diagnosis. 

A simple blood test can identify iron deficiency and guide appropriate treatment. For anyone experiencing persistent fatigue, breathlessness, reduced concentration, or unexplained low energy levels, assessing iron status may be an important first step. 

Given its impact on health, education, productivity, and quality of life, iron deficiency deserves far greater attention from healthcare professionals, policymakers, and the public alike. Addressing it will not solve every nutrition challenge we face, but it represents one of the clearest opportunities to improve health outcomes through timely identification, appropriate treatment and informed dietary choices. 

This commentary is for general informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional regarding concerns about your health or nutritional status. 

References 

1. World Health Organization (WHO). Anaemia. Fact Sheet. Geneva: World Health Organization; 2025. Available at: https://www.who.int/news-room/fact-sheets/detail/anaemia 

2. World Health Organization (WHO). Anaemia in Women and Children. Global Health Observatory Data; 2025. Available at: https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children 

3. British Dietetic Association (BDA). Iron: Food Fact Sheet. British Dietetic Association. Available at: https://www.bda.uk.com/resource/iron-rich-foods-iron-deficiency.html 

4. NHS Scotland. Iron Deficiency Anaemia Guidelines. Available at: https://rightdecisions.scot.nhs.uk